Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
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Volume 34, Issue 1
Displaying 1-18 of 18 articles from this issue
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  • Massive Pericardial Effusion in a Patient with Hashimoto's Thyroiditis: Histological Examination of Underlying Cardiomyopathy
    Takahiro YAMADA, Hiroshi YAMAMOTO, Kenji HIRAHARA, Osamu TOKUNAGA
    1995 Volume 34 Issue 1 Pages 1-5
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.1
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    An unusual case of a hypothyroid patient with huge pericardial effusion due to Hashimoto's thyroiditis is reported. Cardiac tamponade occurred during admission. Eight hundred milliliters of pericardial effusion was withdrawn by pericardiocentesis. Even after successful replacement of thyroid hormone, she had recurrent effusion two years later. Refractory pericardial effusion is a rare complication in treated hypothyroid patients. Underlying Cardiomyopathy was presented with hemodynamic and histological examinations.
    (Internal Medicine 34: 1-5, 1995)
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  • CRST Syndrome (Calcinosis Cuds, Raynaud's Phenomenon, Sclerodactyly, and Telangiectasia) Associated with Autoimmune Hepatitis
    Mamoru ISHIKAWA, Jun OKADA, Akitaka SHIBUYA, Hirobumi KONDO
    1995 Volume 34 Issue 1 Pages 6-9
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.6
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    A case of Raynaud's phenomenon, was complicated with autoimmune hepatitis (AIH) during the clinical course, and subsequently with gangrene of the fingertips caused by CRST syndrome (calcinosis cutis, Raynaud's phenomenon, sclerodactyly and telangiectasia). The presence of anticentromere antibodies is rare in AIH; to date, there has been only one report of a combination of AIH and CRST syndrome. This combination of the two diseases has been identified only in Japan.
    (Internal Medicine 34: 6-9, 1995)
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  • Recurrent Cushing's Disease Associated with Nephrotic Syndrome
    Tomohide TATSUMI, Toyohiko MORISHIMA, Takao WATARAI, Masashi KUBOTA, M ...
    1995 Volume 34 Issue 1 Pages 10-14
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.10
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    A case of recurrent Cushing's disease with nephrotic syndrome due to membranoproliferative glomerulonephritis (MPGN) is presented. Functional pituitary adenoma recurred 6 years after transsphenoidal pituitary adenomectomy. Due to infiltration into the surrounding tissues, transcranial surgery was performed. However, this failed to induce a remission and thus gamma knife therapy was applied. Histopathological evaluation revealed that the glomerular lesions had progressed to a rather advanced stage of MPGN. Although this association could be coincidental, the recurrence of pituitary macroadenoma might be induced by the cessation of steroid treatment for the nephrotic syndrome.
    (Internal Medicine 34: 10-14, 1995)
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  • Chronic Lymphocytic Leukemia Associated with Nephrotic Syndrome and Dermatomyositis
    Takashi ISHIDA, Keiko AIKAWA, Takashi TAMURA, Kouki YOSHIDA, Chikara M ...
    1995 Volume 34 Issue 1 Pages 15-17
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.15
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    Several types of autoimmune complications of chronic lymphocytic leukemia (CLL) have been previously reported. However, the tendency to develop autoantibodies is usually restricted to the hematopoietic system. We report a 68-year-old man who had developed dermatomyositis after ten years of chemotherapy for CLL. He also had secondary nephrotic syndrome at the onset of CLL. Subsequently, the patient died of perforation of the small intestine. The association of both nephrotic syndrome and dermatomyositis with CLL is very rare. We discuss the possibility of a causal relation.
    (Internal Medicine 34: 15-17, 1995)
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  • Boucher-Neuhauser Syndrome Associated with Hypocalciuric Hypercalcemia
    Mayuri ICHINOSE, Katsuyoshi TOJO, Masaaki NAKAYAMA, Takashi HASEGAWA, ...
