Internal Medicine

Glomerular Lesions in Patients with Non-Insulin-Dependent Diabetes Mellitus and Microalbuminuria

Masao KANAUCHI, Kyoko ISHIHARA, Hisayuki NISHIOKA, Kimiaki NISHIURA, K ...

1993 Volume 32 Issue 10 Pages 753-757
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.753

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To evaluate the renal structural changes in non-insulin-dependent diabetes mellitus (NIDDM), we studied the renal histological findings and urinary albumin excretion in 75 patients with NIDDM. They were divided into two groups according to excretion of urinary albumin: 40 cases of normoalbuminuria and 35 cases of microalbuminuria. Renal biopsy specimens were evaluated by light microscopy. Diffuse glomerular lesions were graded on a scale of D0 through DIV (Gellman's criteria). The incidence of microalbuminuria was 19.2% in D0, 53.3% in DI, 61.5% in DII and 100% in DIII. Grade IV lesions were not present in either group. Creatinine clearance differed significantly between the groups with and without microalbuminuria. There was no difference between the groups with normoalbuminuria and microalbuminuria in the incidence of retinopathy and hypertension, or in the urinary excretion of β₂MG and NAG. We conclude that microalbuminuria in NIDDM indicates the early morphological changes of glomerular lesions.
(Internal Medicine 32: 753-757, 1993)

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Simultaneous Ultrasonic Monitoring of Gallbladder Emptying and Gastric Emptying after Liquid Test Meal

Makoto TAKAOKA, Yoshitsugu KUBOTA, Kazuhiro TANI, Hideyuki KIN, Mami O ...

1993 Volume 32 Issue 10 Pages 758-762
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.758

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Gastric emptying and gallbladder emptying were measured simultaneously using simplified ultrasound (US) techniques after a liquid test meal in seven volunteers on two separate days. Sequential changes in cross-sectional areas of the gastric body and antrum and in gallbladder volume were represented as a monoexponential process after the test meal. There was a close correlation between the half emptying time (T1/2) of the stomach at the gastric body measured by US and that by simultaneous scintigraphic technique, but not between US at the antrum and scintigraphy. Gastric emptying measured at the gastric body was more reproducible than that at the gastric antrum. Sequential measurement of cross-sectional areas at the gastric body using ultrasound is simple and reliable for the assessment of gastric emptying after a liquid meal. US technique is promising for the evaluation of the relationship of gallbladder emptying to gastric emptying as a routine practice.
(Internal Medicine 32: 758-762, 1993)

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Effect of Social Factors on Metabolic Improvement in Type II Diabetic Patients

Wari YAMAMOTO, Hideki ORIGASA, Toshio YAGINUMA, Yasunori KANAZAWA

1993 Volume 32 Issue 10 Pages 763-767
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.763

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Psychological and social factors can profoundly influence a patient's success in adhering to a prescribed self-care regimen. A total of 34 inpatients with type II diabetes who attended the diabetes education program at a single clinic were studied as a retrospective cohort, beginning between 6 and 12 months after discharge. At the start of the study, the patients were classified into two groups, those with good control and those with poor control of diabetes, based on the rate of change of the glycosylated hemoglobin (HbAlc) value relative to the value at admission. Data for each patient were collected retrospectively from their medical records. Patients' family function was assessed by the adaptability, partnership, growth, affection, and resolve (APGAR) scoring system. Multiple regression analysis was used to determine the effect of demographic, medical, and social factors on metabolic improvement. The family APGAR score was higher in the good control group than in the group with poor control.
(Internal Medicine 32: 763-767, 1993)

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Selective Killing of Murine Leukemic Cells by Adenosine Triphosphate (ATP): A Study of the Value of Autologous Bone Marrow Transplantation

Yoshihiro HATTA, Shin AIZAWA, Akira HORIKOSHI, Masumi BABA, Takashi HO ...

