Internal Medicine

Antibodies to Liver/Kidney Microsome Type 1 Positive Chronic Hepatitis C and Cryoglobulinemia

Mikio NISHIOKA

1995 Volume 34 Issue 11 Pages 1043-1044
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1043

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Parkinson's Disease: From Etiology to Treatment

Yoshikuni MIZUNO, Hideo MORI, Tomoyoshi KONDO

1995 Volume 34 Issue 11 Pages 1045-1054
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1045

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We review the recent progress in the research of the etiology, pathogenesis and treatment of Parkinson's disease. It has been postulated that mitochondrial respiratory failure and oxidative stress are two major contributors to nigral cell death in Parkinson's disease. Loss of mitochondrial complex I and the α-ketoglutarate dehydrogenase complex in the substantia nigra has been reported. Evidence to indicate oxidative stress includes a high dopamine content, increase in superoxide dismutase activities, increase in iron, and decrease in glutathione in the substantia nigra. The question posed is which one occurs first. We believe mitochondrial respiratory failure occurs first, because slowing down of the electron transport induces an increase in the formation of activated oxygen species. The primary cause of Parkinson's disease is still unknown, but we believe the interaction of environmental toxins and genetic predispositions is important. In this respect, molecular genetic studies on familial Parkinson's disease are very important.
(Internal Medicine 34: 1045-1054, 1995)

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Thyrotropin-Producing Pituitary Adenoma Discovered as a Pituitary Incidentaloma

Noriyoshi YAMAKITA, Tsuneko IKEDA, Toshihiro MURAI, Takashi KOMAKI, To ...

1995 Volume 34 Issue 11 Pages 1055-1060
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1055

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A 46-year-old woman with incidentally discovered thyrotropin (TSH)-producing pituitary adenoma showed endocrine data which was consistent with TSH-producing pituitary tumor. However, she showed only slight hyperthyroidism and the oversecretion and autonomous secretion of TSH from the tumor seemed to be limited from the results of several endocrine examinations. Immunohistochemical examination revealed that not only TSH-β and TSH-α but also prolactin and growth hormone synthesizing cells were present in the tumor tissue. Pituitary-transcription activator 1 (Pit-1) immunoreactivity was also detected in the adenoma cell nuclei. It was conceivable that the presented TSH-producing adenoma clinically located close to the nonfunctioning adenoma and Pit-1 may have played an important role in the multidirectional differentiation or development of this tumor.
(Internal Medicine 34: 1055-1060, 1995)

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Limitations of Electrocardiography in the Diagnosis of Acute Myocardial Infarction - Comparison with Two-Dimensional Echocardiography -

Chisato IZUMI, Kanji IGA, Takahisa KIJIMA, Yoshihiro HIMURA, Hiromitsu ...

1995 Volume 34 Issue 11 Pages 1061-1063
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1061

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In order to assess the sensitivity of the initial electrocardiogram (ECG) in diagnosing the first attack of acute myocardial infarction (AMI), we compared the findings on ECG and two-dimensional echocardiogram (2-D echo) in 74 patients with single vessel coronary artery disease. Group A consisted of 41 patients with infero-posterior AMI while group B consisted of 33 patients with antero-septal AMI. In group A, 12 patients showed normal ECGs, while 2-D echo failed to reveal abnormal left ventricular wall motion in only 2 patients. In those two patients, the quality of the echocardiogram was poor. In group B, only one patient showed a normal ECG, and all patients showed abnormal left ventricular wall motion on 2-D echo. We conclude that electrocardiography has limitations in diagnosing infero-posterior myocardial infarction especially during the acute phase, but 2-D echo is an additional useful diagnostic procedure.
(Internal Medicine 34: 1061-1063, 1995)

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Detection of Coronary Artery Disease Using 12-Lead Electrocardiogram and Simultaneous Dual Myocardial Imaging with Iodine-123-β-Methyl Iodophenyl-Pentadecanoic Acid (BMIPP) and Thallium-201 in Patients with Unstable Angina

Makoto SAITOH, Koh HASEGAWA, Kazuo HASEGAWA, Terao KONDOH, Tetsuo YANA ...

