Lymphokine-activated killer (LAK) cell activity and messenger RNA (mRNA) expression for interleukin-2 (IL-2) were analyzed using lamina propria mononuclear cells (LPMC) in inflammatory bowel disease patients. Compared with control LPMC, Crohn's disease (CD) LPMC exhibited significantly higher levels of LAK cell activity, whereas ulcerative colitis (UC) cells showed significantly lower levels of cytolytic activity with a difference in the frequency of CD3⁺, CD56⁺ and CD3^-, CD56⁺ LAK precursor cells. After incubation with IL-2, the proportion of CD3⁺, CD56⁺ lymphocytes continued to be higher in CD cultures and substantially lower in UC cultures. Freshly isolated CD LPMC exhibited significantly higher levels of IL-2 mRNA than controls. However, no significant difference was observed between UC and control cells. The level of IL-2 expression or responsiveness to IL-2 may be responsible for different mucosal immune reactivity between CD and UC patients.
(Internal Medicine 35: 679-685, 1996)

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We extracted gammaglobulins from the serum of 10 patients with insulin-dependent diabetes mellitus (IDDM) to investigate their effect on anterior pituitary hormone secretion using cultures of rat anterior pituitary cells. Three of the 10 patients also had the polyglandular autoimmune syndrome (PGA) type III with an isolated failure of anterior pituitary hormone secretion. The gammaglobulin from each of the 3 patients with PGA and an isolated failure of secretion of adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH) or gonadotropin inhibited the secretion of ACTH, TSH or gonadotropin in cultures of rat anterior pituitary cells. The gammaglobulins obtained from the other 7 patients with IDDM also showed an inhibitory or stimulatory effect on anterior pituitary hormone secretion in vitro. We postulate that some patients with IDDM, especially those with other endocrine autoimmune diseases, may have substances in their gammaglobulin fraction that can affect the secretion of anterior pituitary hormones.
(Internal Medicine 35: 686-692, 1996)

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Although diffuse panbronchiolitis (DPB) is known to be positively associated with certain major histocompatibility complex (MHC) class I antigens, e.g., HLA-B54 in Japanese patients, it is not clear whether the MHC genes predispose to the disease or are markers for other disease susceptibility gene(s). Because the HLA class III genes such as tumor necrosis factor (TNF) or the fourth component of complement (C4) are localized in the proximity of the HLA-B locus, one or more of these genes might be responsible for susceptibility to DPB. To analyze the role of HLA class III genes in DPB patients, we first evaluated the HLA-B54 association in 32 patients with DPB, and subsequently, studied the restriction fragment length polymorphism (RFLP) of the TNF-α and -β (TNF-α/β) genes as well as the C4A and B (C4A/B) genes in DPB patients and normal individuals. The HLA-B54 antigen was significantly more frequent in DPB patients than in normal individuals (40.3% vs 13.0%, p<0.001), however, we did not detect a significant association between DPB and gene polymorphisms of either TNF-α/β or C4A/B. Furthermore, there was no evidence of C4A gene deletion in patients with DPB. These results suggest that the HLA-B54 antigen itself might be directly involved in the pathogenesis of DPB.
(Internal Medicine 35: 693-697, 1996)

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To clarify the role of bronchoscopy for endotracheobronchial tuberculosis (EBTB), we performed a prospective study in 45 patients with active pulmonary tuberculosis, in 15 (33%) of whom bronchoscopic findings related to EBTB were seen. The findings were classified into six types: edematous hyperemic, submucosal nodule, ulcerative (shallowand deep), polypoid, cicatrical, and compression type. Each of these types was related to the healing process and outcome after antituberculosis chemotherapy. Serial bronchoscopy revealed that lesions less advanced than the deep ulcerative type responded to chemotherapy; the deep ulcerative and polypoid types progressed to cicatrical bronchostenosis despite chemotherapy. In the follow-up of patients with lesions of the deep ulcerative and polypoid types, serial bronchoscopy after chemotherapy is recommended; these patients also require adjunctive therapy to prevent cicatrical bronchostenosis.
(Internal Medicine 35: 698-703, 1996)