1993 Volume 32 Issue 10 Pages 768-772
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.768

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To assess the value of adenosine triphosphate (ATP) for ex vivo purging of leukemic cells in autologous bone marrow transplantation, its biological effects on the murine leukemic cell lines (WEHI3B and L1210) and normal murine bone marrow hemopoietic stem cells (CFU-C and CFUS) were studied. After treatment with 4 mM of ATP for 6 h, the number of viable WEHI3B cells decreased to less than 0.1% of that of the control. Furthermore, ³H-thymidine incorporations were also completely inhibited in both WEHI3B cells and L1210 cells. These phenomena were related to the concentration and exposure period of ATP. Treatment of bone marrow mononuclear cells with ATP under the same condition reduced the number of CFU-C, day 9 CFU-S and day 12 CFUS to only 58.5±8.7%, 92.6±8.2% and 83.5±28.5%, respectively, with no change in the number of marrow nucleated cells. Although the effect of ATP is not entirely specific to leukemic cells, these findings provide evidence that ATP is useful for purging residual tumor cells in autologous bone marrow transplantation.
(Internal Medicine 32: 768-772, 1993)

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Esophageal Squamous Cell Papilloma, Suspected of Squamous Cell Carcinoma

Takehiko YUKI, Sunao KAWANO, Tatsuo OGIHARA, Nobuhiro SATO, Shigeru OK ...

1993 Volume 32 Issue 10 Pages 773-776
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.773

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A 46-year-old male without any subjective complaints was diagnosed by radiography as having one polypoid lesion at the distal esophagus. Endoscopy indicated a semipedunculated polyp about 1 cm in size, the specimens of which included atypical cells with a high N/C ratio in the submucosa. Squamous cell carcinoma of the esophagus was suspected. Cytological studies of PAS, CEA and keratin staining to atypical cells were all negative, with Lugol solution staining of the tumor. After polypectomy the lesion was diagnosed as a squamous cell papilloma of the esophagus; and the atypical cells were determined to be immature fibroblasts and/or endothelium.
(Internal Medicine 32: 773-776, 1993)

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Two Cases of Protruding Atherosclerotic Plaque with Mobile Projections in the Aortic Arch

Sunao MOCHIZUKI, Shinichi TAKAYAMA, Terumasa NISHIYAMA, Hiroyasu KAKIZ ...

1993 Volume 32 Issue 10 Pages 777-780
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.777

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We recently studied two patients with cerebral embolism, in whom transesophageal echocardiography revealed protruding atherosclerotic plaques with freely mobile projections in the aortic arch. Ultrasonic imaging showed that the carotid artery was normal, and transthoracic and transesophageal echocardiography did not reveal a cardiac embolic source in either case. In one patient, we observed that an atherosclerotic plaque became ulcerated and developed mobile projections over the course of a year. More consideration should be given to the thoracic aorta as a source of embolism in patients with unexplained stroke.
(Internal Medicine 32: 777-780, 1993)

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Pheochromocytoma Associated with Nocturnal Hypertension

Yuichiro ISHIYAMA, Teruhiko OHGI, Toshihiro KITA, Akira SASAKI, Kazuo ...

1993 Volume 32 Issue 10 Pages 781-783
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.781

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Pheochromocytoma is often associated with paroxysmal hypertension. Wereport a 49-yearold woman with pheochromocytoma whose blood pressure (BP) was elevated regularly only at night. Plasma norepinephrine (NE) and neuropeptide Y (NPY) concentrations increased in parallel with the elevation of BP. After resection of the adrenal tumor, these circadian changes disappeared. Plasma NE and NPY, especially the former, from the tumor were considered to be the cause of this unusual fluctuation in BP.
(Internal Medicine 32: 781-783, 1993)

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Cushing's Disease: Evaluation of Mineralocorticoid-induced Hypertension

Gen YASUDA, Hiroshi SHIONOIRI, Shuichi HAYASHI, Satoshi UMEMURA, Yumik ...

