Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 33 , Issue 11
Showing 1-17 articles out of 17 articles from the selected issue
  • Hiroshi NAKASHIMA, Yukiharu HONDA, Tomoyuki KATAYAMA
    1994 Volume 33 Issue 11 Pages 659-666
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    The purpose of the present study was to clarify the characteristic findings of electrocardiogram (ECG) in 11 patients with acute myocarditis. ST elevation without reciprocal ST depression was one of the conspicuous findings in the acute stage. Total QRS amplitudes at the acute stage were significantly decreased as compared to those before illness and during the convalescent stage. Abnormal Q waves were present in 7 patients and disappeared in a short period. The number of leads showing Q waves was inversely correlated to left ventricular (LV) ejection fraction (r=-0.87, p<0.01). Conduction disturbances were present in 7 patients. Second degree and advanced AV block was transient while bundle branch block remained over months. Corticosteroid treatment was effective for patients who had edematous myocardial thickening and AV conduction disturbances. As the serial ECG findings in acute myocarditis are so characteristic, and this help to differentiate it from acute myocardial infarction (AMI).
    (Internal Medicine 33: 659-666, 1994)
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  • Tetsuri KONDO, Akira MIYAIRI, Ichiro KOBAYASHI, Iunis SUZUKI, Osamu KA ...
    1994 Volume 33 Issue 11 Pages 667-672
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    Breathing during mechanical ventilation was analyzed in 8 conscious healthy volunteers by application of intermittent positive pressure ventilation through a mouthpiece. In controlled mechanical ventilation (CMV), the respiratory rate and tidal volume were fixed at 110 and 120% of the subject's corresponding spontaneous breathing parameters. The diaphragmatic electromyogram (EMGdi) decreased significantly but become synchronous with the rhythm of the CMV. In assisted mechanical ventilation (AMV), the EMGdi response developed prior to and during the inspiratory phase of AMV. Application of an unexpected mechanical breath elicited the EMGdi. As the triggering sensitivity was decreased, the EMGdi prior to and during a mechanical breath was augmented, however, its rate of rise was unaffected. Our results suggest that the EMGdi during mechanical ventilation in conscious subjects is initiated by the respiratory center, however, this activity is modulated strongly by input from the pulmonary afferents and from the cerebral cortex.
    (Internal Medicine 33: 667-672, 1994)
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  • Tetsuya YOSHIDA, Junji SUZUMIYA, Hideki KATAKAMI, Nobuhiro KIMURA, Shu ...
    1994 Volume 33 Issue 11 Pages 673-676
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We analyzed the parathyroid-related protein (PTH-rP) content in tissue specimens obtained from a 61-year-old man with hypercalcemia associated with lung metastasis from urinary bladder carcinoma using radioimmunoassay and immunohistochemistry. Radioimmunoassay showed that the PTH-rP content was higher in metastatic lung tumor tissue than in non-tumorous lung tissue. Immunohistochemical analysis revealed the presence of PTH-rP in tumor cells. Furthermore, proliferation of osteoclasts was found in bone marrow at autopsy. The results suggest that PTH-rP induced humoral hypercalcemia of malignancy in a patient with urinary bladder cancer.
    (Internal Medicine 33: 673-676, 1994)
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  • Michitaka NAITO, Eiichi MAEDA, Gen YOSHINO, Masato KASUGA, Akihisa IGU ...
    1994 Volume 33 Issue 11 Pages 677-682
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We present findings in the ninth known Japanese family with lecithin: cholesterol acyltransferase (LCAT) deficiency. A 54-year-old man (proband) and his 58-year-old brother presented with corneal opacity. Both subjects showed a marked decrease in serum high density lipoprotein (HDL)-cholesterol and in the cholesteryl ester ratio. Although apo A-I and A-II were low, apo E tended to be high. Serum LCAT activity and mass were not detectable. Urinary examination showed microhematuria or proteinuria. Renal function was normal and no anemia was demonstrated, but blood smears showed poikilocytosis with target cells. The serum LCAT activity of the proband's three sons, obligate heterozygotes of LCAT deficiency, was about one-half the normal level, and HDL-cholesterol and apo A-I levels were low normal.
    (Internal Medicine 33: 677-682, 1994)
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  • Munehiko ISHII, Akiko KIKUCHI, Kunio KUDOH, Kazuki KONISHI, Takashi MO ...
    1994 Volume 33 Issue 11 Pages 683-685
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We describe the hyper sensitivity pneumonitis of a 49-year-old woman who had been cultivating the edible mushroom 'Pholiota nameko' for three years. Her clinical manifestations and laboratory findings including transbronchial lung biopsy (TBLB) and bronchoalveolar lavage fluid (BALF) were consistent with those of other forms of hypersensitivity pneumonitis. Counter-immunoelectrophoresis determined the causative antigen to be the spores of Pholiota nameko. The indoor cultivation method appeared to play a major role in the occurrence of the hypersensitivity pneumonitis.
    (Internal Medicine 33: 683-685, 1994)
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  • Tomonari OKADA, Tetsuya KAWAMURA, Tadashi TAMURA, Ryouichi TOSHIMA, Os ...
