Internal Medicine

Current Problems of Hepatitis C Virus Infection in Hemodialysis Patients

Kendo KIYOSAWA

1999 Volume 38 Issue 8 Pages 615-616
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.615

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Mitral Regurgitation Associated with Ischemic Heart Disease

Akira KITABATAKE, Fumishi TOMITA

1999 Volume 38 Issue 8 Pages 617-618
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.617

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Atypical Wegener's Granulomatosis

Is There a Need of New Concept for Progressive Clinical Staging?

Kimimasa NAKABAYASHI

1999 Volume 38 Issue 8 Pages 619
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.619

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Treatment of Pulmonary Thromboembolism

Samuel Z. GOLDHABER

1999 Volume 38 Issue 8 Pages 620-625
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.620

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The epidemiology, diagnosis, treatment, and prophylaxis of PE are rapidly advancing. Our array of diagnostic imaging tools has expanded to include echocardiography and spiral chest CT with contrast. We have also gained a keen appreciation for the importance of risk stratification of our patients. The decision to administer thrombolysis or undertake embolectomy may now depend upon the presence of right ventricular dysfunction even if systemic arterial pressure is normal. Finally, the availability of low molecular weight heparins broadens our options for pharmacologic management.
(Internal Medicine 38: 620-625, 1999)

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Prevalence and Characterization of Hepatitis C Virus in Hemodialysis Patients

Takashi MORIKAWA, Keisuke NAKATA, Keisuke HAMASAKI, Shohtaro TSURUTA, ...

1999 Volume 38 Issue 8 Pages 626-631
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.626

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Object Chronic hepatitis C virus (HCV) infection is common in hemodialysis (HD) patients. In the present study, the prevalence and properties of HCV in HD patients were analyzed. Methods and Results Of 125 HD patients, 34 (27%) were positive for antibody to HCV, and HCV-RNA was detected in 23 (68%) of the 34 patients using reverse transcription polymerase chain reaction. The HCV-RNA sequence analysis did not identify the alterations specific to HD patients with HCV, although one patient had a variant virus containing the deletion of the core gene sequence. When serial changes in the levels of HCV-RNA were evaluated in 15 patients by a branched DNA assay, the values decreased immediately after HD procedure, but returned to the baseline values 2 days after the procedure. Conclusion These results indicate that HCV in HD patients is replication-competent, although a transient reduction in the levels of HCV-RNA occurs during HD.
(Internal Medicine 38: 626-631, 1999)

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Expression of Selectin Families and Their Ligand Sialyl Lewis X in the Muscles of Inflammatory Myopathies: An Immunohistochemical Study

Takahiro JIMI, Yoshihiro WAKAYAMA, Makoto MURAHASHI, Masahiko INOUE, S ...

1999 Volume 38 Issue 8 Pages 632-635
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.632

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Object Adhesion molecules are suggested to play important roles in the pathogenesis of inflammatory diseases. We examined the expression of adhesion molecules in the muscles of human inflammatory myopathies. Methods We immunohistochemically studied the expression and distribution of two molecules in the selectin family (E- and P-selectin) and their common ligand sialyl Lewis X in 18 inflammatory myopathies, 13 disease controls, and 16 normal controls. Results In inflammatory myopathies, E- and P-selectin were upregulated on the surface of blood vessels, especially on the endothelial cells of the venules. Sialyl Lewis X was upregulated in the blood vessels, infiltrating leukocytes, and the surface of some atrophic myofibers. Some control muscles also showed weakly positive staining with these molecules, however, expression of these molecules was most striking in the muscles of inflammatory myopathies. Conclusion The results suggested that these molecules are upregulated in inflammatory myopathies and might play a role in the pathogenesis of inflammatory myopathies.
(Internal Medicine 38: 632-635, 1999)

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Long-Term Open-Trial of Mizoribine with Prednisolone in 24 Patients with Multiple Sclerosis: Safety, Clinical and Magnetic Resonance Imaging Outcome

Kyoko SAIDA, Zhao ZHIGANG, Kyoko OZAWA, Tetsuro KONISHI, Takahiko SAID ...

1999 Volume 38 Issue 8 Pages 636-642
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.636

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Object Mizoribine (MZR), imidazole nucleotide, inhibits purine synthesis and helper T cell functions. It is used as an immunosuppressant in chronic rheumatic arthritis in Japan. Twenty-four patients with relapsing-remitting and chronic progressive multiple sclerosis (MS) were studied for the long-term effects of MZR over 8 years. Methods Average daily MZR doses of 200 mg along with prednisolone (PSL) were administered in the patients studied. Ten of 24 patients were treated for more than 5 years. Results The mean relapse rate per year at entry (1.50±0.24, mean±SE, n=22) decreased [0.46±0.24 (n=19)] after two years. In 70% of the patients, the disability did not worsen. Eleven of 18 patients showed a mild decrease of the total lesion size in magnetic resonance imaging (MRI). Conclusion MZR was well tolerated and could be used for long-term in MS as an adjunctive immunosuppressant to PSL, and the PSL doses could be decreased. A further randomized controlled trial with PSL is necessary.
(Internal Medicine 38: 636-642, 1999)

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Systemic Lupus Erythematosus with a Giant Rectal Ulcer and Perforation

Junko TERAMOTO, Yasuo TAKAHASHI, Shinichi KATSUKI, Tsutomu SATO, Sumio ...

