Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
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Volume 34, Issue 2
Displaying 1-16 of 16 articles from this issue
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  • Prognostic Value of Electroencephalogram (EEG) in Anoxic Encephalopathy after Cardiopulmonary Resuscitation: Relationship among Anoxic Period, EEG Grading and Outcome
    Shu-ichi YAMASHITA, Toshihiko MORINAGA, Shozo OHGO, Teruo SAKAMOTO, No ...
    1995 Volume 34 Issue 2 Pages 71-76
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.71
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    We studied the prognostic applicability of electroencephalograms (EEGs) of seventy-nine patients within 24 hours after successful cardiopulmonary resuscitation. The EEGs were classified into five grades according to a modified Hockaday's scale. The EEGs of grades I and II implied full recovery, while those of grade III gave a varied but generally unfavorable prognosis. Patients with grades IV and V EEGs survived in a vegetative condition or died without awakening. Eighteen patients showed EEG with periodic patterns, all of which led to a fatal or vegetative outcome. One case showed EEGs associated with periodic triphasic waves and repetitive sharp transients in the same record. Several cases showed EEGs with different periodic patterns in consecutive records. We conclude that an EEG is a good indicator of patient prognosis after cardiopulmonary resuscitation. However, the clinical significance of morphological differences of various periodic patterns that can occur during an EEG remains to be established.
    (Internal Medicine 34: 71-76, 1995)
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  • Long-Term Follow-Up of Patients with a History of Near Fatal Episodes; Can Inhaled Corticosteroids Reduce the Risk of Death from Asthma?
    Kyosuke ISHIHARA, Tsuyoshi HASEGAWA, Miki OKAZAKI, Nobuyuki KATAKAMI, ...
    1995 Volume 34 Issue 2 Pages 77-80
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.77
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    We retrospectively studied the use of inhaled corticosteroids in patients who experienced near fatal episodes (NFE) to determine whether such therapy reduces the risk of death. Forty-eight patients who had near fatal episodes of asthma between January 1981 and December 1989 were divided into two groups. Group A comprised 19 patients who received beclomethasone dipropionate (BDP) daily (mean dose of BDP: 687 μg/day: 200-2, 000) following NFE, and Group B, 28 patients who did not take BDP or who took less than 6 mg BDP/month. During the follow-up period (Group A: 82.9 months, Group B: 66.2 months), no patients in Group A died, but eight deaths occurred in Group B (mean period between near fatal episode and death was 31.5 months: 12-66). These results suggest that the regular use of inhaled corticosteroids, even at low doses, may reduce the risk of death in patients who experience NFE.
    (Internal Medicine 34: 77-80, 1995)
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  • Isozyme Analysis of the High Serum Adenosine Deaminase Activity in Patients with Myasthenia Gravis
    Susumu CHIBA, Masaki SAITOH, Motoi KASHIWAGI, Nobuyoshi KOBAYASHI, Hir ...
    1995 Volume 34 Issue 2 Pages 81-84
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.81
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    The serum activities of adenosine deaminase (ADA) and its isozymes (ADA 1 and ADA 2) were measured in 31 patients with myasthenia gravis (MG). As compared with 50 normal controls, in MG the total activity and ADA 1 were significantly high (p<0.01, respectively), and ADA 2 tended to be high. The total activity and ADA 2 were higher in generalized MG than in ocular MG. ADA 2 was significantly high in grade IIB patients as compared with grade I patients divided by Osserman's classification (p<0.05). Patients with bulbar signs showed a significantly high total ADA (p<0.05) with an increasing tendency for ADA 2. There was a significant elevation of the total activity and ADA 2 in patients with positive anti-acetylcholine-receptor antibody as compared to those of the negative antibody (p<0.05). It was concluded that total ADA, reflecting the increase of both ADA 1 and ADA 2, is high in MG; and the measurement of ADA 2 is more important because ADA 2 was increased with advancing clinical MG grade.
    (Internal Medicine 34: 81-84, 1995)
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  • Percutaneous Intracavitary Antifungals for a Patient with Pulmonary Aspergilloma; with a Special Reference to in vivo Efficacies and in vitro Susceptibility Results
    Taeko ITOH, Hiroshi YAMADA, Akihiko YAMAGUCHI, Nakaaki KAWAMATA, Masaf ...