    1994 Volume 33 Issue 11 Pages 686-688
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    Idiopathic Addison's disease developed in a 52-year-old female with a 15-year history of myasthenia gravis. The association of myasthenia gravis with other autoimmune diseases is well known, however an association with Addison's disease is rare. It was speculated that the development of Addison's disease in this patient might have been due to common immunological abnormalities underlying these two diseases. We report this case and briefly discuss the pathogenetic mechanism of this association.
    (Internal Medicine 33: 686-688, 1994)
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  • Shinji ATAGI, Mitsunori SAKATANI, Masanori AKIRA, Satoru YAMAMOTO, Ein ...
    1994 Volume 33 Issue 11 Pages 689-691
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A case of pulmonary hyalinizing granuloma (PHG) with Castleman's disease in a 43-year-old man is presented. He was asymptomatic, but the disease was recognized due to a routine chest roentgenographic study. Anemia, multiple lymphadenopathy, hypoalbuminemia and polyclonal hypergamma-globulinemia were observed. Histological examination of cervical lymph nodes revealed the plasma cell type of Castleman's disease. The diagnosis of PHG was confirmed by video-assisted thoracoscopical lung biopsy, and the immuno-histochemical staining of lamellar fibrosis for types I and III collagen was positive.
    (Internal Medicine 33: 689-691, 1994)
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  • Taku MIYASHITA, Tetsuo IMAMURA, Yasuro ISHIKAWA, Kouta OKINAGA, Otohik ...
    1994 Volume 33 Issue 11 Pages 692-696
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We present a patient with primary retroperitoneal synovial sarcoma which showed a monophasic fibrous pattern, the fourth such case to be described, and a review of the literature. Synovial sarcoma cells in the present case were stained positive for cytokeratin and epithelial membrane antigen (EM A), of which histology was differentiated from other spindle cell sarcoma with similar light microscopic features. Retroperitoneal synovial sarcoma is usually treated surgically, however only one of 16 cases identified in the literature survived five years after resection. Due to the high fatality rate, physicians should be alerted to the possibility of this disorder in the differential diagnosis of an abdominal mass.
    (Internal Medicine 33: 692-696, 1994)
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  • Hajime KOYANO, Yoshimasa SHISHIBA, Taeko SHIMIZU, Noriyuki SUZUKI, Hid ...
    1994 Volume 33 Issue 11 Pages 697-702
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 62-year-old woman had primary hyperparathyroidism due to parathyroid carcinoma. In spite of surgical removal of the enlarged parathyroid gland, intractable hypercalcemia persisted. 99mTc-methoxyisobutylisonitrile scanning revealed bone metastatic lesions, although conventional 201Tl-chloride scanning failed to demonstrate those lesions. Octreotide inhibited parathyroid hormone (PTH) secretion, although various means such as bisphosphonates, calcitonin and hydration were effective to reduce serum calcium level to some extent but failed to reduce PTH secretion at all. The CT-guided transcutaneous tumor marking facilitated the subsequent orthopedic surgery for successful removal of the metastatic focus of PTH secretion from the iliac bone.
    (Internal Medicine 33: 697-702, 1994)
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  • Tetsuya MIZOKAMI, Ken OKAMURA, Kaori SATO, Takeo KURODA, Yasuto ITOYAM ...
    1994 Volume 33 Issue 11 Pages 703-705
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 28-year-old woman noticed a progressive gait disturbance after her first delivery. At the age of 32, the gait disturbance improved during her second pregnancy, but became worse after delivery and eventually resulted in a scissoring gait. At the age of 34, she became transiently thyrotoxic and was diagnosed as having painless thyroiditis and HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP). The findings of this case suggest that the postpartum exacerbation of HAM/TSP was probably due to a rebound phenomenon after immunosuppression during pregnancy, and that the immunological abnormalities associated with HAM/TSP might have played some role in the development of painless thyroiditis.
    (Internal Medicine 33: 703-705, 1994)
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  • Kazunori TOYODA, Yoshisuke SAKU, Seizo SADOSHIMA, Masatoshi FUJISHIMA
    1994 Volume 33 Issue 11 Pages 706-709
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 57-year-old man with liver cirrhosis developed α-hemolytic streptococcal meningitis following endoscopic injection sclerotherapy for esophageal varices. Central nervous system infection is uncommon as a complication of sclerotherapy, however, when such an infection does develop, it is usually intractable. We therefore emphasize the importance of immediate antibiotic therapy right after the onset of inflammatory symptoms in order to prevent the development of undesired infectious complications following sclerotherapy.
    (Internal Medicine 33: 706-709, 1994)
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  • Keiko ITO, Kouji IWABE, Takahiro OKAI, Sizuo KOUDA, Masao TADOKORO, To ...