1999 Volume 38 Issue 8 Pages 643-649
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.643

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A 41-year-old man with systemic lupus erythematosus (SLE) who developed pelvic inflammation due to perforation of a giant rectal ulcer is described. The patient presented with persistent diarrhea, abdominal pain and fever without development of disease activity of SLE. Endoscopic and radiological examinations revealed a perforated giant ulcer on the posterior wall at the rectum below the peritoneal evagination. The ulcerated area was decreased after a colostomy was performed at the transverse colon to preserve anal function. The patient is currently being monitored on an outpatient basis. It should be noted that life-threatening complications such as perforated ulcer of the intestinal tract could occur without SLE disease activity.
(Internal Medicine 38: 643-649, 1999)

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Acute Liver Injury That Followed Food-Dependent Exercise-Induced Anaphylaxis

Akihiro OKANO, Kiyoshi HAJIRO, Hiroshi TAKAKUWA, Akiyoshi NISHIO

1999 Volume 38 Issue 8 Pages 650-654
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.650

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We describe an unusual case of acute liver injury that followed food-dependent exerciseinduced anaphylaxis (FDEIAn). A 45-year-old man who experienced anaphylactic shock induced by postprandial exercise and took alcohol that night was admitted the following day to our hospital because of general fatigue. Laboratory examinations revealed elevated hepatic enzymes (aspartate aminotransferase (AST) 6, 110 IU, alanine aminotransferase (ALT) 4, 178 IU). He had two similar episodes in the past. We speculated that acute liver injury in this case might be induced by interaction of anaphylactic shock and alcohol.
(Internal Medicine 38: 650-654, 1999)

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A Probable Relationship between an Endogenous Digitalis-Like Substance and Concentric Cardiac Hypertrophy in Primary Aldosteronism

Toshio SHIMADA, Yukihiro NAGASAKA, Yutaka ISHIBASHI, Hironori TSUKIHAS ...

1999 Volume 38 Issue 8 Pages 655-659
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.655

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A 44-year-old woman was admitted to our hospital due to severe hypertension. An electrocardiogram (ECG) and an echocardiogram showed severe left ventricular hypertrophy. Her plasma aldosterone level was elevated. Magnetic resonance imaging revealed a small mass in the right adrenal gland. Before removal of the tumor, plasma endogenous digitalis-like substance (EDLS) levels were elevated. After removal of the tumor, EDLS levels quickly returned to the normal level. A series of echocardiograms and ECGs over a 6- year period after removal of the tumor showed marked regression of cardiac hypertrophy. These findings suggest that EDLS may be closely related to the development of concentric cardiac hypertrophy in primary aldosteronism.
(Internal Medicine 38: 655-659, 1999)

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Transient Severe Mitral Regurgitation Complicating Myocardial Stunning due to Coronary Vasospasm

Hitoki INOUE, Masashi HORIMOTO, Satomi HAMASAKAI, Takashi TAKENAKA, Ke ...

1999 Volume 38 Issue 8 Pages 660-662
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.660

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As in papillary muscle dysfunction complicating mitral prolapse, dyskinesis of the left ventricular wall underlying the papillary muscles has been shown to cause mitral regurgitation following myocardial infarction. Myocardial stunning has been experimentally evidenced to cause mitral regurgitation due to a wall motion abnormality, but it has not yet been clinically defined. We report a clinical case of transient severe mitral regurgitation complicating myocardial stunning caused by coronary vasospasm. Transient wall motion abnormality beneath the anterolateral papillary muscle was considered to be responsible for the mitral regurgitation.
(Internal Medicine 38: 660-662, 1999)

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An Autopsy Case of Familial Idiopathic Dilatation of Bilateral Atria

Masato ARAO, Shuichi SHIMIZU, Yoshiko MIYATAKE, Koichi SETSUTA

1999 Volume 38 Issue 8 Pages 663-667
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.663

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A 59-year-old male patient was followed up for congestive heart failure. Echo cardiogram showed no abnormal findings other than a remarkable dilatation of the bilateral atria. The coronary arteries and left ventricular contraction were normal. Left ventricular endomyocardial biopsy showed no significant abnormal findings. Further, we examined his siblings using dynamic magnetic resonance imaging (MRI) and found that they all also had dilated bilateral atria. After several hospitalizations, the proband died from cardiogenic shock. Pathological findings showed nonspecific change in bilateral atria and ventricles. This is a very rare case of familial idiopathic dilatation of bilateral atria.
(Internal Medicine 38: 663-667, 1999)

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Granulocyte Colony Stimulating Factor-Producing Diffuse Malignant Mesothelioma of Pleura

Hiroyuki OHBAYASHI, Hiroyuki NOSAKA, Kimihiro HIROSE, Hirohiko YAMASE, ...

