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Tare WASADA
2000 Volume 39 Issue 1 Pages
1
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Keiko KAMAKURA
2000 Volume 39 Issue 1 Pages
2-3
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Hiroshi HASHIMOTO
2000 Volume 39 Issue 1 Pages
4-5
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Akito TSUTSUMI, Takao KOIKE
2000 Volume 39 Issue 1 Pages
6-7
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Shunichi SHIOZAWA
2000 Volume 39 Issue 1 Pages
8-9
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Shaur-Horng YAN, Wayne Huey-Herng SHEU, Yuh-Min SONG, Li-Nien TSENG
2000 Volume 39 Issue 1 Pages
10-14
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Objective To analyze the occurrence of DKA in Chinese adults.
Methods and Patients We retrospectively reviewed the medical records of adults presenting with DKA in a tertiary referral center from January 1992 to December 1997. We classified these patients into 3 groups: type 1, type 2 and new-onset diabetes. Clinical features and follow-up treatment were analyzed.
Results One hundred and twenty patients with 141 episodes of DKA were included; 77 episodes (54.6%) were classified as being caused by type 2, 32 (22.7%) by type 1 and 32 (22.7%) by new-onset DM. The average age of type 2 patients was significantly higher. Of the 25 new-onset patients with follow-up for at least 12 months, 11 were not taking insulin. Of these 11 patients, 6 had a family history of DM and 5 had BMI greater than 26.4 kg/m2. The fasting plasma C-peptide values at various times of follow-up varied from 2.3 to 9.5 ng/ml in 6 of the 11 DKA-onset patients.
Conclusion In type 2 patients, the occurrence of DKA is usually associated with old age and another severe illness. "DKA-onset type 2 DM" reported in African-Americans and in Japanese is also observed in Chinese.
(Internal Medicine 39: 10-14, 2000)
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Nobuaki MIYAHARA, Ryosuke EDA, Hiroyasu TAKEYAMA, Tadashi MAEDA, Keisu ...
2000 Volume 39 Issue 1 Pages
15-19
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Objective The ramp exercise test has been widely used to evaluate cardiopulmonary responses to an incremental exercise load. This study was performed to clarify whether different slopes of the ramp exercise test influence exercise tolerance, exercise limiting factors, and respiratory pattern in patients with chronic obstructive pulmonary disease (COPD).
Subjects and Methods We applied three different slopes (5 W/min, 10 W/min and 20 W/min) of the ramp exercise test in 9 patients with COPD and evaluated cardiopulmonary responses.
Results There were no significant differences in peak oxygen uptake, anaerobic threshold (AT), minute ventilation, heart rate, arterial oxygen saturation, expired tidal volume, or respiratory rate at the maximal load among the three different ramp exercises tested. AT could be determined in six of nine patients (67%) at the slope of 5 W/min, in 8/9 (89%) at the slope of 10 W/min, and in 9/9 (100%) at the slope of 20 W/min.
Conclusion The findings suggest that the ramp slope does not affect exercise tolerance, exercise limiting factors, or respiratory patterns and each of these ramp slopes is useful for the evaluation of COPD. Ramp slopes of 10 W/min or 20 W/min should be appropriate for the determination of AT.
(Internal Medicine 39:15-19, 2000)
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Koji NAKAJIMA, Akihiro SAKURAI, Miyuki KATAI, Hiroki YAJIMA, Jun-ichir ...
2000 Volume 39 Issue 1 Pages
20-24
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Hepatocellular carcinoma (HCC) was found in a patient with multiple endocrine neoplasia type 1 (MEN 1). The intriguing finding was that the HCC in the patient was positively stained for chromogranin A (CgA), a cellular marker for endocrine and neuroendocrine tumors. The patient had a pancreas endocrine tumor and type C hepatitis, that made pathological diagnosis of the origin of the tumor complicated.
(Internal Medicine 39: 20-24, 2000)
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Hiroshi NAKASE, Jun MIMURA, Toshihiko KAWASAKI, Toshinao ITANI, Hidesh ...
2000 Volume 39 Issue 1 Pages
25-27
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Inflammatory fibroid polyp (IFP) is a solitary intestinal lesion of unknown etiology. Although IFF is benign, laparotomy for the resection of colonic IFP is performed in most cases because the polyp is usually large. We report a successful endoscopic resection of cecal IFP. It is considered that colonic IFP should be resected endoscopically if the polyp is small and is located submucosally.
(Internal Medicine 39: 25-27, 2000)
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Tomoko IZUMI, Kohsuke AJIKI, Akira NOZAKI, Saeko TAKAHASHI, Fumiko TAB ...
2000 Volume 39 Issue 1 Pages
28-33
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A 73-year-old man who had a family history of sudden death, experienced syncope. His electrocardiogram (ECG) presented right bundle branch block and right precordial ST segment elevation which are findings identical with those in Brugada syndrome. The cardiac MRI showed right ventricular mild dilatation, and endomyocardial biopsy revealed fatty replacement of myocardial fibers. Though no ventricular tachyarrhythmias were induced during an electrophysiologic test, the effects on ECG of antiarrhythmic agents and autonomic modulations were similar to those in Brugada syndrome. This case may suggest the relationship between Brugada syndrome and right ventricular cardiomyopathy.
