Internal medicine
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An 81-year-old woman presented to our hospital with dyspnea. She had been treated with trastuzumab for nine years. Chest radiography revealed pleural effusion. ⋯ Cardiac magnetic resonance imaging revealed increased native T1 values at the interventricular septum and apex, indicating myocardial edema or fibrosis in these areas. A transthoracic echocardiogram after half a year revealed an increase in LVEF from 25% to 48%. Serial transthoracic echocardiography and cardiac magnetic resonance imaging were useful for evaluating the cardiac structure and function in the present case of delayed trastuzumab-induced myocardial injury.
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We encountered a 67-year-old Japanese man with GNE myopathy and homozygous variants (c.1807G>C, p. V603L) of the GNE gene. ⋯ Although severe heart failure is rare in GNE myopathy, mild cardiac dysfunction (ejection fraction 46.1%) was observed. Furthermore, respiratory dysfunction was noted with a preserved diaphragm.
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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 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.