We previously observed that a retinoid analog can protect against liver parenchyma! damage and liver fibrosis, whereas it accelerates liver fibrosis which is not accompanied by any parenchymal damage. To elucidate these conflicting effects, we examined the effects of retinoid in 3T3 L1 preadipocytes as a model of liver stellate cells. Retinoids, including all-trans retinol, all-trans and 9-cis retinoic acids, enhanced the cell growth and the expression of the type I procollagen gene as well as its peptide synthesis, while reducing collagenase activities. Although no retinoid enhanced the transforming growth factor (TGF)-β1 mRNA, retinoids may stimulate collagen production through activating TGF-β, as was recently reported. These results help explain the observation in the liver fibrosis model with no parenchymal damage. In contrast, we also found that interferon (IFN) αβ and γ inhibited cell growth and down-regulated markedly type I procollagen as well as TGF-β1 mRNA, suggesting that they suppress by acting directly on extracellular matrix-producing cells.
(Internal Medicine 33: 309-316, 1994)

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We studied risk factors and the relationship of lacunes to diabetes mellitus, age, hypertension, hyperlipidemia, atherosclerosis and also to intellectual impairment, comparing brain MRI (magnetic resonance imaging) findings to the multiple risk factors and the results of a cube-handdrawing test. Brain MRI was performed using a Shimazu SMT-150, 1.5 Tesla, in 118 asymptomatic NIDDM and 39 asymptomatic nondiabetic patients. In diabetics, 65 had lacunes and the incidence of lacunes was significantly higher in diabetics with coronary insufficiency by ECG and hypertension, but not significantly different in those with or without the other risk factors. Cube hand-drawing is a good indication of space cognition ability supported by the wide association areas of the brain. Drawing was tested in 41 diabetics and 39 nondiabetics. Correlation of lacunes to deformity in drawing and age was high in both diabetics and nondiabetics. Multiple lacunes were closely related to intellectual impairment.
(Internal Medicine 33: 317-320, 1994)

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We investigated the survival of patients with multiple system atrophy (MSA) in a follow-up study of 59 patients admitted to Nagoya University Hospital between 1976 and 1991. They consisted of 24 patients with olivopontocerebellar atrophy (OPCA), 25 with Shy-Drager syndrome (SDS) and 10 with striatonigral degeneration (SND). The mean age at onset was 54 years, the 3-year survival rate from onset was 90%, and the 6-year survival rate was 54%. Comparison of survival curve by clinical type revealed poorer survival in SDS and SND than in OPCA cases. Although in OPCA, SND and SDS the pathological alterations of the central nervous system are known to be very similar, characterized as MSA, the present study suggests that the earlier and the more severe the involvement of the autonomic nervous system, and to a lesser extent the striatonigral system, the poorer the prognosis may be.
(Internal Medicine 33: 321-325, 1994)

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Features of venous return in chronic pulmonary diseases and factors determining such features were studied by analysis of respiration-related variation in the superior vena cava flow on pulsed Doppler echocardiography. Subjects of this study were 85 patients with chronic pulmonary diseases; 54 healthy subjects served as normal controls. In the healthy subjects, the velocity of the S and D waves increased during inspiration (type I pattern), and the velocity of the A wave increased during expiration. In the patients with pulmonary diseases, the pattern of the superior vena cava flow was either type I or type II (disappearance of the D wave or disappearance of both the D and S waves). The incidence of the type II pattern was significantly higher in the patients showing a reduction of both FEV_1.0% and % VC. The respiration-related variation in the superior vena cava flow pattern was found to be determined by the pressure fall between right atrium and subclavian vein. A type II pattern was attributed to the elevation of right atrial pressure caused by positive pleural pressure. The velocity of the A wave increased during expiration, showing a good correlation with pulmonary vascular resistance. Venous return in the presence of chronic pulmonary disease was found to be affected by the type of ventilatory disturbance and intensity of pulmonary vascular resistance.
(Internal Medicine 33: 326-333, 1994)

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A benign Becker muscular dystrophy (BMD) patient with a marked decrease in dystrophin exhibited remarkable expression of dystrophin-related protein (DRP) on most of the muscle cell membrane. A phenotypic Duchenne muscular dystrophy patient with a truncated form of dystrophin exhibited no DRP expression on the muscle cell membrane except for the neuromuscular junction. Increased DRP expression might compensate for a lack of dystrophin in some BMD patients.
(Internal Medicine 33: 334-336, 1994)

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Following a three-week administration of alpha-interferon (IFN-α), a 62-year-old woman with chronic hepatitis C manifested fever and dyspnea and showed diffuse infiltrative opacities on chest roentgenograms. Her laboratory data included results of anemia with reticulocytosis, a decreased complement level and hepatitis with elevated ALP, LDH and γ-GTP, Because laboratory data also revealed a positive lymphocyte stimulation test for IFN-α, this cytokine was considered to be responsible for the development of interstitial pneumonia, hemolytic anemia and cholestatic liver dysfunction due to its immunomodulatory effects. Although these three disorders have been reported to develop singly after IFN-α therapy, this is the first report of a patient in whom these disorders occurred simultaneously.
(Internal Medicine 33: 337-341, 1994)

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A case of HIV-infection presenting as mixed connective tissue disease (MCTD) is reported. A 26-year-old woman from Kenya was admitted with the symptoms and laboratory findings of MCTD. Her peripheral CD4 cell count was decreased. She had high titers of antibodies to HIV antigen by a passive agglutination test and an immunofluorescence technique. Moreover, specific IgG and IgM antibodies to HIV antigens were detected by Western blot analysis after complete absorption of the serum in extractable nuclear antigens from calf thymus. While undergoing azidothymidine treatment, she developed AIDS and died of intracranial bleeding. This is the first report of HIV infection associated with MCTD-like symptoms.
(Internal Medicine 33: 342-345, 1994)

