BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograd...BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing attention.Thus far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years.In this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with B-RTO.CASE SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness.She had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or asterixis.Her blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein.She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt.The patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness.Moreover,there was no abdominal pain or elevated levels of liver enzymes due to complications.The patient was discharged without further consciousness disturbance.CONCLUSION Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.展开更多
BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilat...BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.展开更多
We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bi...We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen-B7 antigen was positive. Moreover, matrix metalloproteinase 3(MMP-3) was high. She was diagnosed with RS3 PE syndrome, and treatment with prednisolone(15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3 PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3 PE syndrome symptoms.展开更多
BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was s...BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.CASE SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.CONCLUSION Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.展开更多
BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation ...BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.展开更多
BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstr...BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.展开更多
BACKGROUND All drugs have the potential to cause drug-induced lung injury both during and after drug administration.Acetaminophen has been reported to cause druginduced lung injury,although this is extremely rare.Here...BACKGROUND All drugs have the potential to cause drug-induced lung injury both during and after drug administration.Acetaminophen has been reported to cause druginduced lung injury,although this is extremely rare.Herein,we present an extremely rare case of acetaminophen-induced pneumonia.CASE SUMMARY A healthy 35-year-old Japanese woman visited a neighborhood clinic with complaints of fever and malaise following a tick bite.Her treatment included1,500 mg acetaminophen(Caronal^(?)) and subsequently minocycline(200 mg) and acetaminophen(2,000 mg;Caronal^(?)) daily when her condition did not improve;the patient was eventually hospitalized.The patient’s chest computed tomography(CT) revealed consolidation and ground-glass opacities in the right middle and lower lobes.Minocycline was shifted to sulbactam/ampicillin.However,her fever did not improve during follow-up,and her chest CT revealed extensive ground-glass opacities in the right middle and lower lobes and thick infiltrative shadows in the bilateral basal areas.Drug-induced lung injury was suspected;hence,acetaminophen was discontinued.The fever resolved immediately,and inflammatory response and respiratory imaging findings improved.A drug-induced lymphocyte stimulation test was performed against acetaminophen(Caronal^(?)),and significant proliferation of lymphocytes was noted only for acetaminophen(stimulation index,2.1).CONCLUSION Even common drugs such as over-the-counter drugs can cause drug-induced lung damage.展开更多
BACKGROUND Neuraminidase inhibitor-associated acute hemorrhagic colitis is rare.We report a case of ischemic enterocolitis that was likely caused by laninamivir.CASE SUMMARY A 54-year-old female patient with influenza...BACKGROUND Neuraminidase inhibitor-associated acute hemorrhagic colitis is rare.We report a case of ischemic enterocolitis that was likely caused by laninamivir.CASE SUMMARY A 54-year-old female patient with influenza type A was administered 40 mg of laninamivir via inhalation once.On the same day,the patient experienced bloody stools and lower abdominal pain.A contrast-enhanced abdominal computed tomography showed edema-like changes from the descending colon to the sigmoid colon,which suggested ischemic enterocolitis.CONCLUSION We treated a patient with ischemic enterocolitis caused by laninamivir,a rare but similar symptom following the administration of oseltamivir.展开更多
BACKGROUND Common symptoms of Campylobacter colitis include abdominal pain,vomiting,diarrhea,and fever,among others.However,Campylobacter colitis also has a high incidence of extraintestinal symptoms.CASE SUMMARY We r...BACKGROUND Common symptoms of Campylobacter colitis include abdominal pain,vomiting,diarrhea,and fever,among others.However,Campylobacter colitis also has a high incidence of extraintestinal symptoms.CASE SUMMARY We report the case of a 51-year-old man who presented with bilateral testicular pain.A scrotal examination failed to reveal any physical findings,but the patient exhibited mild tenderness in the right lower abdomen.Computed tomography revealed ileocecal wall thickening.Post-admission,the patient developed diarrhea,and a stool culture was submitted;Campylobacter jejuni infection was confirmed.Testicular pain is known to be caused by appendicitis.Consequently,we suggest that Campylobacter colitis,which causes ileocecal inflammation,caused the testicular pain in this case.CONCLUSION In patients with testicular pain and no other objective findings,diseases such as Campylobacter colitis should be considered.展开更多
