Internal medicine
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Homocysteine (Hcy) is a sulfhydryl amino acid. Its precursor, the essential amino acid methionine, is derived from dietary protein; recently a number of studies have suggested its relation to atherosclerosis. The present study was performed to clarify the relation between the plasma Hcy concentration and sclerotic lesions of the common carotid arteries. ⋯ The findings of this study confirmed that observations of an association between plasma Hcy concentration and common carotid atherosclerosis in Western populations is also present among the elderly Japanese.
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We treated a 66-year-old man and a 69-year-old woman with high output cardiac failure due to aortocaval fistula. They underwent nephrectomy 40 and 36 years ago, respectively. They suffered from heart failure for a very long time. ⋯ Three-dimensional computerized tomography clearly delineated the aortocaval fistula. Surgical closure of the fistula promptly improved heart failure. We stress the importance of history taking concerning nephrectomy and the importance of abdominal auscultation in high output cardiac failure.
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We describe a 27-year-old woman with disseminated intravascular coagulation and shock due to amniotic fluid embolism after Caesarean section who responded well to continuous hemodiafiltration (CHDF) therapy. The effectiveness of CHDF in treating amniotic fluid embolism is also discussed.
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Tabes dorsalis is uncommon and progresses slowly from infection to clinical manifestation. We report a rare case of rapidly progressive tabes dorsalis associated with selective IgA deficiency (sIgAD). A 28-year-old man was hospitalized with lightning back pain, nausea, and bladder bowel dysfunction. ⋯ Thl-dominant cytokine expression was observed, as is usually seen in neurosyphilis. He was treated with Ceftriaxone and CSF pleocytosis disappeared. We postulate sIgAD influenced the atypical rapid clinical course of tabes dorsalis in this patient.