Internal medicine
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Objective Dysphagia is a common and disabling symptom in patients with myasthenia gravis (MG). Moreover, it is caused by muscle weakness or fatigability in the pharynx, swallowing, and respiration discoordination. The current study aimed to establish a novel method for evaluating swallowing difficulty in patients with MG. ⋯ Results Patients with MG who presented with dysphagia had abnormal excessive expiratory flows, clusters of excessive expiratory flows, high inspiratory flows, and prolonged EMG patterns compared to healthy controls (all p <0.05). Among these parameters, the incidence of an excessive expiratory flow, cluster of excessive expiratory flows, and prolonged EMG pattern significantly improved after treatment (p <0.05). Conclusion Based on this study, the respiratory patterns and submental sEMG are likely to reflect the severity of pharyngeal muscle weakness/fatigability and thus can be used as a quantitative parameter for dysphagia in patients with MG.
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Direct compression of the oculomotor nerve (OcN) is usually accompanied by OcN palsy (OcNP), with an abnormal pupillary function. We herein present the case of a 76-year-old man with pupil-sparing paresis of the right inferior rectus muscle. ⋯ Decompression of the nerve gradually improved the ocular movement. This unique case offers insights into the potential topographical arrangement of the oculomotor nerve fibers.
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Objective Cortisol-producing adenoma (CPA) is a major subtype of functional adrenal tumors. CPAs are generally treated with adrenalectomy; however, it is difficult to predict the ideal duration of glucocorticoid replacement after resection. This study explored pre-operative factors predictive of glucocorticoid replacement therapy duration after CPA resection. ⋯ In multiple regression analyses, the midnight serum cortisol level and presence of lumbar compression fracture were significantly correlated with the replacement therapy duration after adjusting for other parameters. Conclusion Our results suggest that high midnight serum cortisol levels, which cause persistent suppression of the HPA axis, contribute to a delay in HPA axis recovery. Lumbar compression fracture is an important symptom that reflects the severity and persistence of cortisol secretion.
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A 75-year-old man diagnosed with esophageal cancer and lung metastasis received a combination of fluorouracil, cisplatin, and pembrolizumab. During pembrolizumab maintenance therapy, lymphoproliferative lesions at the lips and mouth and multiple lymph node swellings appeared. ⋯ Rituximab was administered, resulting in the improvement of the OIIA-LPD. The emergence of an OIIA-LPD merits close attention in patients receiving immune checkpoint inhibitors.