Complement evaluation was performed in two patients with active eosinophilic pneumonia and in one in remission, to determine the role of complement activation in the pathogenesis of this disorder. All three had cough, dyspnea, malaise, and blood eosinophilia ; two patients also h d pyrexia. In all 3 cases the pulmonary eosinophilic infiltrates (radiographic findings) and symptoms responded rapidly to steroid administration. The two patients with active eosinophilic pneumonia showed elevated CR3 but reduced FcrR on the PMN before and during steroid administration. In contrast PMN from four patients with bronchial asthma exhibited slightly elevated expression of both CR3 and FcrR during their asthma attack. It is suggested that clinical symptoms disappear soon after the beginning of steroid but changes of complement receptors on PMN may last for longer periods. On the basis of the combined results, this study indicates that estimation of complement activation may provide a useful indicator for disease activity in patients with eosinophilic pneumonia of unknown etiology.
(Internal Medicine 31 : 717−724, 1992)

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The effects of the metabolic changes of type 2 diabetic patients on ventricular function, especially diastolic ventricular function were investigated. An examination was performed before and after treatment of 18 diabetic patients divided into 3 groups : insulin therapy, oral hypoglycemic drugs and diet therapy (6 patients each). The results indicated that both systolic and diastolic ventricular dysfunctions observed were improved by the correction of hyperglycemia. Therefore it is necessary to treat diabetes mellitus as early as possible for the prevention of both cardiac dysfunction and microangiopathy.
(Internal Medicine 31 : 725-730, 1992)

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In order to determine the clinical efficacy of coronary angioplasty, the outcome was analyzed in 557 patients who underwent initial angioplasty prior to the end of 1987. Primary success (reduction of stenosis ≥20% and residual stenosis <50%) was achieved in 492 (88.3%) of the patients. Follow-up angiography showed patency (stenosis ≤50%) in 295 or 60.0% of the 471 patients and ultimate lesion patency was achieved by repeating angioplasty up to 4 times in 425 (91.4%) of 465 patients followed angiographically. At the 3-year angiography performed in 209 patients with patent lesions, only 2 patients exhibited progression of their disease at dilated sites, while 48 had new lesions. Taking into consideration the 55 patients with unsuccessful primary angioplasty, 10 patients with major complications and 9 patients with mild restenosis, 434 out of 530, or 81.9% of the patients appear to have benefited from angioplasty.
(Internal Medicine 31 : 731-734, 1992)

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Thromboxane A₂ (TXA₂) biosynthesis was studied in healthy subjects, patients with chronic cerebral infarction, patients under chronic aspirin treatment and patients with atrial fibrillation. Urinary 11-dehydro-TXB₂, as a major metabolite of TXA₂, was measured by radio-immunoassay. The extent of carotid atherosclerosis was determined by B-mode ultrasonography. The mean ± SD urinary excretion in patients with cerebral infarction and distinct carotidatherosclerotic lesions (1, 725 ± 239ng/g creatinine, n = 6) was significantly higher (p < 0.01) than in healthy subjects (911 ± 239 ng/g creatinine, n = 44) and patients with cerebral infarction who had no distinct carotid lesion (1, 050 ± 191 ng/g creatinine, n = 6). The urinary excretion of healthy subjects was higher (p < 0.01) in smokers (1, 063 ± 244 ng/g creatinine, n = 17) than in non-smokers (815 ± 183 ng/g creatinine, n = 27). Aspirin largely suppressed 11-dehydro-TXB₂ excretion (266 ± 114 ng/g creatinine, n = 7). Three of 5 patients with atrial fibrillation showed very high values. Our results indicated that platelet activation occurs in the atherosclerotic lesions, and that urinary 11-dehydro-TXB₂ is the appropriate analytic target for detecting platelet activation.
(Internal Medicine 31 : 735-739, 1992)