    1994 Volume 33 Issue 11 Pages 710-713
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 46-year-old man with chronic myelogenous leukemia (CML) was admitted to our hospital because of high fever. The chest radiographs showed bilateral groundglass-like infiltrates in the perihilar region. Transbronchial lung biopsy (TBLB) and autopsy revealed PAS-positive granular materials characteristic of pulmonary alveolar proteinosis (PAP). He had received interferonalpha since the time of CML diagnosis. Busulfan had never been administered. Altered cell-mediated immunity was thought to be closely related to the development of PAP.
    (Internal Medicine 33: 710-713, 1994)
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  • Katsuhiko ISHIHARA, Masafumi YOSHIMURA, Hirohisa NAKAO, Yuzuru KANAKUR ...
    1994 Volume 33 Issue 11 Pages 714-717
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We report a 28-year-old Japanese with Klinefelter's syndrome who developed mixed connective tissue disease (MCTD) and Sjögren syndrome. Previously being well, he presented with Raynaud's phenomenon, dry eye, fever and polyarthralgia. Clinical examinations revealed anti-nRNP autoantibody, leukopenia and lung fibrosis. Then he was found to have Klinefelter's syndrome. Flow cytometric analysis showed a relative increase of peripheral CD8+ T lymphocytes carrying either HLA-DR or CD57. Lymphocyte IL-2 production induced in vitro by concanavalin A was decreased. Such T cell abnormalities may be implicated in the development of autoimmune disease in Klinefelter's syndrome.
    (Internal Medicine 33: 714-717, 1994)
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  • Emiko SOBUKAWA, Kyoya SAKIMURA, Shigeru HOSHINO, Moritoshi HOSHINO, Ka ...
    1994 Volume 33 Issue 11 Pages 718-722
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    Encephalopathy is widely known as one of the neurological complications of chronic hepatic disease. Recently, the occurrence of progressive myelopathy in patients with advanced hepatic disease has been well documented and differentiated from encephalopathy. We describe a 76-year-old man with decompensatory liver cirrhosis due to hepatitis C virus infection who suffered from progressive paraplegia. Postmortem examination revealed demyelination of the lateral column of the spinal cord, especially of the thoracic segment. No evidence of spontaneous portosystemic shunts was found. These findings suggest that the patient had been affected with hepatic myelopathy, which is a rare complication of liver cirrhosis.
    (Internal Medicine 33: 718-722, 1994)
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  • Atsushi KOMATSUDA, Hideki WAKUI, Tadashi YASUDA, Hirokazu IMAI, Akira ...
    1994 Volume 33 Issue 11 Pages 723-726
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 27-year-old Japanese female developed nephrotic syndrome and impaired renal function during pregnancy. A renal biopsy performed at 21 weeks of gestation revealed crescentic IgA nephropathy. She was treated with steroid pulse therapy followed by conventional steroid therapy. Although the nephrotic syndrome was persistent, the impaired renal function did not deteriorate after the treatment. A live infant was delivered by cesarean section at 37 weeks of gestation. After the delivery, both the nephrotic syndrome and renal insufficiency improved gradually. The indications for renal biopsy and treatments for active IgA nephropathy during pregnancy are discussed.
    (Internal Medicine 33: 723-726, 1994)
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  • Akitoshi KINOSHITA, Masamoto NAKANO, Naofumi SUYAMA, Keiji INOUE, Take ...
    1994 Volume 33 Issue 11 Pages 727-729
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    We report two cases of intrapulmonary lymph nodes detected by a chest roentgenogram or CT scan. The first patient was a 61-year-old fisherman referred complaining of cough and hemosputum. Chest roentgenogram showed a subpleural small nodular shadow at the superior segment of the right lower lobe. Thoracotomy showed a small anthracotic lymph node. The other case was a 68-year-old female patient admitted for further examination of a subpleural small nodular shadow at the latero-basal segment of the left lower lobe detected on a chest CT scan. Thoracoscopic surgery revealed that the black nodule was an anthracotic lymph node. The appearance of an intrapulmonary lymph node on radiological examination is rare, however, it should be considered in the differential diagnosis of a solitary or multiple peripheral pulmonary nodules in adults. A small nodular shadow should be resected if malignancy is suspected though not proven. Subpleural intrapulmonary lymph node warrants thoracoscopic surgery.
    (Internal Medicine 33: 727-729, 1994)
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  • Yukio ANDO, Kazuhiro TASHIMA, Yoshiya TANAKA, Masamitsu NAKAZATO, Bo-G ...
    1994 Volume 33 Issue 11 Pages 730-732
    Published: 1994
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 28-year-old male patient with familial amyloidotic polyneuropathy (FAP) underwent a liver transplantation from a heart-beating cadaveric donor in Sweden. He had suffered from the disease for 2.5 years. It took 5.5 hours to carry out the operation without blood transfusion. After the liver transplantation, serum amyloidgenic variant transthyretin (TTR) levels became extremely low and diarrhea stopped after the 7th day. On day 13, the patient was discharged from the hospital and one month after the transplantation, his general condition remained quite good. This is the first case of a Japanese patient with congenital metabolic disorders as well as FAP to receive a liver transplantation from a heart-beating cadaveric donor.
    (Internal Medicine 33: 730-732, 1994)
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