1995 Volume 34 Issue 11 Pages 1064-1070
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1064

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We investigated the usefulness of 12-lead electrocardiogram and simultaneous single-photon emission computed tomography (SPECT) with ¹²³I-β-methyl iodophenyl-pentadecanoic acid (BMIPP) and thallium-201 (²⁰¹Tl) for detecting coronary artery disease (CAD) in 54 consecutive patients with unstable angina. Discordant BMIPP uptake was denned as less ¹²³I-BMIPP uptake than ²⁰¹Tl uptake in ¹²³I-BMIPP/²⁰¹Tl dual SPECT. In the detection of CAD, ischemic electrocardiographic change during anginal attack had high sensitivity and low specificity, while discordant BMIPP finding had low sensitivity and high specificity. In patients showing ST depression during anginal attack, discordant BMIPP uptake showed high sensitivity and high specificity for detecting CAD. In conclusion, both 12-lead electrocardiogram during anginal attack and discordant BMIPP uptake are useful in detecting CAD in patients with unstable angina.
(Internal Medicine 34: 1064-1070, 1995)

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Primary Hypoparathyroidism in Turner's Syndrome

Yasuyo SUZUKI, Hiroshi WATANABE, Shigehiko HAENO, Takashi OMORI, Ryoji ...

1995 Volume 34 Issue 11 Pages 1071-1073
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1071

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A case of hypoparathyroidism accompanied with Turner's syndrome is reported. On admission, a 44-year-old woman had facial dystonia, deafness, and primary amenorrhea. Laboratory examinations showed a decrease in serum PTH and mosaicism of 45, X and 46, XX(6:34). A brain CT revealed marked calcification in the basal ganglia, cerebellum and periventricular area. Antiparkinsonian drugs were found to be effective for the dystonia. This case therefore suggests that some relationship may exist between intracranial calcification and Turner's syndrome.
(Internal Medicine 34: 1071-1073, 1995)

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Three Cases of Clinical or Preclinical Gushing's Syndrome due to Adrenocorticotropic Hormone-Independent Bilateral Adrenocortical Macronodular Hyperplasia: Pituitary-Adrenocortical Function and Immunohistochemistry

Osamu MURAKAMI, Fumitoshi SATOH, Kazuhiro TAKAHASHI, Kazuhito TOTSUNE, ...

1995 Volume 34 Issue 11 Pages 1074-1081
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1074

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We performed pituitary-adrenocortical function test and analysis of plasma steroids in three cases of adrenocorticotropic hormone-independent bilateral adrenocortical macronodular hyperplasia, and examined the plasma cortisol response to meal and oral glucose in two cases. On pathological examination, nodules were mainly composed of clear cells and some nests of compact cells were observed. Immunohistochemistry of steroidogenic enzymes showed positive P-450_C17 only in the compact cells and positive 3β-hydroxysteroid dehydrogenase only in the clear cells. These cases were similar to clinical or preclinical Cushing's syndrome due to adenoma in both pituitary-adrenocortical function and plasma steroid patterns, but different from adenoma cases in the distribution of steroidogenic enzymes.
(Internal Medicine 34: 1074-1081, 1995)

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Anti-Hu Antibody in a Patient with Lambert-Eaton Myasthenic Syndrome and Early Detection of Small Cell Lung Cancer

Kazuhiro TOMIYASU, Hiroaki ITO, Naomi KANAZAWA, Toyokazu SAITO, Hisayu ...

1995 Volume 34 Issue 11 Pages 1082-1085
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1082

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We report a patient with Lambert-Eaton myasthenic syndrome (LEMS) and anti-Hu antibody, which was an important clue in detecting small cell lung cancer (SCLC) at the early stage. This patient had no symptoms of anti-Hu associated paraneoplastic neurological syndrome. In LEMS patients in whom conventional tests fail to detect malignancy, anti-Hu antibody should be evaluated to diagnose SCLC at the early stage.
(Internal Medicine 34: 1082-1085, 1995)

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A Salivary Gland-Type Monomorphic Adenoma with Trabecular Proliferation in the Lung

Arimasa SHIRASAKI, Yoichi HIRAKATA, Satoshi KITAMURA, Seiji BANDOH, Ke ...

