Effects of a clinical dose of the prokinetic drug, cisapride, on postprandial gallbladder emptying were evaluated in 8 healthy normal volunteers. Gallbladder and gastric emptying after a liquid test meal were simultaneously measured by ultrasonography. Compared with placebo, a single oral dose of cisapride (5 mg) accelerated gastric emptying, but not gallbladder contraction. Cisapride enhanced gallbladder refilling. The same individuals took oral cisapride (15 mg TID) for 14 days, and were reassessed on the following day after oral 5 mg of cisapride. Fasting gallbladder volume was significantly increased. Although gallbladder contractility was not affected, the residual volume was significantly large. Gastric emptying rate returned to the control value. Fasting and post-test meal plasma CCK levels were not significantly attenuated by either single or multiple administration of cisapride. These results suggest that a clinical dose of cisapride may attenuate gallbladder motor function via mechanisms other than direct neural stimulation of the gallbladder.
(Internal Medicine 33: 381-386, 1994)

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We conducted a retrospective study (1981-1990) to determine whether the efficacy of intracoronary thrombolysis (ICT) could be evaluated from data obtained solely after recanalization. We investigated 55 successful ICT patients (38 with anterior and 17 with inferior myocardial infarction (MI)), and 31 control infarct patients without recanalization. The total serum creatine phosphokinase release (∑CPK), the extent of infarction measured by Tl-201 single photon emission computed tomography (total DS) and the disturbance of regional wall motion (asyn.%) were investigated as parameters for distinguishing the successful ICT and control groups. Discriminatory ability for the two groups was highest with the total DS in all patients. Only the total DS differed significantly between the two groups in patients with inferior infarction. Misidentification of control patients as successful patients was least frequent (25.5%) when using the total DS. These findings suggest that the effectiveness of ICT for acute MI may be assessed on the basis of data obtained solely after recanalization, with the total DS being particularly useful.
(Internal Medicine 33: 387-395, 1994)

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The influence of aging and sex on specific IgE production was evaluated in a non-allergic population aged from 18 to 99 years. Specific IgE against mite antigen and Japanese cedar pollen (JCP) were measured by fluorescence enzyme immunoassay. The incidence and titer of positive anti-mite and anti-JCP IgE antibodies decreased with age, particularly in the aged group. There were slight sex-related changes in IgE production. No significant correlation was noted between anti-mite and anti-JCP IgE antibody levels in the same individual subjects. These findings suggest that the production of specific IgE, as an immunoglobulin class, declines with aging.
(Internal Medicine 33: 396-401, 1994)

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In this study, to determine whether preconditioning enhances the process of recovery from post-ischemic dysfunction, ultrasonic crystals were placed in 8 open-chest dogs to measure regional myocardial wall thickening in the ischemic area. A carotid-circumflex coronary artery bypass was created with an electromagnetic flow probe and a fixed stenosis was produced. Ventricular pacing was performed for 15 minutes at a rate of 190-220 bpm. After a 15 minutes rest period, a second pacing was performed in a similar manner. After cessation of the first pacing, circumflex wall thickening remained reduced significantly. Three minutes after cessation of the second pacing, circumflex thickening decreased further. After 15 minutes, wall thickening improved to the value recorded before the second pacing. The degree of improvement from 3 minutes to 15 minutes after the second pacing was greater than that after the first pacing. Thus, preceding demand ischemia modifies the rate of functional recovery from the next post-ischemic dysfunction, indicating that preconditioning of the ischemic myocardium enhances recovery from stunning.
(Internal Medicine 33: 402-406, 1994)

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The effect of the H₂-receptor antagonists cimetidine and famotidine on interdigestive gastric motor activity and lower esophageal sphincter pressure was assessed in 41 patients with uncomplicated progressive systemic sclerosis. There was no significant change in gastric phasic motor activity after the intravenous administration of cimetidine (n=6), famotidine (n=13), and physiological saline (n=15), or the intragastric infusion of 7% sodium bicarbonate (n=7). The lower esophageal sphincter pressure was increased significantly by both cimetidine and famotidine, but only famotidine caused a significant pressure rise in patients without an increase of gastric motility. Cimetidine and physiological saline produced a similar pattern of change in the esophageal sphincter pressure, as did famotidine and sodium bicarbonate. These findings suggest that the inhibition of acetylcholinesterase activity and gastric acid secretion may be involved in the respective mechanisms of action of cimetidine and famotidine.
(Internal Medicine 33: 407-412, 1994)

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To evaluate whether patients with subclinical hypothyroidism have a disturbance in lipid metabolism, and whether supplemental L-thyroxine (L-T₄) therapy would improve their lipid parameters, we measured serum levels of thyroid hormones, TSH and lipid parameters in 34 patients with subclinical hypothyroidism before and 2 months after treatment with L-T₄. Before treatment, patients with subclinical hypothyroidism had elevated serum low density lipoprotein cholesterol (LDL-C) concentrations compared with control subjects (P<0.05). Overall, L-T₄ therapy significantly decreased the serum level of TSH (P<0.01), total cholesterol (TC; P<0.02), high density lipoprotein cholesterol (P<0.02), LDL-C (P<0.05), and the ratio of apolipoprotein B to apolipoprotein Al (P<0.05). Lipid values in patients with basal serum TSH levels below 10 mU/l were not affected by L-T₄ therapy, whereas serum levels of TC and LDL-C decreases significantly (P<0.01) in patients with serum TSH levels above 10 mU/l. Thus, the L-T₄ treatment appears to have a preventive effect on the disturbance of lipid metabolism in patients with subclinical hypothyroidism, especially in patients with serum TSH levels above 10 mU/l.
(Internal Medicien 33: 413-417, 1994)

