Internal medicine
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A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. ⋯ Along with amelioration of sepsis and decrease of the serum concentrations of tumor necrosis factor-alpha and interleukin-6, LV hypokinesis improved. It is suggested that the patient's heart failure may have been due to functional depression of myocardial contractility resulting from a direct effect of the cytokines towards the cardiomyocytes, the so-called "septic myocardial depression".
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A 57-year-old man was admitted with fever and epigastralgia, and presented with splenomegaly and pancytopenia. A CT scan revealed splenic infarctions. There were no lymphadenopathies, skin lesions, or neurological abnormalities. ⋯ The patient died of the disease 11 months after onset. To our knowledge, this is the first report of AIVL that presented with splenic infarction. This distinct lymphoma should be included in the differential diagnosis of splenic infarction.
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Comparative Study
Open-label compassionate use one year-treatment with pirfenidone to patients with chronic pulmonary fibrosis.
We attempted to evaluate the feasibility (therapeutic efficacy, tolerance, and clinical courses after treatment) of pirfenidone, an anti-fibrotic drug for patients with chronic pulmonary fibroses such as idiopathic pulmonary fibrosis (IPF). ⋯ The feasibility of Pirfenidone as a therapeutic drug was confirmed for patients with advanced pulmonary fibrosis.
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Editorial Comment
Headache and spontaneous vertebral artery dissection.
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Hepatic portal venous gas (HPVG) was detected by CT in a 64-year-old woman who suddenly complained of lower abdominal pain. However, the abdominal symptoms disappeared rapidly, and lower gastrointestinal endoscopy indicated only terminal ileitis. Conservative treatment alone was performed, and HPVG completely disappeared approximately 18 hours later. The use of CT proved to be useful for following the course of HPVG.