Internal Medicine
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Volume 37, Issue 11
Displaying 1-26 of 26 articles from this issue
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  • Normal Chest Radiograph and Lung Function do not Necessarily Mean Normal Lungs
    Sanae SHIMURA
    1998 Volume 37 Issue 11 Pages 901-902
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.901
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  • Surgical Treatment of Takayasu's Arteritis
    Keishu YASUDA
    1998 Volume 37 Issue 11 Pages 903-904
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.903
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  • Partial Hypoxanthine Phosphoribosyltransferase Deficiency: Unrecognized Until Adult Ages
    Naoyuki KAMATANI
    1998 Volume 37 Issue 11 Pages 905-906
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.905
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  • Hyponatremia: How to Approach This Confusing Abnormality
    Yutaka OISO
    1998 Volume 37 Issue 11 Pages 907-908
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.907
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  • Many Faces of Mixed Medullary-Follicular and Papillary Carcinoma of the Thyroid
    Tsuyoshi MONDEN, Masatomo MORI
    1998 Volume 37 Issue 11 Pages 909-910
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.909
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  • Hypophosphatemia and Encephalopathy in Alcoholics
    Naokazu NAGATA
    1998 Volume 37 Issue 11 Pages 911-912
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.911
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  • Association of Chronic Infection of Chlamydia pneumoniae and Coronary Heart Disease in the Japanese
    Naoyuki MIYASHITA, Eiji TOYOTA, Toshitami SAWAYAMA, Akira MATSUMOTO, Y ...
    1998 Volume 37 Issue 11 Pages 913-916
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.913
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    The association of Chlamydia pneumoniae with atherosclerosis of coronary and carotid arteries and the aorta has been demonstrated by seroepidemiology and by detection of the organism in atheromata. We investigated the frequency of C. pneumoniae seropositivity in patients with acute myocardial infarction (AMI). C. pneumoniae-specific antibodies were measured by the microimmunofluorescence test in 160 AMI patients and 160 control subjects matched for age and gender. The odds ratios (ORs) were 2.2 (95% confidence interval (CI), 1.2 to 3.9) for immunoglobulin (Ig)G and 2.7 (95% CI, 1.7 to 4.3) for IgA. After adjustment for other cardiovascular risk factors of age, gender, hypertension, diabetes, cigarette smoking and serum cholesterol, the ORs were essentially unchanged. This study confirmed that the observations of an association between antibody against C. pneumoniae and coronary heart disease in Western nations is also present in Japan. Our results are comparable to the previous seroepidemiological studies reporting ORs of 2.0 or greater.
    (Internal Medicine 37: 913-916, 1998)
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  • Mechanism of Increased Serum Cytokeratin 19 Fragment Levels in Patients with Diabetic Nephropathy as a Model of Chronic Renal Failure
    Kosuke KASHIWABARA, Koji KISHI, Hiroyuki NAKAMURA, Hisanaga YAGYU, Kat ...
    1998 Volume 37 Issue 11 Pages 917-921
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.917
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    We examined serum and urinary cytokeratin 19 fragment (CYFRA 21-1) levels in patients with diabetic nephropathy as a model of chronic renal failure, to investigate the mechanism of increased serum CYFRA 21-1 levels in chronic renal failure. Serum and urinary CYFRA 21-1 levels in non-insulin-dependent diabetes mellitus (NIDDM) patients with abnormal urinary immunoglobulin G (IgG) levels (>1.1 mg/g • Cr, n=126) were higher than those with normal urinary IgG levels. In NIDDM patients with normal urinary IgG levels (n=81); the urinary albumin or transferrin levels were not related to serum or urinary CYFRA 21-1 levels. We speculate that the increased serum CYFRA 21-1 levels contribute to metabolic abnormality in the kidney itself rather than the decreased urinary excretion per se, and that increased urinary CYFRA 21-1 levels are found in advanced cases of diabetic nephropathy with destruction of the size barrier.
    (Internal Medicine 37: 917-921, 1998)
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  • Pulmonary Manifestations in Cerebrotendinous Xanthomatosis
    Masaharu KAWABATA, Masaru KURIYAMA, Shinitirou MORI, Izumi SAKASHITA, ...