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A total of 21 patients developed active tuberculosis (TB) during hospitalization. Active TB was identified by bacteria-positive, biopsy or autopsy. Infection was confirmed to the lung, pleura, lymph node and miliary lesions and 7 patients had open tuberculosis. In half of the patients, chest X-ray films demonstrated unusual findings in adult tuberculosis : lower lung field pneumonia and miliary pattern. All the patients suffered from severe underlying diseases and an intensive therapy with steroid, immunosuppressive agents, antitumor drugs, radiation and operation was found as predisposing factors for TB occurrence. Nine patients recovered from current infection with anti-tuberculosis drugs ; 14 patients died and TB directly caused death in 8 patients. These data strongly suggest that TB is one of the most important infections in compromised hosts. We emphasize that this infection presents a serious clinical problem in a general hospital today.
(Internal Medicine 31 : 740-745, 1992)

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We studied the effects of glycated lipoproteins of low-and high-density (LDL and HDL) on platelets and vascular endothelial cells. After pretreatment for 5 minutes at 37°C, the thrombininduced synthesis of thromboxane B₂ in washed platelets was significantly increased by glycated LDL as compared with native LDL (198.9 ± 16.2 vs 90.3 ± 29.4ng/10⁹ platelets, n = 8, p < 0.01). Platelet aggregation was also increased by glycated LDL as compared with native LDL. After treatment with platelet-rich plasma for 5 hours at 37°C, these values were suppressed by native HDL vs the control (buffer), but not by glycated HDL. Abnormalities in the release of 6-keto prostaglandin F₁α and lactate dehydrogenase from vascular endothelial cells were also induced by glycated LDL and/or HDL. These observations suggest that abnormalities induced in platelets and vascular endothelial cells by glycated lipoproteins may play an important role in the development of atherosclerosis in patients with diabetes mellitus.
(Internal Medicine 31 : 746-751, 1992)

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Adenosine deaminase (ADA) activity and tuberculostearic acid (TSA) levels in pleural effusions were measured in 18 patients with active tuberculous pleuritis, 16 patients suspected of having tuberculous pleuritis, 14 patients with carcinomatous pleuritis, and 19 patients uffering from pleuritis of non-malignant and non-tuberculous etiology. In the patients with ctive tuberculous pleuritis, ADA was elevated in 56% and TSA was positive in 78%. In 83% f these patients, either ADA was elevated or TSA was positive. ADA was elevated together ith a positive TSA in 50%. In contrast, TSA was positive in only 6%and ADA was elevated n 24%of the patients with non-tuberculous pleuritis, and none of these patients showed the ombination of an elevation of ADA and a positive TSA. These results suggest that simultaneous easurements of both ADA and TSA in pleural effusions are useful for the diagnosis of uberculous pleuritis.
(Internal Medicine 31 : 752-755, 1992)

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Seven patients (mean age, 50.7 ± 20.4 years ; range 21-77) with plasma cell granuloma (PCG) of the lung are reported. Cough and sputum were the most common presenting symptoms, followed by fever. Elevated erythrocyte sedimentation rate and serum C-reactive protein levels were found in all patients tested. Radiologically, five cases presented as solitary, well-circumscribed masses and two as ill-defined, pneumonia-like densities. One showed focal calcification. No predilection of occurrence was observed in either lobe of the lung. Histologically, the lesions consisted of a proliferation of mature plasma cells and reticulo-endothelial cells supported by a stroma of granulation tissue, with varying degrees of myxoid change or collagenization. Angioinvasion within the lesion was observed in 4 of the 7 cases. Immunohistochemical staining revealed the IgG-predominant polyclonal nature of the plasma cells, indicating a reactive inflammatory process rather than a neoplastic one. Electron microscopy confirmed the benign nature of the plasma cells with fibroblast and myofibroblast proliferation admixed with that of other inflammatory cells.
(Internal Medicine 31 : 756-765, 1992)

