Search

Key Clinical Message In patients with symptoms of viral infection and marked thickening of the gallbladder wall, it is important to suspect acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis. Abstract A 35‐year‐old Japanese man presented with fever, abdominal right upper quadrant pain, and liver dysfunction. Positive immunoglobulin M and ‐G antibodies and negative nuclear antigen for Epstein–Barr virus were observed. Abdominal ultrasonography revealed a markedly thickened gallbladder wall. Acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis was diagnosed.

Key Clinical Message Acute myeloid leukemia (AML) can cause acute abdomen following adrenal insufficiency or adrenal infarction. Therefore, when diffusely enlarged adrenal glands and adrenal insufficiency of unknown cause are seen in a patient presenting with acute abdomen, adrenal infarction due to AML, or other hematologic diseases should be ruled out. Abstract A 49‐year‐old man developed acute abdominal pain following adrenal insufficiency and was diagnosed with acute myeloid leukemia (AML) with myelodysplasia‐related changes. Because AML can cause acute abdominal pain due to adrenal infarction following adrenal insufficiency, a patient with these conditions should be ruled out adrenal infarction due to AML or other hematologic diseases.

Key Clinical Message Listeria can cause neurological symptoms in immunocompromised and older patients. Additionally, it is impossible to rule out meningitis by the absence of typical meningeal irritation signs. Therefore, patients with fever and neurological impairments should be rapidly examined for blood and cerebrospinal fluid cultures to rule out Listeria meningitis. Abstract A woman in her 90s developed fever, dysarthria, and transient disturbance of consciousness. Physical examination revealed no meningeal irritation signs. Listeria monocytogenes were detected in her blood culture the following day. Because of an increased number of cells in cerebrospinal fluid, she was diagnosed with Listeria meningitis.

Key Clinical Message The low sensitivity of ascites culture for acid‐fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on computed tomography may prompt suspicion of tuberculous peritonitis. Abstract A 47‐year‐old Nigerian man presented with fever, abdominal distention, and weight loss. Abdominal computed tomography revealed massive ascites and peritoneal thickening. Despite failing to culture acid‐fast bacilli from ascites, histological examination and culture of peritoneum revealed multidrug‐resistant tuberculosis peritonitis. Peritoneal biopsy is mandatory when tuberculosis peritonitis is suspected.

Abstract Background Few studies have focused on research practice in Japanese university general medicine (GM) departments. Methods This is a questionnaire‐based cross‐sectional study to clarify the research achievement and associated factors of Japanese university GM department. Univariate analysis was performed to compare the number of English‐language research publications and explanatory variables. Results Forty‐seven universities responded. Over a 3 years period, the median number of English‐language research publications was 6. Perceived degree of research necessity, staff numbers, collaborative research, conference presentations, and obtaining research grants were significantly associated with a higher number of English‐language research publications. Conclusions While GM research output was found to be limited, numerous associated factors can potentially change Japanese GM departments' research environments.

We propose five important strategies for young generalists to write original research and papers. We hope that even beginners will understand and practice these five strategies, and help young generalist to write research papers based on clinical questions that arise in their daily practice.

Abstract A 51‐year‐old man with untreated hypertension developed sudden‐onset epigastric pain. Despite a normal D‐dimer level, abdominal contrast‐enhanced computed tomography revealed superior mesenteric artery dissection. Abdominal contrast‐enhanced computed tomography is mandatory when examining patients with sudden‐onset abdominal pain, even those with a normal D‐dimer level.

Abstract A 69‐year‐old man with left eye pain and visual impairment was diagnosed with syphilitic optic neuritis, who was successfully treated by penicillin. Although it is difficult to decide syphilis as the direct cause of optic neuritis, it is essential to diagnose syphilis in every patient with optic neuritis.

Abstract An 85‐year‐old woman presented with pain and a palpable mass in her left flank. Abdominal computed tomography revealed massive splenomegaly and para‐aortic lymphadenopathies. Bone marrow biopsy showed CD79a, CD20, and bcl‐2‐positive atypical lymphocytes, which led to the diagnosis of splenic marginal zone lymphoma.

Abstract A mass shadow in the right lower lung field was detected by chest X‐ray in a 79‐year‐old woman, which was eventually diagnosed as anterior mediastinal lipoma. She remained under watchful waiting without surgery for 9 years without developing symptoms, even though the lipoma had grown to an extremely large size.

Abstract A cross‐sectional questionnaire‐based study was conducted to examine whether the educational performance and achievements are appropriately recognized and contribute to their promotion in university hospitals. We found that the chairpersons of those general medicine departments believed that educational performance had not been appropriately evaluated; educational achievements did not receive sufficient consideration for promotion compared with the performance and achievements related to clinical and research activities.

Abstract Physicians should be familiar with May‐Thurner syndrome, characterized by the compression of the left common iliac vein by the right common iliac artery and the vertebral body, resulting in pain and swelling of the left lower extremity and DVT. A 64‐year‐old woman presented with unexplained edema in the left lower extremity. Computed tomography with contrast enhancement revealed that the left common iliac vein was compressed and narrowed by the right common iliac artery and the vertebral body, leading to the diagnosis of May‐Thurner syndrome.