BACKGROUND An infected hepatic cyst causes clinical symptoms,such as fever and abdominal pain.A cyst with a diameter>10 cm increases the likelihood of exclusion symptoms in adjacent organs.Herein,we report a case o...BACKGROUND An infected hepatic cyst causes clinical symptoms,such as fever and abdominal pain.A cyst with a diameter>10 cm increases the likelihood of exclusion symptoms in adjacent organs.Herein,we report a case of pancreatitis caused by an infected hepatic cyst.CASE SUMMARY The patient was an 88-year-old woman with a history of polycystic liver disease and a cyst>10 cm in diameter.She was referred to our hospital for upper abdominal pain that persisted for four days before consultation.She had a fever of 37.4℃,and a blood test showed a C-reactive protein level of 23 mg/dL.An infected hepatic cyst was diagnosed by abdominal ultrasonography,computed tomography,and magnetic resonance imaging.Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects.As the cyst growth continued,laparoscopic hepatic cyst fenestration was performed on hospitalization day 20.Thereafter,symptoms improved,and she was discharged on hospital day 31.CONCLUSION To our knowledge,this is the second case report of pancreatitis associated with hepatic cyst growth.Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed.Further,attention is needed to avoid potential recurrence.展开更多
AIM To investigate whether GNB3 C825 T single nucleotide polymorphism(SNP) contributes to systolic blood pressure(SBP) ≥ 130 mmH g in a large-scale cross-sectional study among the Japanese population with diastolic b...AIM To investigate whether GNB3 C825 T single nucleotide polymorphism(SNP) contributes to systolic blood pressure(SBP) ≥ 130 mmH g in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure(DBP) < 85 mmH g. METHODS We analyzed 11008 Japanese subjects, including 2797 cases(SBP ≥ 130 and DBP < 85 mmH g) who were not taking anti-hypertensive medication and 8211 controls(SBP < 130 and DBP < 85 mmH g), all of whom enrolled in the genome banking project of the 21 st Century COE(Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender(male and female) and age(≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqM an probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios(ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index. RESULTS Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.CONCLUSION This study indicates that the TT genotype of the GNB3 C825 T SNP may contribute to SBP elevation of greater than 130 mmH g compared to the CC genotype in Japanese males aged ≤ 49 years.展开更多
文摘BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing attention.Thus far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years.In this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with B-RTO.CASE SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness.She had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or asterixis.Her blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein.She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt.The patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness.Moreover,there was no abdominal pain or elevated levels of liver enzymes due to complications.The patient was discharged without further consciousness disturbance.CONCLUSION Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.
文摘BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.
文摘We report a case of remitting seronegative symmetrical synovitis with pitting edema(RS3 PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen-B7 antigen was positive. Moreover, matrix metalloproteinase 3(MMP-3) was high. She was diagnosed with RS3 PE syndrome, and treatment with prednisolone(15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3 PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3 PE syndrome symptoms.
文摘BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.CASE SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.CONCLUSION Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.
文摘BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.
文摘BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.
文摘BACKGROUND All drugs have the potential to cause drug-induced lung injury both during and after drug administration.Acetaminophen has been reported to cause druginduced lung injury,although this is extremely rare.Herein,we present an extremely rare case of acetaminophen-induced pneumonia.CASE SUMMARY A healthy 35-year-old Japanese woman visited a neighborhood clinic with complaints of fever and malaise following a tick bite.Her treatment included1,500 mg acetaminophen(Caronal^(?)) and subsequently minocycline(200 mg) and acetaminophen(2,000 mg;Caronal^(?)) daily when her condition did not improve;the patient was eventually hospitalized.The patient’s chest computed tomography(CT) revealed consolidation and ground-glass opacities in the right middle and lower lobes.Minocycline was shifted to sulbactam/ampicillin.However,her fever did not improve during follow-up,and her chest CT revealed extensive ground-glass opacities in the right middle and lower lobes and thick infiltrative shadows in the bilateral basal areas.Drug-induced lung injury was suspected;hence,acetaminophen was discontinued.The fever resolved immediately,and inflammatory response and respiratory imaging findings improved.A drug-induced lymphocyte stimulation test was performed against acetaminophen(Caronal^(?)),and significant proliferation of lymphocytes was noted only for acetaminophen(stimulation index,2.1).CONCLUSION Even common drugs such as over-the-counter drugs can cause drug-induced lung damage.
