Internal Medicine

Recent Trends in Clinical Immunology

Tohru ABE

1992 Volume 31 Issue 10 Pages 1161-1162
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1161

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Questionnaire Surveys of Cases of Tick Bite and Lyme Borreliosis in Hunters in Hokkaido with Reference to Detection of Anti-Borrelia burgdorferi Antibody

Nobuhiko KUBO, Yasutomo ARASHIMA, Minori YOSHIDA, Masato KAWABATA, Sus ...

1992 Volume 31 Issue 10 Pages 1163-1168
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1163

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An epidemic of Lyme borreliosis on Hokkaido island, Japan, was surveyed by questionnaire in 587 hunters. The 308 returns (52.4%) revealed episodes of tick bite (usually 2 or more) in 210 cases. Skin rashes appeared in 164 cases. Associated itching, pain, etc., but not skin rash, were more frequent after 2 or more tick bite. Previous determinations of anti-Borrelia burgdorferi antibody titers in these subjects and in controls suggested an association with outdoor activities other than hunting, and among 33 cases of dermatological symptoms and 23 of articular symptoms, 4 and 2, respectively, were antibody-positive. Most of these antibody-positive subjects had suffered tick bite at least twice, but had had no antibiotic treatment. Three subjects with joint disorders were antibody-positive. These findings suggested that the many hunters exposed to Borrelia burgdorferi frequently carried latent infections, and that some had latent form of arthritis, dermatitis and other disorders.
(Internal Medicine 31 : 1163-1168, 1992)

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Higher Cortical Dysfunction, Antiphospholipid Antibodies and Neuroradiological Examinations in Systemic Lupus Erythematosus

Etsuko MAESHIMA, Yoichi YAMADA, Susumu YUKAWA, Hiroshi NOMOTO

1992 Volume 31 Issue 10 Pages 1169-1174
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1169

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We performed neuropsychological tests to investigate higher cortical dysfunction in 21 patients with systemic lupus erythematosus (SLE). We also measured antiphospholipid antibodies (APA), performed brain computed tomography (CT), and obtained a single photon emission CT (SPECT) to measure regional cerebral blood flow (rCBF) in order to elucidate a possible relationship between APA and higher cortical dysfunction. Higher cortical dysfunction was noted in as many as 16 (76%) out of 21 cases. APA were positive in 8 (38%) out of 21 cases. Although the relationship between APA and higher cortical dysfunction was not significant, patients positive for lupus anticoagulant (LA) were found to have higher cortical dysfunction. Brain CT revealed at least one abnormality in 6 cases (29%) but none had a localized lesion, SPECT disclosed a reduced rCBF in 9 cases (43%). The findings on brain CT and SPECT were unrelated to higher cortical dysfunction.
(Internal Medicine 31 : 1169-1174, 1992)

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Cardiovascular and Sympathetic Nervous Responses to Mental Stress in Hyperthyroid Patients

Makoto SAITOH, Hiroyuki MIYAKODA, Hideyuki KITAMURA, Hiroshi KOTAKE, H ...

1992 Volume 31 Issue 10 Pages 1175-1178
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1175

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We measured the cardiovascular and sympathetic nervous responses to mental stress in subjects with hyperthyroidism. Ten hyperthyroid subjects and 10 age- and sex-matched normal subjects performed mental arithmetic. At rest, the heart rate was higher in hyperthyroid subjects than in normal subjects, but systolic blood pressure, plasma norepinephrine, and epinephrine concentrations did not differ between the two groups. Systolic blood pressure and heart rate during stress, and the changes in blood pressure and in plasma epinephrine concentration from rest to stress, were higher in hyperthyroid subjects than in normal subjects. Therefore, cardiovascular and adrenal responses to mental stress were abnormally high in subjects with hyperthyroidism.
(Internal Medicine 31 : 1175-1178, 1992)

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Response to Oral Corticosteroid in Patients with Chronic Obstructive Pulmonary Disease

Hiroshi KOYAMA, Koichi NISHIMURA, Tadashi MIO, Takateru IZUMI

1992 Volume 31 Issue 10 Pages 1179-1184
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1179

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We studied the effect of 30mg of prednisolone on 29 Japanese patients with chronic obstructive pulmonary disease (COPD). The mean value of the baseline forced expiratory volume in one second (FEV₁ ; mean±SEM) was 1.14±0.12l (46.9±3.9% pred) and the FEV₁ following the steroid trial was 1.30±0.12l (53.7±4.3% pred). Post-trial FEV₁-baseline FEV₁/predicted FEV₁ was 6.8±1.9%. Five patients (17%) had more than a 15% increase in FEV₁ as a percentage of predicted FEV₁. Post-trial FEV₁/baseline FEV₁ was 117.3±4.3%, and 12 patients (41%) had more than a 20% increase in FEV₁ after the trial. Acute bronchodilator response to β-agonist correlated positively with the response to corticosteroid. Baseline spirometries, blood eosinophil counts, serum IgE levels, sputum eosinophil counts, family history of asthma, and history of paroxysmal dyspnea did not vary across responders and non-responders. Patients with severe COPD should be treated to achieve the best possible pulmonary functions indicated by a steroid trial within the limit of acceptable levels of adverse effects.
(Internal Medicine 31 : 1179-1184, 1992)