    1995 Volume 34 Issue 1 Pages 18-23
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.18
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    A 52-year-old woman was diagnosed as having cerebellar ataxia, hypogonadotropic hypogonadism and retinochoroidal degeneration, the so-called, "Boucher-Neuhauser" syndrome proposed by Limber et al (Am J Med Genet 33:409, 1989). In addition, laboratory findings showed the elevation of serum calcium (Ca) levels, low urinary Ca excretion, and exaggerated reabsorption of filtrated Ca (FECa: 0.14%), suggesting complication of hypocalciuric hypercalcemia. This is a very rare case of Boucher-Neuhauser syndrome associated with hypocalciuric hypercalcemia.
    (Internal Medicine 34: 18-23, 1995)
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  • Thrombotic Thrombocytopenic Purpura and Myoglobinuric Acute Renal Failure following Radiation Therapy in a Patient with Polymyositis and Cervical Cancer
    Hirofumi MAKINO, Yoshio NAGAKE, Kazuhiko MORIWAKI, Shuzo HIRAKAWA, Tak ...
    1995 Volume 34 Issue 1 Pages 24-27
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.24
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    A 73-year-old woman was admitted to receive radiation treatment for uterine cervical cancer, however a complex series of events ensued, leading to death. She developed an acute exacerbation of polymyositis complicated by thrombotic thrombocytopenic purpura, rhabdomyolysis and acute renal failure. Radiation therapy may have produced an immune disturbance leading to the acute exacerbation of polymyositis. Auto-immune-mediated endothelial damage might have triggered a series of events leading to thrombotic thrombocytopenic purpura. Rhabdomyolysis seemed to be the main cause of acute renal failure.
    (Internal Medicine 34: 24-27, 1995)
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  • Refractory Anemia with an Excess of Blasts Developed into Overt Leukemia with Leukothrombocytosis
    Isao TAKAHASHI, Kazuto TOGITANI, Motoharu YOKOYAMA, Tetsunori AITA, Ki ...
    1995 Volume 34 Issue 1 Pages 28-31
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.28
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    A 72-year-old man with refractory anemia with an excess of blasts developed overt leukemia with leukothrombocytosis. Hematological and physical findings closely resembled those of an accelerated or blastic phase of chronic myelocytic leukemia. The cytogenetic anomaly of i(17q) was observed during the course. The present case is suggestive of the diversities of myelodysplastic syndromes (MDS), including relationships between MDS and myeloproliferative disorders (MPD) and acute leukemia.
    (Internal Medicine 34: 28-31, 1995)
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  • Plasmodium vivax Malaria Infection Diagnosed by Indirect Fluorescent Antibody Test
    Michihiro GOTOH, Sohji NAGASE, Kouichi HIRAYAMA, Takashi ISHIZU, Tadas ...
    1995 Volume 34 Issue 1 Pages 32-35
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.32
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    We present the diagnostically challenging case of a 51-year-old Japanese male who visited Papua New Guinea for one month. Approximately a month after returning to Japan, he experienced a high fever. Malaria was suspected and he was admitted to Tsukuba University Hospital. Although the blood smear did not reveal the malarial parasite, a diagnosis of malaria was made using an indirect fluorescent antibody test (IFAT). The patient was treated and discharged but symptoms returned three months later. This time, the blood smear was positive for malarial parasites. IFAT was useful in this case for the early diagnosis of Plasmodium vivax and for ruling out infection by Plasmodium falciparum.
    (Internal Medicine 34: 32-35, 1995)
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  • B-Cell Lymphoma Terminating in Acute Monoblastic Leukemia
    Kazuo MUROI, Shigehiko IMAGAWA, Toshiyuki SUZUKI, Youichi AMEMIYA, Yas ...
    1995 Volume 34 Issue 1 Pages 36-38
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.36
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    A case of CD11b-, CD14- and CD36-positive B-cell lymphoma terminating in acute monoblastic leukemia is presented. The patient was initially suspected as having angiotrophic lymphoma due to proliferation of lymphoma cells within the sinusoid of the liver and clinical signs. Following chemotherapy, the lymphoma cells were converted into CD11b- and CD36-positive monoblasts. Lineage switching of B-cell lymphoma to acute monoblastic leukemia may have occurred in this case.
    (Internal Medicine 34: 36-38, 1995)
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  • Rectus Hematoma Secondary to Vomiting: A Complication of Conditioning Regimen for Bone Marrow Transplantation
    Toshiya KOURA, Takeyoshi ITOH, Jun-ichiro MOTIMARU, Masahiko INOUE, Ak ...
