Internal medicine
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Comparative Study
A health economic evaluation of aspirin in the primary prevention of cardiovascular disease in Japan.
Low-dose aspirin is standard care in patients with a history of cardiovascular disease (CVD). But, the use of low-dose aspirin in primary prevention has not yet been fully established in Japan although meta-analyses and US/European guidelines support its use in persons at increased CVD risk. This study assessed the health economic consequences of the use of low-dose aspirin in the primary prevention of CVD in Japan. ⋯ Administering low-dose aspirin to patients with a 1-year risk of CHD of 1.5% and more is significantly cost-saving from the insurers' perspective in Japan.
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Case Reports
Pulmonary embolism and deep vein thrombosis complicating acute aortic dissection during medical treatment.
Acute aortic dissection of Stanford type A with intramural hematoma was diagnosed based on computed tomography (CT) findings in a 60-year-old man. During medical treatment, pulmonary embolism and deep vein thrombosis developed. ⋯ An inferior vena caval filter was placed because anticoagulation therapy was contraindicated. A CT scan before discharge showed no thrombus in the pulmonary artery or common iliac vein, but a newly captured thrombus was found inside the filter.
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C-reactive protein (CRP) is not only an acute phase reactant but also a sensitive marker of subclinical inflammation associated with atherosclerosis. The aim of the present study was to determine whether glycemic control or blood pressure influences the vascular microinflammation as evaluated by CRP levels in the very elderly. ⋯ These results suggest that tight good glycemic control, even in very elderly subjects, may be able to reduce the systemic inflammation that contributes to leads to atherosclerosis.
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Case Reports
Acute respiratory distress syndrome due to chronic necrotizing pulmonary aspergillosis.
This is the first case report of acute respiratory distress syndrome (ARDS) due to chronic necrotizing pulmonary aspergillosis (CNPA). This patient had pulmonary fibrosis of unknown etiology with a right upper bulla. The wall of the bulla became thicker with the surrounding lung infiltration and the patient suddenly developed severe respiratory failure. It is necessary to confirm the possibility that ARDS may occur in CNPA and that peripheral eosinophilia might forebode worsening of CNPA.
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The patient was 71-year-old male under treatment at a clinic for hypertension, aortic regurgitation, alcoholic hepatitis and dental treatment. He mainly complained fever and anorexia. Since blood culture examination revealed Listeria monocytogenes and echocardiography exhibited vegetation at the mitral leaflet, the patient was diagnosed as infective endocarditis. ⋯ CT revealed type IIIb acute thoracoabdominal aortic dissection which was not observed on admission. The blood pressure was controlled with antihypertensive agents. He could leave the hospital on the 61st day.