Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 34 , Issue 8
Showing 1-26 articles out of 26 articles from the selected issue
  • Saburo MASHIMA
    1995 Volume 34 Issue 8 Pages 701-702
    Published: 1995
    Released: March 27, 2006
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  • Shukuro ARAKI
    1995 Volume 34 Issue 8 Pages 703-704
    Published: 1995
    Released: March 27, 2006
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  • Tohru ABE, Tsutomu TAKEUCHI, Jun KOIDE
    1995 Volume 34 Issue 8 Pages 705-706
    Published: 1995
    Released: March 27, 2006
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  • Masayuki ANDO, Moritaka SUGA, Yuriko NISHIURA, Masufumi MIYAJIMA
    1995 Volume 34 Issue 8 Pages 707-712
    Published: 1995
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    Summer-type hypersensitivity pneumonitis (SHP), the most prevalent type of HP in Japan, is caused by seasonal mold contamination in the home environment. The causative agent of the disease is Trichosporon cutaneum. The fungus grows in warm, moldy, decaying organic matter, and scatters in the air from the colonizing places. The inhaled fungi sensitize susceptible patients intratracheally and induce the disease. Glucuronoxylomannan of the fungus has a potent antigenicity that causes granulomatous alveolitis. Assay of anti-T. cutaneum antibody is very useful to establish the diagnosis of the disease because the antibody activity is virtually positive in all cases of the disease. Elimination of T. cutaneum from the colonizing places prevents recrudescence. SHP, a new form of HP, had been considered to be peculiar to Japan, but the first case of SHP outside Japan was identified in Korea last year. Soon it will be recognized in many countries of temperate and tropical clime.
    (Internal Medicine 34: 707-712, 1995)
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  • Shinji IJICHI, Mitsuhiro OSAME
    1995 Volume 34 Issue 8 Pages 713-721
    Published: 1995
    Released: March 27, 2006
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    Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a well-defined clinicopathological entity, and approximately 1, 900 patients with HAM/TSP have been reported in the world. Improved polymerase chain reaction (PCR)-based in situ techniques have allowed a better appreciation of the cellular localization of the virus activation in infected patients, and there is accumulating evidence that HAM/TSP is characterized by a distributional bias of viral activation between the blood flow and central nervous system (CNS). This review summarizes the current status of our understanding of HAM/TSP, and emphasizes the possible pathogenic involvement of cellular interactions between infected cells and responding immunocompetent cells in the CNS of patients with HAM/TSP. In addition, the notable systemic manifestations with or without myelopathy in HTLV-I-infected individuals are described.
    (Internal Medicine 34: 713-721, 1995)
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  • Shigeomi KURODA, Kazuhiko ISHIKAWA, Hiroshi HANAMITSU, Masaki KOMORI, ...
    1995 Volume 34 Issue 8 Pages 722-727
    Published: 1995
    Released: March 27, 2006
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    The pathogenesis of bronchial asthma is not yet fully understood. Recently much attention has been given to the hypothesis that intracellular free calcium ([Ca2+]i) metabolism is abnormal in various diseases. In this study we investigated whether [Ca2+]i exists abnormally in subjects with bronchial asthma. The [Ca2+]i in 32 treated or untreated subjects with bronchial asthma were compared with 63 normal subjects. Resting levels of [Ca2+]i were estimated by loading the fluorescent indicator Fura-2 in washed platelets. The [Ca2+]i level in the control subjects was 129.7±18.0 nM (mean±SD). However, in that of the bronchial asthma patients was 152.7±44.1 nM, significantly higher than that of the control subjects (p<0.05). It is well recognized that an increase of [Ca2+]i in vascular smooth muscle involves contraction. The findings suggest that the same phenomenon is quite possible in the tracheal smooth muscle and that it plays an important role in the pathogenesis of bronchial asthma.
    (Internal Medicine 34: 722-727, 1995)
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  • Miho TANAKA, Kazuo KITAMURA, Yuko ISHIZAKA, Yuichiro ISHIYAMA, Johji K ...
