Internal medicine
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Case Reports
The middle meningial artery during a migraine attack: 3T magnetic resonance angiography study.
We performed 3T magnetic resonance angiography (MRA) during a spontaneous migraine attack. The patient was a 42-year-old woman migraineur diagnosed by the IHS criteria. ⋯ There were no dramatic changes of vasodilation in the MMA during the attack (2.0 mm), attack-free period (diameter 1.9 mm), or period after medication (1.7 mm), resembling extrapolations of observations in experimental animal models. This finding suggests that the dramatic vasomotion might not be associated with migraine pathophysiology.
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We present the case of a 23-year-old man with steroid-resistant nephrotic syndrome due to minimal change disease who was treated with rituximab. The patient was resistant to conventional therapy. We therefore treated him with a single dose of rituximab (375 mg/m(2)). ⋯ However, six months later, the patient was administered a second dose of rituximab as the peripheral B cell counts began to recover. Thereafter, at present, that is, one year after the first rituximab administration, complete remission has been maintained. We conclude that rituximab may be an effective treatment agent for resistant nephrotic syndrome and the peripheral B cell count may be a useful marker in such patients for preventing disease relapse.
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Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with a dedicated EBUS bronchoscope has been reported as a minimally invasive and accurate method for sampling specimens from mediastinal and hilar lesions. Using this method, not only cytologic but also histologic specimens, which provide valuable information for a definitive diagnosis, can often be obtained. We report a case of an enlarged metastatic mediastinal lymph node from an unidentified primary papillary thyroid carcinoma that was accurately diagnosed by histological and immunohistochemical examination of tissue obtained by EBUS-TBNA.
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Plasma brain natriuretic peptide (BNP) is used as a marker of congestive heart failure. Moreover, plasma BNP levels are increased in patients with acute ischemic stroke, in particular, cardioembolic stroke. We investigated whether the plasma BNP level can also be used as a biological marker to differentiate specific stroke subtype, in particular cardioembolic stroke from the other ischemic stroke subtypes. ⋯ Plasma BNP level is significantly higher in CE patients than in other stroke subtypes, and thus physicians should strongly consider CE when the plasma BNP level is over 140.0 pg/mL in patients with acute ischemic stroke.
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Glycohemoglobin, also known as hemoglobin (Hb) A(1c), is a marker of long-term glycemic control in patients with diabetes. We present two South-Asian diabetic patients whose HbA(1c) peaks were not measurable using high performance liquid chromatography (HPLC). ⋯ Because of the increasing numbers of immigrants in Japan, area-specific hemoglobinopathies are now encountered more frequently than before. Thus, if discrepant results are found on an HbA(1c) assay or if the HbA(1c) value cannot be measured, such patients should be screened for hemoglobinopathies and alternative measurements for monitoring diabetes should be considered.