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A 34-year-old man with partial DiGeorge syndrome suffered from seizures and mental retardation from the age of three years. He was diagnosed as having primary hypoparathyroidism by the Ellsworth-Howard test at the age of 22. He was also found to have a right aortic arch. Immunological studies revealed the presence of immature T cells (CD 38+, OKT 9+), although the subsets and function of his T cells were almost normal. The facts that the cardiovascular anomaly and immunodeficiency were mild and the hypoparathyroidism was well controlled, may account for his survival to this age.
(Internal Medicine 33: 418-121, 1994)

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A 47-year-old man was admitted with appendicitis, and appendectomy was performed. On microscopic examination of the resected specimen, the presence of goblet cell carcinoid in the tip of appendix was revealed. This tumor showed an aggressive nature with perineural and vascular invasion around the appendiceal serosa. The tumor was composed of two main cell populations: mucin-producing (goblet cell type) and silver-positive cells (endocrine differentiation). Additionally, a few cells were also positive for serotonin and lysozyme, but negative for gastrin and ACTH. These findings suggest that goblet cell carcinoid share some functional and histologic characteristics with carcinoid tumors and adenocarcinomas, although it is a distinct entity.
(Internal Medicine 33: 422-426, 1994)

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A 68-year-old man with hepatocellular carcinoma complicated by erythrocytosis showed an increased plasma level of immunoreactive erythropoietin (EPO). Northern blot analysis and RT-PCR (reverse transcriptase and polymerase chain reaction) of EPO mRNA extracted from a surgical specimen indicated high expression of EPO mRNA in the tumor tissue. Histological and immunocytochemical examination showed that the tumor was a hepatocellular carcinoma with predominant immunostaining for EPO. The erythrocytosis improved and the high serum EPO level decreased after resection of the tumor. This is the first demonstration of EPO mRNA expression in hepatocellular carcinoma tissue by RT-PCR.
(Internal Medicine 33: 427-431, 1994)

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A 43-year-old male with a high value of high density lipoprotein cholesterol (151 mg/dl) was found among subjects receiving annual health checks. We investigated the cholesteryl ester transfer protein (CETP) activity and conducted a family study. There was complete deficiency of CETP activities in the proband and his sister, and partial deficiency of CETP activities in his mother and daughter. Genetic analysis revealed a splicing defect (G to A point mutation) in intron 14 of the CETP gene.
(Internal Medicine 33: 432-436, 1994)

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Low-dose methotrexate therapy has been used to treat a variety of chronic inflammatory diseases; a few studies have discussed the efficacy of this therapy for sarcoidosis. We present a patient with symptomatic sarcoidosis who was successfully treated with low-dose methotrexate after being refractory to steroids. This patient showed significant clinical improvement without development of any severe side effects. These findings suggest that low-dose methotrexate therapy may be a useful alternative treatment for sarcoidosis.
(Internal Medicine 33: 437-440, 1994)

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Adamantinoma is a rare bone tumor, most of which originates in the long bone. Here, we present a case of adamantinoma of the rib with liver metastasis.
The patient, a 69-year-old man, complained of dull chest pain for over 6 months. Chest X-ray and CT film revealed osteolytic mass of the right 7th rib. Under the clinical diagnosis of hepatic tumor with rib metastasis, resection of the rib and partial hepatectomy were performed. Pathologically, the bone tumor was diagnosed as primary adamantinoma and the liver tumor was its metastasis. The patient has been well without adjuvant chemotherapy for 5 years after the operation.
(Internal Medicine 33: 441-445, 1994)

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A 47-year-old man diagnosed as having chronic hepatitis C was admitted to our hospital where he was treated with interferon (IFN)-α. After initiation of this treatment, his serum LDH became elevated, and when the drug was stopped, it decreased gradually to within the normal range. The histopathological findings and the liver function were not aggravated. The administration of IFN-α showed a correlation to LDH-linked immunoglobulin, a complex of LDH and immunoglobulin, often causing high levels of LDH. In patients on IFN therapy with elevated LDH, LDH-linked immunoglobulin should be tested.
(Internal Medicine 33: 446-449, 1994)

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A 20-year-old male with massive rhabdomyolysis associated with a high fever and acute renal failure is reported. Influenza A infection was confirmed serologically. Myoglobin kinetics was studied in this case. Blood myoglobin fell exponentially independent of renal function or therapeutic modality such as hemodialysis/filtration, once myoglobin release into the circulation ceased. The finding suggested that catabolic steps of myoglobin take place extrarenally in patients with massive rhabdomyolysis and acute renal failure.
(Internal Medicine 33: 450-453, 1994)

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A case of rhabdomyolysis associated with bacteremic pneumonia due to Staphylococcus aureus is reported. A 58-year-old man was admitted because of severe left lobar pneumonia, and presented myoglobinuria on admission. The serum creatine phosphokinase level was transiently elevated and myoglobinuria were disclosed. Sputum and venous blood cultures grew Staphylococcus aureus. Rhabdomyolysis has rarely been reported in cases of bacterial infection, especially those due to Staphylococcus aureus. This case might be an extremely rare case of rhabdomyolysis complicating Staphylococcus aureus bacteremia following severe left upper lobar pneumonia.
(Internal Medicine 33: 454-155, 1994)

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A 52-year-old woman was admitted to our hospital with a fever and swelling of the tonsils and lymph nodes. A tonsillectomy was performed and she was diagnosed as having non-Hodgkin's lymphoma of T-cell phenotype. Genotypic analysis revealed a rearrangement of the T-cell receptor gene, but not of the immunoglobulin genes. The neoplastic cells of the tonsils also expressed the Ki1 antigen. The clinical course was aggressive with peripheralization of the neoplastic cells, and the patient died of respiratory failure.
(Internal Medicine 33: 456-159, 1994)

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