    1995 Volume 34 Issue 8 Pages 728-733
    Published: 1995
    Released: March 27, 2006
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    Adrenomedullin is a novel hypotensive peptide recently discovered in human pheochromocytoma. In the present study, we measured the plasma immunoreactive adrenomedullin of healthy subjects and patients with various diseases. Immunoreactive adrenomedullin was found to circulate in blood of the healthy subjects at a considerable concentration (3.3±0.3 fmol/ml). Plasma adrenomedullin was significantly increased in the patients with congestive heart failure (5.4±0.3 fmol/ml), essential hypertension (5.3±0.4 fmol/ml) and renal disease (4.9±0.4 fniol/ml). In healthy volunteers physical exercise significantly increased the plasma adrenomedullin concentration. The increase of adrenomedullin was inversely related to systolic blood pressure. These findings indicate that adrenomedullin participates in the circulation control in both physiological and diseased conditions. Although the exact origin of circulating adrenomedullin is still unknown, it is thought to be released rapidly by acute exercise, thereby regulating the cardiovascular system by its vasodilating activity.
    (Internal Medicine 34: 728-733, 1995)
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  • Masayuki IKEDA, Ikuko SATO, Takashi MATSUNAGA, Mafuyu TAKAHASHI, Tatsu ...
    1995 Volume 34 Issue 8 Pages 734-737
    Published: 1995
    Released: March 27, 2006
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    Recent evidence suggests the involvement of nitric oxide (NO) in inflammation and demyelination in the brain. To test this hypothesis, we measured NO markers in the cerebrospinal fluid from patients with bacterial meningitis (BM), aseptic meningitis (AM), multiple sclerosis (MS), and Guillain-Barré syndrome (GBS). Subjects with non-inflammatory neurologic diseases served as the controls. NO markers were cyclic guanosine monophosphate (cGMP) measured with an enzyme immunoassay, and nitrite and nitrate measured with the Griess reaction. Except for BM, cGMP was not increased in AM, MS or GBS compared with the controls. Nitrite and nitrate were unaltered in any of the groups studied. These results do not support the hypothesis that NO is increased in the brain in meningitis, MS or GBS. Otherwise cGMP, nitrite and nitrate in the cerebrospinal fluid do not reflect the increase in NO in the brain.
    (Internal Medicine 34: 734-737, 1995)
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  • Ken SAWADA, Makoto HIRAI, Hiroshi HAYASHI, Fumi INABA-SATO, Hiroaki SA ...
    1995 Volume 34 Issue 8 Pages 738-743
    Published: 1995
    Released: March 27, 2006
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    We investigated the use of the spatial ventricular gradient (VG) from vectorcardiogram (VCG) to determine whether significant repolarization differences were present in patients with WPW syndrome compared with normal subjects and also examined which VG parameter (i.e., elevation, azimuth, and magnitude) reflected the differences in repolarization properties during preexcitation. VG was calculated in 49 patients of Wolff-Parkinson-White (WPW) syndrome (group A: left-sided accessory pathway, n=29; group B: right-sided, n=20). Group N consisted of 607 normal subjects. In group A, the azimuth of VG was significantly (p<0.01) greater than in groups B and N. In group B, the elevation of VG was significantly (p<0.01) greater than in groups A and N. There were no significant differences in the magnitude of VG among groups. QRS duration was significantly (p<0.01) related with the elevation of VG in group B. These findings suggested that VG is useful for spatial evaluation of repolarization abnormalities during preexcitation, which are related to the site of the accessory pathway.
    (Internal Medicine 34: 738-743, 1995)
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  • Makoto UCHINO, Toru OKAJIMA, Komyo ETO, Toshihide KUMAMOTO, Isao MISHI ...
