Internal medicine
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The co-occurrence of subacute thyroiditis (SAT) and Graves' disease (GD) is rare. A 62-year-old Japanese man presented with shifting neck pain and elevated thyroid hormone level. The patient tested positive for thyroid-stimulating hormone receptor antibodies. ⋯ Consequently, concurrent GD was suspected, and diagnostic assistance was obtained by confirming increased uptake on 99mTechnetium thyroid scintigraphy. A genetic analysis of human leukocyte antigen (HLA) revealed genotypes associated with susceptibility to SAT (HLA-B*35:01) and GD (HLA-DPB1*05:01). Furthermore, the possibility of coronavirus disease 2019 as a related environmental factor cannot be ruled out in this case.
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Objective Myosteatosis affects the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) and may be a potential therapeutic target. This study aimed to examine the effects of ipragliflozin on myosteatosis in patients with type 2 diabetes mellitus (T2D) and MASLD. Methods Patients were treated with ipragliflozin (IPR group) or a control (CTR group) for 72 weeks in a randomized trial. ⋯ Conclusion Ipragliflozin had a limited effect on skeletal muscle adiposity in patients with T2D and MASLD. Regardless of the treatment, a specific phenotype of adiposity and hepatic steatosis before treatment is associated with the long-term outcomes of myosteatosis. Maintaining skeletal muscle mass and better glycemic control during treatment are essential for the future improvement of myosteatosis.
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A de novo whitish subepithelial lesion (SEL) with irregular vascular hyperplasia was detected in the lower thoracic esophagus during endoscopic surveillance. Special types of esophageal cancer were suspected; however, endoscopic biopsy specimens were inadequate for a diagnosis. ⋯ Based on the clinical diagnosis of cT2N0M0, subtotal esophagectomy followed by adjuvant chemotherapy was performed immediately after endoscopic reexamination revealing a 20-mm reddish SMT. We herein report the marked changes in endoscopic findings of eNEC within 1.5 months.
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A 64-year-old Japanese woman presented with gross hematuria and was diagnosed with stage IVB cervical cancer. Renal dysfunction was observed following chemoradiation therapy, and a renal biopsy revealed renal thrombotic microangiopathy (TMA) and tubulointerstitial nephritis (TIN), which are atypical features of radiation nephropathy. Contrast-enhanced computed tomography revealed wedge-shaped areas of high contrast, consistent with areas of high radiation dose in the kidneys, thus leading to the diagnosis of radiation nephropathy. This case underscores the importance of integrating clinical, pathological, and radiological findings for the diagnosis of radiation nephropathy, atypical renal biopsy findings, and a combination of TIN and renal TMA.
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Objective Digital evacuation (DE) is an intervention used to address severe constipation. Literature exists on easily administered laxatives; however, reports on mildly invasive DE usage are limited. This study aimed to elucidate the fundamental data regarding constipation management using a comprehensive national database of DE incidence. ⋯ A seasonal analysis revealed a significant increase in DE procedures during winter compared with summer (P<0.0125). A correlation was observed between the DE incidence and certain meteorological variables, particularly the temperature. Conclusion This study highlights the notable demographic patterns and the impact of seasonal and meteorological factors on the DE incidence.