Are nonsmoking physicians more likely to give smoking cessation advice to their patients? To determine this, we sent a questionnaire individually to physicians in Tokyo. The average age of the 323 respondents was 59.8±12.9 (mean±SD); 84.8% of them were male and 21.1% were smokers. Among the respondents, 88.8% asked their patients about their smoking status, 79.9% advised smoking patients to stop, and 93.5% believed smoking cessation interventions to be necessary. Nonsmoking physicians were more likely to advise patients to stop smoking (85.6%) than smoking physicians (70.1%); the smoking physicians who themselves wished to reduce cigarette consumption or stop smoking were more likely to do so (85.0%) than those who did not wish to reduce or stop (43.5%). Moreover, more nonsmoking physicians seriously felt that smoking cessation interventions are necessary (31.2%) than did smoking physicians (6.5%). In conclusion, the smoking status and attitude towards smoking of physicians influences their enthusiasm to give advice to their patients against smoking.
(Internal Medicine 36: 162-165, 1997)

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Fas/APO-1 mediates apoptosis via Fas and Fas ligand transduction. Recently, a soluble form of Fas (sFas) was described which seems to be functionally implicated in the Fas signal system, suggesting a relationship between some disorders and sFas function. We measured sFas-levels in sera from normal controls and patients with disorders linked to human retroviral infection of human immunodeficiency virus (HIV) and human T-cell leukemia virus type-1 (HTLV-1). The sFas level of normal controls. HTLV-1 carriers seronegative for HIV, and patients with HTLV-1 associated myelopathy/tropical paraparesis (HAM/TSP), adult T-cell leukemia (ATL), and AIDS was 1.62±0.49, 1.90±0.49, 2.00±0.59, 3.32±2.05, and 3.06±0.92 ng/ml, respectively. Although the level of sFas in patient groups with HAM/TSP, ATL, and AIDS was significantly high in comparison to that of normal controls (p<0.01), the individual values were highly variable within the groups. The sFas level was statistically correlated to the soluble interleukin-2 receptor (sIL-2R) level, as well as to cells expressing membrane Fas (mFas), indicating the same cellular origin. In some ATL cases, however, serum sFas levels and mFas expression density on leukemic T-cells were discrepant, with especially high levels of the soluble form and a lack of expression of the membrane form observed in 2 cases. sFas detection could serve as a putative marker for active diseases in patients with ATL and AIDS.
(Internal Medicine 36: 166-170, 1997)

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Over a 23-year period, 17 patients with hematologic diseases developed Aeromonas bacteremia while in our hematology ward. Male predominance (14 patients, 82 %) was seen, with a predilection for the elderly. Hematologic malignancies, especially acute leukemia, accounted for 15 (88%) of all patients. Cancer chemotherapy and neutropenia (15 patients each) were the most common preceding host conditions. Aeromonas bacteremia generally occurred in the second half of the year (July-December), with no exposure to water or fish. Seven recent isolates comprised Aeromonas sobria (five isolates) and Aeromonas hydrophila (two isolates). Twelve patients (71%) showed a clinical picture ranging from mild gastroenteritis to severe enterocolitis. Anorectal and hepatobiliary infections were also noted in a few patients. The overall mortality rate was 35%. Ten (77%) of the 13 patients who were treated with aminoglycoside plus cephalosporin or carbapenem survived in association with marrow recovery.
(Internal Medicine 36: 171-174, 1997)

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To study the epidemiology of the neurologic manifestations of human immunodeficiency virus (HIV)-l infection in Japan, we conducted two nationwide surveys. Of 1854 HIV-1 carriers, 578 had acquired immunodeficiency syndrome (AIDS) and 166 (28.7% of AIDS patients) had neurologic manifestations including HIV dementia (11.8%), myelopathy (3.6%) and peripheral neuropathy (2.6%). The incidence of neurologic manifestations in patients with HIV-1 infection through blood products was about 60% of that in patients with HIV-1 infection through sex or unknown routes. This nationwide survey showed that the incidence of neurologic manifestations in AIDS patients in Japan was consistent with that in other countries.
(Internal Medicine 36: 175-178, 1997)

