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70 巻, 10 号
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吉田 謙一郎, 大島 博幸1994 年 70 巻 10 号 p. 1047-1054
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーIt is well accepted that testicular function is controlled by gonadotropins. Androgen secretion is regulated by LH, whereas spermatogenesis is controlled by FSH and locally produced androgens. However, evidence has accumulated to indicate that this extratesticular control system is modulated by equally important intratesticular cell-cell interactions. The study of this local control system has received major impetus from the development techniques which have allowed isolation and culture of purified testicular cells and has revealed that testicular cells respond to previously unexpected variable humoral factors which are produced by testicular cells them-selves, namely testicular paracrinology. Numerous reviews with regard to cell-cell interactions have been published. In this paper, we attempted to summarize recent topics of para and autocrinology of testicular androgen biosynthesis and spermatogenesis.抄録全体を表示PDF形式でダウンロード (944K) -
鈴木 ユリ, 坂根 貞樹, 佐々木 雅子, 上田 新, 槇野 茂樹, 松塚 文夫, 高松 順太, 大澤 仲昭1994 年 70 巻 10 号 p. 1055-1062
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーA 57-year-old woman came to our hospital with complaints of neck swelling and headache in 1991. She was diagnosed as having chronic thyroiditis in euthyroidism because she had a diffuse goiter with both antithyroglobulin antibody (TGHA) and antimicrosomal antibody (MCHA). In 1992, she complained of the rapid growth of her thyroid gland and a swallowing disturbance. Atypical lymphocytes were observed in 16.5% of leukocytes in peripheral blood and similar atypical cells were found in bone marrow. Although an ultrasound scan of the thyroid gland revealed a symmetrical enlargement without a pseudocystic appearance, cytological study with fine needle aspiration biopsy of the thyroid gland demonstrated an abundance of atypical lymphoid cells. A whole body scintigram with 67gallium citrate showed no significant accumulation except in the thyroid gland.
With a diagnosis of suspected primary thyroid lymphoma, total thyroidectomy was performed. However the diagnosis of malignant lymphoma was not confirmed histologically. A study of lymphocytes subset with two-color flow cytometry, which was performed for both lymphocytes in peripheral blood and infiltrating lymphocytes in the resected thyroid gland, revealed abnormal increased CD4 positive T cells and decreased HLA-DR expression. Additionally, southern blot DNA analysis for abnormal lymphocytes using restriction enzymes, EcoRI and BamHI, demonstrated rearrangement of the T-cell antigen receptor, which indicates a monoclonal proliferation of lymphocytes. After total thyroidectomy, atypical lymphocytes in peripheral blood decreased, and circulating autoantibodies including TGHA and MCHA disappeared.
From these data, this patient was finally diagnosed as having a primary T-cell lymphoma of the thyroid gland, which is a very rare type of thyroid lymphoma. Most importantly, this is the first reported case of a thyroid lymphoma in the leukemic stage with a distinct immunological disorder.抄録全体を表示PDF形式でダウンロード (2626K) -
清野 佳紀, 神崎 晋, 久保 俊英, 日比 逸郎, 田中 敏章, 諏訪 〓三, 立花 克彦, 奥野 晃正, 新見 仁男, 土屋 裕, 五十 ...1994 年 70 巻 10 号 p. 1063-1074
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーRecently we developed a sandwich enzyme immunoassay (EIA) specific for intact molecular osteocalcin (I-OC), produced only by osteoblast cell and partially released into blood circulation, to establish a specific bio-chemical marker of bone formation.
In order to confirm whether serum I-OC levels constitute a specific marker for bone formation and to assess the relationship between serum I-OC levels and growth response to growth hormone (GH) therapy, we measured the serum I-OC in serial serume samples using this EIA from 61 children with GH deficiency who showed significant bone growth during GH therapy.