    1995 Volume 34 Issue 2 Pages 85-88
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.85
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    A 61-year-old man with pulmonary aspergilloma received two antifungals intracavitarily. Although clinical, serological and roentgenographic improvement were observed with fluconazole therapy, bronchial secretions continuously yielded Aspergillus fumigatus. When fluconazole was switched to amphotericin B, the pathogen was eradicated immediately. The minimal inhibitory concentrations (MICs) of the isolate were 400 μg/ml for fluconazole, and 0.2 μ/ml for amphotericin B. Although the discrepancy between in vitro and in vivo efficacy of antifungals has been argued, it was suggested the drug of choice should be selected on the basis of the MIC results at least in the intracavitary antifungal therapy for pulmonary aspergilloma.
    (Internal Medicine 34: 85-88, 1995)
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  • Adult-Onset Still's Disease with Submassive Hepatic Necrosis
    Akiyoshi TAKAMI, Shinji NAKAO, Hirotoshi MIYAMORI, Motoshi OOI, Toshih ...
    1995 Volume 34 Issue 2 Pages 89-91
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.89
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    We present a 74-year old woman who was hospitalized because of typical spiking fever, evanescent rash, polyarthralgia, lymphadenopathy, and marked elevation of serum transaminases and lactate dehydrogenase (LDH) due to adult-onset Still's disease (AOSD) with submassive hepatic necrosis. All of the symptoms and abnormal laboratory findings were dramatically improved after treatment with prednisolone. The clinical course of this patient indicates that AOSD with severe hepatic necrosis can successfully be treated with early administration of corticosteroid, although it remains unknown whether the disease can remain in remission with no or minimal treatment.
    (Internal Medicine 34: 89-91, 1995)
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  • Torsades de Pointes Associated with Terfenadine in a Case of Liver Cirrhosis and Hepatocellular Carcinoma
    Toshinori KAMISAKO, Yukihiko ADACHI, Hirotaka NAKAGAWA, Toshio YAMAMOT ...
    1995 Volume 34 Issue 2 Pages 92-95
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.92
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    A 65-year-old woman with liver cirrhosis complicated by hepatocellular carcinoma lost consciousness due to torsades de pointes with prolongation of the QT-interval after 10 days of treatment with terfenadine. Before terfenadine administration, she had shown neither symptoms of heart disease nor any electrocardiographic abnormalities. Serum electrolytes were all normal, although the Ca level was near the lower limit of the normal range. After the withdrawal of terfenadine, the QT-interval was normalized and the torsades de pointes disappeared. Since she had liver cirrhosis, the development of torsades de pointes was thought to be attributable to the impairment of hepatic metabolism by terfenadine.
    (Internal Medicine 34: 92-95, 1995)
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  • Severe Hyponatremia and Hyperkalemia Induced by Trimethoprim-Sulfamethoxazole in Patients with Pneumocystis carinii Pneumonia
    Hiroshi NOTO, Yoshiyasu KANEKO, Tomoko TAKANO, Kiyoshi KUROKAWA
    1995 Volume 34 Issue 2 Pages 96-99
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.96
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    An antimicrobial agent trimethoprim-sulfamethoxazole (Tmp-Smx) does not usually cause electrolyte disturbances at regular doses, and few cases of Tmp-Smx-induced electrolyte imbalance have been reported in the English-language literature to date. Recently, however, we treated two patients with Pneumocystis carinii pneumonia who developed severe hyponatremia and hyperkalemia on administration of high-dose Tmp-Smx. These electrolyte disturbances were attributable to the direct effect of Tmp-Smx on the renal distal tubules, were reversible, and corrected by infusion of a sodium-enriched and potassium-free liquid. Therefore, it is suggested that even after electrolyte disturbances have occurred, high-dose Tmp-Smx therapy may be continued for severe infectious diseases under appropriate electrolyte correction.