1995 Volume 34 Issue 11 Pages 1086-1088
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1086

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Salivary gland-type adenoma, especially monomorphic adenoma in the lung is very rare. We report a 66-year-old previously healthy woman who developed cough, hemosputum, and fever. Bronchoscopy revealed an endobronchial mass in the proximal portion of the left lower lobe bronchus. Following left lower lobectomy, the pathological diagnosis was an unusual monomorphic adenoma of the salivary gland-type with trabecular proliferation.
(Internal Medicine 34: 1086-1088, 1995)

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Non-Obese Cushing's Syndrome in an Aged Woman with Non-Insulin-Dependent Diabetes Mellitus

Kenzo UCHIDA, Ryoji IWASAKI, Shigeru NAKANO, Toshikazu KIGOSHI, Shinpe ...

1995 Volume 34 Issue 11 Pages 1089-1092
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1089

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A 76-year-old diabetic woman with non-obese Cushing's syndrome developed poor glycemic control with glibenclamide. She presented with a slight weight loss while bedridden due to a fall. Cushing's syndrome in this patient was suspected because of hypercortisolemia with eosinopenia, and adrenal Cushing's syndrome was diagnosed by endocrine and radiological examinations. A right adrenal adenoma was confirmed by autopsy. In this patient, progressive obesity and other common features of Cushing's syndrome may have been concealed by aging itself and coexisting diabetes mellitus.
(Internal Medicine 34: 1089-1092, 1995)

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Inflammatory Involvement of the Hypophysis in Tolosa-Hunt Syndrome

Choichi HIDA, Teiji YAMAMOTO, Kazuhiro ENDO, Yoshihiro TANNO, Tasuku S ...

1995 Volume 34 Issue 11 Pages 1093-1096
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1093

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We report a case of painful ophthalmoplegia (Tolosa-Hunt syndrome), which was complicated with diabetes insipidus (DI) and pituitary-adrenal axis hypofunction. A 42-year-old man hospitalized for left orbital pain and impairment of left cranial nerves III, IV, V, VI, developed diabetes insipidus during the corticosteroid treatment. Neuroimaging studies disclosed a thickened, highly contrast-enhanced pituitary stalk, swollen pituitary gland and widened left cavernous sinus up to the superior orbital fissure, which were accompanied by diabetes insipidus and hypofunction of the pituitary-adrenal axis. These were indicative of an extension of granulomatous inflammation of the cavernous sinus to the pituitary portal system and the gland itself.
(Internal Medicine 34: 1093-1096, 1995)

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Occurrence of Graves' Disease during Re treatment with Interferon-α2a for Chronic Hepatitis C

Masaaki WADA, Wataru HIRAIZUMI, Miki FUJIMOTO, Akira KINUGASA, Shigeyu ...

1995 Volume 34 Issue 11 Pages 1097-1100
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1097

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The present report describes a patient who developed Graves' disease 3 months after inception of retreatment with higher doses of interferon-α2a for chronic hepatitis C, although the initial 6-month treatment caused no serious adverse reactions. Severe hyperthyroidism continued despite discontinuation of interferon-α2a, and the patient was subsequently treated with ¹³¹I. This case suggests careful evaluation of the safety of retreatment to prevent manifestation of such a complication in the retreatment of chronic hepatitis C with interferon.
(Internal Medicine 34: 1097-1100, 1995)

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Malignant Intestinal Schwannoma: A Case Report and a Review of the Literature in Japan

Tsukasa Nozu, Atsushi TAKAHASHI, Hiroichi ASAKAWA, Akira UEHARA, Yutak ...

