The cerebral functional impairment in dementia of the Alzheimer type (DAT) was a quantitatively assessed using easily repeatable electroencephalographic analysis. Waveform recognition was employed to analyze the EEG (electroencephalogram) changes displayed before and after tasks of mental calculation, reverse recitation and mental association. Marked decrements in the incidence of theta and alpha waves together with decrements of the average amplitude of alpha waves were noted in normal elderly subjects after mental calculation and reverse recitation. In the patients with DAT, mental association tasks evoked pronounced decrements in the average amplitude of theta waves, the average frequency of alpha waves, and both the average frequency and average amplitude of beta waves. These results indicate that analysis of EEG activity responses to mental tasks provides an objective assessment of dementia.
(Internal Medicine 32: 87-93, 1993)

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To investigate the possible influence of genetics in subjects with obstructive sleep apnea syndrome (OSAS), HLA-A, B, C, and DR antigens were studied in 32 Japanese subjects with OSAS. The frequency of HLA-A2antigen was markedly increased in the patients with OSAS compared with normal controls (81.3% vs 40.6%) and compared with the Japanese population (40.7%), Pc<0.035 and Pc<0.007, respectively. HLA-B39 was found more frequently in OSAS patients than in the Japanese population (Pc<0.018), but not in the controls. No significant deviation was observed in the frequencies of HLA-C and DR antigens between the OSAS patients and the controls. We conclude that genetics is important in the development of OSAS.
(Internal Medicine 32: 94-97, 1993)

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Componentsof culture filtrate antigen of Aspergillus (A.) fumigatus were electrophoretically separated, transferred to hydrophobic durapore membrane, and then probed with patients' sera and lectins. Using human sera from patients with aspergilloma and allergic bronchopulmonary aspergillosis (ABPA), more than 13 IgG binding components were identified. IgG binding to high molecular weight components (HMW)of over 30 kDa was observed in all patient sera tested, but IgG binding to low molecular weight components (LMW)of approximately 18kDa was observed in 7 out of 8 patients' sera which showed a positive precipitin reaction by meansof counterimmunoelectrophoresis. Concanavalin A and lens culinaris agglutinin showed strong binding to HMW but no binding to LMW.Further, strong IgE binding to the 18kDa component was observed in serum from a patient with ABPAduring the acute stage, but not during the convalescence stage. It is suggested that the 18 kDa protein from A. fumigatus is the primary antigen in the serological antibody responses observed in patients with aspergilloma or ABPA.
(Internal Medicine 32: 98- 105, 1993)

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Some advocate moving away from the farm environment for farmers affected with farmer's lung disease (FLD), but most affected farmers still live on farms. In this study, we evaluated the practicality of dust masks and their effectiveness in prevention of FLD. The dust masks we chose were practically used and no new severe episodes of FLD developed in 20 of 21 farmers with FLD using the masks during a 2-year period. When the farmers took off the dust masks in a farming environmental provocation test, statistically significant reductions in FVC (mean 3.43 to 3.351, p < 0.01), D_Lco (mean 19.6 to 18.2 ml/torr/min, p < 0.01), and D_L/V_A (mean 5.1 to 4.8 (×10^-3) 1/torr/min, p < 0.01) were observed several hours after exposure. These findings suggest that the dust masks were used practically during routine dairy farming and were effective in protection against FLD.
(Internal Medicine 32: 106-111, 1993)

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Several neurohormonal factors have been proposed as markers of the severity of acute myocardial infarction (MI). To determine whether plasma concentrations of atrial natriuretic factor (ANF) might predict post-MI prognosis, we studied 130 patients with acute MI (97 males and 33 females, mean age 62 years). Within one-half to one day after admission, a blood sample was taken for estimation of circulating ANF. The mean follow-up period was 37 months, and the follow-up rate was 97%. Of the 130 patients, 28 died from cardiac causes during the follow-up period. Patients were classified into three groups according to plasma ANF levels (group 1, <99pg/ml; group 2, 100-199pg/ml; group 3, >200pg/ml). The survival curves were constructed by the Kaplan-Meier method. There were significant differences in the cumulative survival rate among the three groups (group 1 > group 2 > group 3; p < 0.001). The baseline characteristics (age, atrial pressure, and cardiac index) were different among the groups, therefore these variables were analyzed by a Cox multiple regression model. Significant predictors of cardiac mortality were plasma ANF class (p < 0.002) and pulmonary capillary wedge pressure (p < 0.007). In conclusion, these observations demonstrated that stratification of acute MI patients by plasma ANF level is a useful non-invasive method for predicting prognosis and for identifying individuals at high risk of cardiac death.
(Internal Medicine 32: 112-115, 1993)

