Internal Medicine

Waist/Height Ratio as A Simple and Useful Predictor of Coronary Heart Disease Risk Factors in Women

Shiun Dong HSIEH, Hideyo YOSHINAGA

1995 Volume 34 Issue 12 Pages 1147-1152
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1147

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To determine whether the waist/height ratio is a better predictor of coronary heart disease (CHD) risk factors in women than body mass index (BMI) or the waist/hip ratio, simple and multiple regression analysis for these obesity indices and CHD risk factor levels [systolic and diastolic blood presure, fasting blood glucose, hemoglobin A_1c (HbA_1c), triglyceride, cholesterol, high density lipoprotein (HDL) cholesteroll, prevalences (hypertension, abnormal glucose tolerance, hypertriglyceridemia, hypercholesterolemia, low HDL cholesterol) were measured in 1, 077 women. The highest regression coefficients were consistently between the waist/height ratio and most of the risk factors by simple regression analysis. Furthermore, the waist/height ratio was the single independent variable to all or most of the risk factors by multiple regression analysis of the waist/height ratio and BMI or the waist/height ratio and the waist/hip ratio. These findings suggest that the waist/height ratio may be a better predictor of multiple CHD risk factors than BMI or the waist/hip ratio.
(Internal Medicine 34: 1147-1152, 1995)

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Alcohol Intake Increases Hepatitis C Virus-Induced Hepatocellular Injury

Yuko KATAKAMI, Hideaki OHISHI, Hitoshi KOMATSU, Keiji KIRIZUKA

1995 Volume 34 Issue 12 Pages 1153-1157
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1153

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To examine the effects of drinking on liver injury in anti-hepatitis C virus (HCV)-positive subjects, 3, 062 HBs-negative subjects were divided into 9 groups according to anti-HCV-titer (second-generation passive hemagglutination) and alcohol intake. Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels were analyzed by multiple-comparison test. In 2, 826 anti-HCV-negative subjects and in 73 low titer (<2¹²) subjects (91 % were HCV-RNA-negative), the mean ALT or AST of moderate drinkers (<46 g of ethanol/day) was not significantly higher than that of non-drinkers and all values were within normal limits. In 163 high-titer (≥2¹²) subjects (91% were HCV-RNA-positive), moderate drinkers showed significantly higher levels of mean ALT or AST than non-drinkers; 73 vs 44IU/l or 56 vs 44 IU/l (p<0.05). These data indicated that drinking increases hepatocellular injury in persistent HCV infection.
(Internal Medicine 34:1153-1157, 1995)

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A Family with Adult Type Ceroid Lipofuscinosis (Kufs' Disease) and Heart Muscle Disease: Report of Two Autopsy Cases

Ken-ichi SAKAJIRI, Nae MATSUBARA, Takashi NAKAJIMA, Nobuyoshi FUKUHARA ...

1995 Volume 34 Issue 12 Pages 1158-1163
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1158

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Two cases in a family with Kufs' disease had lethal arrhythmias and heart muscle disease. Autopsy findings showed an abundant accumulation of lipofuscin-like lipopigments in most neurons in the central nervous system (CNS). The heart showed a slight increase in the accumulation of the lipofuscin-like lipopigments in the myocardial fibers, slight to severe fibrosis and infiltration of fat cells in the myocardium. The lipopigments both in the heart and in neurons of the CNS had curvilinear profiles on electron microscope and reacted immunohistochemically to polyclonal antibodies against subunit c of mitochondrial adenosine triphosphate (ATP) synthase. The degenerative process in this heart muscle disease might be attributable to the same metabolic abnormality as seen in the neuronal degeneration associated with Kufs' disease.
(Internal Medicine 34: 1158-1163, 1995)

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A Rare Case of Cardiac Sarcoidosis in a Patient with Progressive Systemic Sclerosis, Sjögren's Syndrome, and Polymyositis

Noriko HOSOYA, Toshihide MIMURA, Yoshifumi ENOKAWA, Takehiko MIZUNO, K ...

