MARCH 2023 Volume5-2

ISSN 2436-018X

JOURNAL OF HOSPITAL GENERAL MEDICINE

JHGM 2023：5(2)：17-20

Case report

Asymptomatic acute cholangitis detected
by dialyzer discoloration

Koichiro Okumura 1)2)※　　Minami Toda 1)　　Riho Yasuno 1)　　Sayo Miyazak 1)
Teruhisa Oikawa 1)　　Masato Hara 1)　　Aya Kume 1)　　Hitomi Kimura 1)
Yuki Nakamura 1)　　Tadashi Onohara 3)　　Yuka Nakamura 1)　　Hiroko Beppu 1)
Hina Ogawa 1)　　Ayumi Ishiwatari 1)　　Yuiko Kamei 1)　　Tomoko Kawanishi 1)
Toshie Ogawa 1)　　Yasutomo Abe 1)　　Mariko Endo 1)　　Sachiko Wakai 1)

1) Nephrology Department, Tokyo Metropolitan Ohkubo Hospital
2) Nephrology Department, Tokyo Metropolitan Tama Medical Center
3) Urology Department, Tokyo Metropolitan Ohkubo Hospital

Key Words：Acute cholangitis, dialyzer, yellow

　　Charcot’s triad is a well-known clinical feature of acute cholangitis. However, some patientsare asymptomatic. We herein report the case of an 84-year-old, female patient with pseudo-Bartter syndrome on hemodialysis with acute asymptomatic cholangitis, which was detected onlythrough the discovery of yellow discoloration of the dialyzer. Blood testing and imaging studiesshould be performed for possible, asymptomatic acute cholangitis if a patient’s dialyzer shows　yellowish discoloration.

JHGM 2023：5(2)：21-24

Case report

A case of airway emergency due to deep neck
infection treated by oral intubation without
tracheostomy：Is tracheostomy essential
in the treatment of deep neck abscesses?

Tatsuya Takenaka 1)2)　　Daisuke Mizokami 1)※　　Saki Takihata 1)
Koji Araki 2)　　Akihiro Shiotani 2)

1) Nishisaitama-Chuo National Hospital, Otolaryngology, Head & Neck Surgery
2) National Defense Medical College, Otolaryngology, Head & Neck Surgery

Key Words：deep neck abscess, mediastinitis, tracheostomy

　　Tracheostomy is a common procedure performed in cases of cervical abscess at risk of airway obstruction. However, tracheostomy may increase the risk of descending necrotizing mediastinitis in deep cervical infections extending caudally. We report a case of a deep cervical abscess that was successfully treated using oral tracheal intubation without tracheostomy. A 74- year-old man was referred to our hospital with fever, sore throat, progressive swelling, and pain in the right neck area starting 4 days prior. Contrast-enhanced computed tomography (CT) revealed an abscess with gas production behind the right side of the thyroid cartilage. The right neck was incised, and debridement of the necrotic tissue and drainage of the abscess were performed under general anesthesia. Because the abscess cavity might have extended caudally behind the cricoid cartilage during surgery, the patient was returned to the intensive care unit under oral intubation without tracheostomy：tracheostomy would have increased the risk of descending mediastinitis. The patient recovered well and was discharged 1 month postoperatively. The routine use of tracheostomy is controversial because of the possibility of increased risk of mediastinal contamination due to wound infection from the tracheostomy site.

JHGM 2023：5(2)：25-28

Brief report

Home Health Care Following Hospital Discharge
Reduces the Rehospitalization Rate of Patients
with Heart Failure Aged 75 Years or Older：
A Prospective Descriptive Study

Masaki Tago 1)¶※　　Risa Hirata 1)¶　　Noriko Ide 1)　　Yoshimasa Oda 2)
Shun Yamashita 1)　　Kenichiro Taniguch 3)　　Naoko E Katsuki 1)　　Shu-ichi Yamashita 1)

1) Department of General Medicine, Saga University Hospital
2) Department of General Medicine, Yuai-Kai Foundation and Oda Hospital
3) Department of Cardiology, Yuai-Kai Foundation and Oda Hospital
¶ These authors contributed equally to this work.

Key Words：Heart failure, Home health care, Rehospitalization

JHGM 2023：5(2)：29-32

Brief report

A Case of Right Brachiocephalic Vein
and Right Internal Jugular Vein Thrombophlebitis
Secondary to Air Entry into a Central Venous Catheter
Inserted into the Right Subclavian Vein

Haruhiko Egawa

Internal Medicine, Sakai Wakabakai Hospital

Key Words：Thrombophlebitis, Central venous catheter, Air entry

JHGM 2023：5(2)：33-34

LETTERS TO THE EDITOR

Researching the proactiveness
of Japanese medical students in the COVID-19 era
– A self-development experience

Mirai Omote 1)　　Yuki Otsuka 2)※

1) School of Medicine, Kanazawa Medical University
2) Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

JHGM 2023：5(2)：35-36

LETTERS TO THE EDITOR

Teaching general hospitalists appropriate leadership
skills and helping them acquire these skills for use
in diverse settings

Masaki Tago 1)※　　Risa Hirata 1)　　Kiyoshi Shikino 2)　　Takashi Watar 3)
Yosuke Sasaki 4)　　Hiromizu Takahashi 5)　　Shinichi Katsukurai 6)
Satoshi Watanuki 7)　　Keita Kondo 8)　　Taro Shimizu 6)

1) Department of General Medicine, Saga University Hospital
2) Department of General Medicine, Chiba University Hospital
3) General Medicine Center, Shimane University Hospital
4) Department of General Medicine and Emergency Care, Toho University School of Medicine
5) Department of General Medicine, Faculty of Medicine, Juntendo University
6) Department of Diagnostic and Generalist Medicine, Dokkyo Medical University
7) Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center
8) Community Based Medicine, Fujita Health University

JHGM 2023：5(2)：37-38

Key Image of General Medicine

Acute Respiratory Failure due to Elevated Diaphragm
Caused by Sigmoid Volvulus

Takamitsu Sakamoto 1)※　　Yoshihisa Fukuda 2)

1) Department of General Medicine, Fukuoka Tokushukai Medical Center
2) Department of Gastroenterology, Fukuoka Tokushukai Medical Center

Key Words：abdominal distension, endoscopic detorsion, bilateral diaphragmatic paralysis

JHGM 2023：5(2)：39-40

Key Image of General Medicine

Klebsiella pneumoniae necrotizing
fasciitis affecting muscle and skin

Shun Miyagawa 1)※　　 Izumi Kitagawa 2)

1) Department of Internal Medicine, Naze Tokushukai Hospital
2) Department of General Internal Medicine, Shonan Fujisawa Tokushukai Hospital

Key Words：Klebsiella pneumoniae, necrotizing fasciitis, skin necrosis

JHGM 2023：5(2)：41-42

Key Image of General Medicine

Diabetic muscle infarction

Tomohiro Hosoda 1)※　　Katsura Emoto 2)

1) Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital
2) Department of Diagnostic Pathology, Keio University Hospital

Key Words：diabetes, misdiagnosed, muscle infarction

JHGM 2023：5(2)：43-44

Key Image of General Medicine

Pancoast tumor overlooked by chest X-ray

Yosuke Sasaki ※　　Yuta Eguchi 　　Tadashi Maeda
Tomoyuki Shigeta　　Yoshihisa Urita

Department of General Medicine and Emergency Care, Toho University School of Medicine

Key Words：back pain, lung cancer, nocturnal pain, pleuritic pain, shoulder pain