To determine the efficacy of the medical interview and the coronary risk factor profile in differentiating vasospastic angina from other causes of chest pain, we examined 59 patients who underwent diagnostic coronary angiography with selective intracoronary injection of acetylcholine. In the medical interview, a questionnaire on the characteristics of chest pain and additional symptoms was given. We examined coronary risk factors from laboratory tests, life history, and physical examination. Chest pain accompanied by cold sweat and occurring in the early morning was the only significant discriminating information; the location of pain and the duration were not discriminating. Classic coronary risk factors did not differ between vasospastic angina and noncardiac chest pain except for gender. We conclude that history taking is the most important means to distinguish vasospastic angina from other causes of chest pain.
(Internal Medicine 36: 676-679, 1997)

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Smoking is the most common cause of secondary polycythemia and may induce leukocytosis. We studied the relationship between hematopoietic growth factors and erythrocytosis and leukocytosis. Two sets of healthy male volunteers, consisting of 177 and 202 (age: 19-59 years) were each divided into four groups according to whether or not they smoked at least one package daily and their leukocyte count. Serum erythropoietin (Epo) concentration and granulocyte-colony stimulating factor (G-CSF) concentration were measured in the 177 and 202 volunteers, respectively. The mean serum Epo concentration was lower in smokers than in nonsmokers (p=0.01 in the subjects without leukocytosis and p=0.107 in those with leukocytosis, respectively). After 3 smokers stopped smoking, the Epo concentration increased 2 weeks later, and remained constant for 20 weeks. Smokers tended to have a higher mean serum G-CSF concentration than nonsmokers in the subjects without leukocytosis. Neither Epo nor G-CSF is the main etiology of smokers' polycythemia, and Epo production may be down-regulated by an elevated red-cell volume.
(Internal Medicine 36: 680-684, 1997)

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The levels of sialyl Lewis X-i antigen (SLX), which is one of the cancer-associated carbohydrate antigens, were evaluated in 83 malignant and 46 benign pleural effusions. SLX levels in pleural effusion due to lung adenocarcinoma were significantly higher than those due to benign diseases (p<0.0001), lung cancer other than adenocarcinoma (p=0.0052), and adenocarcinoma originating from other organs (p=0.0492). According to receiver operating characteristic (ROC) curve analysis, the optimal cut-off level in the discrimination between malignant and benign pleural effusions was 92 U/ml, which gave a sensitivity of 57.1 % and a specificity of 77.8 %. The cut-off level of pleural effusion in patients with carcinomatous pleuritis might be higher than that of serum (38 U/ml).
(Internal Medicine 36: 685-689, 1997)

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The neurological manifestations of twenty-one Japanese patients with Sjögren's syndrome (SjS) were evaluated. All patients were women, and sixteen of the twenty-one cases (76%) demonstrated objective abnormal neurological symptoms, the most frequently observed of which was trigeminal neuropathy (50%). Multiple mononeuropathy was seen in almost one-third of the examined cases (31%). Central nervous system (CNS) involvement was observed in three cases (14%). All of these values differed greatly from those previously reported. Therefore, this study revealed characteristic features of Japanese SjS and also implied the existence of different immunopathological mechanisms associated with SjS in Japanese patients.
(Internal Medicine 36: 690-693, 1997)

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Three methods for molecular typing of methicillin-resistant Staphylococcus aureus using polymerase chain reaction (PCR) were compared. The method which amplified the variable number of tandem repeat of dru sequences grouped the isolates into six types. Whereas, the method examining restriction fragment length polymorphism of coagulase gene and the method using arbitrarily primed-PCR showed poor diversity in typing. We investigated the distribution of dru types in two hospitals. Obvious concentration of a type in one ward was not recognized in our hospital. In the other hospital, a rare type was detected from the inpatients in the pediatrics ward. It suggested that the infection was an epidemic. We also found that some patients were infected with more than two strains. Even if two isolates show the same type, it does not necessarily mean that they originated from one clone. However, this method brings meaningful information on nosocomial infection, more easily than other genotyping.
(Internal Medicine 36: 694-699, 1997)