1999 Volume 38 Issue 8 Pages 668-670
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.668

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We report the rare case of a 61-year-old man with a diffuse malignant mesothelioma of mixed subtype which produced granulocyte colony-stimulating factor (G-CSF). The white blood cell (WBC) was elevated to 85, 100/mm³ without any evidence of infection, and the G-CSF level in the pleural effusion was also increased at 13, 200 pg/ml. The lobes of the lung were encased in a tumor. Histopathologically, the tumor cells were of a polymorphous morphology with an epithelial and sarcomatoid mixed pattern. Immunohistochemistry showed that the tumor cells were positive for vimentin, cytokeratin, epithelial membrane antigen, thrombomodulin, and G-CSF, and negative for carcinoembryonic antigen (CEA), CD34, and surfactant apoprotein-A.
(Internal Medicine 38: 668-670, 1999)

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Pseudoaneurysm of the Subclavian Artery due to Xanthomonas Pneumonia in a Patient with Acute Myeloid Leukemia: Its Rupture Treated by Transcatheter Coil Embolization

Yasushi OHKOSHI, Haruhiko NTNOMIYA, Harumi Y. MUKAI, Naomi MOCHIZUKI, ...

1999 Volume 38 Issue 8 Pages 671-674
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.671

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A 52-year-old male with acute myeloid leukemia developed pseudoaneurysm of the subclavian artery. Pneumonia due to Xanthomonas maltophilia, which was multi-drug resistant, progressed to a lung abscess even under administration of antibiotics. This lung infection contiguous to the left carotid and subclavian arteries was suggested to have caused the pseudoaneurysm of the subclavian artery. The rupture of the aneurysm by penetration to the trachea amounted to about 1, 000 ml of bleeding; fortunately the bleeding ceased spontaneously. Nonetheless, an emergency transcatheter coil embolization prevented re-bleeding. Endovascular treatment should be considered especially for aneurysms which develop in patients with underlying diseases.
(Internal Medicine 38: 671-674, 1999)

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Giant Cell Arteritis Associated with Rheumatoid Arthritis Monitored by Magnetic Resonance Angiography

Seishi HARADA, Fumihiro MITSUNOBU, Fumiko KODAMA, Yasuhiro HOSAKI, Tak ...

1999 Volume 38 Issue 8 Pages 675-678
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.675

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A 57-year-old Japanese woman with well controlled rheumatoid arthritis visited our hospital with a severe bitemporal headache and marked fatigue. Based on the classification criteria by the American College of Rheumatology, she was diagnosed as having giant cell arteritis. Magnetic resonance (MR) angiography was performed, from which stenotic changes in the bilateral superficial temporal arteries were strongly suspected. Corticosteroid therapy was quickly started. The patient followed an uneventful course with no complications. Therapeutic effect was confirmed by MR angiographic findings obtained 4 weeks after the initiation of therapy.
(Internal Medicine 38: 675-678, 1999)

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Atypical Wegener's Granulomatosis with Positive Cytoplasmic Antineutrophil Cytoplasmic Antibodies, Ophthalmologic Manifestations, and Slowly Progressive Renal Failure without Respiratory Tract Involvement

Tomoko KAKIZAWA, Kazuo ICHIKAWA, Keishi YAMAUCHI, Teiji TAKEDA, Minoru ...

1999 Volume 38 Issue 8 Pages 679-682
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.679

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A 68-year-old woman had microscopic hematuria and proteinuria since the age of 50. She also had hearing impairment, arthralgia, retinal embolism, peripheral arterial occlusion of the right foot and chronic renal failure during the course. At the age of 68, she had progressive renal failure and nephrotic syndrome with high titers of serum cytoplasmic antineutrophil Cytoplasmic antibodies (c-ANCA). No evidence of respiratory tract involvement was found. Methylprednisolone pulse therapy and low dose cyclophosphamide therapy ameliorated the renal failure and reduced the serum c-ANCA level. She, however, died on July 19, 1998 due to pulmonary fungal and pneumocystis carinii infection.
(Internal Medicine 38: 679-682, 1999)

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Nocardia asteroides Pneumonia, Subcutaneous Abscess and Meningitis in a Patient with Advanced Malignant Lymphoma: Successful Treatment Based on In Vitro Antimicrobial Susceptibility

Chikara SAKAI, Toshiyuki TAKAGI, Yoko SATOH

1999 Volume 38 Issue 8 Pages 683-686
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.38.683

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Nocardia asteroides pneumonia, subcutaneous abscess and meningitis without brain abscesses developed in a patient with advanced non-Hodgkin's lymphoma, who had received corticosteroid therapy and cancer chemotherapy for a long time. At the time of nocardial pneumonia, profound lymphocytopenia and hypogammaglobulinemia was seen. The severely immunosuppressed condition most likely accounted for the uncommon infection, nocardiosis. The organism isolated from the sputum, subcutaneous abscess and cerebrospinal fluid was strongly resistant to cotrimoxazole, which is the recommended standard treatment, but it was susceptible to imipenem (IPM) and erythromycin (EM) in an in vitro antimicrobial susceptibility study. The patient's nocardiosis responded well to chemotherapy including IPM and EM.
(Internal Medicine 38: 683-686, 1999)

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