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Malignant Lymphoma in the Mesentery with Immune Thrombocytopenia

Yuji MORIWAKI, Michiko NAKA, Tetsuya YAMAMOTO, Shotaro TAKAGI, Toshihi ...

1992 Volume 31 Issue 10 Pages 1185-1189
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1185

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A 69-year-old man was referred to our hospital for further evaluation of an abdominal mass. After admission, he was suspected of having a malignant mesenteric tumor. Laboratory data disclosed thrombocytopenia with increased levels of platelet-associated immunoglobulin G. On surgery, the tumor involved the ileal mesentery, invading the urinary bladder and mucosal surface of the terminal ileum. The diagnosis of mesenteric lymphoma with immune thrombocytopenia was made. Complete remission was obtained after surgery and the subsequent three courses of combination chemotherapy. However, thrombocytopenia still persisted. This rare presentation is discussed with a review of the available literature.
(Internal Medicine 31 : 1185-1189, 1992)

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Chronic Active Epstein-Barr Virus Infection in an Adult

Takemi SAKAMOTO, Masahito UEMURA, Hiroshi FUKUI, Masahide YOSHIKAWA, K ...

1992 Volume 31 Issue 10 Pages 1190-1196
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1190

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We report a rare adult case of chronic active Epstein-Barr virus (EBV) infection. A 54-year-old woman was admitted to our hospital with intermittent fever, weight loss, hepatosplenomegaly, pancytopenia and liver disturbance. In serological tests for EBV, anti-virus capsid antigen (VCA)-IgG antibody and anti-early antigen (EA)-IgG antibody were markedly elevated and anti-EBV nuclear antigen (EBNA) antibody was negative. EBV genome was detected in the bone marrow nucleated cells and peripheral lymphocytes by Southern blot hybridization. The patient developed left facial edema, bilateral breast tumor and pneumonia. She died one year after admission in spite of the administration of prednisolone, interferon and acyclovir.
(Internal Medicine 31 : 1190-1196, 1992)

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Inherited Heterozygous Protein C Deficiency and Dysfunctional Protein S with Recurrent Venous Thrombotic Diseases : A Study of Three Generations of a Japanese Family

Toshikazu HASHIZUME, Nobuko TSUSHIMA, Hiroshi MATSUO, Akira ITO, Keiza ...

1992 Volume 31 Issue 10 Pages 1197-1200
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1197

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We describe a rare occurence of a family affected with venous thrombosis, exhibiting a protein C (PC) deficiency and dysfunctional protein S (PS). The propositus and his father developed recurrent venous thrombosis. Their PC deficiency was characterized by low levels of both antigen and activity, and their dysfunctional PS was suggested by low PS activities despite the presence of normal free PS antigen. Over three generations, six family members had a PC deficiency, and three had both a PC deficiency and a dysfunctional PS. The mode of inheritance of PC deficiency appears to be autosomal dominant.
(Internal Medicine 31 : 1197-1200, 1992)

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Isolated IgA Deficiency Accompanied by Autoimmune Thyroid Disease

Toshiki MANO, Akitoshi KAWAKUBO, Masahiro YAMAMOTO

1992 Volume 31 Issue 10 Pages 1201-1203
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1201

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Selective immunoglobulin (Ig) A deficiency is reported to occur in 1 in 16, 000 in Japan and has been reported to be complicated with various autoimmune diseases. A 49-year-old woman was diagnosed as having autoimmune thyroid disease. Her serum IgA, IgM and IgG were revealed to be 4.1, 154 and 1930 mg/dl, respectively. Severe skin eruption which occurred with 30mg/day of methimazole (MMI) or 300mg/day of propylthiouracil (PTU), was relieved by reducing MMI to 15mg/day and administering anti-allergic drugs. Although the influence of IgA deficiency on autoimmunity and allergy still remains unclear, this is a report of IgA deficiency associated with autoimmune thyroid disease.
(Internal Medicine 31 : 1201-1203, 1992)

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Hypersensitivity Pneumonitis Induced by Shiitake Mushroom Spores