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Delayed cutaneous reactivity to Candida albicans (C. albicans) and PPD (purified protein derivative) was examined in 52 patients with bronchial asthma in relation to the production of specific IgG₄ antibodies against the antigen. 1. The frequency of a positive, immediate skin reaction to C. albicans was similar among the five age groups, ranging from 60.0% to 66.7%. 2. The incidence of a positive delayed skin reaction to C. albicans was lower in patients between the ages of 10 and 30 and tended to decrease with aging in the patients over the age of 51.3. A delayed skin reaction to PPD was positive in patients between 31 and 50 with a higher incidence ; this incidence decreased in patients over age 51.4. The level of C. albicans-specific IgG₄ antibodies was significantly higher (26.7u/ml) in patients with a negative delayed skin reaction to the antigen than in those with a positive reaction (5.9u/ml) (p<0.001). There was no correlation between delayed skin reaction to PPD and production of specific IgG₄ antibodies.
(Internal Medicine 31 : 766-769, 1992)

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Skin manifestations associated with malignant diseases are designated syndroma dermatotumorale. A case of lung cancer combined with atypical erythema is reported. A 70-year-old man was admitted to hospital because of a 4-month history of atypical erythema of unknown origin. A nodule in the right lung was revealed on chest roentgenogram which was diagnosed as lung cancer. After right upper lobectomy, the erythema regressed gradually and disappeared completely in 7 days. It is suggested that the erythema was a manifestation associated with the lung cancer.
(Internal Medicine 31: 770-773, 1992)

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A 25-year-old man with a history of Kawasaki disease from the age of 7 had acute inferior myocardial infarction. Emergency right coronary arteriogram showed successive coronary aneurysms at the proximal to middle portion of the right coronary artery, and total occlusion at the proximal segment. Intracoronary thrombolysis was performed and the right coronary artery was recanalized. On left coronary arteriography, coronary aneurysms and mild localized stenoses at the inlet and outlet of the aneurysms were found. It was suggested that the myocardial infarction was caused by thrombotic occlusion of coronary aneurysms complicated with Kawasaki disease.
(Internal Medicine 31 : 774-777, 1992)

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A 32-year-old female was diagnosed as having systemic lupus erythematosus based on her laboratory tests. In 1985 she began to complain of hearing difficulty. Her hearing ability deteriorated to the extent that her audiogram revealed a hearing loss of 90db to 110db in both ears in September 1989. She received two series of plasmapheresis treatments using the double filtration method. After two series of plasmapheresis treatments, her hearing improved dramatically. This improvement suggests that circulating immune complexes and anti-phospholipid antibodies might play a pathological role in the hearing impairment in SLE patient.
(Internal Medicine 31 : 778-781, 1992)

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Plain abdominal X-rays of a 13-year-old girl with chief complaints of back pain revealed calcification in the upper left abdomen. A calcified tumor was confirmed at the dorsal side of the pancreatic tail upon admission. A completely formed colic membrane free of all other germ layers was discovered within the tumor, leading to a diagnosis of heterotopic colonic membrane. To our knowledge, there have been no other cases of heterotopic intestinal tissue of this type, so we consider this an extremely rare case worth reporting.
(Internal Medicine 31 : 782-785, 1992)

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A 57-year-old woman with hepatopulmonary syndrome was treated for eight years. Severe hypoxemia continued and her erythrocytosis was slowly progressive. Two episodes of intracranial hemorrhagic attack had occurred during the follow-up period and the patient died due to multiple organ failure after the second intracranial hemorrhage. Her autopsy findings confirmed not only established liver cirrhosis associated with intracranial hemorrhage but also the marked dilatation of pulmonary capillaries in both lungs. These findings suggest that secondary erythrocytosis in hepatopulmonary syndrome can be contributed to fatal intracranial vascular accidents. The containment of erythrocytosis should be considered in these patients.
(Internal Medicine 31 : 786-790, 1992)