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The effects of recombinant human (rh) interleukin (IL)-4 or rhIL-13 on survival, and chemotactic activity of human eosinophils were examined. Only rhIL-13 prolonged eosinophil survival in a dose-dependent manner above 3 ng/ml. Eosinophil survival induced by rhIL-13 was inhibited by monoclonal antibodies (mAbs) against IL-3 (p<0.01) and granulocyte-macrophage colony-stimulating factor (GM-CSF) (p<0.05), suggesting that rhIL-13 induced IL-3 and GM-CSF production from eosinophils and an autocrine mechanism is responsible for the eosinophil survival. The effects of rhIL-13 on eosinophil chemotactic activity were also examined. rhIL-13 showed chemotactic activity for eosinophils in a dose-dependent manner. Checkerboard analysis revealed that eosinophil migration was dependent on the concentration gradient, confirming that rhIL-13 is a chemotactic factor. rhIL-4 showed no effects. IL-13 may play an important role in the survival and recruitment of eosinophils in allergic diseases.
(Internal Medicine 36: 179-185, 1997)

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We report a case of giant hepatic angiomyolipoma in a 68-year-old woman who had an increase in the flbrinolytic activity concomitant with disseminated intravascular coagulation (DIG). The presence of the tumor was confirmed by ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and the selective arteriography of the liver via the superior mesenteric artery. Following treatment with heparin and gabexate mesilate, abnormal hemostatic values were corrected. Furthermore, the surgical removal of the huge hepatic angiomyolipoma completely normalized the alternations of the clotting system. These findings suggest that giant hepatic angiomyolipoma was profoundly associated with DIG.
(Internal Medicine 36: 186-190, 1997)

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A 47-year-old man died from fatal pulmonary hemorrhage. Cardiac angiosarcoma with lung metastases was found at postmortem examination. His chest radiograph showed bilateral, diffuse nodular infiltrates without cardiomegaly. No cardiac signs and symptoms were observed. The clinical outcome was rapidly fatal. Angiosarcoma of the heart should be suspected in patients with hemoptysis and nodular chest radiograph abnormalities, even in the absence of cardiac signs and symptoms.
(Internal Medicine 36: 191-193, 1997)

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A 21-year-old man with isolated adrenocorticotropic hormone (ACTH) deficiency complained of loss of consciousness in association with hypoglycemia. Both plasma ACTH and cortisol levels were low and failed to respond to corticotropin-releasing hormone (CRH) stimulation. The patient also showed abnormal findings in hematological examination, such as neutropenia and anemia with lymphocytosis, activity of coagulation factors, and electroencephalography (EEC). Furthermore, mitogen-induced lymphocyte proliferation was increased. After successful replacement therapy with hydrocortisone 15 rag/day, most of these abnormalities including the lymphocyte proliferation were fully restored.
(Internal Medicine 36:194-197, 1997)

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An 83-year-old woman taking isoniazid (INH) suddenly developed a headache, palpitations, and skin eruptions with itching while eating raw tuna. The symptoms were compatible with those of histamine intoxication. When given fresh raw tuna to eat, no such reactions were evoked in this patient. The episode was speculated to be due to two conditions; eating spoiled raw tuna and at the same time being on a course of INH, a potent histaminase inhibitor. We should therefore be aware of the possible adverse effects due to the interactions between drugs and foods.
(Internal Medicine 36:198-200, 1997)

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We treated two cases of renal hypouricemia with nephrolithiasis. The serum uric acid level of the first patient was 1.5 mg/dl, and the ratio of uric acid clearance to creatinine clearance (CUA/Ccr) was 75.7%. In the benzbromarone (BZB) suppression test, CUA/Ccr was increased from 60.4% to 130.0%, but was not decreased in response to the pyrazinamide (PZA) suppression test. This patient was considered to have a presecretory reabsorptive urate transportation defect. His condition was also associated with IgA nephropathy. The serum uric acid level in the second patient was 1.0 mg/dl and CUA/Ccr was 56.0%. Neither PZA nor BZB had a significant effect on CUA/Ccr. He was considered to have a subtotal uric acid transportation defect. Both patients were incidentally found to have nephrolithiasis. The second patient had abnormal maximum tubular secretory capacity for para-aminohippurate (PAH) (TmPAH), and was found to have two kinds of proximal tubular abnormalities related to uric acid and PAH.
(Internal Medicine 36: 201-205, 1997)