The serum I-OC levels in children with GH deficiency before GH therapy were slightly lower than those in normal children (Kanzaki S. et al., J Clin Endocrinol Metab. 1992; 75: 1104-9), and had a wide distribution overlapped with the normal range. These levels were apparently increased during GH treatment;that is, in contrast to the levels of 22.9 ± 1.5ng/ml (mean ± SE) before GH treatment, the levels after 1 and 2 months of GH treatment were 29.1 ± 1.6ng/ml and 32.5 ± 1.8ng/ml, respectively. However they decreased slightly at 3 months and then they gradually rose to 37.5 ± 2.8ng/ml after 12 months. I-OC ratios, represented by the I-OC level at each month of GH therapy in relation to pretreatment level, correlated well with the growth response (growth velocity, growth velocity SD score and A growth velocity SD score) after 12 month of GH treatment. Correlation coefficients of the growth velocity versus I-OC ratio at 1 and 6 months of GH treatment were 0.677 (p<0.001, N=58) and 0.752 (p<0.001, N=55), respectively. However, both IGF-I and ALP ratios represented in the same way as the I-OC ratio, correlated poorly as compared with the I-OC ratio.
These results demonstrate that the change of serum I-OC levels indicates a direct and sensitive reflection of bone formation, because serum I-OC levels significantly increased with the growth response to GH therapy. The measurement of serum I-OC levels after 1 month of GH treatment may be a useful tool in predicting improved growth velocity during long-term GH therapy.抄録全体を表示PDF形式でダウンロード (1013K) -
竹中 克斗, 柳瀬 敏彦, 長友 英博, 田中 彰人, 名和田 新1994 年 70 巻 10 号 p. 1075-1082
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーA-26-year-old female was admitted to our hospital on December 4, 1992, because of recurrent fever. She had experienced recurrent fever of over 38°C, occurring at irregular intervals 4-6 times a year with chest or abdominal pain, since the age of 19. After delivery of a baby at the age of 25, her symptoms had increased to once a week. In the febrile phase, leukocytosis, an increased erythrocyte sedimentation rate and positive CRP were recognized. These symptoms and laboratory findings spontaneously disappeared within a few days. Despite systemic and careful examinations, no evidence of infectious diseases, collagen diseases or malignant diseases were found. There were no significant differences of serum and urine catecholamines, and urine etiocholanolone between the febrile phase and the afebrile phase. An intravenous infusion of metaraminol induced symptoms similar to a spontaneous attack, and the metaraminol rechallenge test became negative after she was treated with oral colchicine. Based on these findings, she was diagnosed as having familial Mediterranean fever. Since she was treated with colchicine, the febrile attacks have decreased. Significantly, her elder brother has had similar recurrent fever with abdominal pain. He was diagnosed as having familial Mediterranean fever due to a positive metaraminol provocative test, and his febrile attacks have also been suppressed by colchicine.
This is the first case of familial Mediterranean fever with obvious family history in Japan.抄録全体を表示PDF形式でダウンロード (607K) -
杉本 高士, 百渓 尚子, 飯野 史郎, 伊藤 國彦1994 年 70 巻 10 号 p. 1083-1092
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーIn order to differentiate silent thyroiditis (SLT) from Graves' disease, the usefulness of the measurement of the urinary concentration of iodine was evaluated in this study. The subjects employed were 39 patients with SLT and 40 patients with Graves' disease. Patients were advised to avoid any iodine-containing food or medication for a week before the examination. The urinary concentration of iodine (UI) and the serum concentration of thyroid hormones were determined. UI was calculated from the amount of iodine in the spot urine by multiplying it by the ratio of iodine to creatinine. Since the UI value thus obtained was significantly well correlated with the UI value for 24 hour urine, the former value was used instead of the latter value thereafter. Mean UI value in the patients with SLT was 482.4±296.4μg/day and that in the patients with Graves' disease was 169.8±75.2μg/day, the former value being significantly higher than the latter (p<0.0001). A strong and significant correlation between UI and the serum concentration of FT4 or T3 (TT3) was found in the patients with SLT (r=0.76, p<0.0001 and r=0.54, p<0.02), but not in those with Graves' disease (r=0.34, p=0.07 and r=0.24, p=0.14) Mean UI/FT4 ratio and mean UI/TT3 ratio was significantly higher in patients with SLT than those with Graves' disease and the overlaps in the ratios between these two groups were very slight.
These results indicate that both the ratios of UI/FT4 and UI/TT3 were useful parameters to differentiate SLT from Graves' disease. The higher UI value observed in the patients with SLT was thought to be due to the increase in the amount of inorganic iodine which was liberated from the iodinated material leaked from the damaged thyroid tissue by the deiodinating mechanism in the peripheral tissues.抄録全体を表示PDF形式でダウンロード (681K) -
石突 吉持, 広岡 良文, 谷川 俊一1994 年 70 巻 10 号 p. 1093-1100
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーIn order to evaluate whether or not iodine intake in Japanese is variable among different aged subjects and also whether this variation is concordant with the age distribution in patients with chronic thyroiditis, we tried to examine the urinary iodine excretion of euthyroid people in various decades of age.
