Internal medicine
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Background Recent guidelines recommend dual antiplatelet therapy (DAPT) for six months following percutaneous coronary intervention (PCI) in patients with chronic coronary disease, as unexpected hospitalization can trigger DAPT discontinuation. This study evaluated the predictive factors for unexpected hospitalization within six months after PCI in patients with chronic coronary disease. Methods This prospective multicenter study included 412 patients who underwent PCI for chronic coronary disease. ⋯ Among the major ARC-HBR criteria, oral anticoagulant use (adjusted HR, 2.39; 95% CI, 1.14-5.02, P=0.021) and active malignancy (adjusted HR, 3.85; 95% CI, 1.47-10.05; P=0.006) were significantly associated with unexpected hospitalization after adjusting for a low body weight and diabetes mellitus. Conclusions The majority of unexpected hospitalizations after PCI in patients with chronic coronary disease are attributed to non-bleeding causes. The assessment using major ARC-HBR criteria in these patients not only addresses bleeding risks but also underscores its predictive value in conjunction with a low body weight and diabetes mellitus for the prediction of unexpected hospitalization.
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We herein report a case of bacterial meningitis and bacteremia in a 3-month-old boy caused by Streptococcus pneumoniae serotype 35B multidrug resistance. Intravenous ampicillin was administered on admission. ⋯ The patient recovered without complications after 16 days of CTRX and LZD treatment. This case suggests that LZD is a viable treatment option for bacterial meningitis.
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We herein report a rare case of duodenal adenocarcinoma with a rapidly progressive course. Esophagogastroduodenoscopy revealed Brunner's gland hyperplasia in the bulbs of the duodenum three years prior to this presentation. Two years earlier, gastric foveolar metaplasia had been observed in the bulbs. ⋯ At this time, the lesion had markedly increased in size, and the duodenum was circumferentially stenotic due to the mass. Pathologically, he was diagnosed with duodenal adenocarcinoma with a gastric-dominant immunophenotype and he died two months later. Although extremely rare, we should keep in mind that duodenal tumors with a gastric phenotype may sometimes progress rapidly within a short period of time.
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Idiopathic inflammatory myopathies, such as dermatomyositis, are implicated as possible risk factors for venous thromboembolism. We herein report the first known case of a 50-year-old woman who presented to our hospital with a fever, chest pain, and elevated creatine kinase levels and was ultimately diagnosed with pulmonary embolism and anti-OJ antibody-positive antisynthetase myopathy. ⋯ However, only a few cases of pulmonary embolism developing before the diagnosis of inflammatory myositis have been reported. Idiopathic inflammatory myopathy should be considered as a differential diagnosis when creatine kinase levels are elevated in patients with pulmonary embolism.
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Objective To investigate the clinical course of ulcerative colitis (UC) during pregnancy, focusing on their mutual influence. Methods We retrospectively reviewed the medical records of 58 patients with UC who had 73 pregnancies and 3 patients with newly developed UC during pregnancy. We recorded the rate of relapse of UC; the relationship between medication use and UC relapse during pregnancy; treatment for relapse; and the incidence of pregnancy, childbirth, and newborn abnormalities. ⋯ In two of the three patients with new-onset UC, UC was severe and required intensive care; however, the pregnancies continued uneventfully. Conclusion Although the progress of pregnancies complicated by UC was mostly uneventful, discontinuing medication carries the risk of UC relapse. Thus, appropriate management of medical treatments for UC during pregnancy is important.