1995 Volume 34 Issue 12 Pages 1164-1167
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1164

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A 56-year-old woman with overlap syndrome of progressive systemic sclerosis (PSS), Sjögren's syndrome, and polymyositis is reported. She developed complete atrioventricular (AV) block and progressive bilateral hilar adenopathy, and was diagnosed as having sarcoidosis by histological examination of the hilar lymph nodes biopsied thoracoscopically. Although coexistence of one or two autoimmune diseases with sarcoidosis is not uncommon, coexistence of three or more autoimmune diseases with sarcoidosis is rare. To our knowledge, the described case is the first case in which the three above-mentioned autoimmune diseases were accompanied by myocardial sarcoidosis.
(Internal Medicine 34: 1164-1167, 1995)

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Primary Adrenal Ganglioneuroblastoma in an Adult

Kinya HIROSHIGE, Shinjou SONODA, Masasuke FUJITA, Masayuki TAKASUGI, A ...

1995 Volume 34 Issue 12 Pages 1168-1173
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1168

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We present here a case of adrenal incidentaloma in a 35-year-old male. Imaging technology including magnetic resonance imaging (MRI) clarified that the tumor was heterogeneous, and large in size (9×7 cm), and that it originated from the left adrenal gland. MRI scans on Tl-weighted sequence showed the tumor with a low signal intensity followed by rapid contrast enhancement, whereas those on T2-weighted sequence showed markedly increased intensity. The tumor was surgically removed, and pathologic diagnosis was well-differentiated ganglioneuroblastoma. Ganglioneuroblastoma in adults is extremely rare, with only about 30 cases documented in people over the age of 20 years.
(Internal Medicine 34: 1168-1173, 1995)

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Association of Sick Sinus Syndrome with Hyperinsulinemia and Insulin Resistance in Patients with Non-Insulin-Dependent Diabetes Mellitus: Report of Four Cases

Taro WASADA, Kozo KATSUMORI, Sumiko HASUMI, Hiroshi KASANUKI, Hiroko A ...

1995 Volume 34 Issue 12 Pages 1174-1177
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1174

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We report four non-insulin-dependent diabetic (NIDDM) patients accompanied by a unique combination of sick sinus syndrome (SSS) and hyperinsulinemia of unknown etiology. SSS of all four cases was due to sinus arrest in association with paroxysmal atrial fibrillation (Rubenstein-III). Of special interest is that one patient showed a high prevalence of SSS and NIDDM among her close relatives. Hyperinsulinemia of moderate degree was seen at fasting state or after carbohydrate ingestion in the absence of obesity. The resistance to the action of insulin on glucose metabolism which was evaluated in three patients by the euglycemic hyperinsulinemic clamp study was found to be comparable to the lowest quartile level for common NIDDM patients. Because insulin is a physiological regulator of cell-membrane Na⁺/K⁺-ATPase, we speculate that malfunction of the sinus node automaticity may be caused by chronic exposure to hyperinsulinemia secondary to insulin resistance in these NIDDM patients.
(Internal Medicine 34: 1174-1177, 1995)

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Pulmonary Paragonimiasis with Pleural Effusion Containing Paragonimus Ova: Sonographical Appearance of Pleural Effusion

Kazuhito UCHIDA, Shigeo SEKIGUCHI, Yoshiyuki DOI, Hiroshi YAMAZAKI

1995 Volume 34 Issue 12 Pages 1178-1180
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1178

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In the pleural effusion of a 46-year-old man with pulmonary paragonimiasis, numerous floating particles containing parasitic ova and granulation tissue were observed. The floating particles appeared as diffuse hyperechoic foci in the anechoic pleural effusion on ultrasonography. We concluded that rupture of the intrapulmonary paragonimiasis lesion into the pleural cavity caused the formation of these floating particles.
(Internal Medicine 34: 1178-1180, 1995)

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Glomerular Localization of Interleukin-6 Suppressed by Steroid Mini-pulse Therapy in an IgA Nephropathy Patient

Yoshihiko TANIGUCHI, Noriaki YORIOKA, Hiroaki ODA, Sayuri OKUSHIN, Yoj ...

1995 Volume 34 Issue 12 Pages 1181-1185
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1181

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A 16-year-old female with IgA nephropathy harboring histologically active lesions was treated with steroid mini-pulse therapy. Immunohistochemical examination revealed a diffuse distribution of interleukin-6 (IL-6) in the renal biopsy tissue. After treatment, her clinical factors and renal function improved, and renal biopsy showed reduced histological lesions and disappearance of the IL-6 distribution. Immunohistological studies of cytokines, such as IL-6, may be useful for evaluating the therapeutic effects in IgA nephropathy.
(Internal Medicine 34: 1181-1185, 1995)

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Combination Therapy with Granulocyte Colony-Stimulating Factor, All-Trans Retinoic Acid, and Low-Dose Cytotoxic Drugs for Acute Myelogenous Leukemia

Kensuke USUKI, Koichi KITAZUME, Mitsue ENDO, Keiko ITO, Seiko IKI, Aki ...

