A Case of Pulmonary Tuberculosis and Cytomegalovirus Infection During Treatment for COVID-19 Pneumonia / 日本農村医学会雑誌

The patient was a man in his 80s. PCR test was performed after he developed a fever, and the result was positive for SARS-CoV-2 infection. On admission, CT showed ground-glass opacities and consolidation in both lung fields, leading to a diagnosis of COVID-19 pneumonia. The fever promptly resolved after starting treatment with dexamethasone 6.6 mg injection, but high fever returned the day after discontinuing dexamethasone. We considered bacterial pneumonia as a complication, but antibiotics were ineffective. We suspected cytokine storm and began steroid pulse therapy. The fever temporarily resolved but returned when the steroid dose was reduced. In the differential diagnosis, we considered opportunistic infections such as fungal infection and cytomegalovirus infection, pulmonary tuberculosis, and non-infectious lung diseases such as idiopathic organizing pneumonia. Examination and treatment were performed with these in mind. Finally, we diagnosed pulmonary tuberculosis and cytomegalovirus infection, and treatment was started for each. He was subsequently transferred to a treatment facility for patients with tuberculosis. Steroids are a key drug in the treatment of COVID-19, but they may reduce immune function and increase susceptibility to infection, so caution is required for various infectious diseases.

Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. METHODS: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. RESULTS: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. CONCLUSIONS: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Progression-free survival, post-progression survival, and tumor response as surrogate markers for overall survival in patients with extensive small cell lung cancer

The effects of first-line chemotherapy on overall survival [OS] might be confounded by subsequent therapies in patients with small cell lung cancer [SCLC]. We examined whether progression-free survival [PFS], post-progression survival [PPS], and tumor response could be valid surrogate endpoints for OS after first-line chemotherapies for patients with extensive SCLC using individual-level data. Between September 2002 and November 2012, we analyzed 49 cases of patients with extensive SCLC who were treated with cisplatin and irinotecan as first-line chemotherapy. The relationships of PFS, PPS, and tumor response with OS were analyzed at the individual level. Spearman rank correlation analysis and linear regression analysis showed that PPS was strongly correlated with OS [r = 0.97, p < 0.05, R[2] = 0.94], PFS was moderately correlated with OS [r = 0.58, p < 0.05, R[2] = 0.24], and tumor shrinkage was weakly correlated with OS [r = 0.37, p < 0.05, R[2] = 0.13]. The best response to second-line treatment, and the number of regimens employed after progression beyond first-line chemotherapy were both significantly associated with PPS [p

Effects of Drinking Habits on Results of Vital and Liver Functions Tests: A Survey of Old People in Rural Area / 日本農村医学会雑誌

  In view of the situation where an increasing number of old women as well as old men have health problems associated with drinking, some measures should be taken in terms of setting sensible limits of alcoholic intake for these people to keep to, the Report of Kenko (Health) Nippon 21 for 2011 warned. It also suggested that further studies be made to amass necessary data in order to introduce effective measures and give a right assessment to the situation.<br>  The present study was carried out with the aim of providing fundamental pieces of information usable in primary prevention of alcohol-related health problems among the aged. For this purpose, we looked into the drinking habits as well as the numerical data of vital and liver functions tests of old people in a rural area in Yokote, Akita Prefecture. A total of 448 old people (206 men, 242 women) were involved in this study. Nineteen items out of 25 in the Kihon-Checklist, which was designed to reduce the need for nursing care, revealed notable decreases in vital functions in those men who took in over 21 grams of alcohol per day. Of those men specially categorized as individuals who are 65 and older and who are regarded as very likely to need nursing care in the near future, 88.9% took in 21 grams of alcohol. In women, there was no relation between drinking habits, BMI and liver functions. However, it was found that daily alcoholic consumption was greater in those specially categorized group of women at high risk for institutional care than in the other women.<br>  Our study made it clear that drinking habits, which were found to bear on liver and vital functions, could serve as a yardstick for judging whether the old people are at high risk for institutional care. We concluded that it is necessary to spread the knowledge about the adverse effects of alcohol among the elderly and advise them to act their age and drink in moderation even before they enter advanced age.

Studies of Takotsubo-type Myocardioparthy-Centering on Our Cases / 日本農村医学会雑誌

  During the period of two years from 2001 to 2003, we treated nine cases of takotsubo-type myocardiopathy. In this paper, the clinical characteristics and patients' conditions are described, and the mechanisms leading to dyskinesia of the muscular walls of the heart are discussed. All the cases were female. The mean age was 73 years. Physiological as well as psychological stress was implicated as a major cause of the disease, with onset occurring when some members of their family were suddenly taken ill or when they started quarreling with others. Echocardiograms revealed sigmoid septa in almost half of the nine patients. The prognosis was good. Only one patient had cardiac insufficiency as a sequela, but her condition improved. No one died.Eight patients got over dyskinesia of the left ventricular walls in two weeks. From our experience and studies of literature, we ruled out the possibility of the involvement of circulatory disorder and myocarditis in the onset of the disease. Women of advanced age are apt to have sigmoid septa and left ventricular walls thinning. When the old patient in this condition suffer psychosomatic stress, catecholamines will be released, causing the hypercontraction of the left ventricle, the pressure difference in the chamber, and the collapse of the apical of the heart. We concluded that these physiopathological states may be responsible for the abnormal movements of the muscular walls of the heart peculiar to the disease taken up in this study.