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A 65-year-old man was hospitalized due to an abdominal tumor. Several imaging studies showed multilocular tumors in the right hepatic lobe and in the pancreatic head, 4 and 7 cm in size, respectively. The hepatic tumor rapidly grew to 9 cm in 4 weeks, associated with a rapid increase in the serum carcinoembryonic antigen level from 125 ng/ml to 1, 000 ng/ml. The pathologic diagnosis of the resected liver tumor was mucinous cholangiocarcinoma. This hepatic tumor produced a large amount of mucin, but did not secrete mucin into the bile ducts. Therefore, there was no obstructive jaundice. The incidentally accompanied pancreatic tumor was a typical serous cystadenoma. The present case suggested that mucinous cholangiocarcinoma could present rapid growth of the tumor. The clinicopathological features of mucinous cholangiocarcinoma are demonstrated for the first time, and the differences between mucinous cholangiocarcinoma and mucin-producing papillary adenocarcinoma of duct-spreading type are discussed.
(Internal Medicine 32: 116-121, 1993)

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A 59-year-old woman showed chronic progressive autonomic failure consisting of orthostatic hypotension and dyshidrosis. No signs of Parkinsonism, cerebellar or peripheral neuropathy were observed. Autonomic nervous function tests and findings of biopsied sural nerve suggested that this case had both sympathetic and parasympathetic dysfunctions, mainly postganglionic. A decrease in the total peripheral resistance and no increase in the heart rate on standing seemed to be the mechanism of orthostatic hypotension in this case. We conclude that pure PAF can be recognized as a distinct clinical syndrome of systematic degeneration of the autonomic nervous system.
(Internal Medicine 32: 122-127, 1993)

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A 74-year-old male patient with diabetes mellitus and hypertension who had been treated for a long period was admitted to our hospital. Laboratory data on admission revealed high values for fasting blood sugar and fructosamine, 219 mg/dl and 389 μmol/l respectively, while the concentration of glycated hemoglobin (HbA_1c) was low (3.0%). High performance liquid chromatography and isoelectric focusing analysis of the patient's Hb disclosed abnormal Hb with the content being 41.3%. The structural analysis indicated that this abnormal Hb was Hb Riyadh [β120 (GH3) Lys→Asn]. The low value of HbA_1c despite the high blood glucose level may be attributed to this abnormal hemoglobin.
(Internal Medicine 32: 128-132, 1993)

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A 35-year-old man with congenital nephrogenic diabetes insipidus (NDI) is reported. Renal biopsy revealed miniaturized and rounded mitochondria of the proximal tubular cells and decreased brush-borders. Trichlormethiazide combined with triamterene resulted in an apparent reduction of daily urine volume and concomitant increment in urine osmolarity. The present case seems rare in that some morphological changes in the renal tissues could be demonstrated in an adult case with congenital NDI.
(Internal Medicine 32: 133-138, 1993)

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We report a case of unusual B-cell malignant lymphoma of the kidney and mediastinum. Renal biopsy showed prominent myxoid changes and sarcomatous features, leading to considerable difficulty in histologic diagnosis on routinely stained histologic sections. However, immunohistochemical staining for lymphocyte markers led to the final histologic diagnosis of B-cell malignant lymphoma. Although myxoid change is not generally found in malignant lymphoma, malignant lymphoma should not be excluded from consideration when one encounters a small round cell sarcoma with myxoid stroma, especially in extranodal soft tissue tumors.
(Internal Medicine 32: 139- 144, 1993)

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A 47-year-old woman who was homozygous for a silent cholinesterase gene (hereditary serum cholinesterase deficiency) presented with nephrotic syndrome and hyperlipidemia. Renal biopsy performed in 1986 demonstrated mesangial proliferative glomerulonephritis. Four years later, a second biopsy revealed progression with mesangial interpositions and severe lipid deposition in the glomeruli, tubules and interstitium. This is the first case of hereditary serum cholinesterase deficiency accompanied by renal disease. Serum cholinesterase deficiency may be related to hyperlipidemia and abnormal lipid deposition in the kidney, which promotes the progression of renal disease.
(Internal Medicine 32: 145- 151 1993)

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A case of common variable immunodeficiency (CVID) who developed non-Hodgkin's lymphoma (NHL) of the rectum is reported. A 22-year-old male student in whom CVID was diagnosed at 7 years of age was referred to our department for the treatment of rectal NHL. The patient had stage IE disease confined to the rectum after clinical diagnostic procedures. He was initially treated with radiation therapy alone, but a relapse soon occurred in the
paraaortic lymph nodes. He was successfully treated with CHOP-Bleo chemotherapy and supplementation with immunoglobulin preparations. He has since remained free of NHL and infectious complications for over 30 months despite his persistent immunodeficiency.
(Internal Medicine 32: 152-155, 1993)