    1998 Volume 37 Issue 11 Pages 922-926
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.922
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    We investigated five cases with cerebrotendinous xanthomatosis (CTX) with particular reference to biochemical and pathological pulmonary disorders. To date, few reports discuss the pathophysiology of pulmonary disorders of CTX patients. This study is the first investigation of such pulmonary disorders. All 5 patients had no pulmonary symptoms and no disturbances on radiological studies and pulmonary function tests. However, in bronchoalveolar lavage (BAL) fluids, many cells with cruciform reflexes, which is characteristic of intracellular sterol accumulation, were found under phase contrast microscopy. Biochemically, cholestanol was found to be increased in the BAL fluid as well as in serum. Pathological findings of transbronchial lung biopsy (TBLB) samples disclosed foamy macrophages and small granulomas in alveolar septa. In conclusion, the lung was apparently involved in CTX, and the lesions were characterized with the accumulation of foamy and giant cells with a high concentration of cholestanol, which likely results in the formation of foreign body granulomas.
    (Internal Medicine 37: 922-926, 1998)
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  • Acute Liver Damage with Characteristic Apoptotic Hepatocytes by Ingestion of Aplysia kurodai, a Sea Hare
    Yoshikuni SAKAMOTO, Tomoki NAKAJIMA, Shinichi MISAWA, Hiroki ISHIKAWA, ...
    1998 Volume 37 Issue 11 Pages 927-929
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.927
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    A case of acute liver damage by ingestion of Aplysia kurodai, a sea hare is reported. A 40-yearold man, complaining of vomiting and pyrexia after eating a sea hare, was admitted. Laboratory data showed mild liver damage with sustained elevations of aminotransferases. Microscopic findings in the liver biopsy specimen revealed characteristic apoptotic hepatocy tes accompanied by mitotic hepatocytes. It is suggested that bioactive substances in the sea hare might induce such apoptosis of hepatocytes in the liver.
    (Internal Medicine 37: 927-929, 1998)
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  • Aneurysm of the Gastroduodenal Artery
    Yasuyuki MATSUZAKI, Toshihiko INOUE, Kazuko KUWAJIMA, Yuji ITO, Yasuhi ...
    1998 Volume 37 Issue 11 Pages 930-933
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.930
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    We report a case of gastroduodenal arterial aneurysm incidentally discovered by abdominal ultrasonogram, in which three-dimensional computed tomography (3D-CT) was useful for diagnosis. An 85-year-old man was hospitalized because of fever and liver dysfunction. Carcinoma of the papilla of Vater was diagnosed by endoscopic retrograde cholangio-pancreatography, while abdominal ultrasonogram and CT scan revealed a round mass measuring 6.2×4.1 cm on the ventral side of the pancreatic head. Three-dimensional CT demonstrated that the mass arose from a branch of the common hepatic artery and projected downward, indicating a gastroduodenal arterial aneurysm. During pancreatoduodenectomy and aneurysmectomy, it was confirmed that this aneurysm arose from the gastroduodenal artery.
    (Internal Medicine 37: 930-933, 1998)
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  • Long-Term Patency of an Aorta-Aortic Graft Bypass in a Patient with Takayasu Arteritis
    Gustavo MONCADA, Yasushi KOBAYASHI, Yoshiaki MARUYAMA, Toru KATO, Mako ...
    1998 Volume 37 Issue 11 Pages 934-939
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.934
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    A 39-year-old woman was diagnosed by means of angiography as Takayasu Arteritis complicated with severe systemic hypertension due to atypical coarctation of the aorta. Aortaaortic bypass graft surgery was carried out successfully and hypertension remarkably improved. An evaluation of the graft 23 years later confirmed an almost perfect condition with a very satisfactory clinical status. Extensive long-term follow-up studies have been conducted among young people after surgical repair of aortic coarctation showing encouraging results, however the situation seems to be different for the atypical coarctation in Takayasu patients, since not only the age at the time of intervention affects the outcome, but the different circumstances mainly related to the natural history of the disease. We evaluated the long-term outcome based on similar cases with particular consideration to the extremely rare coexistence of familiar hypercholesterolemia.
    (Internal Medicine 37: 934-939, 1998)
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  • Cardiac Malignant Pheochromocytoma with Bone Metastases
    Atsumi ARAI, Mitsuhide NARUSE, Kiyoko NARUSE, Akiyo TANABE, Takanobu Y ...
