Objective We performed single-photon emission computed tomography (SPECT) to investigate the influence of renal transplantation on cerebral blood flow (CBF).
Patients and Methods Fifteen renal transplant recipients and twelve normal subjects underwent cerebral SPECT with N-isopropyl-p -[¹²³I] iodoamphetamine (¹²³I-IMP). All transplant recipients received prednisolone and cyclosporine (CyA). Regional CBF (rCBF) was measured by defining regions of interest in the cerebral cortex, deep white matter, striatum, thalamus, and cerebellum. In transplant recipients, correlations to the mean overall cortical CBF were assessed using the interval from transplantation to measurement of SPECT, as well as the serum creatinine concentration. Moreover, to investigate the influence of CyA on CBF, the correlation between mean overall cortical CBF and CyA trough concentrations was assessed.
Results In all regions, CBF in renal transplant recipients was significantly lower than in normal subjects. No significant correlation was seen between serum creatinine, interval from transplantation, or CyA trough concentrations and mean overall cortical CBF.
Conclusion Renal transplant recipients demonstrated a decrease in CBF, that can have an associated secondary pathology. Therefore, renal transplant recipients may benefit from post-operative MRI or CT.
(Internal Medicine 41: 677-683, 2002)

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Objective To study subclinical involvement of the peripheral nerves in myelitis with hyperlgEaemia and mite antigen-specific IgE (atopic myelitis: AM).
Material and Methods We carried out a nerve conduction study of the median, ulnar, tibial, and sural nerves in 21 patients with AM and in 28 patients with clinically definite or laboratory-supported definite multiple sclerosis (MS).
Results The patients with AM showed a significantly higher frequency of abnormal records than the MS patients in the sensory nerve conduction study (52.4% vs. 14.3%, p=0.0106). The frequency of abnormal records in the motor nerve conduction study in AM patients was twice as high as in MS patients (38.1% vs. 17.9%), but the difference was not statistically significant. Abnormality in the F-wave-evoked frequency in the median nerve was also significantly more common in AM patients than in MS patients (57.9% vs. 10.7%, p=0.0016).
Conclusions These findings suggest that subclinical peripheral neuropathy is frequent in patients with AM.
(Internal Medicine 41: 684-691, 2002)

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Objective Most cerebrovascular disturbances in Behçet's syndrome are occlusive in nature, while hemorrhage is rare. In this paper, we report three cases of neuro-Behçet's syndrome presenting with intracerebral hemorrhaging, and discuss the possible causes as they relate to cyclosporine treatment.
Patients Three cases of neuro-Behçet's syndrome presented with intracranial hemorrhage. One patient had been taking cyclosporine, and the other two patients had never taking cyclosporine.
Results Together with previous reports, these cases suggest that there are two types of intracranial hemorrhage in neuro-Behçet's syndrome. One type occurs in the center of a lesion and during the acute phase of the disease, while the other occurs in the peripheral lesion and during the subacute phase.
Conclusions It appears that the intractanial hemorrhages in neuro-Behçet's symdrome can be divided into two groups. It is possible that the vascular pathologies caused by Behçet's symdrome and by cyclosporine conspire to induce CNS hemorrhaging in some cases.
(Internal Medicine 41: 692-695, 2002)

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A case of autoimmune hepatitis (AIH) complicated by primary sclerosing cholangitis (PSC) in a 36-year-old woman is reported. AIH overlapping with PSC has been rarely reported, and to the best of our knowledge, there have been no reports in Japan. Based on the criteria for diagnosis of AIH and on typical endoscopic retrograde cholangiograph (ERC) findings, the patient was diagnosed as having AIH overlapping with PSC. Her transaminase levels normalized within 1 month after administration of prednisone, azathioprine and ursodeoxycholic acid, but her cholestatic enzyme level remained elevated. The effect of treatment on the cholestatic features is thought to be an important factor for predicting the prognosis of AIH overlapping with PSC.
(Internal Medicine 41: 696-700, 2002)

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A 50-year-old woman patient began receiving lamivudine because of acute exacerbation of chronic hepatitis B. She also suffered from adult-onset Still's disease and had received prednisolone for 5 years. Lamivudine was effective for treatment of the first flare. Fifteen months after lamivudine treatment was started, a breakthrough due to lamivudine-resistant strain M552I occurred. Between 10 and 12 months after the breakthrough, flare with jaundice occurred 3 times. We decided interferon would not be suitable, because it could induce activation of Still's disease. Prolonged lamivudine therapy is only recommended in cases of hepatitis B in which there is no alternative treatment.
(Internal Medicine 41: 701-705, 2002)