1995 Volume 34 Issue 12 Pages 1186-1189
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1186

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A 67-year-old man presented with acute myelogenous leukemia (M2). Peripheral blood examination revealed a leukocyte count of 1, 700/μl with 1% myeloblasts, and bone marrow aspiration showed 42.6% myeloblasts with Auer bodies. Culture of his marrow cells at diagnosis showed that granulocyte colony-stimulating factor (G-CSF) promoted cell proliferation, while all-trans retinoic acid (ATRA) inhibited the proliferative effect of G-CSF and induced differentiation. Combination therapy with G-CSF, ATRA, and low-dose cytotoxic drugs achieved complete remission without severe marrow suppression.
(Internal Medicine 34: 1186-1189, 1995)

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Effect of Prone Position on Apnea Severity in Obstructive Sleep Apnea

Yukinori MATSUZAWA, Shinichiro HAYASHI, Shinji YAMAGUCHI, Sawako YOSHI ...

1995 Volume 34 Issue 12 Pages 1190-1193
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1190

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We describe a patient with obstructive sleep apnea (OSA) whose apnea-hypopnea index (AHI) improved remarkably in the prone position accompanied by an improved sleep quality, despite a higher AHI in the supine position and even in the lateral position. Magnetic resonance imaging revealed the most dilated upper airway in the prone position, which suggests the role of anatomical narrowing of the upper airway as an important component in the pathophysiology of positional apnea patients. Further studies are needed to determine the therapeutic efficacy of a prone sleeping position in patients with OSA.
(Internal Medicine 34: 1190-1193, 1995)

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Veno-Occlusive Disease in Hypereosinophilic Syndrome

Kensuke KOJIMA, Takashi SASAKI

1995 Volume 34 Issue 12 Pages 1194-1197
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1194

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A 68-year-old male with hypereosinophilic syndrome developed acute hepatic veno-occlusive disease. The diagnosis of veno-occlusive disease was made mainly based on clinical symptoms and hepatic phlebography. Although veno-occlusive disease caused hepatic failure complicated with massive ascites, consciousness disturbance and coagulation abnormality, all of these manifestations subsided shortly after the start of corticosteroid therapy for hypereosinophilic syndrome. Since eosinophils cause direct tissue damage and local hypercoagulation, it is suggested that hypereosinophilia may be actively involved in the development of hepatic veno-occlusive disease in the course of the disease state.
(Internal Medicine 34: 1194-1197, 1995)

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Thalassemia Incidentally Found by Marked Erythrocytosis Due to an Ochre Mutation at Codon 35 in a Japanese Man

Mutsumi YASUNAGA, Yoshihide FUJIYAMA, Akiko MIYAGAWA, Tetsuya INOUE, A ...

1995 Volume 34 Issue 12 Pages 1198-1200
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1198

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We present a patient with β-thalassemia minor diagnosed on the basis of the incidental findings of marked hypochromic and microcytic erythrocytosis. Hemoglobin analysis revealed increased hemoglobin (Hb) A₂ levels and decreased β/α synthesis ratio in both the propositus and his mother. Further molecular studies identified a single base substitution of TCA to TAA within codon 35 in heterozygous state, which creates a premature terminator resulting in a defect of effective β globin synthesis. This is the first report of β-thalassemia due to a nonsense mutation at codon 35 of β-thalassemia gene in the Japanese population.
(Internal Medicine 34: 1198-1200, 1995)

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Big Insulin-like Growth Factor II-producing Hepatocellular Carcinoma Associated with Hypoglycemia

Shigeo ISHIDA, Mitsuhiko NODA, Nobuaki KUZUYA, Fumiyoshi KUBO, Shigeki ...