Studies of Takotsubo-type Myocardioparthy / 日本農村医学会雑誌

During the period of two years from 2001 to 2003, we treated nine cases of takotsubo-type myocardiopathy. In this paper, the clinical characteristics and patients' conditions are described, and the mechanisms leading to dyskinesia of the muscular walls of the heart are discussed. All the cases were female. The mean age was 73 years. Physiological as well as psychological stress was implicated as a major cause of the disease, with onset occurring when some members of their family were suddenly taken ill or when they started quarreling with others. Echocardiograms revealed sigmoid septa in almost half of the nine patients. The prognosis was good. Only one patient had cardiac insufficiency as a sequela, but her condition improved. No one died.Eight patients got over dyskinesia of the left ventricular walls in two weeks. From our experience and studies of literature, we ruled out the possibility of the involvement of circulatory disorder and myocarditis in the onset of the disease. Women of advanced age are apt to have sigmoid septa and left ventricular walls thinning. When the old patient in this condition suffer psychosomatic stress, catecholamines will be released, causing the hypercontraction of the left ventricle, the pressure difference in the chamber, and the collapse of the apical of the heart. We concluded that these physiopathological states may be responsible for the abnormal movements of the muscular walls of the heart peculiar to the disease taken up in this study.

Clinical Features and Therapeutic Outcome of Fulminant Myocarditis / 日本農村医学会雑誌

Four patients with fulminant myocarditis (two males and two females, age 21-67 years old) were examined during 1995-2001. Fulminant myocarditis was diagnosed based on clinical features, abnormal electrocardiographic and echocardiographic findings, and increased serum enzyme levels. In three of four cases, the diagnoses were confirmed histologically in autopsy. All four patients had flu-like symptoms and fever at the start. One patient died suddenly next day. Other three patients went into cardiogenic shock five and seven days after the onset of symptoms and hospitalized, and treated with temporary pacing, steroid pulse therapy, catecholamine (in all three patients) and percutaneous cardiopulmonary support : PCPS (in one patient), but they died within ten days. Electrocardigrams showed ventricular escape rhythm, ST elevation associated with Q wave, and low voltage of the QRS complex. Markedly increased serum enzyme levels, severe metabolic acidosis and disseminated intravascular coagulation were thought to be indicative of poor prognosis. Early recognition of cardiac involvement and using of PCPS without hesitation in an acute phase could improve the outcome of fulminant myocarditis.

A Case of Churg-Strauss Syndrome (Allergic Granulomatous Angiitis) with Severe Heart Failure Treated by Steroid Pulse Therapy / 日本農村医学会雑誌

A19-year-old man was admitted to the hospital because of severe congestive heart failure on 7 April 2000. In the previous year his case had been diagnosed as Churg-Strauss syndrome (allergic granulomatous angiitis, AGA) with bronchial asthma and mononeuritis multiplex. Echocardiography revealed the dilatation of the left ventricle (LVDd 74 mm) and impaired left ventricular systolic function (LVEF 20%). On the 21st hospital day, the irregularity of peripheral branches of left and right coronary arteries was detected by coronary arteriography. Right ventricular endomyocardial biopsy yielded little fibrosis and no infiltration of eosinophil. Although all the laboratory tests showed lower activity of AGA, steroid pulse therapy was tried and the use of steroids was tapered at intervals of two weeks. Left ventricular function was slowly improved (LVDd 60 mm, LVEF 36%). He was discharged on foot on the 71st hospital day.

Clinical and Electrophysiologic Features of Paroxysmal Atrio-Ventricular Block in 9 Patients / 日本農村医学会雑誌

We examined the clinical features, 12-leads ECG, Holter ECG, monitor ECG, and electrophysiologic study (EPS) in nine consecutive paroxysmal atrioventricular block (PAVB) patients treated in our hospital between 1995 and 2000. In some of them, parasympathetic nerve stimulating maneuvers, drug administration and head-up tilt test (HUT) were performed as provocative tests. EPS documented that the sites of AV block were within the His-Purkinje system (H-PSB) in five patients, proximal to the His bundle potential (AHB) in three patients. In the remaining one patient, the His bundle potential was not recorded. The main features of the patients with H-PSB were as follows: 1) often wide QRS complex with or without axis deviation; 2) variable degrees of AV conduction disturbance in a short period; 3) sinus tachycardia, and normal length and constant PQ intervals in a daytime being apt to precede PAVB; 4) rather long ventricular asystoles leading to abrupt syncope; 5) easy induction of the block by intravenousadministration of atropine. In the other hand, the features of the patients with AHB included: 1) narrow QRS; 2) progressively increasing or decreasing in PQ intervals preceding PAVB; 3) ventricular asystole lasting about 3 to 10 seconds; 4) the failure to induce PAVB by any probale provocative tests.<BR>Although we treated all the patients with permanent pacemakers, there might have been other management method for AHB patients who had about 3-second ventricular asystole.