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We investigated the relationship between cigarette smoking and silent brain infarction in 365 neurologically normal male Japanese subjects (smokers: 119, nonsmokers: 246). Silent brain infarction was identified in 32 (26.9%) of 119 smokers and in 54 (22.8%) of 246 nonsmokers. Mild or moderate periventricular hyperintensity was presented in 27 smokers (22.7 %) and 54 nonsmokers (22.8%). There was no significant difference in the regional cerebral blood flow or the average systolic, diastolic, and mean arterial blood pressures between groups. The HDL-cholesterol level was significantly lower in smokers than in nonsmokers (p<0.01). Cigarette smoking was not related to the incidence of silent brain infarction or leuko-araiosis in healthy adults in Japan.
(Internal Medicine 35: 704-706, 1996)

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Forty-five patients with fungemia during 1982-1993 (periods 1=1982-1985, 11=1986-1989, III=1990-1993) in a Japanese university hospital were reviewed to follow changes in the clinical features of fungemia. The percentage of fungi among microorganisms isolated from blood cultures was almost constant (6-10%) throughout the study period. Fungemia was highly associated with use of intravascular catheters, and some changes in clinical features were observed: 1) Candida albicans, C. parapsilosis and C. glabrata were the main isolates, and the number of fungal species showed a tendency to increase. 2) The percentage of patients over 65 years old increased from 36 to 50 %. 3) The percentage of patients who were treated with anti-fungal agents and/or removal of catheter increased from 50 to 89 and to 86 %. 4) The percentage of patients who died within 28 days after isolation of fungus decreased from 64 to 27%. The improved prognosis was thought to be due to the development of new anti-fungal agents and faster removal of intravascular catheter when infection was suspected.
(Internal Medicine 35: 707-711, 1996)

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A patient with severe type II cryoglobulinemia after ten years of asymptomatic hepatitis C virus (HCV) infection is reported. Laboratory data showed hypergammaglobulinemia with polyclonal IgG and monoclonal IgM, blood hyperviscosity, high level of cryocrit (60%), HCV viremia, and normal levels of serum transaminases. Due to cold exposure, acrocyanosis and cardiac ischemic attack occurred; he recovered after being artificially warmed. Administration of prednisolone and natural interferon-alpha for three months resulted in significant decreases in the levels of serum IgM and cryocrit.
(Internal Medicine 35: 712-716, 1996)

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The efficacy of the H₂ receptor antagonist, cimetidine, in the treatment of a patient with porphyria cutanea tarda (PCX) was evaluated. After administration of cimetidine for 2 weeks, urinary excretion of uroporphyrin (UP) and coproporphyrin (CP) was significantly decreased. Urinary porphyrin levels remained low even after the cessation of cimetidine for 1 week. Although the readministration of cimetidine did not decrease porphyrin excretion, skin lesions were markedly improved, and serum γ-glutamyl transpeptidase (GGT), aminotransferases and serum ferritin decreased to the normal range. These results suggest that, in addition to efficacy in the treatment of acute intermittent porphyria (AIP) and erythropoietic protoporpyria (EPP), cimetidine is effective in the treatment of PCT.
(Internal Medicine 35: 717-719, 1996)

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A 57-year-old woman was admitted for evaluation of liver dysfunction. A physical examination revealed jaundice and a left abdominal mass, which was diagnosed as being a large renal tumor. Cholangiography showed a smooth filling defect 1 cm in diameter at the common bile duct. Left nephrectomy, and resection of the common bile duct were performed. The pathological diagnosis was metastasis of the common bile duct wall resulting from renal cell carcinoma. Metastatic common bile duct tumors are extremely rare. However, it is important to consider that this is one of the causes of obstructive jaundice.
(Internal Medicine 35: 720-723, 1996)

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A 47-year-old man was admitted to our hospital for abrupt onset of hemoptysis and dyspnea. Chest roentgenography revealed a left lower mass shadow with obstruction of the left main bronchus. However, on the third hospital day, he expectorated a coagulum-like substance which resembled bronchial tree, and his symptoms then dramatically subsided. Except for small amounts of bleeding from left B¹⁰a, the endobronchus was intact on bronchoscopic examination, and the pathologic diagnosis of the tumor using resected material was fibrous histiocytoma of low-grade malignancy. In addition, given the similarity in histologic findings between the expectorated substance and resected tumor, the expectorated substance was considered to be a part of the tumor which had grown along the endobronchial tree.
(Internal Medicine 35: 724-727, 1996)