    1995 Volume 34 Issue 1 Pages 39-41
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.39
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    A 41-year-old woman with chronic myelogenic leukemia was scheduled to undergo transplantation of bone marrow. The patient complained of nausea and vomiting following the initiation of chemotherapy. One day prior to the planned termination of chemotherapy, the patient developed left-sided abdominal pain. Physical examination and imaging examination indicated the possibility of acute abdomen associated with bleeding or herniation. For therapeutic and diagnostic purposes, an emergency operation was performed. A 6×5 cm hematoma was detected within the left rectus abdominis muscle. It is suggested that the gastrointestinal symptoms should be carefully controlled in patients undergoing bone marrow transplantation.
    (Internal Medicine 34: 39-41, 1995)
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  • Septic Pulmonary Emboli Secondary to Pyogenic Liver Abscess in a Diabetic Patient
    Takahiro ZENDA, Ichiro ARAKI, Yoshio HIRAIWA, Shiro MIYAYAMA, Takaharu ...
    1995 Volume 34 Issue 1 Pages 42-45
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.42
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    A 70-year-old woman with poorly controlled diabetes mellitus was admitted because of persistent remittent fever. Soon a liver abscess was detected as the cause of the fever by ultrasonography, and antibiotic therapy was started. However, suddenly serious dyspnea with chest and back pain developed. The morbid condition was definitely diagnosed as septic pulmonary emboli (SPE) with pulmonary perfusion scan. It should be recognized that liver abscess can be a latent focus of systemic metastatic complications such as SPE, and not only early detection but also prompt appropriate drainage of liver abscesses is essential.
    (Internal Medicine 34: 42-45, 1995)
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  • Nephrotic Syndrome Associated with Fibrillary Deposits in the Glomeruli
    Wako YUMURA, Kosaku NITTA, Shigeru HORITA, Hiroyuki Ozu, Kazuho HONDA, ...
    1995 Volume 34 Issue 1 Pages 46-50
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.46
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    A 48-year-old woman with nephrotic syndrome underwent renal biopsy. Light microscopy showed nodular sclerosis and thickening of the glomerular capillary wall. Immunoglobulins (Ig) G, especially IgG2, IgM, IgA, C3, and C1q were detected along the glomerular capillary walls by immunofluorescent microscopy. Electron microscopy revealed that fibrillar materials of about 25 nm were accumulated in the subepithelial area of the glomerular basement membrane. These materials were negative for Congo-red staining. Neither cryoglobulinemia nor paraproteinemia including light chains was found. This case was diagnosed as membranous nephropathy by clinical findings and pathological examinations, and seemed to be a case of fibrillary glomerulonephritis.
    (Internal Medicine 34: 46-50, 1995)
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  • Postcholecystectomy Syndrome Mimicking Angina Pectoris Detected by the Morphine Provocation Test
    Hiroyuki OSAWA, Muneyasu SAITO, Mikihisa FUJII, Takeo YAMANAKA, Toshio ...
    1995 Volume 34 Issue 1 Pages 51-53
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.51
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    A 66-year-old woman had had intermittent anterior chest pain and upper abdominal pain for 15 years. Angina pectoris was diagnosed at the age of 51 years, as she had typical anginal pain that was relieved by nitroglycerine, although coronary arteriography was normal and the ergonovine provocative test was negative. She had undergone cholecystectomy at the age of 38 years. Her bile duct pressure increased markedly after morphine injection and severe pain with the aforementioned distribution was produced. Postcholecystectomy syndrome due to sphincter of Oddi spasm was diagnosed and her pain was relieved by endoscopic sphincterotomy.
    (Internal Medicine 34: 51-53, 1995)
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  • Detection of Cryptococcus neoformans in Bronchial Lavage Cytology: Report of Four Cases
    Shigefumi MAESAKI, Shigeru KOHNO, Hideo MASHIMOTO, Jun ARAKI, Sadahiro ...