1995 Volume 34 Issue 11 Pages 1101-1105
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1101

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We report the rare case of malignant intestinal schwannoma, not accompanied with von Recklinghausen's disease. The main tumor was located in the ileum with multiple small tumors observed on the peritoneum. Histologically the tumor was composed of spindle cells exhibiting a nuclear palisading formation and abnormal mitotic figures were observed. The tumor was immunohistochemically positive for S-100 protein, glial fibrillary acidic protein, vimentin and neuron-specific enolase, but negative for desmin. Electron microscopically the tumor cell exhibited morphological findings characteristic of schwann cell differentiation. On the basis of these results, the tumor was diagnosed as malignant schwannoma occurring in the ileum.
(Internal Medicine 34:1101-1105, 1995)

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Fatal Diarrhea in a Patient with Castleman's Disease Associated with Intestinal Amyloidosis

Akira MIURA, Isao SATO, Chiyuki SUZUKI

1995 Volume 34 Issue 11 Pages 1106-1109
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1106

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A 32-year-old woman presented with Castleman's disease associated with intestinal amyloidosis. The association of amyloidosis and Castleman's disease is very rare, with only 15 cases reported in the literature. To our knowledge, this is the second case in which persistent diarrhea and malnutrition led to the patient's death.
(Internal Medicine 34: 1106-1109, 1995)

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Wegener's Granulomatosis with Multiple Cranial Nerve Involvements as the Initial Clinical Manifestations

Tetsuya KASHIYAMA, Akira SUZUKI, Kunio MIZUGUCHI

1995 Volume 34 Issue 11 Pages 1110-1113
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1110

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Wegener's granulomatosis (WG) is a disease of unknown origin characterized by necrotizing granulomas of both the upper and lower respiratory tracts and glomerulonephritis. A 62-year-old woman presenting unusual neurological manifestations is reported. The patient suffered from palsies of multiple cranial nerves without manifestation of respiratory tracts in the initial clinical course. Seven years after the onset, pulmonary consolidations appeared on the chest X-ray study. A diagnosis was made by a needle biopsy of the lung. Palsies of cranial nerves suspected to be due to meningeal involvement of WG. During the entire clinical course, no finding of glomerulonephritis was observed.
(Internal Medicine 34: 1110-1113, 1995)

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Anti-Liver/Kidney Microsome-1-Positive Chronic Hepatitis C with Type I Cryoglobulinemia Responding to Interferonv

Kazuhiro ABE, Hiroshi MIYAKAWA, Kiyomitsu MIYACHI, Makoto KAKO, Hisash ...

1995 Volume 34 Issue 11 Pages 1114-1119
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1114

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A 53-year-old man was admitted to our hospital for close examination of his liver. Serum hepatitis C virus (HCV) RNA and anti-liver/kidney microsome (LKM) 1 were positive. Benign monoclonal gammopathy and type I cryoglobulinemia (both of IgG λ class) which are rarely seen in association with chronic hepatitis C, were found to be present. Interferon therapy was given, resulting in the disappearance of both HCV-RNA and type I cryoglobulin in the blood. We propose a hypothesis that the primary cause of anti-LKM-1-positive chronic hepatitis C is HCV infection which triggers secondary autoimmune phenomena presenting anti-LKM-1 and cryoglobulinemia.
(Internal Medicine 34: 1114-1119, 1995)

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Intention Tremor and Olivary Enlargement: Clinico-Radiological Study

Toshiya FUKUI, Hiroo ICHIKAWA, Koujiro SUGITA, Hiroshi TSUKAGOSHI

1995 Volume 34 Issue 11 Pages 1120-1125
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1120

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This study describes two patients who presented with intention tremor (IT) concomitant with olivary enlargement (OE), and discusses the relationship between these phenomena. Both patients had a vascular lesion in the brain stem, which subsequently caused IT and OE ipsilateral or contralateral to the site of the lesion, depending on the structures effected by the lesion. The results of our study suggest that damage involving the superior cerebellar tract, and central tegmental tract, or both, may result in IT and OE. However, IT and OE appear to have little physiological association, unlike the relation between OE and palatal myoclonus.
(Internal Medicine 34: 1120-1125, 1995)

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Malignant Hemangioendothelioma of the Aorta

Noriharu SHIJUBO, Hisashi NAKATA, Fumiko SUGAYA, Akihiro IMADA, Akihir ...