Shigeru MATSUI, Tsugio NAKAZAWA, Yoshio UMEGAE, Masatomo MORI

1992 Volume 31 Issue 10 Pages 1204-1206
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1204

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Hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores was demonstrated in a 38-year-old woman. Symptoms of cough, nausea and malaise, and clinical findings of cyanosis, bibasilar crackles, reduced lung volumes, hypoxemia, leukocytosis, elevated ESR, positive C-reactive protein, and bilateral diffuse reticulonodular shadows on chest roentgenogram improved after the patient was removed from exposure. Alveolitis was demonstrated by transbronchial lung biopsy, as well as an increase in lymphocytes in bronchoalveolar lavage. Serum precipitins and specific IgG antibodies to an extract of Shiitake mushroom spores, but not to other common molds or mushroom body, were detected in serum. Provocative inhalation test with the extract of mushroom spores caused the same clinical symptoms and signs as experienced in the workroom. This is the first report of typical hypersensitivity pneumonitis induced by Shiitake mushroom spores. Mushroom spores as well as thermophilic actinomycetes must be considered a causative agents for mushroom worker's lung.
(Internal Medicine 31 : 1204-1206, 1992)

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Increased Interleukin-6 Activity in Cardiac Myxoma with Mediastinal Lymphadenopathy

Shigetaka KUROKI, Keiko NAITOH, Osamu KATOH, Hozumi YAMADA, Tsuyoshi I ...

1992 Volume 31 Issue 10 Pages 1207-1209
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1207

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We report a case of cardiac myxoma with mediastinal lymphadenopathy which seems to be a very rare feature. Laboratory examination revealed high level of interleukin-6 (IL-6) activity in serum. Interestingly, after removal of cardiac myxoma, mediastinal lymphadenopathy disappeared on the chest CT and the level of serum IL-6 was decreased. These findings suggest that IL-6 which was probably derived from myxoma, may have played an important role in the development of lymphadenopathy.
(Internal Medicine 31 : 1207-1209, 1992)

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Brain Tumor in a Pedigree of Cancer Family Syndrome

Mitsuro CHIBA, Osamu MASAMUNE, Makoto MIZUNO, Shigeyoshi NAKAJIMA

1992 Volume 31 Issue 10 Pages 1210-1212
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1210

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Brain tumors have not been previously described as a cancer found in cancer family syndrome (Lynch Syndrome II). Astrocytoma found in the 24-year-old son of a proband of cancer family syndrome with an unusual aggregation of transitional cell cancer is reported. The possibility of brain tumors as a rare spectrum of neoplasms in cancer family syndrome is discussed.
(Internal Medicine 31 : 1210-1212, 1992)

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Hashimoto's Thyroiditis in HTLV-I Carriers

Hisaomi KAWAI, Miho SAITO, Miho TAKAGI, Takayuki TSUCHIHASHI, Yoshihar ...

1992 Volume 31 Issue 10 Pages 1213-1216
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1213

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We describe two HTLV-I virus carriers who have biopsy-proven Hashimoto's thyroiditis. The first patient, a 64-year-old female, has had goiter and hypothyroidism since the age of 56. The second patient, a 66-year-old male, developed hyperthyroidism and goiter at the age of 44, but at present he is hypothyroid. Both patients are positive for anti-thyroid antibodies and anti-HTLV-I virus antibody. Findings of the thyroid biopsy specimens were consistent with Hashimoto's thyroiditis. These data suggest that Hashimoto's thyroiditis develops in HTLV-I carriers who have no clinical evidence of HAM/TSP.
(Internal Medicine 21 : 1213-1216, 1992)

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Renal Artery Aneurysm : The Significance of Abdominal Bruit and Use of Color Doppler

Mitsunori OKAMOTO, Masaki HASHIMOTO, Takashi SUEDA, Makoto MUNEMORI, T ...

1992 Volume 31 Issue 10 Pages 1217-1219
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1217

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A case of renal artery aneurysm is presented. The patient had no hypertension and no signs of arteriosclerosis obliterans or aortitis syndrome, except for abdominal bruit. A saccular aneurysm, 1cm in diameter, was demonstrated by two-dimensional and color Doppler ultrasound and documented by angiography. The aneurysm was embolized by a steel coil. The abdominal bruit, though uncommon, is a very important bed-side sign of renal artery aneurysm, if the patient exhibits no arteriosclerosis obliterans or aortitis syndrome. Ultrasound Doppler is very useful in screening for aneurysm.
(Internal Medicine 31 : 1217-1219, 1992)

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Fatal Abdominal Thorotrast Granuloma

Hidehiro ISHII, Akira TANAKA, Yoshifumi NAKAYAMA, Yuichi KURODA, Hiros ...

