Internal medicine
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Conventional magnetic resonance imaging (MRI) sequences of patients with complex regional pain syndrome (CRPS) have shown abnormal signals in skin, soft tissue, joints, bone, and bone marrow, but not yet in skeletal muscles, during the acute phase. The aim of this study was to clarify whether or not the affected muscles in CRPS patients show abnormal MRI signal intensities or signal enhancement by gadolinium dimeglumine during the acute phase. ⋯ MRI abnormalities in the acute phase are consistent with muscular edema, interstitial edema, and vascular hyperpermeability. These MRI findings suggest the presence of hemodynamic abnormalities caused by microangiopathy, sympathetic abnormalities, or both, which may lead to ischemia of affected muscles. Chronic phase abnormalities indicated the presence of muscle atrophy and fibrosis or fatty infiltration of the affected muscle.
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A 17-year-old-man developed left-sided pneumothorax in 1995. Chest computed tomography (CT) showed a thick-walled cavity in the left lower lobe. Video-assisted thoracic surgery was performed, and pathologic findings of the resected lung showed a cavity, organizing hematoma, and a fibrous nodule. ⋯ Several vascular changes including aneurysmal formations have been found since 2002, and an aneurysm of the left ulnar artery was resected. The patient continues to be followed regularly on an outpatient basis. We report a rare case of vascular-type EDS who developed pulmonary symptoms as an initial complication.
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Case Reports
Churg-Strauss syndrome presenting with diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis.
A 46-year-old man with a 4-month history of bronchial asthma was admitted to our hospital complaining of progressive dyspnea, weakness of the lower extremities, multiple truncal erythematous purpura and hemoptysis. Neurological examination identified the presence of mononeuritis multiplex. Laboratory data indicated marked anemia, eosinophilia, severe renal failure with nephrotic condition and elevated serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (1,050 EU). ⋯ Consequently, he was diagnosed as having CSS presenting with diffuse alveolar hemorrhage (DAH) and rapidly progressive glomerulonephritis (RPGN) with MPO-ANCA-associated systemic vasculitis. His clinical condition markedly improved with the administration of intravenous corticosteroid (CS) and cyclophosphamide (CY). Thus, we report a case of CSS presenting with the rare complication of DAH and RPGN.
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We describe a case of encephalomyelitis mimicking multiple sclerosis associated with chronic graft-versus-host disease (GVHD) occurring after allogeneic bone marrow transplantation (BMT) for myelodysplastic syndrome. Immunosuppressive therapy, consisting of a therapeutic dose of cyclosporine A and a maintenance dose of methylprednisolone, was effective in treating symptoms. Although central nervous system GVHD is very rare and remains controversial, presentation of neurological symptoms after allogeneic BMT warrants consideration of GVHD in the differential diagnosis.
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In the present study, we tried to clarify the prevalence of selective serotonin reuptake inhibitor (SSRI) prescription and early discontinuation of SSRI in a outpatient unit where primary care physicians are working in Japan. ⋯ These results suggest for the first time that there is a high prevalence of early discontinuation of SSRI in young male patients in Japan.