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We report three non-typical cases of renal angiomyolipoma including clinical features, imaging examinations (with ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography) and histological findings. Microaneurysms observed by angiography were common to the three cases and were considered to be an important finding in the diagnosis of renal angiomyolipoma. Moreover, the short tau inversion recovery (STIR) method of MRI, which suppresses photon signals of fat, was considered to be useful for the diagnosis. Case 1 was accompanied by spontaneous rupture, Case 2 was difficult to diagnose because of little fat tissue and Case 3 revealed a very small tumor.
(Internal Medicine 36: 206-210, 1997)

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Scrofula or cervical tuberculous lymphadenitis (CTBL) should be suspected in patients with a history of potential exposure to tuberculosis present with cervical lymphadenopathy. A 55 year-old frequent traveler to Philippine and Thailand developed swelling of the bilateral cervical lymph nodes, and positive conversion of purified protein derivative of tuberculin (PPD) without pulmonary manifestations. The excisional biopsy of the cervical lymph nodes was useful for prompt diagnosis of CTBL, and the patient was successfully treated with isoniazid (INH) and rifampicin (RFP).
(Internal Medicine 36: 211-213, 1997)

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A 57-year-old man was admitted to our hospital because of dyspnea and abnormal shadow on chest roentgenogram. He had received two herbal drugs: Saikokeisikankyou-tou (SKT) for one month and Licium Halimifolium Mil (LHM) for two weeks. After admission, all medication was stopped and his symptoms were gradually diminished. Transbronchial lung biopsy specimens showed interstitial pneumonia. Lymphocyte stimulation test, skin test and challenge test were positive to these herbal drugs. We diagnosed him as drug-induced pneumonitis. This is the first report on pneumonitis caused by Saikokeisikankyou-tou diagnosed by lymphocyte stimulation test, skin test and challenge test.
(Internal Medicine 36: 214-217, 1997)

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Disseminated intravascular coagulation (DIG) is a very rare complication of pulmonary tuberculosis. We herein describe a case of cavitary tuberculosis complicated with DIG. Rifampin was considered to deteriorate the clinical course of DIG in this case.
(Internal Medicine 36: 218-220, 1997)

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We report a rapidly fatal Bacillus cereus septicemia in a leukemic patient receiving remission-induction therapy. Symptoms resembling food poisoning and fever preceded coma accompanied by neurologic abnormalities. Autopsy revealed necrotizing leptomeningitis with subarachnoid hemorrhage and coagulation necrosis of the liver with bacterial infiltration. These clinicopathologic findings were closely similar to those of reported cases. Because of a rapidly fatal clinical course, suspicion of this syndrome early in the course is important to determine an appropriate treatment. Therefore, we propose that this type of septicemia should be termed as fulminant septicemic syndrome of Bacillus cereus.
(Internal Medicine 36: 221-226, 1997)

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The patient, a 64-year-old male, complained of morning stiffness, polyarthralgia and bilateral knee joint swelling with leukocytosis (24, 200/μl) in peripheral blood. The leukocyte differentiation revealed 54% medium-sized immature lymphocytes. The majority of lymphocytes showed the B-cell characteristics of IgG& monoclonality, and CD19⁺ and CD20⁺ in cell surface phenotype, suggesting a B-cell malignancy, non-Hodgkin lymphoma in the leukemic phase. Arthropathy associated with lymphoid malignancy was suspected. However, the infiltrated leukocytes in the synovial fluid of the left knee joint were dominantly neutrophils and CD3⁺ T-cells, and compatible with the findings in rheumatoid arthritis (RA). The association of B-cell malignancy and RA is not frequently reported. We discuss the common underlying immunological abnormalities in both B-cell malignancy and RA.
(Internal Medicine 36: 227-231, 1997)

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