    1995 Volume 34 Issue 8 Pages 744-747
    Published: 1995
    Released: March 27, 2006
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    To better understand the neurologic events related to chronic Minamata disease (organic mercury poisoning), we studied data from 77 patients with Minamata disease as certified at autopsies performed from 1976 to 1994 (mean age: 72.3 years). Major neurologic findings included: sensory impairment in 80.5% of the patients which was limited to the extremities in 42.9%. Impairment of lower extremity coordination was present in 35.8% of the patients, constriction of the visual fields in 28.8%, and retrocochlear hearing loss in 15.3%. There was no correlation between the degree of cerebellar incoordination and the methylmercury concentration in the cerebellum. Compared with the classic type of Minamata disease, the incidence of major neurologic findings was markedly decreased. In light of these findings, supplemental examinations including brain computed tomography (CT), magnetic resonance imaging (MRI), short latency somatosensory evoked potential (SSEP), or tremogram may be necessary to clinically diagnose Minamata disease, especially in atypical or mild cases.
    (Internal Medicine 34: 744-747, 1995)
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  • Kazuhiro TASHIMA, Yukio ANDO, Yoshiya TANAKA, Makoto UCHINO, Masayuki ...
    1995 Volume 34 Issue 8 Pages 748-750
    Published: 1995
    Released: March 27, 2006
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    To investigate the influence of environmental factor(s) on the pathogenesis of familial amyloidotic poly neuropathy (FAP) type I, the age of onset in 33 FAP patients in the Arao district of Kumamoto Prefecture in Japan and in 20 of their ancestors to the 3rd prior generation was carefully examined. The age of onset in FAP patients progressively became younger. This tendency was more apparent in female FAP patients than in male patients. Since the pathogenesis of amyloid formation in FAP as well as other amyloidosis diseases is not still elucidated, this phenomenon may be of interest.
    (Internal Medicine 34: 748-750, 1995)
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  • Tohru IZUMI, Youichi AMEMIYA, Noriaki IWAO, Toshiyuki SUZUKI, Kazuo MU ...
    1995 Volume 34 Issue 8 Pages 751-755
    Published: 1995
    Released: March 27, 2006
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    A 28-year-old man with acute promyelocytic leukemia at first early relapse received HLAmatched allogenic bone marrow transplantation (BMT) at first early relapse. Cyclosporin A and methotrexate were administered at conventional doses as a prophylaxis for graft-versus-host disease (GVHD). He presented with severe bloody diarrhea on day 87 after BMT. Examination of the lower gastrointestinal tract revealed diffuse mucosal change of inflammation. A diagnosis of late onset of acute gut GVHD was made, in the absence of other manifestations such as skin and liver involvement. A further survey is needed to clarify the incidence and the pathogenesis of atypical gut GVHD.
    (Internal Medicine 34: 751-755, 1995)
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  • Shinjiro MUNETA, Yoriaki YAMASHITA, Hiroshi FUKUDA, Seiichiro WATANABE ...
    1995 Volume 34 Issue 8 Pages 756-761
    Published: 1995
    Released: March 27, 2006
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    We report a 48-year-old man who suffered from viral encephalitis and developed involuntary movements of the hands and astatic seizures as sequelae. T2-weighted magnetic resonance imaging of the brain showed high intensity areas in the bilateral insulae. Electroencephalography (EEG) revealed spike and slow wave complexes and high-amplitude slow waves. The involuntary movements of the hands were diagnosed as asterixis by electromyography. Asterixis affected both hands. Administration of sodium valproate aggravated asterixis and EEG findings, but treatment with clonazepam markedly improved these findings and astatic seizures. The present case indicates that insular lesions might be also responsible for the development of asterixis.
    (Internal Medicine 34: 756-761, 1995)
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  • Eri WATANABE, Hidefumi OHSAWA, Hirofumi NOIKE, Kiyoshi OKAMOTO, Atsush ...
