Amyopathic dermatomyositis (ADM) is a clinical subtype of dermatomyositis, characterized by the absence of motor weakness and the presence of normal muscle enzyme levels. ADM is sometimes accompanied by interstitial pneumonia that shows a rapid progressive course associated with a poor prognosis. We describe a 70-year-old man who presented rapidly progressive interstitial pneumonia associated with clinically ADM (C-ADM); he was successfully treated with polymyxin B-immobilized fiber column (PMX) hemoperfusion.

Constipation can be caused by adverse drug reactions as a result of many drugs and might be induced by sleep disorders; however, the relative risk of its occurrence with individual drugs and the in‰uence of sleep conditions have not been clariˆed. To clarify the relationship between constipation and various drugs in consideration of sleep disorders, we investigated the self-reported bowel habits, use of laxatives, and the Athens Insomnia Scale (AIS, a self-administered psychometric instrument to measure insomnia) in 344 inpatients on admission. They were divided into a constipation group (self-reported bowel habits of``Constipation'' or``Occasional constipation'' and/or use of laxatives, n＝161) and a non-constipation group (both``Normal'' and the non-use of laxatives, n＝183). A comparison of the backgrounds of the two patient groups revealed signiˆcant diŠerences in age, gender, number of used drugs, AIS score, hypothyroidism, chronic obstructive pulmonary disease, use of diuretics, coronary vasodilators, thyroid hormones, non-steroidal anti-in‰ammatory drugs, proton pump inhibitors, antidepressants, anti-anxiety drugs, and hypnotics. Multiple logistic regression analysis using these fourteen factors as autonomous variables showed that age (odds ratio [OR], 1.03; 95％ conˆdence interval [CI], 1.01 1.04; p＝0.007), female gender (OR, 1.96; 95％ CI, 1.21 3.18; p＝ 0.006), the AIS score (OR, 1.10; 95％ CI, 1.02 1.18; p＝0.010), and the use of hypnotics (OR, 2.33; 95％ CI, 1.30 4.16; p＝0.004) were signiˆcantly related to constipation; therefore, as hypnotics appear more likely to cause constipation than other drugs, they should be used with caution.

Abstract

Constipation is a common problem in hospitalized patients; however, the relative risks of its development with various factors have not been clariˆed. To clarify the risk factors associated with constipation, we performed a case-controlled study of 165 hospitalized patients who were not laxative users on admission. They were divided into case (n＝35) and control (n＝130) groups according to laxative administration during hospitalization. Comparison of the patient backgrounds in the two groups revealed signiˆcant diŠerences in the activities of daily living, length of fasting, rest level on admission, cerebrovascular disease, and administration of hypnotics. Multiple logistic regression analysis using thesê ve factors as autonomous variables showed that administration of hypnotics (odds ratio, 2.79; 95％ conˆdence interval, 1.10 7.06; p＝0.031) was signiˆcantly related to laxative use. Therefore, the administration of hypnotics may be the principal cause of constipation development in hospitalized patients and they should be used with caution.

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