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We report a case of increased aspartate aminotransferase (AST, EC 2.6.1.1; GOT) in a 17-year-old girl which persisted for 3 years. The patient was healthy, but a high level of serum AST was detected during a school health check. Further examination revealed that AST was increased to as high as 259 IU/l while alanineaminotrans ferase (ALT) was normal. Immunoelectro syneresis and immunoprecipitation methods revealed that this atypical AST combined with IgG - kappa, lambda globulin and formed macromolecular complexes. Including the present case, 26 cases of IgG-complexed AST have been reported. It is important to be aware of this syndrome, and thereby avoid unnecessary examinations and therapies.
(Internal Medicine 32: 156-159, 1993)

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We report a case of double male syndrome, a type of Klinefelter's syndrome with 48, XXYY chromosome, associated with acromegaloidism. Although the patient presented acromegalic appearance, he did not show hypersecretion of growth hormone (GH). GH provocation tests revealed a rather low GH responses or no responses. After testosterone therapy, the GH responses were normalized except to Insulin tolerance test (ITT). On the other hand, the plasma corticotropin (ACTH) and cortisol levels were decreased paradoxically after hypoglycemia. Testosterone therapy did not restore this ACTH response. It was speculated that these abnormal GH and ACTH responses to hypoglycemia might indicate another congenital anomaly.
(Internal Medicine 32: 160-165, 1993)

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Myelolipoma of the adrenal gland is a rare, benign, nonfunctioning lesion consisting of fat and bone marrow elements in varying proportions. This tumor is commonly asymptomatic and usually discovered during various diagnostic imaging examinations performed for unrelated diseases. If a primary malignant or metastatic adrenal tumor cannot be excluded, ultrasoundor computed tomography-guided needle biopsy of the tumor is necessary. We report a case of adrenal myelolipoma associated with advanced gastric carcinoma and compare the diagnostic imaging findings with the pathological findings of the adrenal myelolipoma.
(Internal Medicine 32: 166-170, 1993)

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A 54-year-old woman with nephrotic syndrome underwent renal biopsy. By light microscopy, the glomerular capillary lumen was remarkably narrowed because of diffuse accumulation of Periodic acid Shiff (PAS) positive material along the glomerular capillary wall. By electron microscopy, collagenous fibers were observed in the mesangium and subendothelial area. The fibrous material reacted with antibodies against type I and III collagen but not with those against laminin or type IV collagen by an indirect immunofluorescence technique. This case seemed to be a case of collagenofibrotic glomerulonephropathy.
(Internal Medicine 32: 171-176, 1993)

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A case of a 42-year-old woman who had combined sinus and atrioventricular nodal tachycardia is reported. Programmed atrial stimulation study showed the induction of the two types of paroxysmal supraventricular tachycardia. The mechanisms of these supraventricular tachycardias were both sinus nodal and atrioventricular re-entrant tachycardia. Sinus nodal reentrant tachycardia could be induced only after injection of atropine. The tachycardias could no longer be induced after the administration of verapamil.
(Internal Medicine 32: 177-181, 1993)

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A 56-year-old man had been treated with phenobarbital seven weeks prior to admission. One month after initiation of administration of phenobarbital, fever, skin rash and lymphadenopathy occurred. Nine days later, marked atypical lymphocytosis, eosinophilia and hepatic injury was noticed. The histology of the biopsied skin was indistinguishable from lymphoma. CHOP-therapy was started but the patient was followed without further treatment because of polyclonal T-lymphocytosis. Afterward, clinical and hematologic improvement ensued and he has been well until now, 52 months later. The marked T-lymphocytosis observed in this case is probably a lymphoid leukemoid reaction secondary to hypersensitivity to phenobarbital.
(Internal Medicine 32: 182-184, 1993)

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Intramural rupture of the esophagus developed after short-term nasobiliary catheter placement in an 87-year-old female with choledocholithiasis and suppurative cholangitis. Endoscopy revealed bleeding accompanied by circumferential disruption of the mucosa along the lower third of the esophagus. Withdrawal of the catheter and conservative treatment resulted in recovery of the lesion and relief of symptoms. This rare complication should be kept in mind during the placement of nasobiliary catheter.
(Internal Medicine 32: 185-188, 1993)

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We describe a patient with Wegener's granulomatosis in whom the serum levels of interleukin-6 (IL-6) and other laboratory parameters were monitored. The IL-6 and CRP levels, which were extremely high before treatment, declined rapidly with corticosteroid and cyclophosphamide. IgG, leukocyte count and platelet count declined more gradually. Thus, determination of the serum IL-6 level might be useful in diagnosing and monitoring Wegener's granulomatosis.
(Internal Medicine: 32: 189-192, 1993)

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