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A case of hepatocellular carcinoma producing carcinoembryonic antigen and carbohydrate antigen 19-9 is reported. The serum level of carcinoembryonic antigen was 26, 800ng/ml and carbohydrate antigen 19-9, 5, 500U/ml on the final day. Immunohistochemical study revealed positive monoclonal antibodies for these two antigens within the cytoplasm of the hepatocellular carcinoma cells.
(Internal Medicine 31 : 791-793, 1992)

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An SLE patient developed aseptic necrosis of the right scaphoid bone 4 years after an episode of aseptic necrosis of bilateral femoral heads caused by corticosteroid treatment. Since the aseptic necrosis of the right scaphoid bone was preceded by the insidious exacerbation of SLE as evidenced by facial erythema, it was considered to be a result of vasculopathy due to active SLE. It took 14 months to make a correct diagnosis of the aseptic necrosis of the scaphoid bone by a chanced roentgenogram for the routine evaluation for osteoporosis. Therefore, the importance of an awareness of this possibility and repeated radiographic examinations is emphasized for the correct diagnosis of joint manifestations in SLE.
(Internal Medicine 31 : 794-797, 1992)

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A 40-year-old woman was admitted with complaints of headache, palpitation and diaphoresis. She had undergone right hemithyroidectomy 12 years previously. Histological reexamination of the operative specimen revealed a medullary thyroid carcinoma. Abdominal ultrasonography, CT scan and angiography showed bilateral adrenal tumors. Serum catecholamine levels in both adrenal veins were high. Based on these data, bilateral adrenalectomy was performed. Histological examination confirmed the diagnosis of pheochromocytomas. After operation, serum calcitonin and urinary noradrenaline levels were still high. Further examination by ¹³¹I-metaiodobenzylguanidine (MIBG) scintigraphy is planned.
(Internal Medicine 31 : 798-802, 1992)

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The occurrence of adrenal myelolipomas is reported in an untreated patient with congenital adrenal 21-hydroxylase deficiency. Laparotomy demonstrated the presence of two lesions, a large tumor which arose from an ectopic adrenal cortex and a smaller tumor in the left adrenal gland. Six cases of adrenal myelolipomas and congenital adrenal hyperplasia have been reported in the literature. All patients were associated with excessive ACTH secretion for a long period of time. The relative frequency of this association, coupled with the observation by Selye and Stone (Am J Pathol 26 : 211, 1950) that anterior pituitary extracts cause myelolipomatous changes in rats, may indicate a possible role for ACTH in the development of myelolipomas.
(Internal Medicine 31 : 803-806, 1992)

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Two patients with primary hyperparathyroidism had hyperuricemia due to the decrease in urate clearance. In analysis by 4-component model system, the tubular secretion of urate commonly decreased without changes in either filtered urate or presecretory reabsorption of urate. Both patients had a reduction of urea clearance, and both parathyroidectomy in the former case and intravenous infusion of saline in the latter case could reduce the serum urate level associated with the increase in the ratio of urate clearance to creatinine clearance. It is of interest that the former case with a higher serum urate level had a relatively higher postsecretory reabsorption, even with the decrease in tubular secretion of urate. However, the latter patient with a lower serum urate level had a decrease in postsecretory reabsorption of urate in proportion to the decrease in tubular secretion. These results suggest that in hyperuricemia patients with primary hyperparathyroidism, the reduction of tubular urate secretion via hypoperfusion of the capillary network is typically present, however, the severity of the hyperuricemia might be dependent on the dysfunction of the postsecretory reabsorption of urate.
(Internal Medicine 31 : 807-811, 1992)

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A 26-year-old woman had myocarditis and peritonitis during an acute multisystem attack of Still's disease. To our knowledge, these complications are rare manifestations of adult Still's disease. Treatment with high-dose adrenocorticosteroids was rapidly successful in controlling these manifestations.
(Internal Medicine 31 : 812-815, 1992)

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A 38-year-old man developed prominent hypoproteinemia after acute elevation of serum transaminase levels. Giant hypertrophy of the gastric mucosa, a short serum albumin half-life, and the absence of massive hepatocyte necrosis established the diagnosis of protein-losing gastropathy. The hypoproteinemia, gastric fold hypertrophy and hepatitis remitted spontaneously within 4 months. A high antibody titer against cytomegalovirus suggested an association between the viral infection and the patient's disease.
(Internal Medicine 31 : 816-819, 1992)