    1995 Volume 34 Issue 8 Pages 762-767
    Published: 1995
    Released: March 27, 2006
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    We report a case of dilated cardiomyopathy with hyperthyroidism. A 28-year-old man was admitted because of congestive heart failure and atrial fibrillation, and was newly diagnosed as having hyperthyroidism. Despite administration of antithyroid medication, he developed recurrent congestive heart failure. An echocardiogram revealed a moderately dilated left ventricle with diffuse hypokinesis. Though his thyroid function normalized, the patient's cardiac dysfunction did not improve. Beta-blocker therapy was begun with subsequent improvement in clinical symptoms. This suggests that beta-blocker treatment may be effective in patients with atrial fibrillation associated with cardiomyopathy and hyperthyroidism.
    (Internal Medicine 34: 762-767, 1995)
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  • Masaru HARADA, Hiroshi YOSHIDA, Yoshihiro MIMURA, Masahito OHISHI, Ich ...
    1995 Volume 34 Issue 8 Pages 768-771
    Published: 1995
    Released: March 27, 2006
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    A 25-year-old woman, diagnosed with Sjögren's syndrome at age 20, presented with painful edema of her left neck. Three days later, she additionally complained of bilateral auricular pain, and her nasal cartilage was tender to palpation. She was diagnosed as having phlegmon on the basis of her neck findings. Anti-human cartilage antibodies were demonstrated by indirect immunofluorescence, and the diagnosis of relapsing polychondritis was established. The patient was administered antibiotics and a non-steroidal anti-inflammatory drug, and her symptoms gradually improved. Relapsing polychondritis is one of the possible complications of autoimmune diseases, and infection might be a precipitating factor for this disease.
    (Internal Medicine 34: 768-771, 1995)
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  • Jun YATSUNAMI, Yoichi NAKANISHI, Hiroaki MATSUKI, Kentaro WAKAMATSU, K ...
    1995 Volume 34 Issue 8 Pages 772-775
    Published: 1995
    Released: March 27, 2006
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    We report a case of bronchobronchiolitis obliterans associated with Stevens-Johnson syndrome diagnosed using bronchography and bronchoscopy in a 25-year-old man with dyspnea. Eighteen months prior to admission, the diagnosis of Stevens-Johnson syndrome due to anticonvulsant therapy was made at another hospital. On admission, the patient was wheezing and had overinflation of the lungs, with marked obstructive pulmonary dysfunction. Ventilation and perfusion scintigrams revealed multiple ventilation and perfusion defects but not mismatch. Bronchography revealed central bronchiectasis and obstruction of the peripheral bronchi. Occlusion of the fifth right basal bronchus was observed with fiberoptic bronchoscopy. Bronchography and bronchoscopy provide useful information for the diagnosis of this disease.
    (Internal Medicine 34: 772-775, 1995)
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  • Isamu MATSUNAGA, Hiroko OKA, Makiko UEDA, Tetsuo ARAKAWA, Kenzo KOBAYA ...
    1995 Volume 34 Issue 8 Pages 776-781
    Published: 1995
    Released: March 27, 2006
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    We describe a 35-year-old woman with colonic phlebitis of unknown origin accompanied by effusion of serum protein into the peritoneal cavity. Abdominal ultrasonography and computed tomography showed massive ascites and edematous wall thickness of the colon. Laboratory examination of the peritoneal fluid showed a high concentration of protein, probably due to nonselective efflux of serum protein. The main histopathological finding was extensive edema of the submucosa with vasculitis in the colon. This kind of phlebitis with massive ascites, but without systemic involvement, and with the ascitic fluid almost identical to the serum protein level, has not been reported previously.
    (Internal Medicine 34: 776-781, 1995)
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  • Yoshinori SEKO, Miyuki AZUMA, Hideo YAGITA, Ko OKUMURA, Hisamaru HIRAI ...