1993 Volume 32 Issue 10 Pages 784-788
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.784

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A patient (32-year-old female) with Cushing's syndrome due to pituitary adenoma and hypertension with hypokalemia is reviewed. Endocrinological studies demonstrated low plasma renin activity, low plasma aldosterone concentration and high plasma deoxycorticosterone concentration. Blood pressure response to exogenous angiotensin II was enhanced. After the withdrawal of cortisol replacement following surgery, her abnormal endocrinological findings, hypertension and serum potassium level returned to normal and her blood pressure response to exogenous angiotensin II was reduced. These results suggest that in this case deoxycorticosterone might have contributed to the development and maintenance of her hypertension accompanied with hypokalemia.
(Internal Medicine 32: 784-788, 1993)

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Malignant Pheochromocytoma with Hepatic Metastasis Diagnosed 20 Years after Resection of the Primary Adrenal Lesion

Shoichi TANAKA, Toshio ITO, Jun TOMODA, Toshihiro HIGASHI, Gotaro YAMA ...

1993 Volume 32 Issue 10 Pages 789-794
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.789

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A 59-year-old woman developed multiple hepatic tumors 20 years after resection of pheochromocytoma of the left adrenal gland. Thin-needle aspiration biopsy of the tumor at segment 2 of the liver under ultrasound control showed histology compatible to pheochromocytoma. Then, on the basis of the diagnosis of hepatic metastasis of malignant pheochromocytoma, transcatheter arterial embolization (TAE) was performed for the purpose of the treatment of hepatic metastasis. After TAE, the size of the hepatic metastatic lesions was decreased. The present case suggests the necessity of long-term follow-up in pheochromocytomacases.
(Internal Medicine 32: 789-794, 1993)

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Spontaneous Submucosal Dissection of the Esophagus

Tatsuya SHIMADA, Keishi KIMURA, Kiichiro HIGASHI, Kazuhiro MAEDA, Shin ...

1993 Volume 32 Issue 10 Pages 795-797
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.795

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A 41-year-old woman was found to have had spontaneous submucosal dissection of the esophagus by esophagoscopy. Food ingestion was postulated to have been an initiating factor in this instance. Conservative therapy was sufficient in this case. Patients who complain of sore throat with retrosternal pain and an obstructed sensation on swallowing or mild hematemesis should be examined by esophagoscopy for evidence of this disorder.
(Internal Medicine 32: 795-797, 1993)

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High-Output Heart Failure in Mitochondrial Myopathy: A Fulminant Form with Severe Lactic Acidosis and Rhabdomyolysis

Yasuo HIROSE, Tsutomu MIIDA, Kazukiyo YOSHIDA, Hideki KIMURA, Hirotaka ...

1993 Volume 32 Issue 10 Pages 798-801
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.798

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A 17-year-old male with mitochondrial myopathy was transferred to our hospital because of respiratory distress and a rapidly deteriorating level of consciousness. He had a markedly increased cardiac output with low systemic vascular resistance and decreased arteriovenous oxygen difference. Severe lactic acidosis, rhabdomyolysis and acute renal failure were also present. He was treated in the intensive care unit with continuous hemofiltration and hemodialysis. This case demonstrates that cardiac failure in mitochondrial encephalomyopathy may be caused by myocardial abnormalities as well as by reduced systemic vascular resistance secondary to disturbed oxidative metabolism.
(Internal Medicine 32: 798-801, 1993)

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Primary Biliary Cirrhosis Associated with Multiple Myeloma

Haruo KANEKO, Takao ENDO, Hirokazu SAITOH, Yasumi KATSUTA, Takumi ARAM ...

1993 Volume 32 Issue 10 Pages 802-805
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.802

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An association between autoimmune disease and malignancy, in particular lymphoproliferative neoplasms, has been reported, as has an increased incidence of extrahepatic malignancy in primary biliary cirrhosis (PBC). Monoclonal immunoglobulin elevations in PBC are rare, and there have been only three cases in the literature of PBC associated with multiple myeloma. We describe a patient who was concurrently diagnosed as having PBC and multiple myeloma, and emphasize the need to consider myeloma when evaluating monoclonal gammopathy in PBC. We also discuss the possible mechanisms for the association of the two conditions.
(Internal Medicine 32: 802-805, 1993)

