Internal medicine
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Japanese chronic lymphocytic leukemia (CLL) provides a diagnostic dilemma due to the low incidence and the heterogeneity shown in its morphology and immunophenotype. We clarified the diagnostic problems in Japanese CLL through our retrospective observation. ⋯ Fluorescence in situ hybridization for CCND1/IGH, the presence of leukocytosis and lymphadenopathy at diagnosis, and the morphological evaluation using naturally air dried preparations are important clues to make a correct diagnosis of Japanese CLL.
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Case Reports
Thrombolytic therapy for cardiac arrest due to pulmonary embolism after varicose vein surgery.
Anticoagulant therapy is the mainstay in the management of venous thromboembolism. Nevertheless, the situation is entirely different in the patients with submassive or massive pulmonary embolism (PE) and cardiac arrest, and the diagnosis and therapy strategy for such conditions are lacking. ⋯ She survived after administration of 50 mg recombinant tissue plasminogen activator (rt-PA) for over half an hour, along with continued anticoagulant therapy. Unfortunately, gastrointestinal and cerebral hemorrhaging occurred during the process.
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Branched-chain amino acid (BCAA) supplements have mainly been administered as a nutritional intervention for decompensated liver cirrhosis. Several studies have shown that short-term BCAA supplementation improves insulin and glucose tolerance in patients with liver cirrhosis. ⋯ Herein, we report 2 cases of NASH-related liver cirrhosis in which long-term BCAA supplementation improved glycemic control. We conclude that in the absence of an effective conventional therapy for NASH-related liver cirrhosis, BCAA supplementation should be considered as an alternative treatment.
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A patient with immune thrombocytopenia (ITP) was administered a thrombopoietin (TPO) receptor agonist, romiplostim. After a step-wise increase the dose of romiplostim, the platelet count was highly fluctuated; it initially markedly increased, but then it subsequently steeply dropped. ⋯ After the re-administration of romiplostim, the dose was gradually increased, and the platelet count rose steadily. The highly fluctuating platelet count in the present patient indicates the need for careful monitoring of the platelet count at the beginning of romiplostim administration.
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Case Reports
Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis.
Patients with bacterial endocarditis often have renal complications. This report presents the case of an elderly man with rapidly progressive glomerulonephritis (RPGN) associated with subacute bacterial endocarditis (SBE) due to Enterococcus faecalis infection. ⋯ Treatment for SBE with antibiotics and the surgical replacement of the affected valves resulted in an improvement of RPGN, the disappearance of PR3-ANCA and RF, and the normalization of hypocomplementemia. This rare case suggests the importance of recognizing the cause of positive PR3-ANCA, because SBE could be an occult cause of RPGN mimicking ANCA-associated vasculitis.