Internal medicine
-
A 67-year-old man with a history of esophageal cancer resection was referred to our hospital because of nausea and appetite loss. Laboratory findings showed severe hyponatremia and were compatible with syndrome of inappropriate antidiuretic hormone (SIADH) secretion. ⋯ Right thoracotomy was performed, and the histopathological diagnosis was small-cell lung cancer (T1bN0M0; Stage 1b). Although SIADH is frequently associated with small-cell lung cancer, it is extremely rare as the initial clinical feature in stage I small-cell lung cancer.
-
Objective The Suita score is used to predict the 10-year prognosis of developing coronary heart disease (CHD). This study examined the association between the Suita score and stroke recurrence within one year in Japanese patients who experienced first-ever ischemic stroke. Methods This prospective cohort study at a stroke center in Japan included patients who experienced first-ever acute ischemic stroke (AIS) or a transient ischemic attack (TIA). ⋯ In the multivariate analysis, after adjusting for confounding and prognostic factors, such as non-small vessel occlusion and prescription of lipid-lowering agents at the time of discharge, a ≥5% predicted CHD risk was associated with the 1-year stroke recurrence after the initial onset [adjusted hazard ratio (HR) =2.20, 95% confidence interval (CI) =1.00-4.91, p=0.049; adjusted HR=2.00, 95% CI=1.01-4.14, p=0.048; adjusted HR=0.42, 95% CI=0.24-0.73, p=0.002]. Conclusion The Suita score, adapted for use in ischemic stroke with the same mechanism, correlated with the short-term recurrence within one year. Our findings suggest that the Suita score may be useful for predicting the long-term prognosis of developing CHD as well as the short-term recurrence for patients with first-ever AIS and TIA.
-
We herein report a patient with a high bleeding tendency as a result of acquired factor V inhibitor and immune thrombocytopenia (ITP). The administration of prednisolone increased the platelet count, but a fatal bleeding event occurred before platelet levels had sufficiently increased. ⋯ Bleeding tendency may be high in rare cases where factor V inhibitor is complicated with severe thrombocytopenia. In such patients, physicians should consider aggressive hemostatic therapy, including plasma exchange, in addition to immunosuppressive therapy.
-
Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. ⋯ In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.
-
Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disorder, and a genetic analysis is important to make a definitive diagnosis. A comprehensive genetic analysis using next generation sequencing (NGS) and whole exome sequencing (WES) is feasible. However, the application of NGS in the assessment of genomic structural variations is generally limited, and a substantial number of control samples are needed for such assessments. Thus, NGS alone is unlikely to detect genomic structural variations in a "singleton." We present the case of a patient with compound HeFH (heterozygous FH), whose causative mutations in the LDLR gene could not be identified by WES, necessitating the application of the multiplex ligation-dependent probe amplification (MLPA) technique.