A case of Left Ventricular Apical Aneurysm with Ventricular Tachycardia and Congestive Heart Failure Detected 17 Years after the Diagnosis of Apical Hypertrophic Cardiomyopathy / 日本農村医学会雑誌

A 73-year-old man was admitted to the hospital on March 31, 2000 because of nonsustained ventricular tachycardia (VT). In 1983, he was diagnosed as having apical hypertrophic cardiomyopathy (APH). Electrocardiograms showed high amplitude of R waves and giant negative T waves (GNT), and left ventriculography (LVG) revealed spade like configuration. He stopped medication without leave six months after the diagnosis. The latest ECG showed a decrease in amplitude of R waves, no signs of GNT, ST elevation in precordial leads, and an increase in QRS duration. LVG demonstrated midventricular obstruction, apical aneurysm, and the intraventricular pressure gradient in systolic phase was 56 mm Hg. No stenotic lesion was observed in coronary arteriography. Early diastolic paradoxic flow from the apical chamber toward the outflow of the left ventricle was detected by pulsed Doppler echocardiography. VT was successfully treated with beta-blocker and amiodarone, but he needed hospital treatment again one month later because of congestive heart failure. During the follow-up of APH, the decrease in amplitude of R waves and disappeasance of GNT, ST elevation, and the increase in QRS duration in electrocardiograms, and the detection of early diastolic paradoxic flow by echocardiography could be the predictors of developing apical aneurysm and/or left ventricular dysfunction.

A Case of Myotonic Dystrophy with Marked Intraventricular Conduction Defects Induced by Pilsicainide / 日本農村医学会雑誌

A 48-year-old man was readmitted to the hospital because of severe intraventricular conduction defects (QRS duration was 0.30 sec). The patient had been given pilsicainide hydrochloride (150 mg/day) prior to the hospitalization. The blood tests revealed that the concentration of pilsicainide was 3.30 μg/ml, which was several times higher than the average value in patients given in a dosage of 150 mg per day. Five months before the second admission, impaired left ventricular (LV) myocardial function and paroxymal atrial fibrillation were observed in the patient. His illness was diagnosed as myotonic dystrophy as the patient presented with skeletal muscle atrophy, premature frontal baldness, hatchet face, cataract, and testicular atrophy. The trial of remedication with pilsicainide in the same dosage for seven days did not produce the toxic effects as seen previously. Both load-dependent LV dysfunction in myotonic muscular dystrophy and moderately impaired renal function in the patient probably underlay the state of intoxication.

The Effects of a Kampo Formula in Combination with Amoxicillin and Omeprazol in Eradicating Helicobacter pylori / 日本東洋医学雑誌

Helicobacter pylori (HP) is associated with gastroduodenal disease. Although it has been reported that HP is highly sensitive to beta-lactams and macrolides, the efficacy of these monotherapies for eradicating HP is rather poor. Recent pharmacological studies have shown the effectiveness of combined therapy using PPI, antibiotics, and bismuth agents or metronidazole, but it has been known to lead to side effects and poor patient compliance. In Japan, mucosal protective agents are principally used for the treament of gastritis and gastric ulcers, and as previously reported, some mucosal protective agents, such as sofalcon and plaunotol, have anti-HP properties. Although they are not sufficiently effective to be used as monotherapy in the eradication of HP, in combination with antibiotics and PPI, eradication rates were elevated and side effects were uncommon.<br>Chinese medicinal formulas have been used for stomach disease in traditional Oriental medicine. The authors studied the effects of combined therapy with Omeprazole (OPZ), AMPC and Chinese medicine (Hangeshashin-to and Sanoshashin-to) instead of mucosal protective agents in the eradication of HP. The study was conducted on a total of 137 HP positive patients with endoscopic evidence of ulcers or gastritis. Dual therapy with OPZ and AMPC had a weak eradicating effect on HP (75%), but combined therapy using OPZ, AMPC and a Chinese medical formula was successful in eradicating HP in 20 out of 24 patients (85%).<br>The antibacterial effects of pharmaceutical preparations and crude drug extracts of Chinese medicine against HP were examined in an <i>in vitro</i> study. No antibacterial action against HP was demonstrated by these agents at concentrations of less than 2000μg/m<i>l</i> concentration. Chinese medicinal preparations should be used in combined therapy with antibiotics and PPI for optimum efficacy in eradicating HP.<br>This new eradication regimen including OPZ, AMPC and Hangeshashin-to is well tolerated; side effects are minimal and uncommon. This triple therapy may be useful in the treatment of HP infection, and is referred to as a “new Japanese regimen.”