(Internal Medicine 39: 28-33, 2000)
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Hitoko OGATA, Hidehisa NAKAGAWA, Kou HAM ABE, Atsuo HATTORI, Yuka ISHI ...
2000 Volume 39 Issue 1 Pages
34-38
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A 45-year-old female carrier of Duchenne muscular dystrophy (DMD) complicated with cardiomyopathy is described. She had no symptoms of muscle weakness or heart failure. Her chest X-ray film revealed marked cardiomegaly. Echocardiogram showed marked enlargement and severe hypokinesis of the left ventricle. In myocardial scintigraphic images, perfusion defects of the myocardium were revealed. Dystrophin immunostaining of myocardial biopsy specimens showed a mosaic pattern of dystrophin-negative and -positive fibers. Cardiomyopathy is sometimes the only clinical symptom in female carriers of DMD. They are thought to be in a high risk group for developing heart failure.
(Internal Medicine 39: 34-38, 2000)
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Hirokazu SHIRAISHI, Takeshi SHIRAYAMA, Keiji INOUE, Hiroyuki TANAKA, H ...
2000 Volume 39 Issue 1 Pages
39-44
Published: 2000
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Myotonic dystrophy (MD) is characterized by myotonia and muscular dystrophy and cardiac involvement with tachy-arrhythmia is rarely encountered. We report a case of MD complicated with severe left ventricular hypofunction and incessant ventricular tachycardia (VT) with varying heart rates. The morphology of VT suggested that it originated from the right ventricular outflow tract, and electrophysiological study disclosed that the mechanism of VT was abnormal automaticity. Catheter ablation was performed to treat this VT. The patient had a cardiomyopathy with normal coronary arteries. The specimen of RV biopsy showed moderate hypertrophy, mild fat infiltration and slight fibrosis. These findings are histologically consistent with myotonic dystrophy.
(Internal Medicine 39: 39-44, 2000)
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Yoshio OHTANI, Masayuki YAMAOKA, Megumi SAWADA, Yasunari MIYAZAKI, Ryu ...
2000 Volume 39 Issue 1 Pages
45-49
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A 44-year-old woman with acute intermittent porphyria (AIP) was admitted to Kudanzaka Hospital because of abdominal pain. A cholecystectomy was performed in another hospital without improvement. On admission, her transaminases were elevated to greater than 1, 000 mU/ml. After an intravenous drip of mainly glucose, her transaminases returned to normal. Her acute attacks occurred during stress, and she died of respiratory failure after repetitive acute episodes. AIP should be included in a list of the differential diagnosis of gastrointestinal diseases, neurosis, and hysteria. This is the first case of AIP accompanied by transient marked elevation of transaminases during an acute attack.
(Internal Medicine 39: 45-49, 2000)
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Shigenori NAKAMURA, Yoshihiro KAJITA, Yukio OCHI
2000 Volume 39 Issue 1 Pages
50-54
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A 56-year-old Japanese housewife had been diagnosed as having Graves' disease and was treated with methimazole. When she was referred to our hospital, the serum T3 level was high irrespective of high TSH level. High serum T3 levels were also observed in two out of her three sisters. Electrophoresis revealed that binding of 125I-T3 to serum albumin was markedly increased whereas the binding of 125I-T4 to serum albumin was slightly increased in the three sisters whose serum T3 levels were high. These data indicate that the presence of an albumin variant is the cause of hypertriiodothyroninemia in this family.
(Internal Medicine 39: 50-54, 2000)
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Masami MATSUMURA, Akikatsu NAKASHIMA, Yohei TOFUKU
2000 Volume 39 Issue 1 Pages
55-57
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We present a case of a 47-year-old man with Type 2 diabetes mellitus who attempted suicide with 2, 100 U of insulin injected subcutaneously. Administration of dextrose intravenously was required to maintain the blood glucose concentration normally for 5 days. Moreover, hypokalemia, hypophosphatemia, and hypomagnesemia were also seen for 24 hours after insulin injection. The serum phosphorus and magnesium concentrations decreased to nadirs of 1.6 mg/dl and 1.6 mg/dl respectively 7 hours after insulin injection. Electrolyte disorders other than hypokalemia may be induced in hypoglycemic patients by massive insulin overdose.
(Internal Medicine 39: 55-57, 2000)
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Takuya FUJIWARA, Minoru KAWAMURA, Shunichi SASOU, Katsuhiko HIRAMORI
2000 Volume 39 Issue 1 Pages
58-62
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A rare, compound adrenal tumor consisting of ganglioneuroblastoma and pheochroniocytoma was completely resected in an adult woman. Most of the tumor was occupied by the ganglioneuroblastoma component. This ganglioneuroblastoma was an intermixed tumor, which is known to have a favorable prognosis in children. Based on the lack of spread, the resectability of the tumor, and the histology of the ganglioneuroblastoma, no adjuvant therapy was employed. There was no evidence of recurrence at the 5-year follow-up. This suggests that adjuvant therapy may not be necessary in these compound tumors.
