Asunto(s)
Alopecia/etiología , Pestañas/patología , Hipotiroidismo/complicaciones , Anciano , Femenino , Humanos , Ilustración MédicaAsunto(s)
Dolor Abdominal/etiología , Síndrome del Ligamento Arcuato Medio/diagnóstico , Dolor Abdominal/cirugía , Adulto , Auscultación , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/fisiopatología , Femenino , Humanos , Laparoscopía , Síndrome del Ligamento Arcuato Medio/complicaciones , Síndrome del Ligamento Arcuato Medio/fisiopatología , Síndrome del Ligamento Arcuato Medio/cirugía , Respiración , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
To clarify the potential relevance of patients' chief complaints at a general medicine department to their self-rating depression scale (SDS) and frequency scale for symptoms of gastroesophageal reflux disease (GERD) (FSSG) scores, we analyzed data of 478 patients who visited our general medicine department. The chief complaints (553 symptoms of 447 patients) were categorized into major symptom-based groups: respiratory (31%), circulatory (3%), gastrointestinal (GI) tract (26%), neurology (8%), orthopedic and skin (10%), and systemic (22%) symptoms. The SDS score tended to be higher in females and younger patients. The FSSG score did not differ by gender but was higher in younger patients. The patients receiving social welfare had higher SDS and FSSG scores. A close inter-relationship between the FSSG (including both degrees of reflux and dysmotility) and SDS was observed in all patients. Although the averages of the SDS and FSSG scores were not significantly different among the symptom-based categories, we observed significantly positive correlations between the FSSG and SDS in each category, suggesting that depressive status may be closely related to GERD-related symptoms regardless of the patients' chief complaints. An initial checkup of patients' psychological condition and/or GERD-like symptoms could help screen for latent disorders in outpatients with uncertain complaints.
Asunto(s)
Trastorno Depresivo/complicaciones , Reflujo Gastroesofágico/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Eight years prior to her present admission, a 61-year-old Japanese woman was diagnosed with autoimmune hepatitis, slowly progressive insulin-dependent diabetes mellitus, and chronic thyroiditis; she had been treated with oral prednisolone (PSL). After she suddenly discontinued PSL, she newly developed systemic lupus erythematosus. A combination therapy of oral PSL and intravenous cyclophosphamide resulted in remission. She was finally diagnosed with autoimmune polyglandular syndrome (APS) type 3 (3A ,3B, 3D), complicated with four different autoimmune diseases. Since patients with type 3 APS may present many manifestations over a long period of time, they should be carefully monitored.
Asunto(s)
Hepatitis Autoinmune/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Poliendocrinopatías Autoinmunes/diagnóstico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Femenino , Hepatitis Autoinmune/diagnóstico , Hepatitis Autoinmune/tratamiento farmacológico , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Persona de Mediana Edad , Poliendocrinopatías Autoinmunes/complicaciones , Poliendocrinopatías Autoinmunes/tratamiento farmacológico , Prednisolona/administración & dosificación , Prednisolona/uso terapéuticoRESUMEN
We report a case of a woman with typical dermatomyositis (DM) with skin manifestations, severe myalgia and muscle weakness complicated by interstitial lung disease (ILD) and pneumomediastinum. Pneumomediastinum persisted despite treatment with immunosuppressive therapy (steroids and cyclosporine). After the test for anti-melanoma differentiation-associated gene 5 (MDA5) antibody came out positive, we doubled the cyclosporine dose and her condition improved. Despite typical clinical features of DM, in cases complicated by pneumomediastinum or steroid resistance, measurement of anti-MDA5 antibody may be useful for immunosuppressant dose titration.
Asunto(s)
Anticuerpos/sangre , Dermatomiositis/genética , Dermatomiositis/inmunología , Helicasa Inducida por Interferón IFIH1/inmunología , Anciano , Ciclosporina/administración & dosificación , Ciclosporina/uso terapéutico , Dermatomiositis/sangre , Dermatomiositis/tratamiento farmacológico , Femenino , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéuticoRESUMEN
OBJECTIVE: Patients with urosepsis associated with urinary tract calculi occasionally require drainage, primarily via ureteric stenting. Such patients require longer hospitalization. However, the indications for early ureteric stenting for this condition have not been clearly defined. To compare the length of stay (LOS) in the hospital between patients treated with earlier ureteric stenting versus those with delayed ureteric stenting. METHODS: Design: Retrospective cohort study. Setting: An acute care teaching hospital in Japan. MEASUREMENT: Length of hospital stay in days. Patients Patients with urosepsis associated with urinary tract calculi. RESULTS: Among a total of 30 patients (mean age, 72; 13 men), the mean number of days from emergency room admission to ureteric stenting was 3.5 days (range, 1-14 days), and the overall mean LOS was 36 days (range, 8-102 days). The early stenting group (mean LOS, 21 days) had a significantly shorter LOS than the delayed stenting group (mean LOS, 50 days), with an adjusted beta coefficient of -26 days [95% confidence interval (CI), -46, -6]. CONCLUSION: In patients with urosepsis associated with urinary tract calculi, performing early stenting within two days of admission may reduce the LOS in the hospital.
Asunto(s)
Drenaje/métodos , Sepsis/cirugía , Stents , Cálculos Ureterales/complicaciones , Infecciones Urinarias/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales de Enseñanza , Humanos , Masculino , Estudios Retrospectivos , Sepsis/etiología , Factores de Tiempo , Resultado del Tratamiento , Cálculos Ureterales/diagnóstico , Cálculos Ureterales/cirugía , Infecciones Urinarias/etiologíaAsunto(s)
Cálculos/diagnóstico , Cuerpos Extraños/diagnóstico , Ombligo , Anciano de 80 o más Años , Femenino , Humanos , Uraco/anomalíasAsunto(s)
Betainfluenzavirus/inmunología , Coinfección/inmunología , Galactosilceramidas/inmunología , Síndrome de Guillain-Barré/inmunología , Gripe Humana/inmunología , Infecciones por Mycoplasma/inmunología , Mycoplasma/aislamiento & purificación , Anticuerpos/inmunología , Coinfección/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycoplasma/diagnósticoRESUMEN
Group A streptococcal endocarditis has been described in intravenous drug misusers and as a post-varicella infection in children. We report a 64-year-old man with no prior risk factors who presented with a persistent fever, malaise, polyuria and cola-colored urine. On examination peripheral stigmata of endocarditis without a cardiac murmur and asymptomatic pharyngeal exudates were found. Blood and urine analysis revealed renal failure from suspected glomerulonephritis. Blood cultures revealed fully sensitive Group A streptococci. Transthoracic and transesophageal echocardiographies revealed no vegetation. The Modified Duke's Criteria aided in the diagnosis of definite infective endocarditis, despite the absence of valvular vegetation.