    1995 Volume 34 Issue 8 Pages 782-784
    Published: 1995
    Released: March 27, 2006
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    Here we report a rare case of T-cell prolymphocytic leukemia in whom leukemic killer cells, expressing a cytolytic factor perforin, infiltrated the heart. Perforin may have directly injured myocardial cells which showed marked expression of human leukocyte antigens (HLAs) and intercellular adhesion molecule-1 (ICAM-1) as well as costimulatory molecules B7 and B70, which are ligands for CD28 expressed on T-cells. In spite of chemotherapy against leukemic cells, this autoimmune process finally caused fatal congestive heart failure.
    (Internal Medicine 34: 782-784, 1995)
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  • Keiko ASAO, Yasunori UTSUNOMIYA, Keita HIRANO, Toshihide SHIKE, Toshiy ...
    1995 Volume 34 Issue 8 Pages 785-789
    Published: 1995
    Released: March 27, 2006
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    A 25-year-old man was admitted with complaints of fever and macrohematuria. Laboratory tests showed a substantial increase in serum creatine phosphokinase and creatinine in association with myoglobinuria and proteinuria. Blood culture grew Streptococcus salivarius and Streptococcus oralis. Findings of renal biopsy were compatible with IgA nephropathy. The glomeruli had a mild mesangial proliferation without crescentic lesions. Changes of the interstitium and tubules were not evident. The clinical course and laboratory results strongly suggested a possible link between Streptococcus salivarius/oralis infection, and rhabdomyolysis. Rhabdomyolysis is rarely seen as a complication of bacterial infection, and the present case emphasizes the importance of suspecting bacteremia due to Streptococcus salivarius/oralis in the presence of rhabdomyolysis.
    (Internal Medicine 34: 785-789, 1995)
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  • Noriaki AOKI, Kazui SOMA, Takashi OWADA, Hideaki ISHII
    1995 Volume 34 Issue 8 Pages 790-793
    Published: 1995
    Released: March 27, 2006
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    Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and kidneys. A 56-year-old Japanese man with Wegener's granulomatosis died of intraperitoneal hemorrhage from a ruptured aneurysm of his left gastric artery. Histological findings revealed necrotizing granulomatous vasculitis involving this artery. No previously published reports have described Wegener's granulomatosis patients with aneurysms in such a large artery. We conclude that this case represents either an atypical form of Wegener's granulomatosis or a polyangiitis overlap syndrome of Wegener's granulomatosis and classic polyarteritis nodosa.
    (Internal Medicine 34: 790-793, 1995)
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  • Taishi KUWAHARA, Mareomi HAMADA, Yoshikazu INOUE, Shuji AONO, Kunio HI ...
    1995 Volume 34 Issue 8 Pages 794-796
    Published: 1995
    Released: March 27, 2006
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    A 51-year-old man was admitted to our hospital because of dry cough and low grade fever with right-sided pleural fluid and blood eosinophilia. Warfarin had been prescribed following coronary artery bypass grafting. After the discontinuation of warfarin the clinical and chest X-ray findings improved; readministration of the drug caused recurrent blood eosinophilia and pleural effusion in the other lung. Since no other specific etiologies for eosinophilia and pleural effusion were determined by extensive evaluation, warfarin seemed to be associated with his illness. This is the first report of warfarin-induced eosinophilic pleurisy.
    (Internal Medicine 34: 794-796, 1995)
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  • Hiroshi SODA, Mikio OKA, Shigeru KOHNO, Masami WATANABE, Hiroshi TAKAT ...
    1995 Volume 34 Issue 8 Pages 797-800
    Published: 1995
    Released: March 27, 2006
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    The bronchoscopic findings of arteriovenous malformation of the bronchial artery are compared with findings on angiography and pathology. A non-pulsatile protrusion with engorged vessels on its glossy and uneven surface was seen at the distal portion of the right anterior segmental bronchus. A bronchial angiogram demonstrated that the protrusion corresponded to the hypervascular area of convoluted vessels. Histologically, a glossy, uneven surface and engorged vessels represented normal mucosa overlaying an extramuscular tortuous artery and proliferation of submucosal tiny vessels, respectively. These bronchoscopic findings were important clues for diagnosis.