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A very rare case of highly probable retroperitoneal fibrosis leading to extrahepatic portal obstruction is described. The patient was a 44-year-old woman with right pleural effusion and splenomegaly. Computed tomography indicated a large accumulation of soft tissues in the retroperitoneum, and abdominal angiography showed extensive portal obstruction. A twenty-year-long abuse of analgesics is suspected to have caused the retroperitoneal fibrosis.
(Internal Medicine 33: 346-350, 1994)

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Tuberculous liver abscess has been reported in only fourteen patients in Japan and in twenty-nine patients outside Japan. Only nine of the non-Japanese patients and none of the Japanese patients have been treated for this condition without laparotomy. We report a patient who developed tuberculous liver abscess during treatment of tuberculous peritonitis. Diagnosis was made by ultrasound-guided aspiration biopsy, and the patient was treated with percutaneous drainage and transcatheter infusion of antituberculous agents. Direct infusion of antituberculous agents has more direct effects in the treatment of an abscess than systemic chemotherapy alone. Therefore, if a percutaneous catheter can be safely placed, the use of transcatheter infusion of antituberculous agents should be considered.
(Internal Medicine 33: 351-356, 1994)

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A 52-year-old female with polysplenia accompanied by major cardiovascular anomalies (a ventricular septal defect, atrial septal defect, persistent left superior vena cava, absent inferior vena cava with a hemiazygos connection and visceral heterotaxia) is reported. She underwent successful surgical treatment and showed prolonged survival.
(Internal Medicine 33: 357-359, 1994)

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A 36-year-old man developed fulminant hepatitis and acute renal failure with profound hyponatremia (116 mEq/L). Emergent hemodialysis corrected the serum sodium to 136 mEq/L within 24 hours. He developed generalized convulsions 11 days later. Magnetic resonance imaging (MRI) revealed a single large symmetrical lesion in the pons and extensive white matter lesions in the bilateral occipital, temporal, parietal and right frontal regions. These lesions showed marked resolution as the patient recovered. Fulminant hepatitis and acute renal failure could induce extensive edema in the cerebral white matter. Therefore, not all MRI abnormalities in the white matter after correction of hyponatremia necessarily reflect myelinolysis.
(Internal Medicine 33: 360-362, 1994)

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Two cases of high-output heart failure associated with pulmonary hypertension are presented. In a 32-year-old man with hyperthyroidism, pulmonary hypertension subsided after antithyroid therapy. Increased pulmonary blood flow and elevated left ventricular end-diastolic pressure were suspected as the causes of pulmonary hypertension. In a 51-year-old man with cardiac beriberi, the pulmonary hypertension improved after thiamine administration. We suspect that increased pulmonary blood flow, elevated left ventricular end-diastolic pressure, and probably pulmonary vasoconstriction were the causes of pulmonary hypertension. Thus, high-output heart failure should be considered as a possible cause of pulmonary hypertension and right ventricular failure.
(Internal Medicine 33: 363-365, 1994)

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Although hyperplastic polyps are the most common polyps of the stomach, the etiology of these polyps is not completely understood. We report a 61-year-old woman who developed gastric hyperplastic polyps following acute gastric lesions. She was admitted for endoscopic injection sclerotherapy of esophageal varices. After the end of sclerotherapy, acute gastric lesions developed. For treatment of the lesions, omeprazole was used for 8 weeks followed by famotidine for 8 weeks. At the end of the treatment, she developed multiple gastric hyperplastic polyps, suggesting that acute gastric lesions and/or treatment of the gastric lesions are related to the development of hyperplastic polyps in the stomach.
(Internal Medicine 33: 366-368, 1994)

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Female siblings with Pendred's syndrome were admitted to our clinic. The abnormality of the acoustic structure was examined by MRI. Bilateral enlargement of the vestibular aqueduct and a prominently marked endolymphatic sac were found on MRI. These findings seemed likely to represent a Mondini deformity. Acoustic structure in Pendred's syndrome was examined here by MRI for the first time. We examined their HLA-DR locus as a genetic marker using the affected sibpair method preliminary. HLA typing might be a diagnostic criteria of Pendred's syndrome, although the present siblings possessed 2 HLA genes in common.
(Internal Medicine 33: 369-372, 1994)

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A 39-year-old man was admitted because of an abrupt onset of right-side weakness and dysarthria. During the 2 years before admission, he had suffered from insomnia, depressed mood and progressive memory disturbance. Neurological and psychiatric examination revealed severe intellectual impairment in addition to the neurological deficits. Neuroradiological examinations revealed multiple brain infarcts. He had no risk factor for stroke except for lupus anticoagulant. He was diagnosed as having multi-infarct dementia associated with antiphospholipid antibodies. This case suggests that it is necessary to investigate antiphospholipid antibodies in addition to neuroradiological examination when relatively young patients present with unexplained cognitive or behavioral symptoms.
(Internal Medicine 33: 373-375, 1994)

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A 56-year-old man with left anterior chest pain showed two well-defined tumors in the left anterior chest wall and left parietal region. A large osteolytic lesion in the parietal bone and several punched-out lesions in the temporal bone were revealed by a skull X-ray examination. He showed monoclonal gammopathy (IgG, kappa type) and Bence Jones proteinuria, but no proliferation of plasma cells was observed in the bone marrow. The tissue specimens from both lesions consisted of abnormal plasma cells, indicating plasmacytoma. Although a bulky intracranial plasmacytoma was present, the patient did not exhibit intracranial hypertensive symptoms, or neurological abnormalities.
(Internal Medicine 33: 376-379, 1994)

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