BackgroundBenign gynecologic tumor, such as uterine adenomyosis, has been suggested to develop hypercoagulability. Although some cases of cerebral infarction associated with adenomyosis have been reported, the mechanism of hypercoagulation initiated by adenomyosis is still not clear, and the therapeutic strategy is uncertain.Case presentationA 44-year-old woman was presented to our department with headache, left hand weakness, and gait disturbance during her menstrual phase. She had a history of adenomyosis and infertility treatment for 18 years and heavy menstrual bleeding. Magnetic resonance imaging on admission showed multiple hyperintense lesions in cortical and subcortical areas in the cerebrum and cerebellum on diffusion-weighted imaging. Transesophageal echocardiography showed neither embolic sources nor existence of foramen ovale. Her laboratory data revealed anemia, a high D-dimer level, and elevated levels of a mucinous tumor marker. She had adenomyosis and no malignancy was detected. Anticoagulation therapy with intravenous heparin followed by rivaroxaban did not prevent recurrence of cerebral infarction. We discontinued rivaroxaban, and started warfarin therapy with pseudomenopause treatment, which prevented recurrence for 6 months. Five months after her last pseudomenopause treatment, multiple cerebral infarctions occurred. Total hysterectomy was performed, which prevented recurrence of the multiple cerebral infarctions for 2 years without anticoagulation therapy.ConclusionsOur findings reveal for the first time that anticoagulation therapy, including novel oral anticoagulants, had no preventive effect against cerebral infarctions associated with adenomyosis in a middle-aged woman. Although pseudomenopause treatment temporarily prevented recurrence, resection of the adenomyosis might be the most effective therapy in these cases.
Background Drug-induced pneumonia (d-pneumonia) and bacterial pneumonia (b-pneumonia) are often difficult to differentiate; therefore, this study examined the possibility of differentiating them using serum biomarkers. Methods The study included 22 and 16 patients diagnosed with b- and d-pneumonia, respectively, at our institution or affiliated institutions. For d-pneumonia, the causative drug was minocycline hydrochloride in four patients, gefitinib in two patients, nivolumab in two patients, pembrolizumab in two patients, sulfasalazine in two patients, loxoprofen in one patient, Bouiougitou in one patient, edoxaban tosilate hydrate in one patient, and abemaciclib in one patient. White blood cell (WBC), C-reactive protein (CRP), Krebs von den Lungen-6 (KL-6), surfactant protein (SP)-D, and SP-A levels were measured in each patient and compared between the groups. Results Significant differences were noted in the WBC and SP-D levels between the two groups (P < 0.05, P < 0.001), but not in the CRP, KL-6, or SP-A levels. Conclusion The study results suggest that SP-D is a useful marker for differentiating b-pneumonia and d-pneumonia.
Background: In Japan, pulmonary Mycobacterium avium-intracellulare complex (MAC) disease is highly prevalent. This study aimed to evaluate the efficacy of Jiinshihoto (JST) for treating pulmonary MAC disease. Methods: Twenty-four patients, not receiving standard treatment for pulmonary MAC disease, were enrolled in this study; of these, 21 patients (3 patients dropped out of the study) were eligible and selected to participate. They were administered JST (3.0 g; Tsumura Co., Tokyo, Japan) three times per day for 12 months. Their weight, chronic obstructive pulmonary disease assessment test (CAT) score, NK cell activity, chest computed tomography (CT) results, blood sample results, Self-rating Depression Scale (SDS) scores, and State-Trait Anxiety Inventory (STAI) scores were measured: (i) before JST administration, (ii) after 3 months, and (iii) at the end of the study. Results: Before JST administration, the exacerbation group (n = 10 patients; 6 patients with worsened conditions at the end of the study and 4 patients who were switched to standard treatment during the study because of exacerbation) had a significantly low body mass index (BMI), mild depression, and high anxiety. The overall patient population showed no significant differences in the chronic obstructive pulmonary disease assessment score, body weight, or natural killer cell activity after 3 months of treatment; however, the SDS score improved significantly. At the end of treatment, the nutritional scores had worsened, but the SDS score improved significantly. Specifically, the SDS scores improved significantly only in the non-exacerbation group (n = 11 patients), and natural killer cell activity improved in the non-exacerbation group. Additionally, a comparison of the data of both groups before and after JST administration showed that the exacerbation group had significantly lower BMI and worse CT scores when using a BMI cutoff of 18.4 (sensitivity, 81.8%; specificity, 70%). Conclusion: Patients with a high BMI and low CT score at the time of initial diagnosis may benefit from JST treatment, which may significantly improve depression and immunity and prevent disease progression. Therefore, JST may be an effective treatment in selected pulmonary MAC patients. Trial registration: This study has been registered in the UMIN-Clinical Trials Registry (UMIN000033590, August 1, 2018).
