Journal of General and Family Medicine最新文献

A man in his 60s was ultimately diagnosed with a secondary lung abscess caused by an esophagorespiratory fistula. On admission, however, he had initially been diagnosed with a primary lung abscess because of aspiration, given his history of alcohol use. Secondary lung abscesses can result from various underlying conditions. Among these, esophagorespiratory fistulas are significant causes and are often associated with esophageal cancers. An intriguing aspect of this case is that secondary lung abscesses originating from esophageal cancer can occur under similar conditions as aspiration-related pulmonary suppuration. Given the difficulty in distinguishing between the two based solely on imaging, physicians should exercise caution when encountering patients with a history of heavy alcohol consumption.

A 68-year-old man was emergently transported to the hospital due to a sudden onset of motor paralysis and sensory impairment in the left upper and lower limbs. He arrived 90 minutes after symptom onset. He reported no headache, chest pain, or back pain. His vital signs on admission were as follows: body temperature, 36.0°C; blood pressure, 130/102 mmHg; heart rate, 98 beats per minute (regular); respiratory rate, 20 breaths per minute; and peripheral saturation in oxygen, 95% on room air. His consciousness was clear, with no conjugate gaze deviation or dysarthria. On physical examination, he had muscle weakness (Medical Research Council grade 4) and decreased superficial sensation in the left upper and lower limbs. The National Institutes of Health Stroke Scale score was 3. Carotid ultrasound revealed good-color Doppler signals in both carotid arteries, with no evidence of arterial dissection. There were no apparent stroke findings on head computed tomography (CT) and magnetic resonance imaging.

Laboratory tests revealed a markedly elevated D-dimer level (33.0 μg/mL). Additionally, supine chest radiography showed mild mediastinal widening (9 cm in the upper mediastinum). The pulses in the left radial and dorsalis pedis arteries were not palpable. Contrast-enhanced CT demonstrated extensive aortic dissection extending from the ascending aorta to the level of the common iliac arteries, with pericardial effusion. Blood flow beyond the left subclavian artery and left common iliac artery was completely occluded (Figure 1), but the dissection did not extend into the carotid or intracranial arteries. The patient was diagnosed with Stanford type A acute aortic dissection (AAD). He was transferred to a higher-level medical facility but developed cardiac arrest because of cardiac tamponade during transport. Despite resuscitative efforts and intensive care, he did not survive.

In Stanford type A AAD, aortic dissection frequently extends beyond the carotid arteries, leading to cerebral infarction and subsequent unilateral upper and lower limb neurological deficits.¹ However, cases in which unilateral upper and lower limb paralysis and sensory impairment mimic stroke because of simultaneous dissection-related arterial occlusion are exceedingly rare. There have been reports of AAD causing unilateral lower limb paresthesia and pain^{2, 3} and of acute limb ischemia presenting as unilateral upper and lower limb paresthesia.⁴ These findings underscore the importance of differentiating ischemia from neurological disorders in cases of acute unilateral symptoms. In our case, the absence of pain made differentiation from stroke even more challenging. When urgent evaluation is required to administer intravenous thrombolysis (t-PA) for acute ischemic stroke, carotid ultrasound is often useful in ruling out AAD.⁵ However, as demonstrated in this case, carotid ultr

Chronic kidney disease (CKD) is a growing public health concern globally, with primary care physicians (PCPs) playing a pivotal role in its early detection and management. This review explores the epidemiology, risk factors, screening strategies, and clinical manifestations of CKD within primary care settings. PCPs are integral in recognizing at-risk populations, initiating timely screening through eGFR and albuminuria tests, and managing modifiable risk factors like hypertension and diabetes. The article discusses current guideline-recommended pharmacologic therapies—including RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal MRAs—that slow disease progression. Lifestyle modifications and dietary interventions are emphasized as essential components of care. Additionally, the review outlines key indications for nephrology referral and the management of common CKD complications, such as anemia and mineral-bone disorder. By embracing a proactive and multidisciplinary approach, PCPs can significantly influence CKD outcomes, reduce progression to end-stage renal disease, and improve overall patient prognosis.

We report an 80 year old man in the terminal stage of cancer receiving home care. On the 18th day after starting home care, he experienced a sudden onset of impaired consciousness, unsteadiness of gait, and ophthalmoplegia. Based on the clinical symptoms and a prolonged loss of appetite, Wernicke encephalopathy (WE) was suspected. Thiamine 100 mg was administered intravenously, and 20 minutes later, the patient responded to verbal stimuli. After 1 h, he was able to engage in conversation. When impaired consciousness occurs in cancer patients receiving home care, it is important to consider WE as a differential diagnosis.