    1995 Volume 34 Issue 1 Pages 54-57
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.54
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    Four cases of pulmonary cryptococcosis were diagnosed by cytological detection of Cryptococcus neoformans in bronchial lavage. Three patients had underlying diseases, but not HIV infection. The chest X-rays showed 2 patients with nodular lesions and 2 with cavitary lesions. The cryptococcal antigen in the serum was positive in all four patients. In the cytology of bronchial lavage, Cryptococcus neoformans was detected after periodic-acid-Schiff (PAS) staining and was cultured in Sabouraud-dextrose agar. The cytology of bronchial lavage is useful for the rapid diagnosis of pulmonary cryptococcosis.
    (Internal Medicine 34: 54-57, 1995)
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  • Graves' Hyperthyroidism Following Transient Thyrotoxicosis during Interferon Therapy for Chronic Hepatitis Type C
    Shigeki KOIZUMI, Yasuo MASHIO, Hitoshi MIZUO, Akira MATSUDA, Kumiko MA ...
    1995 Volume 34 Issue 1 Pages 58-60
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.58
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    We report a case of Graves' hyperthyroidism induced by long-term interferon (IFN) therapy.A 52-year-old woman suffered from chronic active hepatitis type C and was treated with a total of 456×106 units of IFN-α for 23 weeks. During the 12th week of treatment she showed transient thyrotoxicosis. One week after the termination of IFN therapy, TSH-receptor antibodies became positive and subsequently she showed Graves' hyperthyroidism. This case showed sequential manifestation from transient thyrotoxicosis to the appearance of TSH-receptor autoantibodies, and then the occurrence of Graves' hyperthyroidism during IFN therapy. The course of this case may be useful in the understanding of the pathogenesis of autoimmune hyperthyroidism.
    (Internal Medicine 34: 58-60, 1995)
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  • Squamous Cell Carcinoma of the Pancreas with Massive Invasion of the Retroperitoneum
    Hideyasu NAKASHIMA, Tomihiro HAYAKAWA, Makoto HOSHINO, Yasutaka KAMIYA ...
    1995 Volume 34 Issue 1 Pages 61-64
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.61
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    A 79-year-old woman with a rare form of pancreatic carcinoma with massive invasion of the retroperitoneum presented with upper abdominal pain and vomiting. Although examination (computed tomography, barium enema, upper gastrointestinal series) suggested peritonitis carcinomatosa due to pancreatic cancer, a primary lesion of the pancreas was not confirmed by endoscopic retrograde pancreatography. Autopsy ultimately revealed a small tumor (5×8 mm) of the uncinate process of the pancreas near the duodenum with peritonitis carcinomatosa. Microscopically, the tumor and its metastasis consisted of poorly differentiated squamous cell carcinoma without adenocarcinomatous change, a rare form of pancreatic tumor.
    (Internal Medicine 34: 61-64, 1995)
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  • IL-5 Predominant in Bronchoalveolar Lavage Fluid and Peripheral Blood in a Patient with Acute Eosinophilic Pneumonia
    Shinji YAMAGUCHI, Yoshio OKUBO, Mahboob HOSSAIN, Keisaku FUJIMOTO, Tak ...
    1995 Volume 34 Issue 1 Pages 65-68
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.65
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    We describe an acute eosinophilic pneumonia (AEP) patient with bronchoalveolar lavage fluid (BALF). Eosinophil cell number (47%), content of interleukin (IL)-5 (8.22×102 pg/ml) and eosinophil cationic protein (9.25 μg/ml) were high in BALF. No eosinophilia was seen in peripheral blood on admission; however, content of IL-5 was 9.47×102 pg/ml. After methylprednisolone pulse therapy, he improved rapidly with a reduction in eosinophil cell number (7%) and the content of IL-5 (<100 pg/ml) in BALF. However, a high content of IL-5 (6.9×102 pg/ml) and transient eosinophilia (17.5%) were seen in peripheral blood. It is important to distinguish between AEP and infectious pneumonia, because of the differing treatments. If the diagnosis of AEP is doubtful, BALF should be performed early.
    (Internal Medicine 34: 65-68, 1995)
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  • Liver Damage after Danazol and Glucocorticoids for Chronic Idiopathic Thrombocytopenic Purpura (ITP)
    Atsushi SAKUMA, Isao TSUBOI, Kohji MORIMOTO, Umihiko SAWADA, Takashi H ...
    1995 Volume 34 Issue 1 Pages 69
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.69
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