Internal medicine
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The goals of this study were to assess the efficacy and tolerability of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF) and to identify predictors of tolerability to pirfenidone. ⋯ We found that pirfenidone was better tolerated in patients with milder disease symptoms, as indicated by their baseline CPI, %FVC and %DLCO, and that patients in the tolerant group could benefit from the use of pirfenidone.
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This study is the first case report of the treatment of methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis using therapeutic drug monitoring of the serum and wound exudate concentrations of linezolid in a renal dysfunction patient. In the present study, the serum trough concentration of linezolid was maintained between 2 and 7 μg/mL. Therapeutic drug monitoring dosage adjustments may be especially useful in patients with renal dysfunction and severe MRSA infection.
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Case Reports
Acute Liver Failure Associated with Diffuse Hepatic Infiltration of Malignant Melanoma of Unknown Primary Origin.
An 83-year-old man admitted for left hand pain due to a large necrotic ulcer presented with many sites of erythema on his trunk. Computed tomography revealed multiple poorly marginated masses in the liver; however, no malignant cells were detected on a biopsy of several skin lesions. ⋯ No tumor cells were detected in the skin lesions or lymph nodes. Immunohistochemically, the patient was diagnosed to have metastasis from malignant melanoma of unknown origin.
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The Importance of Stabilizing PaCO2 during Long-term Non-invasive Ventilation in Subjects with COPD.
In subjects with chronic obstructive pulmonary disease (COPD), the effect of partial pressure of CO2 (PaCO2) alterations during long-term non-invasive ventilation (NIV) on continuance remains uncertain. We herein investigated the utility of PaCO2 stability during long-term NIV as a prognostic outcome. ⋯ A lower 6 m-PaCO2 and a lower annual alteration of PaCO2 during long-term NIV are significant predictive variables for patients with COPD.
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A 52-year-old woman with ulcerative colitis was admitted to our hospital for an ulcerative colitis flare-up under salazosulfapyridine therapy. The symptoms improved with high-dose corticosteroids. After prednisolone was tapered to 10 mg, the frequency of diarrhea increased. ⋯ The patient was started on adalimumab. A positive response to the adalimumab therapy was observed after 2 weeks, during which time the ulcerative skin lesion healed completely, however, colonic mucosal healing was achieved at 2 months. Therefore, adalimumab appears to be an effective therapeutic option for patients with ulcerative colitis-associated pyoderma gangrenosum.