Background: In Japan, pulmonary Mycobacterium avium-intracellulare complex (MAC) disease is highly prevalent. This study aimed to evaluate the efficacy of Jiinshihoto (JST) for treating pulmonary MAC disease. Methods: Twenty-four patients, not receiving standard treatment for pulmonary MAC disease, were enrolled in this study; of these, 21 patients (3 patients dropped out of the study) were eligible and selected to participate. They were administered JST (3.0 g; Tsumura Co., Tokyo, Japan) three times per day for 12 months. Their weight, chronic obstructive pulmonary disease assessment test (CAT) score, NK cell activity, chest computed tomography (CT) results, blood sample results, Self-rating Depression Scale (SDS) scores, and State-Trait Anxiety Inventory (STAI) scores were measured: (i) before JST administration, (ii) after 3 months, and (iii) at the end of the study. Results: Before JST administration, the exacerbation group (n = 10 patients; 6 patients with worsened conditions at the end of the study and 4 patients who were switched to standard treatment during the study because of exacerbation) had a significantly low body mass index (BMI), mild depression, and high anxiety. The overall patient population showed no significant differences in the chronic obstructive pulmonary disease assessment score, body weight, or natural killer cell activity after 3 months of treatment; however, the SDS score improved significantly. At the end of treatment, the nutritional scores had worsened, but the SDS score improved significantly. Specifically, the SDS scores improved significantly only in the non-exacerbation group (n = 11 patients), and natural killer cell activity improved in the non-exacerbation group. Additionally, a comparison of the data of both groups before and after JST administration showed that the exacerbation group had significantly lower BMI and worse CT scores when using a BMI cutoff of 18.4 (sensitivity, 81.8%; specificity, 70%). Conclusion: Patients with a high BMI and low CT score at the time of initial diagnosis may benefit from JST treatment, which may significantly improve depression and immunity and prevent disease progression. Therefore, JST may be an effective treatment in selected pulmonary MAC patients.Trial registration: This study has been registered in the UMIN-Clinical Trials Registry (000033590, August 1, 2018).
Background: In Japan, pulmonary Mycobacterium avium-intracellulare complex (MAC) disease is highly prevalent. This study aimed to evaluate the efficacy of Jiinshihoto (JST) for treating pulmonary MAC disease. Methods: Twenty-four patients, not receiving standard treatment for pulmonary MAC disease, were enrolled in this study; of these, 21 patients (3 patients dropped out of the study) were eligible and selected to participate. They were administered JST (3.0 g; Tsumura Co., Tokyo, Japan) three times per day for 12 months. Their weight, chronic obstructive pulmonary disease assessment test (CAT) score, NK cell activity, chest computed tomography (CT) results, blood sample results, Self-rating Depression Scale (SDS) scores, and State-Trait Anxiety Inventory (STAI) scores were measured: (i) before JST administration, (ii) after 3 months, and (iii) at the end of the study. Results: Before JST administration, the exacerbation group (n = 10 patients; 6 patients with worsened conditions at the end of the study and 4 patients who were switched to standard treatment during the study because of exacerbation) had a significantly low body mass index (BMI), mild depression, and high anxiety. The overall patient population showed no significant differences in the chronic obstructive pulmonary disease assessment score, body weight, or natural killer cell activity after 3 months of treatment; however, the SDS score improved significantly. At the end of treatment, the nutritional scores had worsened, but the SDS score improved significantly. Specifically, the SDS scores improved significantly only in the non-exacerbation group (n = 11 patients), and natural killer cell activity improved in the non-exacerbation group. Additionally, a comparison of the data of both groups before and after JST administration showed that the exacerbation group had significantly lower BMI and worse CT scores when using a BMI cutoff of 18.4 (sensitivity, 81.8%; specificity, 70%). Conclusion: Patients with a high BMI and low CT score at the time of initial diagnosis may benefit from JST treatment, which may significantly improve depression and immunity and prevent disease progression. Therefore, JST may be an effective treatment in selected pulmonary MAC patients.Trial registration: This study has been registered in the UMIN-Clinical Trials Registry (UMIN000033590, August 1, 2018).
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