1995 Volume 34 Issue 11 Pages 1126-1129
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1126

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We present a rare case of aortic malignant hemangioendothelioma with a mural growth pattern in which the endothelial nature was confirmed by immunohistochemical demonstration of Factor VIII-related antigen. Aortic sarcomas and malignant hemangioendotheliomas in the literature are reviewed.
(Internal Medicine 34: 1126-1129, 1995)

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Human T-Cell Lymphotropic Virus Type-I (HTLV-I)-Associated Myelopathy/Tropical Spastic Paraparesis with Acute Type of Adult T-Cell Leukemia

Yoshitaka FURUKAWA, Toshihide OKADOME, Mitsutoshi TARA, Kiyoshige NIIN ...

1995 Volume 34 Issue 11 Pages 1130-1133
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1130

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We report a 47-year-old Japanese woman with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) combined with acute type adult T-cell leukemia (ATL). The susceptibility for HAM/TSP and acute type of ATL is hitherto explained by human leukocyte antigen (HLA) haplotype-linked immune responsiveness to HTLV-I. This patient's HLA (A24CwlB54DR4DQ4/A24Cw3B51DR8DQl) included a RAM-associated HLA haplotype. This suggests that HAM patients with HAM-associated HLA haplotype can also develop the acute type of ATL.
(Internal Medicine 34: 1130-1133, 1995)

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Angiotropic B-Cell Lymphoma Presenting with Progressive Dementia: An Autopsy Case and Review of the Literature in Japan

Tatsuyuki HAYASHI, Eiichi WATANABE, Maki OGAWA, Moriyuki TERAKURA, Yas ...

1995 Volume 34 Issue 11 Pages 1134-1139
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1134

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We report an autopsy case of angiotropic lymphoma and review the literature in Japan. A 68-year-old female presented with transient right facial nerve palsy, right hemiplegia and progressive dementia. Laboratory studies showed raised erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase. Computed tomography of the brain did not show any abnormal density areas but on T2-weighted magnetic resonance imaging high signal areas were recognized at the basal ganglia. She was diagnosed as having dementia caused by cerebrovascular insufficiency. She soon developed a febrile state and died of respiratory failure within three months of presentation. Postmortem examination showed widespread angiotropic B-cell lymphoma.
(Internal Medicine 34: 1134-1139, 1995)

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Familial Macrothrombocytopenia with Unusually Elongated Mitochondria

Katsunori YAMADA, Kazuma MIWA, Yoshitsugu WAKITA, Yoshio IKOMA, Yohich ...

1995 Volume 34 Issue 11 Pages 1140-1143
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1140

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We report a familial case of macrothrombocytopenia without inclusion bodies in polymorphonuclear cells or any congenital abnormalities. The results of the hemostatic and platelet function tests were all normal except for the platelet retention rate. The number of megakaryocytes increased slightly and some were relatively small. Electron microscopic studies revealed a unique morphological abnormality of the platelets' mitochondria.
(Internal Medicine 34: 1140-1143, 1995)

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Sarcoidosis with Multiple Nodular Shadows in Bilateral Lung Fields

Hiroyuki NAKAMURA, Kousuke KASHIWABARA, Toshiya WATANABE, Hisanaga YAG ...

1995 Volume 34 Issue 11 Pages 1144-1145
Published: 1995
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.34.1144

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Sarcoidosis is a disease of unknown etiology which is characterized pathologically by widespread non-caseating granulomas involving multiple organ systems. We report a case of Sarcoidosis with multiple nodular shadows in bilateral lung fields. Abnormal shadows were completely disappeared without medication after one six months.
(Internal Medicine 34: 1144-1145, 1995)

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