文摘BACKGROUND Neuraminidase inhibitor-associated acute hemorrhagic colitis is rare.We report a case of ischemic enterocolitis that was likely caused by laninamivir.CASE SUMMARY A 54-year-old female patient with influenza type A was administered 40 mg of laninamivir via inhalation once.On the same day,the patient experienced bloody stools and lower abdominal pain.A contrast-enhanced abdominal computed tomography showed edema-like changes from the descending colon to the sigmoid colon,which suggested ischemic enterocolitis.CONCLUSION We treated a patient with ischemic enterocolitis caused by laninamivir,a rare but similar symptom following the administration of oseltamivir.
文摘BACKGROUND Common symptoms of Campylobacter colitis include abdominal pain,vomiting,diarrhea,and fever,among others.However,Campylobacter colitis also has a high incidence of extraintestinal symptoms.CASE SUMMARY We report the case of a 51-year-old man who presented with bilateral testicular pain.A scrotal examination failed to reveal any physical findings,but the patient exhibited mild tenderness in the right lower abdomen.Computed tomography revealed ileocecal wall thickening.Post-admission,the patient developed diarrhea,and a stool culture was submitted;Campylobacter jejuni infection was confirmed.Testicular pain is known to be caused by appendicitis.Consequently,we suggest that Campylobacter colitis,which causes ileocecal inflammation,caused the testicular pain in this case.CONCLUSION In patients with testicular pain and no other objective findings,diseases such as Campylobacter colitis should be considered.
文摘BACKGROUND An infected hepatic cyst causes clinical symptoms,such as fever and abdominal pain.A cyst with a diameter>10 cm increases the likelihood of exclusion symptoms in adjacent organs.Herein,we report a case of pancreatitis caused by an infected hepatic cyst.CASE SUMMARY The patient was an 88-year-old woman with a history of polycystic liver disease and a cyst>10 cm in diameter.She was referred to our hospital for upper abdominal pain that persisted for four days before consultation.She had a fever of 37.4℃,and a blood test showed a C-reactive protein level of 23 mg/dL.An infected hepatic cyst was diagnosed by abdominal ultrasonography,computed tomography,and magnetic resonance imaging.Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects.As the cyst growth continued,laparoscopic hepatic cyst fenestration was performed on hospitalization day 20.Thereafter,symptoms improved,and she was discharged on hospital day 31.CONCLUSION To our knowledge,this is the second case report of pancreatitis associated with hepatic cyst growth.Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed.Further,attention is needed to avoid potential recurrence.
基金Supported by The Jichi Medical University 21st Century Center of Excellence Program from Minister Education,Culture,Sports,Science and Technology in Japan
文摘AIM To investigate whether GNB3 C825 T single nucleotide polymorphism(SNP) contributes to systolic blood pressure(SBP) ≥ 130 mmH g in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure(DBP) < 85 mmH g. METHODS We analyzed 11008 Japanese subjects, including 2797 cases(SBP ≥ 130 and DBP < 85 mmH g) who were not taking anti-hypertensive medication and 8211 controls(SBP < 130 and DBP < 85 mmH g), all of whom enrolled in the genome banking project of the 21 st Century COE(Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender(male and female) and age(≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqM an probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios(ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index. RESULTS Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.CONCLUSION This study indicates that the TT genotype of the GNB3 C825 T SNP may contribute to SBP elevation of greater than 130 mmH g compared to the CC genotype in Japanese males aged ≤ 49 years.
