Internal medicine
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Direct compression of the oculomotor nerve (OcN) is usually accompanied by OcN palsy (OcNP), with an abnormal pupillary function. We herein present the case of a 76-year-old man with pupil-sparing paresis of the right inferior rectus muscle. ⋯ Decompression of the nerve gradually improved the ocular movement. This unique case offers insights into the potential topographical arrangement of the oculomotor nerve fibers.
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A 79-year-old man with smoldering multiple myeloma (MM) developed sudden severe thrombocytopenia and active bleeding. Since anti-GPIIb/IIIa autoantibodies were detected on the platelet surface, thrombocytopenia due to an autoimmune etiology was diagnosed. ⋯ MM is rarely associated with immune thrombocytopenic purpura (ITP). Although the underlying pathogenesis of MM and ITP remains elusive, anti-myeloma drugs might be beneficial.
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Objective Dysphagia is a common and disabling symptom in patients with myasthenia gravis (MG). Moreover, it is caused by muscle weakness or fatigability in the pharynx, swallowing, and respiration discoordination. The current study aimed to establish a novel method for evaluating swallowing difficulty in patients with MG. ⋯ Results Patients with MG who presented with dysphagia had abnormal excessive expiratory flows, clusters of excessive expiratory flows, high inspiratory flows, and prolonged EMG patterns compared to healthy controls (all p <0.05). Among these parameters, the incidence of an excessive expiratory flow, cluster of excessive expiratory flows, and prolonged EMG pattern significantly improved after treatment (p <0.05). Conclusion Based on this study, the respiratory patterns and submental sEMG are likely to reflect the severity of pharyngeal muscle weakness/fatigability and thus can be used as a quantitative parameter for dysphagia in patients with MG.
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Objective Crohn's disease (CD) is a chronic inflammatory bowel disease that is associated with malnutrition. Sarcopenia is a malnutrition condition characterized by skeletal muscle loss that impairs the physical function. We investigated the clinical characteristics of patients with CD with sarcopenia and sarcopenic obesity (sarcopenic-o). ⋯ Conclusion Sarcopenia and sarcopenic-o are relatively common conditions among patients with CD. Sarcopenia can be predicted using the clinical parameters of BMI and CDAI. Sarcopenic-o can be a severe form of sarcopenia.
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Objective Angiotensin receptor-neprilysin inhibitors (ARNIs) have been widely used as a treatment for heart failure. However, they have only been approved for the treatment of hypertension in a limited number of countries. We investigated the effect of ARNIs on arterial stiffness using the cardio-ankle vascular index (CAVI) in patients with hypertension to reveal the mechanism underlying cardiovascular interaction. ⋯ Forty-eight of the 50 patients (96%) were switched from angiotensin II receptor blockers (ARBs) due to inadequate antihypertensive control. Results The systolic blood pressure (BP), diastolic BP, and CAVI were significantly decreased by ARNI administration (systolic BP: 145 [135, 162] to 131 [123, 143] mmHg [p=0.000]; diastolic BP: 92 [78, 100] to 82 [74, 89] mmHg [p=0.000]; and CAVI: 9.9 [9.1, 10.5] to 9.5 [8.8, 10.2] mmHg [p=0.005], respectively). Conclusion Hypertension treatment with ARNIs may improve not only the blood pressure but also the CAVI, reducing the afterload on the heart.