    1998 Volume 37 Issue 11 Pages 940-944
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.940
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    A patient with malignant cardiac pheochromocytoma with bone metastases is described. The primary tumor was located between the pulmonary trunk and the left atrium, while metastatic lesions were found in the iliac bones. Treatments with antihypertensive agents, α-methylparatyrosine, and combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine partially improved the patient's symptoms, catecholamine levels, and the metastatic lesion of the iliac bones. However, the primary tumor in the heart progressively increased in size and the patient died of disseminated intravascular coagulation and other various complications about 4 years after the diagnosis of the disease.
    (Internal Medicine 37: 940-944, 1998)
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  • Partial Deficiency of Hypoxanthine-Guanine Phosphoribosyltransferase Manifesting as Acute Renal Damage
    Miho HIKITA, Tatsuo HOSOYA, Kimiyoshi ICHIDA, Hideaki OKABE, Masakatsu ...
    1998 Volume 37 Issue 11 Pages 945-949
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.945
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    A 32-year-old man who had had frequent gouty arthritis over the past 17 years, was admitted for acute renal failure. Acute renal failure was improved rapidly after medication was resumed and the patient was sufficiently hydrated. The hypoxanthine-guanine phosphoribosyltransferase (HPRT) activity in the patient had been reduced to about 30% of the normal control. Therefore we considered that this patient suffered from a partial deficiency of HPRT. A point mutation of HPRT gene 68G (guanine) to T (thymine) was detected. This is a mutation that has not been previously reported. Familial analysis indicated that his mother and sister were heterozygotes.
    (Internal Medicine 37: 945-949, 1998)
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  • Asymptomatic Hyponatremia due to Inappropriate Secretion of Antidiuretic Hormone as the First Sign of a Small Cell Lung Cancer in an Elderly Man
    Kyuzi KAMOI, Izumi KUROKAWA, Hidehiro KASAI, Akio MIZUSAWA, Tatsuo EBE ...
    1998 Volume 37 Issue 11 Pages 950-954
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.950
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    A 72-year-old man was hospitalized with asymptomatic hyponatremia. Despite hyponatremia, urinary sodium excretion with urine osmolality exceeding plasma osmolality persisted. Plasma vasopressin levels were high and independent of plasma osmolality during hypertonic saline infusion. Computed tomography of the chest showed enlarged mediastinal and right hilar lymph nodes. Microscopically, a specimen of lymph nodes obtained by biopsy represented vasopressinproducing small cell lung carcinoma. Chemotherapy plus irradiation improved the hyponatremia. Thus, careful evaluation is necessary to determine the cause of hyponatremia disorders in elderly patients.
    (Internal Medicine 37: 950-954, 1998)
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  • Mixed Medullary-Follicular Carcinoma and Papillary Carcinoma of the Same Thyroid
    Chung-Jung Wu, Hsiang-Ling CHEN, Yuh-Min SONG, Wayne Huey-Herng SHEU, ...
    1998 Volume 37 Issue 11 Pages 955-957
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.955
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    We report a rare case of mixed medullary-follicular carcinoma and papillary carcinoma of the same thyroid. A 27-year-old Chinese female complained of a single thyroid nodule for 2-3 months. Needle aspiration revealed suspicious papillary carcinoma and thyroidectomy performed later showed mixed medullary-follicular carcinoma and papillary carcinoma of the same thyroid which was extremely rare. Whether neoplastic transformation is due to tumorigenic stimulus or just due to the collision phenomenon is still controversial for its etiology.
    (Internal Medicine 37: 955-957, 1998)
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  • Disturbance of Consciousness Associated with Hypophosphatemia in a Chronically Alcoholic Patient
    Yasuko FUNABIKI, Hirotaka TATSUKAWA, Ko ASHIDA, Kinya MATSUBARA, Yasus ...
    1998 Volume 37 Issue 11 Pages 958-961
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.958
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    A 69-year-old man with chronic alcoholism was admitted to our hospital due to disturbance of consciousness and oliguria. Emergency laboratory examination revealed metabolic acidosis, hypoglycemia, hyponatremia, mild liver dysfunction, acute renal failure and rhabdomyolysis. After administration of fluids and nutrients and continuous hemodiaflltration, he recovered from all signs and symptoms except for disturbance of consciousness after 7 days. Since severe hypophosphatemia persisted, we administered adequate phosphates, and then his level of consciousness normalized. We discuss the relationships among alcohol abuse, hypophosphatemia and disturbance of consciousness, and recommend that hypophosphatemia be considered a potential cause of disturbance of consciousness in alcoholic patients.