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A 60-year-old man was admitted to our hospital for productive cough. Chest roentgenography and CT scan disclosed a left hilar tumor invading the mediastinum, with inediastinal lymphadenopathy and diffuse micronodular shadows in both lung fields. A biopsied sample of the tumor revealed squamous cell carcinoma, while noncaseating epithelioid cell granulomas were observed in the samples obtained by transbronchial lung biopsy. The granulomas in the pulmonary parenchyma were determined to be sarcoid reactions secondary to lung cancer, since there was no evidence of sarcoidosis. Combination chemotherapy was effective for the tumor, and the granulomas disappeared after completion of the chemotherapy. These findings suggest the presence of a relationship between sarcoid reactions and lung cancer in this case.
(Internal Medicine 35: 728-731, 1996)

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Two patients with small cell lung cancer (SCLC) developed "web-like" mucosa that obstructed bronchi after concurrent chemoradiotherapy. It seemed that the orifice of the bronchi had disappeared. Since the patients were free of local recurrence and the histologic findings of "weblike" mucosa were negative for malignancy, we believe that "web-like obstruction" was additional sign of regional complete remission of SCLC after concurrent chemoradiotherapy.
(Internal Medicine 35: 732-735, 1996)

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A 53-year-old male of allergic bronchopulmonary aspergillosis (ABPA) with pulmonary fungus ball, who had been administered steroid and suffered repeatedly from dyspnea, was treated successfully with continuous percutaneous instillation of antifungal agents into the cavity. Although the pulmonary fungus ball in his left upper lobe was thought to be worsening ABPA, oral and intravenous antifungal agents failed to improve the clinical course. We selected to use continuous instillation of antifungal agents via an indwelling catheter which was inserted percutaneously into the cavity. Although the instillation of fluconazole (FCZ) for four weeks did not alter the process, two-week instillation of amphotericin B (AMPH) caused disappearance of the fungus ball. We measured the plasma concentration of FCZ and AMPH during their instillation into the cavity to ascertain this treatment to be free from side effects pharmacokinetically.
(Internal Medicine 35: 736-741, 1996)

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A 53-year-old female infected with human T lymphotropic virus type-I (HTLV-I) suffered from chronic renal failure, aplastic anemia, myelopathy, uveitis, Sjögren's syndrome and Weber-Christian disease. Although HTLV-I antibody was negative in cerebrospinal fluid, she was diagnosed as HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) based on clinical and histological findings. Though to date there is no direct evidence, other complications have also been reported to be HTLV-I related diseases. This case provided the unique opportunity to observe various HTLV-I related diseases.
(Internal Medicine 35: 742-745, 1996)

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Hemolytic anemia developed in a male who had been diagnosed as having myotonic muscular dystrophy (MMD). His red cell life-span examined by ⁵¹Cr-labeling method was shortened (T_1/2 = 6.5 days). Specific abnormalities of red cells were not found other than increased osmotic resistance, increased intracellular sodium, and decreased intracellular potassium of red cells. A clinical review of 18 other patients with MMD did not reveal any signs of hemolysis. It may be suggested that the underlying red cell membrane defects due to MMD contributed to this rare association with hemolysis.
(Internal Medicine 35: 746-748, 1996)

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The patient is a 25-year-old Filipino who showed polymorphous eruptions over the whole body, right ulnar nerve paresis, polyneuropathy and hypalgesia in the area of eruptions. Because the biopsy specimen showed foam cells, histiocytes, epithelioid cells, many Mycobacterium leprae and no giant cells, the diagnosis of borderline-lepromatous (BL) type was made. The symptoms were improved by the administration of 300 mg/day ofloxacin. Because the monotherapy using ofloxacin has been reported to be effective in all 5 previously reported cases of BL type leprosy, it may be recommended for a larger number of leprosy cases.
(Internal Medicine 35: 749-751, 1996)

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