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A 26-year-old man who was diagnosed with myocarditis presented eosinopilia after having eaten raw meat several times before the admission. Since the antibody titer against Toxocara canis was high, we diagnosed that he had visceral larva migrans due to Toxocara canis associated with myocarditis and eosinophilia. He was then treated with oral albendazole and prednisolone for 4 weeks and eosinophil count and hepatic enzymes were normalized along with the decrease in the antibody titer. We consider that his myocarditis was probably caused by direct larval migration and/or by hypersensitivity reaction, for which combined therapy with albendazole and prednisolone was effective.
(Internal Medicine 41: 706-708, 2002)

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Two patients with amiodarone-induced pulmonary toxicity (APT) showed abnormally increased serum SP-D concentrations, although their KL-6 level was within the normal range. In a 59-year-old man with ischemic heart disease, APT progressed rapidly and required steroid pulse therapy. During the clinical course, SP-D was as high as 375 ng/ml, although the KL-6 level was only 289 U/ml. In a 58-year-old man treated for dilated cardiomyopathy, SP-D increased to 289 ng/ml, while KL-6 remained at less than 500 U/ml. These cases indicate that SP-D is a useful and early diagnostic marker for APT even when KL-6 is not elevated.
(Intrenal Medicine 41: 709-712, 2002)

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A case of a 63-year-old man with isolated dissection of the superior mesenteric artery (SMA), demonstrated by enhanced computed tomography (CT) and abdominal angiography, was admitted to our hospital. The severity of this disease varies from mild to severe; the severe cases require surgery. But the mild cases, like the one presented here, only need conservative therapy. This case demonstrated the usefulness of anticoagulation therapy and the indications for surgical and radiological intervention.
(Intrenal Medicine 41: 713-716, 2002)

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A 20-year-old Japanese man was admitted to our hospital because of thirst and weight loss. His fasting plasma glucose, glycated hemoglobin, and urinary C-peptide were 262 mg/dl, 13.6%, and 44.8 μg/day, respectively, and the autoimmune antibodies related to type 1 diabetes were negative. Chromosome analysis of his peripheral blood lymphocytes showed a mos45, XY, der(14;14)(q10;q10)[129]/46, XY, +14, der(14;14)(q10;q10)[1] karyotype. His parents were karyotypically normal. Microsatellite marker analysis on chromosome 14 demonstrated mosaic maternal segmental isodisomy for 14q21-q24. Although the parents had normal glucose regulation, the patient who finally returned to impaired glucose tolerance and his mother both have a deficiency in early postprandial insulin secretion. Since obesity was mild (body mass index, 24.1 kg/m²) and he was relatively young for type 2 diabetes, we speculated that his isodisomy 14 may have been involved in the onset of diabetes mellitus in this patient.
(Internal Medicine 41: 717-721, 2002)

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We report here a very rare case of a nephrotic patient who developed acute myelogenous leukemia (AML, M2) 8 months after receiving cyclosporin A (CsA) therapy. A 30-year-old man with nephrotic syndrome had been taking diphenylhydantoin (DPH, 300 mg/day) for 6 years for treatment of convulsion and then received treatment of prednisolone and CsA (75 mg/day) for a nephrotic syndrome. Approximately 4 months after CsA therapy began, myeloblasts appeared in his peripheral blood at a ratio of 1%. Four months later, bone marrow aspiration and a biopsy confirmed a diagnosis of AML M2, showing hypercellular bone marrow with 60% leukemic cells. He received induction chemotherapy, which led to a complete remission.
(Internal Medicine 41: 722-724, 2002)

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A case of antiphospholipid syndrome (APS) is reported. A 48-year-old man visited our hospital because of proteinuria. He had suffered from thrombosis and had high titers of antibodies to β2-glycoprotein I (aβ2GPI) and anticardiolipin antibodies (aCLIgG) and thrombocytopenia. We started anticoagulation therapy using warfarin combined with prednisolone. Although platelet count was improved, the titers of anti-β2GPI and aCLIgG still remained high. Therefore, double-filtration plasmapheresis (DFPP) was carried out to remove the antibodies. After the treatment with DFPP, Cyclophosphamide was administered. These therapies resulted in lower titers of aβ2GPI and aCLIgG and no more thrombosis occurred. A combination therapy using warfarin, prednisolone, Cyclophosphamide and DFPP might be effective for the treatment of patients with APS.
(Internal Medicine 41: 725-729, 2002)