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A 40-year-old male, with a past history of hypertension but receiving no medical treatment, was referred. He manifested malignant hypertension (190/130 mmHg; Keith-Wagener III), renal dysfunction (serum creatinine, 3.8 mg/dl), and elevated plasma aldosterone (450 pg/ml) and active renin concentration (ARC, 104 pg/ml). His blood pressure was controlled with multiple antihypertensive agents and ARC thus decreased (4.3 pg/ml), but aldosterone remained elevated. Abdominal magnetic resonance imaging (MRI) revealed a right adrenal adenoma, and aldosterone-producing adenoma was confirmed by adrenal venous sampling. Primary aldosteronism very rarely develops to malignant hypertension, and even in that case ARC is suppressed. Therefore this is a rare case of primary aldosteronism complicated with malignant hypertension and high ARC.
(Internal Medicine 36: 700-704, 1997)

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Pentamidine isethionate induced torsades de pointes in a 33-year-old woman with acute myelogenous leukemia. This is the first report of Pentamidine-induced torsades de pointes in Japan for over ten years. On the 4th day of intravenous pentamidine for Pneumocystis carinii pneumonia, asymptomatic sinus bradycardia was noted with QT interval prolongation, and torsades de pointes were revealed on the 8th day. Although torsades de pointes was dissolved with discontinuation of the intravenous pentamidine and administration of magnesium sulfate, sinus bradycardia and prolonged QT interval persisted. Ventricular pacing resulted in no arrhythmia and normalization of the QT interval on the 10th day after discontinuation of pentamidine. Careful monitoring of the electrocardiogram should be carried out during intravenous pentamidine therapy.
(Internal Medicine 36: 705-708, 1997)

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A 50-year-old woman with allergic granulomatous angiitis (AGA) presented with an elevated serum interleukin-5 (IL-5) level upon admission to a hospital. Administration of prednisolone showed marked improvement of asthmatic symptoms, reduced eosinophil counts of peripheral blood, and normalized serum IL-5 levels. This is the first report describing an elevated serum level of IL-5 in AGA. The present findings suggest that IL-5 is involved in the pathogenesis of AGA.
(Internal Medicine 36: 709-711, 1997)

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A 74-year-old man who had been diagnosed with malignant mesothelioma developed malignant lymphoma of B-cell origin involving the penis. He had a history of occupational exposure to asbestos as a construction worker. The association of malignant mesothelioma with lymphoma is rare, and the possibility of asbestos exposure as a common etiology is discussed. The intense stimulation of B lymphocytes and decreased T lymphocyte activity in asbestos-exposed populations may result in development of B-cell malignancies. Though the relationship between asbestos exposure and malignant mesothelioma is firmly established, the relationship between asbestos exposure and lymphoma remains to be investigated.
(Internal Medicine 36: 712-715, 1997)

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An 83-year-old female patient with a giant thymic cyst that was successfully treated by percutaneous aspiration and ethanol injection. The patient had complained of coughing and chest discomfort for several years. A chest X-ray film revealed the shadow of a large abnormal mass in the anterior mediastinum. We diagnosed it as a thymic cyst. The patient refused surgery because of her age. We chose a less invasive therapy, namely, ethanol sclerosis of the cyst. The cyst was successfully treated without any complications, and no recurrence was found at the one-year follow-up. This therapy may be one of the best treatments for thymic cysts, especially in very elderly patients.
(Internal Medicine 36: 716-719, 1997)

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A 56-year-old Japanese woman was referred to us for the treatment of lung cancer. On admission, the patient showed multiple bone metastases, including the skull, without brain metastasis. During chemoradiotherapy for the primary tumor and bone metastasis involving the thoracic spine, she suffered a fatal intracerebral hemorrhage. Since the patient had no risk factors for intracerebral hemorrhage, the skull bone metastasis was thought to be responsible for this event. At autopsy, penetration of the metastatic tumor from the skull bone into the dura, with direct invasion of the brain tissue, was confirmed histologically. A hematoma also was identified at the same site adjacent to the skull bone metastasis. To our knowledge, direct tumor invasion to the brain from a skull metastasis of non-small cell lung cancer has not been previously reported.
(Internal Medicine 36: 720-723, 1997)

