Search

Cardiac involvement is a rare complication with thromboangiitis obliterans (TAO). We report a 29-year-old man with TAO accompanied with non-ischemic dilated cardiomyopathy. He had no history of heart disease, but echocardiogram demonstrated diffuse hypokinesis and dilated left ventricle. Coronary angiography revealed no organic stenotic lesion. For limb salvage, he was treated with granulocyte-colony stimulating factor (G-CSF)-mobilized peripheral blood mononuclear cell (PBMNC) implantation on his right leg. Not only ischemic leg symptoms, but also plasma level of BNP and ^I-metaiodobenzylguanidine scintigraphic parameters improved after 24 weeks. G-CSF-mobilized PBMNC implantation could be an effective approach to treating non-ischemic cardiomyopathy., 論文

A 39-year-old man had been suffering from periodic fever since childhood. He was started on hemodialysis due to secondary amyloidosis on December 2000. The patient was believed to have Familial Mediterranean fever (FMF) because of recurrent fever with peritonitis, arthritis and inflammatory changes and secondary amyloidosis in his kidneys, heart and colon. No other family member had recurrent fever. IL-6, TNF, and dopamine β-hydroxylase were not increased in the febril phase. The patient was homozygous for the M694I mutation. We report the first Japanese case of FMF associated with amyloidosis and confirmed by a gene mutation.(Internal Medicine 41: 221-224, 2002)

We report a case of IgA nephropathy with renal failure in which the deterioration of renal function was inhibited by the addition of angiotensin II receptor blocker (ARB) losartan. Before administration of losartan, the mean decline in the patient's glomerular filtration rate (GFR) was 0.64 ml/min/1.73 m2/month. Losartan treatment was started when serum creatinine rose above 4.0 mg/dl. With this treatment the serum creatinine level has remained stable for 3.5 years, and the mean decline in GFR was 0.06 ml/min/1.73 m2/month. We document successful retardation of renal failure with the use of losartan. Our experience suggests that dialysis therapy can be delayed significantly in patients using this drug.(Internal Medicine 41: 1167-1170, 2002)

A 33-year-old woman was referred from an outside dialysis clinic to our hospital because of severe abdominal pain during hemodialysis. She had been on chronic hemodialysis for the past 11 years due to chronic glomerulonephritis. Nafamostat mesilate was used as an anticoagulant for hemodialysis, because it was during her menstrual period with hypermenorrhea. On admission, she had no abdominal pain or gynecological abnormalities. On the second day, she had similar abdominal pain during hemodialysis with nafamostat mesilate in our dialysis unit. The abdominal pain disappeared within 60 minutes after discontinuing the hemodialysis. We re-started dialysis using heparin instead of nafamostat mesilate and she had no symptoms. The titer of total immunoglobulin E was high. The drug lymphocyte stimulation test was positive for nafamostat mesilate and antigen specific immunoglobulin E to nafamostat mesilate was highly positive in her blood. Although an allergic reaction to nafamostat mesilate is a rare complication, it should be one of the differential diagnoses of abdominal pain occurring during hemodialysis.