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2.
J Gen Fam Med ; 18(5): 271-274, 2017 10.
Article in English | MEDLINE | ID: mdl-29264040

ABSTRACT

A 42-year-old man with schizophrenia was referred to our hospital after 2 weeks of worsening fatigue. His hemoglobin level was 2.8 g/dL owing to folic acid deficiency stemming from alcohol abuse and consumption of unbalanced meals. We induced behavioral changes in the patient by motivational interviewing. We had direct methodical conversations with medical staff involved with the patient as well as his family, and established new social support for him as well as public assistance. These have resulted in the patient maintaining a favorable lifestyle ever since.

3.
Intern Med ; 56(14): 1843-1847, 2017.
Article in English | MEDLINE | ID: mdl-28717080

ABSTRACT

We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis. In addition, the presence of active tuberculosis needs to be assumed whenever we treat patients with Addison's disease caused by tuberculosis, despite its rarity.


Subject(s)
Addison Disease/etiology , Hyperpigmentation/physiopathology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/physiopathology , Addison Disease/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged
4.
BMC Cancer ; 16(1): 801, 2016 10 13.
Article in English | MEDLINE | ID: mdl-27769217

ABSTRACT

BACKGROUND: Most cases of disseminated carcinomatosis of the bone marrow (DCBM) arise from gastric cancer. DCBM from pancreatic cancer is very rare. We herein present a case of DCBM from pancreatic cancer. CASE PRESENTATION: A 57-year-old man was referred to our hospital for severe lumbago. Laboratory data indicated that he suffered from disseminated intravascular coagulation (DIC). Non-contrast abdominal computed tomography (CT) revealed multiple bone masses but no other abnormal findings. Left iliac bone marrow biopsy revealed poorly differentiated adenocarcinoma cells. Positron emission tomography (PET)-CT showed diffuse abnormal uptake in the bones and tail of the pancreas. Contrast whole-body CT showed a tumor measuring approximately 28 mm in diameter with poor enhancement in the tail of the pancreas. The patient's final diagnosis was pancreatic cancer located in the tail of the pancreas with diffuse bone metastases and DIC. His DCBM was thus believed to originate from the pancreatic cancer. He succumbed to the disease approximately 2 months after admission to our hospital. CONCLUSION: We herein describe a case of pancreatic cancer located in the tail of the pancreas with diffuse bone metastases and DIC, which, in our case, was DCBM. Therefore, in cases of DCBM with an unknown primary tumor, pancreatic cancer should be considered during differential diagnosis.


Subject(s)
Bone Marrow/pathology , Carcinoma/diagnosis , Neoplasms, Second Primary/diagnosis , Pancreatic Neoplasms/diagnosis , Biopsy , Carcinoma/etiology , Fatal Outcome , Humans , Image Enhancement , Male , Middle Aged , Neoplasms, Second Primary/etiology , Positron Emission Tomography Computed Tomography , Tomography, X-Ray Computed
5.
Atherosclerosis ; 251: 132-138, 2016 08.
Article in English | MEDLINE | ID: mdl-27318833

ABSTRACT

BACKGROUND AND AIMS: Low-flow-mediated constriction (L-FMC), the endothelial response to reduced blood flow by forearm compression, is present in some smokers. The differences between smokers with and without L-FMC are unclear. It is also unknown whether flow-mediated total dilation (FMTD) or modified flow-mediated dilation (mFMD), both of which incorporate information concerning L-FMC, could be used to estimate cardiovascular risk. We sought to clarify the clinical factors associated with the presence of L-FMC in smokers according to sex and examine whether L-FMC incorporated indices would be better than a conventional index to estimate cardiovascular risk in smokers. METHODS: In total, 140 consecutive smokers (58 ± 13 years old) with no coronary heart disease and 48 non-smokers, who comprised the age- and sex-matched control group, were enrolled. RESULTS: L-FMC was demonstrated in 33.6% (47/140) and 25% (12/48) of the smokers and non-smokers, respectively. In male smokers, the predictors of the presence of L-FMC were age (p = 0.014), body mass index (BMI) (p = 0.045), and baseline brachial arterial diameter (Dbase) (p = 0.048). In female smokers, there were no predictors of the presence of L-FMC. The correlations between the Framingham risk score (FRS) and %FMTD (r = -0.34) and between FRS and %mFMD (r = -0.33) were stronger than that between FRS and conventional flow-mediated dilation (%cFMD) (r = -0.20). CONCLUSIONS: Independent predictors of the presence of L-FMC were age, BMI, and Dbase in male smokers. L-FMC incorporated indices may be good alternatives to cFMD to estimate cardiovascular risk.


Subject(s)
Brachial Artery/pathology , Cardiovascular Diseases/diagnosis , Coronary Disease/diagnosis , Smoking/adverse effects , Vasoconstriction , Age Factors , Aged , Blood Flow Velocity , Body Mass Index , Endothelium, Vascular/physiopathology , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Regional Blood Flow , Risk Factors
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