    (Internal Medicine 37: 958-961, 1998)
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  • Use of Bronchopulmonary Lavage for Eliminating Inhaled Fume Particles from a Patient with Arc Welder's Lung
    Gen YAMADA, Tomofumi IGARASHI, Hajime SONODA, Shiho MORITA, Kazuhiko S ...
    1998 Volume 37 Issue 11 Pages 962-964
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.962
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    A 42-year-old man, who had worked as a welder for 20 years, was admitted to our hospital complaining of a dry cough. A chest radiograph showed diffuse small nodular shadows and chest computed tomography revealed small patchy opacities. A transbronchial lung biopsy specimen showed welding fume particles mainly located in alveolar space with mild fibrosis of alveolar septa. In order to prevent further fibrosis, bronchopulmonary lavage (BPL) was performed to eliminate the fume particles. The amount of iron particles derived from the total lavage fluid was 911.7 mg.
    (Internal Medicine 37: 962-964, 1998)
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  • Benign Asbestos Pleural Effusion Associated with Pulmonary Aspergilloma
    Junichiro HIYAMA, Masaomi MARUKAWA, Yutaro SHIOTA, Tetsuya ONO, Keiji ...
    1998 Volume 37 Issue 11 Pages 965-968
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.965
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    A rare case of benign asbestos pleural effusion associated with aspergilloma is reported. A chest radiograph of a 75-year-old Japanese man who was admitted with right chest pain showed a right pleural effusion and nodular shadows in the right apex and left middle lung field. Thoracocentesis revealed an exudate with atypical mesothelial cells. An open lung biopsy showed aspergilloma in the right S2 area and no evidence of malignancy. Many reactive mesothelial cells were found in the pleura. A quantitative asbestos digestion study of the lung tissue biopsy showed high-grade asbestos exposure.
    (Internal Medicine 37: 965-968, 1998)
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  • Acute Pulmonary Edema Caused by Accidental Aspiration of Sweetened Water in Two Cases of Diabetes Mellitus
    Toshimichi KANEKI, Keishi KUBO, Shusuke SONE, Akira KAWASHIMA
    1998 Volume 37 Issue 11 Pages 969-972
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.969
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    We treated two cases of diabetes mellitus who developed acute pulmonary edema following accidental aspiration of sweetened water for emergency treatment, when they had fallen into hypoglycemic coma following an overdose of injectable insulin. Although they showed hypoxemia and radiological examinations revealed pulmonary edema, they improved by giving only oxygen and antibiotics in a few days. The osmotic pressure of the sweetened water in each case was approximately 2, 600 mOsm and 1, 900 mOsm. We suppose that the pathogenesis of the pulmonary edema was due to the sweetened water causing water within the pulmonary vessels to permeate into the alveoli.
    (Internal Medicine 37: 969-972, 1998)
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  • Two Cases of Myelodysplastic Syndrome with Extramedullary Polyclonal Plasma Cell Proliferation and Autoantibody Production: Possible Role of Soluble Fas Antigen for Production of Excessive Self-Reactive B Cells
    Kensaku KATSUKI, Kenji SHINOHARA, Naoko KAMEDA, Tetsuya YAMADA, Koumei ...
    1998 Volume 37 Issue 11 Pages 973-977
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.973
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    Two cases of myelodyspalstic syndrome (MDS) with extramedullary polyclonal plasma cell proliferation and autoantibody production are reported. These cases, which showed leukemic change of refractory anemia with excess of blast (RAEB), developed lymph node swelling and muscle abscess; both were infiltrated mainly with plasma cells, without preceding infection. The proliferation of plasma cells was polyclonal and was proven by negative rearrangement of immunoglobulin heavy chain gene or polyclonal staining of immunoglobulin light chains. These patients showed polyclonal gammopathy and autoantibody production such as positive antinuclear factor and direct antiglobulin test. As was observed in one of the present cases, and as we reported previously, the elevated level of soluble Fas antigen in MDS patients, and its inhibition of apoptotic signaling may be responsible for the excessive accumulation of self-reactive B cells, resulting in these clinical manifestations.
    (Internal Medicine 37: 973-977, 1998)
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  • Atypical Rigid Form of Huntington's Disease: A Case with Peripheral Amyotrophy and Congenital Defects of a Lower Limb
    Naomi KANZATO, Mineki SAITO, Takashi HORIKIRI, Yukihiro KOMINE, Masano ...