(Internal Medicine 39: 58-62, 2000)
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Hisako MATSUMOTO, Katsuhiro SUZUKI, Isao WATANABE, Terumi KIMOTO, Kazu ...
2000 Volume 39 Issue 1 Pages
63-65
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Hemoptysis in patients with tuberculosis is usually associated with smear-positive and cavitary lung disease. The present case describes a patient suffering from recurrent hemoptysis associated with tuberculosis who had smear-negative and non-cavitary lung disease, and who was subsequently diagnosed as having mild hemophilia A. Although mild hemophilia A sometimes escapes detection until adolescence, there has been no reported case of mild hemophilia A detected by recurrent hemoptysis due to pulmonary tuberculosis. Here, we report a rare case of recurrent hemoptysis in a patient with tuberculosis who had smear-negative and non-cavitary lung disease and who was finally shown to have hemophilia A.
(Internal Medicine 39: 63-65, 2000)
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Hiromoto SHINTANI, Masaki FUJIMURA, Masahide YASUI, Kousei UEDA, Shoun ...
2000 Volume 39 Issue 1 Pages
66-68
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It has been suggested that acute eosinophilic pneumonia (AEP) is associated with cigarette smoking because in Japan, the patients with AEP are young and have a high incidence of short-term smoking history. However, there has been no direct evidence to support that cigarette smoke causes AEP. Herein is reported the first case showing the direct evidence and a long-term clinical course of cigarette smoking-induced AEP, in which tolerance to repeated resumption of smoking cigarettes might have occurred. We should pay attention to the history of cigarette smoking in seeing patients with AEP, especially in young patients.
(Internal Medicine 39: 66-68, 2000)
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Etsuko FUKAYA, Masayuki MIYATA, Atsushi TAKAHASHI, Makoto TAKANO, Hiro ...
2000 Volume 39 Issue 1 Pages
69-72
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Takayasu's arteritis and temporal arteritis share many clinical and pathological features. The most discriminatory feature between the two diseases is the age at onset; the mean age at onset of the disease was reported as being 26 years for Takayasu's arteritis and 69 years for temporal arteritis. Here we report a 69-year-old woman who presented with a weak right radial artery pulse. The ethnic background and the presence of vascular insufficiency of the right upper extremity and the absence of clinical signs such as shoulder stiffness and tender scalp indicate that her diagnosis is Takayasu's arteritis. It must be emphasized that the two conditions could be differentiated based on the clinical findings even in a patient as old as 69 years old.
(Internal Medicine 39: 69-72, 2000)
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Yoshio KATAYAMA, Kenji KOHRIYAMA, Keiji KIRIZUKA, Hiroshi NISHIZAKI, H ...
2000 Volume 39 Issue 1 Pages
73-76
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A 56-year-old Japanese female simultaneously developed thrombocytopenia, sicca symptoms, and an elevation of transaminase. Antiphospholipid antibodies were detected in her serum. The presence of anti-SS-A antibodies in the serum and sialectasis, disclosed by sialography, suggested the presence of primary Sjögren's syndrome (SjS). The laboratory data and the biopsy of the liver showed compatible findings with autoimmune hepatitis (AIH). Thrombocytopenia and liver dysfunction satisfactorily responded to corticosteroid. To our knowledge, this is the first reported case of SjS with AIH and antiphospholipid antibody syndrome (APAS). Analysis of serum cytokine levels showed a predominance of Th0-Th1 response, which is not compatible with AIH, in this complicated autoimmune state.
(Internal Medicine 39: 73-76, 2000)
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Hiroyuki MAEDA, Futoshi KONISHI, Keiko HIYAMA, Shinichi ISHIOKA, Michi ...
2000 Volume 39 Issue 1 Pages
77-79
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Adult onset Still's disease is recognized as an adult variant of the systemic form of juvenile rheumatoid arthritis, whose disease-predisposition is still debated. On the other hand, the association between HLA subtypes and several groups of seronegative arthritis including psoriatic arthritis has been well documented. This report describes a family where adult onset Still's disease in a young man and psoriatic arthritis in his father were seen. Both patients were HLA-B39-positive, which was likely playing important pathogenic roles in the latter case. Clinical and immunological aspects of HLA-B39-related inflammatory diseases are also discussed.
(Internal Medicine 39: 77-79, 2000)
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Tadanori HAMANO, Akemi TAKANO, Shin'ichi MIYAO, Jun TERAMOTO, Shunmats ...
2000 Volume 39 Issue 1 Pages
80-81
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Kenji SHINOHARA
2000 Volume 39 Issue 1 Pages
82
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Hiroyuki OKURA, Miyo TOMON, Shoji NISHIYAMA, Tadashi YOSHIKAWA
2000 Volume 39 Issue 1 Pages
83
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