1995 Volume 34 Issue 12 Pages 1201-1206
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1201

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A 76-year-old female with a hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) was hospitalized because of fasting hypoglycemia. Her sera contained a low concentration of immunoreactive insulin and insulin-like growth factor (IGF)-I, while the IGF-II level was normal. However, most of the IGF-II consisted of the high molecular weight form (big IGF-II). The tumor tissue contained fetal type of IGF-II mRNA (6.0 kb). Furthermore, we found that one of the four patients examined with HCV-related HCC had big IGF-II in serum. This indicates that non-islet cell tumor hypoglycemia (NICTH) in HCV-related HCC might be accompanied by production of big IGF-II by the tumor.
(Internal Medicine 34: 1201-1206, 1995)

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Allergic Reaction Involving Liver Dysfunction and Disseminated Intravascular Coagulation Caused by a Health Food, Proporis

Akihiro TAKESHITA, Kaori SHINJO, Kazunori OHNISHI, Ryuzo OHNO

1995 Volume 34 Issue 12 Pages 1207-1209
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1207

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A 43-year-old woman was hospitalized with skin eruption and liver dysfunction complicated with disseminated intravascular coagulation (DIC) after taking Proporis, a so-called health food. Her clinical course was well correlated with discontinuation and the retaking of Proporis. No other reason for the development of DIC was detected except for allergic reaction to Proporis, as demonstrated by a patch skin test. DIC subsided after the discontinuation of Proporis and treatment with gabexate mesilate and heparin. The consumption of health foods with various ingredients is recently increasing. Thus, attention should be paid to any possible serious allergic reaction related to such foods.
(Internal Medicine 34:1207-1209, 1995)

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Creatine Phosphokinase-Linked Immunoglobulin Associated with Hypokalemic Myopathy

Jin HOSHINO, Hiroyuki ARAI, Toshio FUKUSATO, Tetsuya NAKAMURA, Noboru ...

1995 Volume 34 Issue 12 Pages 1210-1214
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1210

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We present three women with hypokalemic myopathy in whom serum creatine phosphokinase (CPK) was bound to serum immunoglobulin (macro-CPK). In all three cases, CPK isozyme electrophoresis demonstrated an extra CPK band between CPK-MM and CPK-MB. The bound immunoglobulins were identified as IgA/A-κ and λ, , IgA-λ and IgA-κ and λ, respectively. In all cases, histological examination of the biopsied muscles revealed necrotic and/or regenerating fibers. In each patient, potassium replacement therapy returned the macro-CPK as well as the marked elevations of serum muscle enzymes to normal. Taken together with other recent reports, our findings suggested that CPK-immunoglobulin binding may be related to the emergence of pathophysiology of hypokalemic myopathy.
(Internal Medicine 34: 1210-1214, 1995)

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Human T-Lymphotropic Virus Type I Associated Myelopathy Treated Effectively with Lymphocytapheresis Using a Leukocyte Removal Filter

Minoru OISHI, Yoko MOCHIZUKI, Motohiko HARA, Hiroko URYU, Shunzo OSAKA ...

1995 Volume 34 Issue 12 Pages 1215-1219
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1215

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The patient, a 61-year-old woman, received a blood transfusion at the age of 33 years. Weakness of the lower extremities developed at the age of 42 and the diagnosis of human T-lymphotropic virus type I (HTLV-I) associated myelopathy was made. Somatosensory evoked potential examination showed that the latency of P27 evoked by peroneal nerve stimulation was 44 msec. Lymphocytapheresis was performed 3 times with one-week intervals using a leukocyte removal filter. The muscle weakness began to improve on the second day after the second lymphocytapheresis and the sensory impairment began to improve on the third day after the third lymphocytapheresis. The delayed latency of P27 improved after the lymphocytapheresis. The effectiveness of lymphocytapheresis in this case suggests that lymphocytes are involved in the pathogenesis of HTLV-I associated myelopathy.
(Internal Medicine 34: 1215-1219, 1995)

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Systemic Capillary Leak Syndrome Associated with Multiple Myeloma of IgG κType

Eiji HIRAOKA, Yumi MATSUSHIMA, Yoko INOMOTO-NARIBAYASHI, Hirohisa NAKA ...

1995 Volume 34 Issue 12 Pages 1220-1224
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1220

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A case of systemic capillary leak syndrome in a 67-year-old woman is reported. The patient suddenly presented with severe edema and hypotension associated with an increased hematocrit and a decreased level of serum albumin, suggesting capillary hyperpermeability. The patient had IgG κ monoclonal gammopathy in association with not only a slight increase in plasma cells in the bone marrow but also several punched out lesions in the skull, indicating multiple myeloma. Although most of the cases of systemic capillary leak syndrome reported previously were accompanied by monoclonal gammopathy, this appears to be the first case in which capillary leak syndrome developed in a patient with multiple myeloma.
(Internal Medicine 34: 1220-1224, 1995)

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