Internal medicine
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A 62-year-old man with adult T cell leukemia (ATL) presented with complaints of anorexia and abdominal fullness. Evaluation revealed ascites and pleural effusion, but no lymph node swelling, hepatosplenomegaly, or skin involvement. The diagnosis of ATL was made by the detection of specific surface markers for T lymphocytes in pleural effusion and ascitic fluid, and by determination of human T cell leukemia virus type I (HTLV-I) proviral DNA integration in mononuclear cells of pleural effusion. This case was considered a rare type of ATL with infiltration of the pleura and peritoneum.
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The bronchoscopic findings of arteriovenous malformation of the bronchial artery are compared with findings on angiography and pathology. A non-pulsatile protrusion with engorged vessels on its glossy and uneven surface was seen at the distal portion of the right anterior segmental bronchus. ⋯ Histologically, a glossy, uneven surface and engorged vessels represented normal mucosa overlaying an extramuscular tortuous artery and proliferation of submucosal tiny vessels, respectively. These bronchoscopic findings were important clues for diagnosis.
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Sjögren's syndrome (Sjs) can cause many organic changes, but is rarely accompanied by pleuritis. We report here a 62-year-old patient with subclinical Sjs who developed unilateral pleuritis with moderate effusion. He was diagnosed to have subclinical Sjs based on the positivity of anti SS-A/SS-B antibodies and the biopsy findings of minor salivary glands which revealed lymphocyte infiltration around the duct. ⋯ We conclude that the pleuritis was caused by Sjs. In patients with Sjs, activated polyclonal B lymphocytes and autoantibodies are considered to cause systemic tissue damage. This case indicates that these factors can cause pleuritis in Sjs patients.
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Two Japanese cases of streptococcal toxic shock syndrome (STSS) are reported. The first patient was a 45-year-old male who developed necrotizing fasciitis and myositis of the left thigh, refractory hypotension, hepatic dysfunction and acute renal failure; the patient died despite treatment. ⋯ Streptococcus pyogenes was isolated from blood culture. She was immediately placed on high-dose ampicillin as well as other supportive measures, and she survived.
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Case Reports
Effect of octreotide on ventilation and dyspnea sensation in a patient with cirrhotic hypoxemia.
We examined the long-term effects of octreotide, a somatostatin analogue, on ventilation in a case of cirrhotic hypoxemia. After daily administration of octreotide for one month, the dyspnea on exertion was notably ameliorated, although pulmonary gas exchange was only slightly improved. The octreotide therapy reduced the hypoxic ventilatory drive, which may be one reason for the relief of the dyspnea sensation.