Internal medicine
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A 70-year-old man with a history of left-sided renal donation surgery 11 days earlier developed rupture of a pancreaticoduodenal artery (PDA) aneurysm caused by median arcuate ligament syndrome (MALS). The patient also had a congenital anomaly and left-sided inferior vena cava (IVC). ⋯ Although PDA aneurysms related to MALS and left-sided IVC are rare conditions, PDA aneurysm rupture is life-threatening, and left-sided IVC presents a potential risk for deep vein thrombosis. However, comprehensive management strategies for these conditions have not yet been established.
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AA amyloidosis is a rare renal complication of Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL). A 66-year-old man with WM/LPL presented with nephrotic syndrome. A renal biopsy showed AA amyloidosis. ⋯ However, increased prednisolone did not improve proteinuria. The patient ultimately died of cryptococcal meningitis. This case highlights the diverse spectrum of renal involvement in monoclonal IgM-secreting diseases and difficulty in managing fatal complications.
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Objective The prevalence rates of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are 3%-11% and 8%-16%, respectively, in the general Japanese adult population. Few reports on patients' perceptions of BA, cough variant asthma (CVA), COPD, and asthma and COPD overlap (ACO) are available in Japan, and we aimed to investigate the agreement between the perception and diagnosis of BA and COPD-related diseases. Methods The subjects were 229 datasets matched to the sex and age distribution of the Japanese population of 1,000 adult patients who underwent respiratory function tests and screening for each disease at Nagasaki University Hospital between July 2014 and July 2017. ⋯ Conclusion Self-perception of asthma-related disease was adequately high, whereas that of COPD-related disease was low. The prevalence rates of BA, COPD, ACO, and CVA in our study were 10.0%, 11.8%, 2.6%, and 0.9%, respectively. An increase in the perception of COPD may help improve community healthcare for respiratory diseases.
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Nicorandil is commonly used to treat angina pectoris. However, the adverse neurological effects of nicorandil remain unclear. Herein, we report the case of a patient who presented with isolated abducens nerve palsy associated with the administration of nicorandil. ⋯ No abnormalities were observed in the laboratory tests or neuroradiological findings. The patient recovered immediately after the discontinuation of nicorandil treatment. In cases of cranial nerve palsy after the initiation of nicorandil treatment, consideration of the involvement of nicorandil is necessary.