Internal medicine
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Emphysematous cholecystitis has a poor prognosis and necessitates prompt surgery or drainage. Emphysematous cholangitis (EC) is believed to have a similar clinical course, but reports are limited. ⋯ We reviewed the background, causative organisms, treatment, and outcomes of EC through a literature search. Our findings provide insights into its similarities to emphysematous cholecystitis, emphasizing the need for expeditious drainage and anaerobic bacterial coverage during antibiotic therapy.
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A 79-year-old man with smoldering multiple myeloma (MM) developed sudden severe thrombocytopenia and active bleeding. Since anti-GPIIb/IIIa autoantibodies were detected on the platelet surface, thrombocytopenia due to an autoimmune etiology was diagnosed. ⋯ MM is rarely associated with immune thrombocytopenic purpura (ITP). Although the underlying pathogenesis of MM and ITP remains elusive, anti-myeloma drugs might be beneficial.
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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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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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We encountered a 67-year-old Japanese man with GNE myopathy and homozygous variants (c.1807G>C, p. V603L) of the GNE gene. ⋯ Although severe heart failure is rare in GNE myopathy, mild cardiac dysfunction (ejection fraction 46.1%) was observed. Furthermore, respiratory dysfunction was noted with a preserved diaphragm.