    (Internal Medicine 34: 96-99, 1995)
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  • Jaundice Associated with Pseudomonas aeruginosa Bacteremia Complicating Acute Leukemia
    Hisashi FUNADA, Tamotsu MATSUDA, Yoshikatsu OKADA
    1995 Volume 34 Issue 2 Pages 100-103
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.100
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    Two adult patients with acute leukemia developed marked jaundice during Pseudomonas aeruginosa bacteremia. The progressive increase in serum conjugated bilirubin levels was disproportionate to the gradual decrease in serum alkaline phosphatase and transaminase activity to or below low normal. The production of coagulation factors decreased. Autopsy revealed periportal cholestasis with minimal liver-cell damage. These findings suggested decreased metabolic activity of liver cells associated with bacteremia, probably leading to impaired bilirubin excretion. Both patients died despite appropriate antibiotic therapy. Isolated hyperbilirubinemia, thus, seemed to be an ominous prognostic sign in severe infection.
    (Internal Medicine 34: 100-103, 1995)
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  • Malignant Hypercalcemia due to Gastric Endocrine Cell Carcinoma
    Kazuro SUGISHITA, Masataka TANNO, Masanori KIJIMA, Hiroshi KAMOSHITA, ...
    1995 Volume 34 Issue 2 Pages 104-107
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.104
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    A 62-year-old man was admitted to our Neurology Unit due to consciousness disturbance. Laboratory data showed marked hypercalcemia and azotemia. Serum parathyroid hormone-related protein (PTHrP) level was extremely high. We performed intensive hemodialysis for renal failure, but his condition deteriorated rapidly. On day 10, he died of multiple organ failure. The autopsy revealed gastric undifferentiated adenocarcinoma with systemic dissemination. Immunohistological study showed positive PTHrP staining in carcinoid-like parts of the tumor. This is the first reported case of malignant hypercalcemia due to PTHrP-producing carcinoid or endocrine cell carcinoma of the stomach.
    (Internal Medicine 34:104-107, 1995)
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  • Periodic Angioedema with Eosinophilia: Increased Serum Level of Interleukin 5
    Yoshio OKUBO, Etsuro SATO, Mahboob HOSSAIN, Teruo OTA, Sawako YOSHIKAW ...
    1995 Volume 34 Issue 2 Pages 108-111
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.108
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    A 48-year-old man developed episodic non pitting edema and eosinophilia. Symptoms were alleviated promptly when treated with prednisolone. However, major basic protein (MBP), eosinophil cationic protein (ECP), and eosinophil-derived neurotoxin (EDN) levels in the serum as well as the total number of eosinophils remained high. During periods of attack serum levels of interleukin-5 (IL-5) were elevated, but the levels were lowered following treatment, suggesting that IL-5 is involved in periodic angioedema with eosinophilia.
    (Internal Medicine 34:108-111, 1995)
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  • Crohn's Disease Associated with Growth Hormone Secretory Dysfunction
    Toshio OGURA, Jingo KAGEYAMA, Yasuo ITANO, Takayoshi YAMAUCHI, Tetsuya ...
    1995 Volume 34 Issue 2 Pages 112-117
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.112
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    A 10-year-old boy presented in 1989 with repeated episodes of vomiting, abdominal distension and severe growth retardation. Endocrinologic examination indicated growth hormone (GH) secretory dysfunction. Administration of recombinant human GH (rhGH) led to growth, but the patient discontinued treatment. He was readmitted to our hospital in 1993, at the age of 16. His stature was very short. Laboratory findings suggested malnutrition. Radiologic examination revealed regional stenosis and a cobblestone appearance of the intestine. The histologic diagnosis was compatible with Crohn's disease. Administration of prednisolone alleviated gastrointestinal symptoms with the improvement of GH secretory function.
    (Internal Medicine 34:112-117, 1995)
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  • Smoldering Adult T-Cell Leukemia with B-Cell Lymphoma and Early Gastric Cancer
    Mayumi KODAMA, Hitoshi MATSUOKA, Koichi MAEDA, Muneou SUZUKI, Akihiko ...
    1995 Volume 34 Issue 2 Pages 118-121
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.118
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    We report a case of smoldering adult T-cell leukemia (ATL) with B-cell lymphoma and early gastric cancer. A 64-year-old man was admitted to our hospital because of proteinuria and hypergammaglobulinemia. Systemic lymphadenopathy, "flower cells" in peripheral white blood cells, and hypergammaglobulinemia with monoclonal gammopathy (IgA, λ type) were found. As Southern blot analysis revealed monoclonal integration of human T-lymphotrophic virus type I proviral DNA in peripheral blood mononuclear cells, he was diagnosed as having smoldering ATL. The tissue specimen of an inguinal lymph node showed proliferation of abnormal lymphocytes which were stained with anti-λ antibody, indicating B-cell lymphoma. A polypoid lesion in the stomach was histologically diagnosed as early gastric cancer.