    (Internal Medicine 34: 797-800, 1995)
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  • Kazuhiro ISHII, Yuji UEDA, Norio OHKOSHI, Hidehiro MIZUSAWA, Shin'ichi ...
    1995 Volume 34 Issue 8 Pages 801-805
    Published: 1995
    Released: March 27, 2006
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    We present a 55-year-old man who suddenly became afflicted with a bilateral auditory disturbance. Auditory acuity was preserved relatively well. Brainstem auditory evoked potentials (BAEPs) were normal. Middle latency auditory evoked potentials (MLAEPs) revealed the total absence of all waves. Brain computed tomography (CT) showed infarctions of the temporal lobes bilaterally, involving the superior temporal and transverse temporal gyri. The recognition of verbal and nonverbal sounds was also impaired. Brain CT, MLAEPs and auditory recognition tests were useful in diagnosing the cortical auditory disorder.
    (Internal Medicine 34: 801-805, 1995)
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  • Mitsuyoshi ADACHI, Akito HAYASHI, Norio OHKOSHI, Hiroshi NAGATA, Hideh ...
    1995 Volume 34 Issue 8 Pages 806-810
    Published: 1995
    Released: March 27, 2006
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    A 67-year-old woman with a one-year history of tinnitus and headache had multiple cranial nerve palsies of V, VII, VIII, IX, X, XI and spastic paraparesis. She also had a secretory otitis media. Gd-DTPA-enhanced magnetic resonance imaging (MRI) revealed hypertrophy of the dura of the posterior fossa and spinal epidural mass which extended from C7 to T10. A biopsy of the epidural mass showed chronic granulomatous change. These lesions were completely cured with administration of antibiotics. We believe this case of double-lesion of hypertrophic cranial pachymeningitis and spinal epidural granulomatous lesion originated from a bacterial infection secondary to the secretory otitis media.
    (Internal Medicine 34: 806-810, 1995)
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  • Takehide OGIHARA, Atsushi NAKATANI, Hitoshi ITO, Masataka IROKAWA, Shi ...
    1995 Volume 34 Issue 8 Pages 811-814
    Published: 1995
    Released: March 27, 2006
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    Sjögren's syndrome (Sjs) can cause many organic changes, but is rarely accompanied by pleuritis. We report here a 62-year-old patient with subclinical Sjs who developed unilateral pleuritis with moderate effusion. He was diagnosed to have subclinical Sjs based on the positivity of anti SS-A/SS-B antibodies and the biopsy findings of minor salivary glands which revealed lymphocyte infiltration around the duct. In the pleural effusion, both increased lymphocytes and anti SS-A/SS-B antibodies were observed. He showed no signs of infection nor malignancy. There was no direct evidence that he had other collagen diseases which cause pleuritis. We conclude that the pleuritis was caused by Sjs. In patients with Sjs, activated polyclonal B lymphocytes and autoantibodies are considered to cause systemic tissue damage. This case indicates that these factors can cause pleuritis in Sjs patients.
    (Internal Medicine 34: 811-814, 1995)
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  • Yoshio SABURI, Tsuyoshi INAGE, Kaoru OHTSUKA, Takayuki NAGAI, Takanori ...
    1995 Volume 34 Issue 8 Pages 815-818
    Published: 1995
    Released: March 27, 2006
    JOURNALS FREE ACCESS
    A 62-year-old man with adult T cell leukemia (ATL) presented with complaints of anorexia and abdominal fullness. Evaluation revealed ascites and pleural effusion, but no lymph node swelling, hepatosplenomegaly, or skin involvement. The diagnosis of ATL was made by the detection of specific surface markers for T lymphocytes in pleural effusion and ascitic fluid, and by determination of human T cell leukemia virus type I (HTL V-I) proviral DNA integration in mononuclear cells of pleural effusion. This case was considered a rare type of ATL with infiltration of the pleura and peritoneum.
    (Internal Medicine 34: 815-818, 1995)
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