    1998 Volume 37 Issue 11 Pages 978-981
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.978
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    We describe a patient showing an atypical phenotype of Huntington's disease (HD), including prominent generalized dystonia, peripheral amyotrophy of the legs with an inverted champagne bottle configuration and pes equinus. The patient also had congenital defects of the lower left leg. Chorea and psychiatric symptoms were not prominent. Polymerase chain reaction assessment revealed 51 CAG repeats in gene IT 15. Magnetic resonance imaging of the brain demonstrated mild atrophy of the pons and cerebellum, and hyperintensity of the transverse pontine fibers and neostriatum on spin-echo images. Peripheral amyotrophy in this case might have resulted from axonal degeneration related to neuronal damage in the central nervous system, although at the present time we cannot confirm it as a new HD phenotype.
    (Internal Medicine 37: 978-981, 1998)
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  • Localizing Value of Bilateral Cheiro-Oral Sensory Impairment
    Yuzuru YASUDA, Toshiyuki WATANABE, Hisataka TANAKA, Akira OGURA
    1998 Volume 37 Issue 11 Pages 982-985
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.982
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    We present a case of bilateral cheiro-oral syndrome with paresthesia in the right toes following pontine infarction. The causative lesions were situated in the bilateral paramedian pontine tegmentum (PPM). As the lesion on the left side was larger than that on the right, the foot area in the left medial lemniscus was involved, causing paresthesia in the right toes. Bilateral cheiro-oral sensory impairment is rare, and there have been only 4 previous reports. The responsible lesion of complete bilateral cheiro-oral syndrome showing paresthesia in the hand and mouth region on both sides is in the bilateral PPM, while that of incomplete bilateral cheiro-oral syndrome showing paresthesia around both sides of the mouth and in the unilateral hand is in the PPM contralateral to the hand with paresthesia. Bilateral cheiro-oral sensory impairment can occur only in the brainstem.
    (Internal Medicine 37: 982-985, 1998)
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  • Efficacy of Early Plasmapheresis in Bickerstaff's Encephalitis
    Tetsutaro OZAWA, Osamu ONODERA, Takashi INUZUKA, Yoshiaki SOMA, Shoji ...
    1998 Volume 37 Issue 11 Pages 986-989
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.986
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    Double filtration plasmapheresis (DFPP) was performed in a patient with Bickerstaff s brainstem encephalitis (BBE) in its early phase. He was a 27-year-old male patient suffering from diplopia, facial palsy and drowsiness following upper respiratory tract infection, and had high titers of immunoglobulin G (IgG) antibodies against ganglioside NeuAcα2-8NeuAcα2-3Galβl-3GalNAcβ1-4(NeuAcα2-8NeuAcα2-3)Galβl-4Glcβ1-l'Cer (GQ1b) in the serum. DFPP effected immediate improvement of his drowsiness, supporting the diagnosis of BBE. Our observations suggest that DFPP during the early phase of BBE efficiently prevents the progression of consciousness disturbances.
    (Internal Medicine 37: 986-989, 1998)
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  • Adrenal Hemorrhage Associated with Klebsiella Oxytoca Bacteremia
    Kazutoshi HORI, Hitoshi YASOSHIMA, Akihiko YAMADA, Kazunari SAKURAI, E ...
    1998 Volume 37 Issue 11 Pages 990-994
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.990
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    Septic adrenal hemorrhage is classically caused by meningococcemia. An autopsied case is presented of a 45-year-old man with adrenal hemorrhage due to Klebsiella oxytoca bacteremia following placement of a central venous catheter. He died 5 hours after developing disseminated intravascular coagulation (DIC). The bacterial entry site may have been the catheter. The cause of death was considered to be pulmonary edema due to bacteremia rather than adrenal insufficiency due to hemorrhage. Septic adrenal hemorrhage should be recognized as a subtype of sepsis rather than adrenal insufficiency, and may be caused in conditions of severe sepsis with DIC, independent of the microorganic variety.
    (Internal Medicine 37: 990-994, 1998)
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  • Increased Plasma Lipoprotein(a) Level in Cardioembolic Stroke with Non-Valvular Atrial Fibrillation
    Hiroyuki OKURA, Hiroo INOUE, Miyo TOMON, Shoji NISHIYAMA, Tadashi YOSH ...
    1998 Volume 37 Issue 11 Pages 995
    Published: 1998
    Released on J-STAGE: March 27, 2006
    DOIhttps://doi.org/10.2169/internalmedicine.37.995
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