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Non-small cell lung cancer patient was found to have auto-antibodies against L-Myc in both the serum and pleural effusion. The titer of anti-L-Myc antibodies was higher in the pleural effusion than in the serum. Overexpression of L-Myc without DNA amplification was observed in the tumor cells. L-Myc antigen was not detected in either the serum or the pleural effusion. Anti-nuclear antibodies were also detected in both the serum and pleural effusion, although this patient did not have collagen-vascular disease.
(Internal Medicine 36: 724-727, 1997)

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We report a case of spontaneous remission of desquamative interstitial pneumonia (DIP) in a 50-year-old male. The histological diagnosis of DIP was based on open lung biopsy. A chest X-ray revealed reticulo-nodular shadows in the bilateral lung fields, and the patient had mild dyspnea on exertion. Without treatment, these shadows decreased gradually and disappeared after several months. The patient recovered completely within one year, and recurrence of the disease has not been observed for 4 years. Recently, DIP has rarely been described, and the spontaneous remission of DIP has not been reported since Carrington et al in 1978 (1).
(Internal Medicine 36: 728-731, 1997)

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A malignant solitary fibrous tumor arising in the right buttock associated with metastatic parietal pleural and intrapulmonary tumors and pleural effusion was found in a 59-year-old man. A chest computed tomogram revealed three tumors attached to the parietal pleura with rib destruction, and a tumor in the left lower lung field. Histologically, the tumors of the buttock and parietal pleura were characterized by proliferation of bundles of spindle-shaped or oval cells separated by wavy hyalinized collagen tissue with no expression of cytokeratin, S-100 protein, muscle actin or epithelial membrane antigen, but these cells weakly expressed CD34 and strongly expressed vimentin.
(Internal Medicine 36: 732-737, 1997)

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A 46-year-old man was referred to us for treatment of non-Hodgkin's lymphoma (NHL; diffuse large immunoblastic B cell type), which had initially developed in the breast. He was treated with five courses of chemotherapy with CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) and achieved a complete response. One year later, he noticed a gait disturbance. Magnetic resonance imaging (MRI) of the brain showed multiple nodules. A few abnormal cells were found in the cerebrospinal fluid (CSF). He was treated with high-dose etoposide (1, 350 mg/m²/course). After two courses, both the multiple nodular lesions in the brain and the abnormal cells in the CSF were resolved. High-dose etoposide is effective for CNS involvement by NHL.
(Internal Medicine 36: 738-741, 1997)

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A patient with chronic bromvalerylurea poisoning showed cerebellar ataxia and peripheral neuropathy. The patient was a 42-year-old Japanese man who developed consciousness disturbance, diplopia, slurred speech, ataxia and gait disturbance after having taken bromvalerylurea for ten years. Magnetic resonance imaging revealed atrophy of the cerebellum and pontine tegmentum. An electrophysiological study revealed decreased motor nerve conduction velocity and amplitude of compound muscle action potentials of the right tibial nerve. Histological findings of the left sural nerve indicated a slightly decreased large myelinated fiber diameter, which suggested chronic axonal damage.
(Internal Medicine 36: 742-746, 1997)

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The nucleoprotein (NP) gene of type B influenza virus was detected by reverse transcription polymerase chain reaction (RT-PCR) from the cerebrospinal fluid (CSF) of a patient presenting with ataxia due to cerebellitis. The CSF was obtained 7 and 9 weeks after flu syndrome occurred, suggesting persistence of viral genes in the central nervous system (CNS). Although an unusually high serum hemagglutination inhibition (HI) titer against influenza virus B was noted, HI titers of the CSF were not elevated.
(Internal Medicine 36: 747-749, 1997)

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A 66-year-old man was hospitalized for abdominal pain and diarrhea of more than 10 times a day. He had been under regular medication with prednisolone for rheumatoid arthritis. On admission, laboratory data and clinical examination indicated inflammation, dehydration, acute renal failure with a high level of serum musculogenic enzyme (creatine kinase), and ileus. Salmonella enteritidis was isolated from his fecal and blood samples. The patient died within 24 hours after admission, and autopsy showed hemorrhagic necrotic enteritis localized to the ileum. Enterocolitis due to Salmonella enteritidis, which is usually an acute self-limited gastrointestinal illness, may occasionally be a serious and lethal disease.
(Internal Medicine 36: 750-753, 1997)

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