1992 Volume 31 Issue 10 Pages 1220-1223
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1220

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We report a case of fatal abdominal thorotrast granuloma seen in a 65-year-old man who had undergone a femoral angiography of thorotrast with some accidental extravasation 49 years previously. As the thorotrast granuloma gradually increased in size, it caused ureteral obstruction, venous thrombosis, and perforation of the urinary bladder and rectum. Symptomatic abdominal thorotrast granuloma is quite rare and this is the first reported case of the granuloma associated with perforation through the urinary bladder and rectum.
(Internal Medicine 31 : 1220-1223, 1992)

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Essential Thrombocythemia Developing into Refractory Anemia and Complicated by Acute Myeloid Leukemia

Shuji YONEKURA, Tadami NAGAO, Shigeru ARIMORI

1992 Volume 31 Issue 10 Pages 1224-1227
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1224

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We report a case of essential thrombocythemia (ET) that climaxed in acute myeloid leukemia after developing into refractory anemia. The male patient had ET that was stable for 8 years on carboquone therapy. However, at the age of 72 years he developed an acute terminal illness that was characterized by severe pancytopenia, circulating myeloblasts, extensive bone marrow infiltration by myeloblasts, and an abnormal karyotype [46, XY, t(8q- ; 20q+)]. He subsequently died of severe bilateral pneumonia and heart failure. This case suggests that ET maybe similar to polycythemia vera ; progression to leukemia is unusual except after chemotherapy. Therefore, treatment of patients with asymptomatic ET may not be advisable.
(Internal Medicine 31 : 1224-1227, 1992)

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Pericholangitis with Ulcerative Colitis Following Autoimmune Hepatitis over 12 Years

Seiko CHUJO, Choitsu SAKAMOTO, Shigekazu OHNO, Shinsuke MORIMOTO, Masa ...

1992 Volume 31 Issue 10 Pages 1228-1232
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1228

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A 35-year-old woman was diagnosed as autoimmune hepatitis 12 years ago by abnormal findings of liver tests including lupus erythematosus (LE) cell phenomenon and liver biopsy. She was admitted in May 1990 with a history of lower gastrointestinal bleeding. Colonoscopy with biopsy and barium enema revealed chronic ulcerative colitis along the entir colon. Since liver tests did not respond well to prednisolone treatment, liver biopsy was again performed and it revealed periductal inflammation with small duct proliferation, a finding compatible with pericholangitis. We herein report this patient who was initially diagnosed as autoimmune hepatitis and thereafter found to be pericholangitis associated with ulcerative colitis.
(Internal Medicine 31: 1228-1232, 1992)

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Rhabdomyolysis Accompanying Thyroid Crisis : An Autopsy Case Report

Hiroyuki HOSOJIMA, Ryouji IWASAKI, Eiji MIYAUCHI, Hiroshi OKADA, Shinp ...

1992 Volume 31 Issue 10 Pages 1233-1235
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1233

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Rhabdomyolysis is occasionally associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. We describe rhabdomyolysis accompanying thyroid crisis. A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. Postmortem examination revealed rhabdomyolysis in the cardiac and psoas muscles, old myocardial infarction, hepatic centrilobular necrosis, renal cortical necrosis, and follicular hyperplasia in the thyroid. Circulatory collapse and dehydration under excessive hypermetabolic state presumably suppressed the source of energy and oxygen for muscle cells, leading to cellular damage.
(Internal Medicine 31 : 1233-1235, 1992)

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Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman

Masanobu KAWAGUCHI, Seiji IWATA, Yoshinobu KAMIYA, Fuminori HAYAKAWA, ...

1992 Volume 31 Issue 10 Pages 1236-1238
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1236

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A 73-year-old woman was admitted to the hospital for severe persistent vomiting with fever, drowsiness, and weight loss. Elevated serum levels of thyroid hormones and the presence of a consciousness disorder with fever and vomiting led to the diagnosis of thyroid storm. A low normal concentration of serum cortisol, urinary 17-hydroxycorticosteroids and an elevated plasma level of corticotropin suggest that an inadequate adrenal reserve have been involved in the pathogenesis of the thyroid storm in this patient. She responded to the administration of intravenous methimazole and oral supersaturated potassium iodide solution.
(Internal Medicine 31 : 1236-1238, 1992)

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Paraganglioma Associated with Hypoglycemia

Kazuyuki FUJINO, Shinro YAMAMOTO, Mitsuhito MATSUMOTO, Mitsutoshi SUNA ...

1992 Volume 31 Issue 10 Pages 1239-1241
Published: 1992
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.31.1239

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A 63-year-old female had frequent attacks of palpitations with sweating and occasional loss of consciousness for 7 years before admission. These symptoms and documented hypoglycemia (blood glucose : 46mg/dl) suggested insulinoma, but computed tomography demonstrated a retroperitoneal tumor which was diagnosed as a paraganglioma by histological examination of the resected specimen.
(Internal Medicine 31 : 1239-1241, 1992)

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