One hundred and twenty outpatients without thyroid disorders, aged 22 to 77 y. o., were selected at random and were divided into 6 groups according to age. Mean total urinary iodine excretion (UIT) and concentration (UIC) were 336.1μg/day and 31.4μg/dl/cr, respectively, and they were in good correlation (r=+0.82, p<0.001). A straight line on log normal probability was recognized between the ratio of cumulative frequency and values of UIT. UIT and UIC were significantly correlated with serum nonhormonal iodine, respectively (r=+0.21, p<0.01; r=+0.28, p<0.01). These indicators in the 3rd decade were lower than those in the 6th decade (p<0.01, p<0.05). UIT increased with age up to the 6th decade and then decreased gradually to the 8th decade. Therefore, UIT in all the subjects formed a bell-shaped distribution with a significant peak in the 6th decade (H=12.1, p<0.05). Rates of renal iodine clearance (UIC/SNI) in the 6th decade increased significantly more than those in the 4th decade (p<0.01), and the distribution of those rates in the 6 groups were similar to that of UIT. The mean frequency of UIT in less than 200 μg/day of the necessary amounts of iodine intake was 32.5%, but it was 63.6% in the 3rd decade, whereas it was 19% in the 6th decade. The difference between the 3rd and 6th decades was significant (p<0.01).
It was indicated that differences in the amounts of iodine intake in Japanese euthyroid people were present and that the distribution was virtually matched to the age distribution of the patients with chronic thyroiditis. The data suggest that the increment of iodine intake in the middle-aged group could affect the pathophysiology of autoimmune thyroid disorders.抄録全体を表示PDF形式でダウンロード (690K) -
合阪 幸三, 吉田 浩介, 香山 文美, 木村 好秀, 爲近 慎司, 佐藤 孝道, 松岡 良, 森 宏之1994 年 70 巻 10 号 p. 1101-1114
発行日: 1994/12/20
公開日: 2012/09/24
ジャーナル フリーThe present study was conducted to investigate the effects of the transient increase of serum prolactin levels on the gonadotropin secretion system in patients with occult hyperprolactinemia (OHP). 216 cases of normoprolactinemic hypothalamic anovulatious were selected by LH-RH and TRH loading tests, and 5mg/day of bromocriptine was administered for more than 8 weeks. The effectiveness of the bromocriptine administration was estimated by the ultrasonic examination of the follicular development. The endocrinological backgrounds were compared between bromocriptine effective (154 cases, group A) and non-effective (62 cases, group B) patients. Serum prolactin levels 30min. after LH-RH and TRH loading (PRL30 in group A were significantly higher than those of group B (74.1±36.5 vs. 38.0±18.2ng/ml, p<0.01). From this result, it was thought that many of the OHP patients were selected in group A. Serum LH levels 30min. after loading test (LH30) in group A also increased compared to those of group B (65.0±66.5 vs. 43.1±34.3mIU/ml, p<0.02). The LH/FSH ratio before loading was also higher in group A (1.3±0.6) than that of group B (1.0±0.5, p<0.02). This fact showed that group A also contained patients with hyper-LH hypothalamic anovulation, which is known as the endocrinological PCOD. There were also significant inverse correlations between serum levels of prolactin and FSH in group A (before loading values: r=0.272, 30min. after loading: r=0.224, p<0.01). By the administration of bromocriptine, serum prolactin levels decreased both in group A and B, and the elevated serum LH/FSH ratio (1.0±0.4, p<=0.02), LH30 (46.1±37.0mIU/ml, p<0.005) also decreased significantly. Serum levels of FSH in group A increased significantly with treatment (before loading: 5.4±2.6→6.2±2.0, 30min. after loading:10.6±6.0→14.6±9.9mIU/ml, p<0.005).
From these facts, it was concluded that FSH secretion was suppressed even by a slight increase of serum prolactin levels which was usually seen in the OHP, and bromocriptine administration was effective not only for the suppression of serum prolactin and LH levels, but also for the improvement of FSH secretion in the OHP patients.抄録全体を表示PDF形式でダウンロード (912K)
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