Internal medicine
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We herein report the first case of occipital neuralgia secondary to spinal cord infarction. A 74-year-old woman suddenly developed numbness and dysmetria in her right arm. ⋯ The patient was subsequently diagnosed with occipital neuralgia secondary to spinal cord infarction. Diverse etiologies need to be considered in occipital neuralgia secondary to spinal cord lesions.
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We herein report two patients with hepatocellular carcinoma (HCC) who exhibited intraabdominal bleeding caused by tumor rupture soon after lenvatinib initiation. A hypervascular nodule was present in the lateral segment manifesting extrahepatic protrusion in an 81-year-old-man and in the caudate lobe, which was completely occupied by the tumor, in an 83-year-old-man. ⋯ Computed tomography revealed high-attenuation areas suggesting bleeding around the left and caudate lobes. Considering the strong antiangiogenic effects by lenvatinib, transcatheter arterial embolization should be performed before lenvatinib initiation in patients with subcapsular HCC.
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A 66-year-old woman underwent partial mastectomy and a sentinel lymph node biopsy for left breast cancer; the pathological diagnosis was invasive ductal carcinoma (pT1aN0, pStage I, triple-negative subtype). Postoperative radiotherapy was performed. Two years later, she developed redness and induration at both breasts. ⋯ After four cycles of dose-dense epirubicin and cyclophosphamide followed by 12 weekly paclitaxel cycles, bilateral total mastectomy and axillary lymph node dissection were performed. At the one-year follow-up after undergoing operation and radiotherapy, she remained alive without recurrence. Dose-dense treatment regimens may help patients achieve complete resection without short-term recurrence.
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Objective The coronavirus disease 2019 (COVID-19) pandemic continues to spread across the world, and the utility of many drugs for treatment has been suggested. However, few studies have examined the efficacy and safety of treatment with baricitinib, remdesivir, and dexamethasone. Methods A retrospective, cohort study of patients who were admitted to Kurashiki Central Hospital in Japan between April 6 and June 29, 2021, was conducted. ⋯ In the non-BCT group, the ordinal scale was 1.9% with 3, 18.9% with 4, 58.5% with 5, 13.2% with 6, and 7.5% with 7. After adjusting by the IPTW analysis, the BCT group did not have an increased bacterial infection rate [odds ratio (OR), 1.1; 95% confidence interval (CI), 0.36-3.38; p=0.87] or 28-day mortality rate (OR, 0.31; 95% CI, 0.07-1.3; p=0.11) compared with the non-BCT group. Conclusion BCT can be administered without increasing the infection risk compared with non-BCT.
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Objective To identify the risk factors for severe diverticular bleeding in an elderly population. Methods Using a comprehensive computerized hospital database, severe and non-severe diverticular bleeding cases were compared for 19 factors: the age, sex, body mass index, comorbid conditions (hypertension, cardiovascular disease, cerebrovascular disease, and chronic renal failure, including those undergoing dialysis), history of diverticular bleeding, use of low-dose aspirin, use of antiplatelet agent besides aspirin, use of anticoagulant agent, use of prednisolone, use of non-steroidal anti-inflammatory drugs, use of cyclooxygenase-2 selective inhibitors, changes in vital signs, hypoalbuminemia, bilateral diverticula, identification of bleeding lesion, and rebleeding. Severe bleeding was defined as the need for blood transfusion, emergency surgery, or vascular embolization. ⋯ Independent risk factors for severe diverticular bleeding were as follows: change in vital signs [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.9-14.4; p=0.0014], hypoalbuminemia (OR, 12.3; 95% CI, 1.97-77.3; p=0.0073), bilateral diverticula (OR, 3.47; 95% CI, 1.33-9.02; p=0.011), and rebleeding (OR, 5.92; 95% CI, 2.21-15.8; p<0.001). The area under the receiver operating characteristic curve was 0.79 after cross validation. Conclusion Severe diverticular bleeding in elderly population may be predicted by changes in their vital signs, hypoalbuminemia, bilateral diverticula, and rebleeding.