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A patient with severe hypomagnesemia due to chronic alcoholism is presented who repeatedly exhibited marked hypocalcemia with a dissociation between radioimmunoassay findings for mid region of parathyroid hormone (PTH-M) and immunoradiometric assay findings of serum intact PTH (PTH-intact). Serum PTH-M was moderately elevated whereas serum PTH-intact was in a low normal range every time when her serum magnesium (Mg) concentration was markedly reduced. There was also a marked reduction in serum osteocalcin concentration. Supplementation of Mg resulted in a sharp increase in serum PTH level with a rapid disappearance of the dissociation between the two immunoassays of PTH. Shortly after serum PTH and 1, 25 (OH) ₂D levels reached their peak, serum osteocalcin started to increase, and was elevated into a supranormal level with normalization of serum Ca concentration. Mg is thought to act as a mimic/antagonist of calcium (Ca), and high extracellular Ca is shown to cause an inhibition of secretion with a stimulation of degradation of PTH. Thus, these observations are consistent with the hypothesis that Mg deficiency causes an increase in the metabolism of PTH and a reduction in the secretion of bioactive intact PTH by increasing the sensitivity of parathyoid cells to Ca. In addition, the fact that hypocalcemia disappeared concomitant with a marked increase of serum osteocalcin from undetectable levels suggest that refractoriness of bone to calcitropic hormones is present which plays a significant role in the development of hypocalcemia under hypomagnesemia, and that serum osteocalcin can be a good marker for the assessment of the responsiveness of bone to calcitropic hormones in these patients.
(Internal Medicine 31 : 820-824, 1992)

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Thymoma is associated with a wide variety of syndromes. However, an association with peroxidase-negative acute myeloid leukemia and pinealoma, although feasible due to the marked influence of this tumor on the lymphoid system, has not been described previously. A patient with thymic carcinoma and pinealoma who developed peroxidase-negative acute myeloid leukemia as a late event is presented in this report.
(Internal Medicine 31 : 825-827, 1992)

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A case of leukoencephalopathy induced by tegafur, an antineoplastic derivative of 5-FU, is reported. The patient received 600mg of tegafur p. o. for 16 days before excision of rectal cancer. After the operation, gait disturbance and mental abnormalities appeared. He became akinetic and mute within a few days following readministration of tegafur. Serial studies of brain CT, somatosensory evoked potentials (SEP) were made, and myelin basic proteins (MBP) in the cerebrospinal fluid were measured. The level of MBP was about twice the normal value and the central conduction time (CCT) of SEP was prolonged at admission. The value of MBP and CCT improved with recovery from akinetic mutism.
(Internal Medicine 31 : 828-831, 1992)

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A 73-year-old male was admitted with a large rounded atelectasis with pleural effusion. The involved lung was refilled with air as soon as surgical decortication of the thickened visceral pleura covering it was performed. Surgical treatment is believed to be necessary when a large rounded atelectasis with pleural effusion persists for a long time, or when malignancy is not completely excluded.
(Internal Medicine 31 : 832-834 1992)

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A 36-year-old Japanese woman complained of right hypochondralgia followed by ascites. Paracentesis showed a turbid, straw-colored sterile exudate. Computed tomography and magnetic resonance imaging of the abdomen revealed a left periuteric mass and ascites. The mass and ascites spontaneously regressed within a month with no specific treatment. Later, after the patient had been discharged from hospital, immunofluorescence antibody titers for Chlamydia trachomatis were successfully determined using stored ascitic fluid and serum. Though the number of cases of Chlamydia trachomatis peritonitis has increased, few cases with ascites have been reported, and spontaneous regression of the ascites is also rare.
(Internal Medicine 31 : 835-839, 1992)

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