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Radiation therapy is commonly used for the treatment of lung cancer. However, radiation pneumonitis frequently occurs as a complication of the radiation therapy. Although corticosteroids are widely used for the treatment of radiation pneumonitis, they are not always effective. In this report, we used cycosporin A in the treatment of a patient suffering from steroid-refractory radiation pneumonitis. To our knowledge, this is the first report in which cyclosporin A was successfully used in the treatment of radiation pneumonitis.
(Internal Medicine 41: 730-733, 2002)

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A 63-year-old man presented with a perforation of the small intestine. A diagnosis of intestinal T-cell lymphoma (ITCL) was made from CD (cluster differentiation) 3 positivity and a rearrangement of T-cell receptor genes. The tumor also expressed CD56, which suggests it belongs to a rare subtype derived from activated cytotoxic intraepithelial T lymphocytes. Although the prognosis of ITCL has been considered to be very poor irrespective of CD56 positivity, complete remission was achieved in this case by high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) even after relapse. Auto-PBSCT in the earlier stage of the disease might improve the prognosis.
(Internal Medicine 41: 734-737, 2002)

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A 66-year-old man, with a history of pulmonary tuberculosis 40 years before admission, complained of headache and dysarthria that lasted for 2 weeks and was followed by diplopia. MRI revealed an isolated nodular lesion in the pons with a marked enhancement mimicking brain tumor and other diseases. Antituberculous drugs were started under the presumptive diagnosis of tuberculoma. The lesion was completely resolved after 9 months of treatment and thus, the final diagnosis was confirmed. An empiric administration of antituberculous drug may be an important and non-invasive diagnostic tool as well as a treatment in such cases.
(Internal Medicine 41: 738-742, 2002)

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A 46-year-old man with hypokalemic periodic paralysis (HypoPP) and diabetes mellitus (DM) had worsened muscle weakness after acetazolamide (ACZ) treatment. During the paralytic episode, serum potassium levels were reduced, and serum chloride and insulin levels were increased. The data suggested proximal renal tubular acidosis due to ACZ. We determined arterial-venous concentrations of potassium, insulin and glucose across the forearm. Venous potassium levels were markedly reduced. ACZ is thought to potentiate potassium uptake into muscles. Hyperinsulinemia and DM could contribute to ACZ-induced exacerbation in our patient. We should pay more attention to ACZ-treated HypoPP patients with hyperinsulinemia and DM.
(Internal Medicine 41: 743-745, 2002)

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A 41-year-old man noticed weakness and atrophy in his right hand and forearm resembling the non-progressive juvenile muscular atrophy of unilateral upper extremity (Hirayama's disease). MRI showed an abnormal cavity in the posterior epidural space which appeared on neck flexion communicating with the subarachnoid space in addition to the flattening of the lower cervical spinal cord on neck flexion. When evaluating atypical cases of Hirayama's disease, the pathomechanism demonstrated in the present case should be taken into consideration.
(Internal Medicine 41: 746-748, 2002)

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A 55-year-old man suffered from nasal obstruction, swelling of the salivary glands, and diplopia caused by markedly enlarged lacrimal glands. The diagnosis of primary Sjögren's syndrome was made by a positive Schirmer's test and nasal mucosal biopsy with severe lymphocyte infiltration. He was also found to have swelling of the whole pancreas and increased wall thickness in the common bile duct and the gall bladder. His serum was positive for an anti-carbonic anhydrase II antibody. Since carbonic anhydrase II is present in the ductal cells of various exocrine organs, this autoantibody is considered to be related to the pathogenesis of primary Sjögren's syndrome with a marked swelling of multiple exocrine organs.
(Internal Medicine 41: 749-753, 2002)

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An 18-year-old woman who presented with photosensitivity, butterfly rash and acute visual disturbance was diagnosed as SLE with retinopathy. The level of IFN-α in the cerebrospinal fluid (CSF) was markedly elevated. Her visual acuity recovered with high-dose prednisolone therapy. IFN-α in the CSF also reduced to within the normal range. The mechanism causing lupus retinopathy is not clearly understood. Although the association between lupus retinopathy and a high level of IFN-α has not been reported, the injection of IFN-α is known to frequently cause retinopathy in hepatitis patients. We discuss the possibility of IFN-α causing retinopathy in SLE patients.
(Internal Medicine 41: 754-756, 2002)

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