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Immune Complex Glomerulonephritis in a Pregnant Woman with Congenital C9 Deficiency

Kazue HIRONAKA, Hirofumi MAKINO, Tetsuki AMANO, Zensuke OTA

1993 Volume 32 Issue 10 Pages 806-809
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.806

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A 27-year-old womandeveloped proteinuria, hypertension, and peripheral edema during the ninth monthof her first pregnancy. The clinical and serological features were compatible with a diagnosis of toxemia of pregnancy, except for the presence of hypocomplementemia. The patient had glomerulonephritis characterized by large electron-dense deposits, predominantly in the mesangium. Immunofluorescence studies revealed striking accumulations of Clq and C3, and the presence of small amounts of IgG and IgM in the mesangium. Serum and plasma levels of complement components were normal, except for the C9 component. Family studies demonstrated that the C9 deficiency was inherited.
(Internal Medicine 32: 806-809, 1993)

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Superficial and Protruding Type of Esophageal Adenocarcinoma Mucocellulare and Muconodulare Confined Mostly to the Lamina Propria Mucosa and Partly in the Submucosal Layer

Megumi HONDA, Shohei KOYAMA, Takehiko SUGITANI, Hisayuki FUKUTOMI, Tos ...

1993 Volume 32 Issue 10 Pages 810-814
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.810

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We report a case with an adenocarcinoma mucocellulare and muconodulare of the esophagus which is limited to the lamina propria mucosa and the submucosal layer. The patient, a 74-year old man had the chief complaints of hematemesis and melena. A superficial and protruding (0-1) type of lesion was found at the lower thoracic portion of the esophagus by X-ray and endoscopic examination. The surgically resected esophageal specimen showed 0-1 and predominantly subepithelial (Sep) type. The tumor is presumed to have arisen from the cardiac glands in the lamina propria mucosa of the lowermost region of the esophagus.
(Internal Medicine 32: 810-814, 1993)

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Sudden Cardiac Death from Hypertrophic Cardiomyopathy and Acute Idiopathic (Fiedler's) Myocarditis: Autopsy Report

Yoshifumi TAKATA, Kunihiko TERAOKA, Masahiro ABE, Takashi OGAWA, Hiros ...

1993 Volume 32 Issue 10 Pages 815-819
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.815

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A 45-year-old man with a rapidly deteriorating heart condition died suddenly, two hours after admission, after resistance to attempts of cardiac pacing. At autopsy, the heart weighed 600g with asymmetric septal hypertrophy. Histological examination revealed an extensive and diffuse disarray of myocardial fibers in the ventricular septum and in the free wall of both ventricles. Pronounced mononuclear cell infiltrations and interstitial edema were distributed widely in both ventricles. There were few abnormal findings in the other organs. The diagnosis was hypertrophic cardiomyopathy accompanied by Fiedler's myocarditis. Such a case appears to be rare.
(Internal Medicine 32: 815-819, 1993)

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Abscessing Bronchioloectasia with Elements of Plasma Cell Granuloma

Akitaka NONOMURA, Yuji MIZUKAMI, Shinya MURAKAMI, Junzo SHIMIZU, Yoh W ...

1993 Volume 32 Issue 10 Pages 820-823
Published: 1993
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.32.820

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A 79-year-old male was admitted to the hospital with the complaint of bloody sputum. Chest X-ray revealed an abnormal shadow in the right upper lobe. Macroscopically, the lesion measured about 3.5×2.5×2.0 cm with a central cavity containing pus. Histologically, the lesion was composed of interlacing fibroblastic proliferation with abundant plasma cell infiltration and central cavitation. The inner surface of the cavity wall was partially covered by bronchial epithelial cells; there was no cartilage found, suggesting that the lesion had developed from chronic inflammatory processes in relation to ectatic bronchioles. Since the pathogenesis of plasma cell granuloma (PCG) has not been well established, it is probable that this case represents one stage in the development of classic PCG.
(Internal Medicine 32: 820-823, 1993)

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