    (Internal Medicine 34:118-121, 1995)
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  • Secondary Amyloidosis Associated with Castleman's Disease
    Katsuhiro TANAKA, Masakazu HORITA, Hitoshi SHIBAYAMA, Masataka SEIKE, ...
    1995 Volume 34 Issue 2 Pages 122-126
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.122
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    A rare case of secondary amyloidosis associated with Castleman's disease is reported. A 53-year-old woman was referred for investigation of proteinuria. Biopsy specimens from kidney and gastric mucosa revealed numerous amyloid deposits, denned as AA amyloidosis by immunohistological staining. Castleman's disease was found in the abdomen as the primary disease for the amyloidosis. Although the urinary protein was somewhat reduced and the inflammatory findings were improved after removal of the lymphoma, renal insufficiency progressed and hemodialysis was begun.
    (Internal Medicine 34:122-126, 1995)
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  • T-Cell Acute Lymphoblastic Leukemia with Transient Pure Red Cell Aplasia Associated with Myasthenia Gravis and Invasive Thymoma
    Ryoji NISHIOKA, Shinji NAKAJIMA, Yuji MORIMOTO, Hiroshi SUZUKI, Haruo ...
    1995 Volume 34 Issue 2 Pages 127-130
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.127
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    A 43-year-old male developed rapidly progressing anemia and a bone marrow examination revealed pure red cell aplasia (PRCA). He was diagnosed as having myasthenia gravis (MG) and invasive thymoma, and achieved complete remission by radiation and chemotherapy six years ago. Despite increased doses of oral prednisolone from 7.5 mg/day to 60 mg/day, a diagnosis of T-cell acute lymphoblastic leukemia (T-ALL) was made one month later based on findings of 37.2% abnormal lymphoblasts and positive surface markers for CD2, CD3 and CD7 T-cells. Cases of PRCA associated with MG and thymoma have been reported in the literature, however such a case followed by T-ALL is very rare.
    (Internal Medicine 34: 127-130, 1995)
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  • Herpes Simplex Encephalitis with Transient Global Amnesia as an Early Sign
    Seigo KIMURA, Takanori KUMANO, Shin'ichi MIYAO, Jun TERAMOTO
    1995 Volume 34 Issue 2 Pages 131-133
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.131
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    Cerebral ischemia has been proposed as the etiology of transient global amnesia. Recentry, however, migranous and epileptic etiologies have attracted attention. A 56-year-old man had transient global amnesia and the next day began to display symptoms of meningoencephalitis. Herpes simplex encephalitis was diagnosed based on the titer of herpes simplex virus antibodies. The transient global amnesia appears to have occurred as an early sign of herpes simplex encephalitis and may have been provoked by an epileptic mechanism.
    (Internal Medicine 34: 131-133, 1995)
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  • Cholesterol Emboli Following Percutaneous Transluminal Coronary Angioplasty as Speculated by Toe Skin Biopsy
    Hiroko OTSUBO, Ken KAITO, Hajime TAKAHASHI, Kiyoshi YOKOI, Keiji IWANO ...
    1995 Volume 34 Issue 2 Pages 134-137
    Published: 1995
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.34.134
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    A 55-year-old man required hemodialysis for acute renal failure 3 days after repeat percutaneous transluminal coronary angioplasty (PTCA). Bilateral acrocyanosis and necrotic lesions of the toes occurred 10 days after PTCA. Skin biopsy samples revealed needle-shaped cholesterol crystals of the intraluminal clefts in his small arteries. He was diagnosed with cholesterol emboli presenting as blue toe syndrome. The conditions improved with anticoagulation and vasodilation, but improvement in renal function was temporary. He later required maintenance hemodialysis. Cholesterol emboli following PTCA are life threatening because they are difficult to diagnose and can cause severe complications.
    (Internal Medicine 34: 134-137, 1995)
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