Ecthyma gangrenosum mimicking cellulitis.

This report has strong implications for carefully examining the common skin signs of cancer patients receiving chemotherapy. These signs can warn clinicians of the potential for severe infections such as fatal sepsis.

Schistosomiasis Diagnosed Using Laparoscopy and Colonoscopy.

Schistosomiasis infection is a major cause of morbidity and mortality in endemic areas. Developed countries have declared that schistosomiasis has been eradicated; however, residents of these countries may travel and stay in endemic areas and the number of foreign travelers is increasing in the recent years. Thus, schistosomiasis is regarded as an imported infection. Ultrasonography and serum antibody titer tests are well established as diagnostic methods for schistosomiasis. However, a definitive diagnosis cannot be obtained using these tests in some cases. We herein report a case in which schistosomiasis was confirmed based on laparoscopic liver biopsy without a definitive diagnosis by blood test, fecal examination, or imaging.

Severe herpes simplex virus pneumonia in an elderly, immunocompetent patient.

Although not common, herpes simplex virus (HSV) pneumonia can occur in immunocompromised patients. However, HSV pneumonia in immunocompetent hosts is very rare. The authors encountered a very rare case of severe HSV pneumonia in an immunocompetent host. The patient was an 85-year-old Japanese woman who presented with severe intractable pneumonia refractory to empirical antimicrobial therapy. Furthermore, the causative microorganisms remained unknown. Therefore, cytological examination of bronchoalveolar lavage fluid and protected brush biopsy of the lower respiratory tract were performed, which indicated herpes virus-infected cells with nuclear inclusions; PCR assay was positive for HSV DNA. Accordingly, the patient was diagnosed with HSV pneumonia. Her respiratory condition improved immediately after initiation of acyclovir monotherapy. In selected cases of intractable pneumonia refractory to standard antimicrobial therapy, the possibility of HSV pneumonia should be pursued.

Cigarette smoking is a risk factor for the onset of fatty liver disease in nondrinkers: A longitudinal cohort study.

BACKGROUND: The effect of cigarette smoking on the onset of nonalcoholic fatty liver disease (NAFLD) is unclear, especially that associated with drinking small amounts of alcohol. We conducted a longitudinal study to investigate the relationship between cigarette smoking and NAFLD onset, which was stratified according to the amount of alcohol consumed. METHODS: We enrolled 7,905 Japanese subjects who had received annual health checkups more than twice between April 2003 and August 2013, 4,045 of whom met at least one of the following exclusion criteria and were excluded: (a) fatty liver at baseline; (b) hepatitis B or hepatitis C; (c) alcohol consumption (men: ≥210 g/wk; women: ≥140 g/wk); (d) change in alcohol drinking status between baseline and the study's endpoint; (e) change in cigarette smoking habits between baseline and the study's endpoint; or (f) current treatment with antidiabetic agents, antihypertensive agents, and/or lipid-lowering agents. The remaining 3,860 subjects (1,512 men, 2,348 women) were divided into two groups based on average alcohol consumption. RESULTS: After adjusting for the variables associated with metabolic disease, smoking was associated with fatty liver disease onset compared with nonsmokers in nondrinkers (adjusted hazard ratio = 1.988, 95% confidence interval 1.057-3.595; p = 0.034). No association was found between smoking and fatty liver disease onset in the low alcohol consumption group (men: <210 g alcohol/week; women: <140 g alcohol/week). The fatty liver disease incidence increased significantly among the nondrinkers as the number of cigarettes smoked increased (p = 0.001). CONCLUSIONS: Cigarette smoking may be a significant risk factor associated with NAFLD onset in nondrinkers. These results may help clinicians to identify patients who are at a high risk of developing NAFLD and to prevent the progression of NAFLD by promoting earlier interventions that help people discontinue unhealthy lifestyle habits.

Clinical Course of Eosinophilic Cellulitis.

The patient was a previously healthy 23-year-old woman who made an outpatient visit to our hospital's Department of General Internal Medicine after developing pain and edema of the lower legs a week earlier. The patient was diagnosed with eosinophilic cellulitis (EC) based on an increased eosinophil count of 5,418/mm3 and the results of a skin biopsy of the lower leg that showed eosinophilic infiltration of the dermal tissue. Her condition improved after oral prednisone therapy. EC presents clinically as edema and eosinophilia. Therefore, in many cases, patients make an outpatient visit to the internal medicine department. In the present study, the clinical course of nine patients diagnosed with EC as outpatients at our Department of General Internal Medicine over the past 10 years was examined.

[Superficial urothelial carcinoma of ureter with elevated serum CA19-9 and CEA].

We report a 77-year-old Japanese man with superficial ureteral carcinoma with elevation of serum CA19-9 and carcinoembryogenic antigen (CEA) at recurrence. We performed radical nephroureterectomy and partial bladder resection for the right ureteral carcinoma. Pathological diagnosis was UC, G2 > G1, pTa, NO, MO (according to UICC classification). Eighteen months later, local recurrence and multiple metastases were observed, accompanied by the elevation of serum CA19-9 and CEA. His autopsy specimens showed positive immunostaining for serum CA19-9 and CEA. In Ki-67 labeling index, the autopsy specimens showed higher scores than the surgical specimen.

[Relationships between infant lifestyle and adolescent obesity. The Enzan maternal-and-child health longitudinal study].

OBJECTIVE: A longitudinal study was analyzed to clarify relationships between infant lifestyle, obesity, features of family life and adolescent obesity. SUBJECTS AND METHODS: Subjects in the present study were born between April 1987 and March 1991, in Enzan City, Yamanashi prefecture. Infant height and weight were measured and questionnaires were collected at medical check-ups at 1.5- and 3-year-of age. Adolescent height and weight were measured in April 2000. Obese adolescents were defined as those with on obesity index > or = 20%. RESULTS: At 1.5-years-of age, 883 responses to the questionnaire were obtained, and 737 subjects were followed to adolescence (83.5%). Mean follow-up period was 10 years 11 months. A high Kaup index at 1.5-years-of age (odds ratio (OR) 2.61; 95% confidence interval (CI) 1.11-6.12) and when 3-years-of age (OR 5.34; CI 2.54-11.23), as well as maternal obesity (OR 5.32; CI 2.67-10.60) represented risk factors for adolescent obesity. Of the lifestyle items, "playing alone inside" at 1.5-years-of age (adjusted OR 3.01; CI 1.01-8.99) and "taking snacks without time constraints" at 3-years-of age (adjusted OR 2.12; CI 1.25-3.61) were additional risk factors. In food items, only low intake of cow's milk displayed a significant relationship with adolescent obesity, the link being negative with an adjusted OR of 0.63 (CI 0.41-0.95). Covariance structural analysis was performed and a causal model was constructed. Maternal obesity, obesity at 3-years-of age, playing alone inside, taking snacks without time constraints, and low intake of cow's milk were all associated with obesity in infancy. Maternal obesity affected methods of answering child demands, in turn affecting snacking habits. CONCLUSIONS: Adolescent obesity displays relationships with maternal obesity, a high Kaup index in infancy, play activity, snacking habits, and intake of cow's milk. Although genetic factors exert a strong influence, these components of infant lifestyle all play a role in the development of adolescent obesity.