Internal Medicine

Causes of Non-B, Non-C Hepatocellular Carcinoma: Is TTV a Causative Agent?

Kojiro MlCHITAKA, Morikazu ONJI

2003 Volume 42 Issue 12 Pages 1157-1158
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1157

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Corticosteroid Pulse the Therapy for the Treatment of Cholesterol Embolic Disease

Takao SAITO

2003 Volume 42 Issue 12 Pages 1159-1160
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1159

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Another Possibly Important Function of VEGF Related to Polyneuropathy

Takashi SAWAI

2003 Volume 42 Issue 12 Pages 1161-1162
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1161

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Autoimmune Aspects of Pulmonary Hypertension in Collagen Vascular Diseases

Hirobumi KONDO

2003 Volume 42 Issue 12 Pages 1163-1164
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1163

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A Detective Story for Biomedical Footprints towards New Therapeutic Interventions in Diabetic Nephropathy

Toshio MlYATA, Kiyoshi KUROKAWA

2003 Volume 42 Issue 12 Pages 1165-1171
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1165

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The biochemistry of protein modifications in human disease teaches us a number of lessons as it reveals factors and pathways implicated in the genesis of human pathology. For instance, diabetic renal damage is associated with a variety of stresses, e.g., glycemic stress resulting from hyperglycemia, oxidative stress from reactive oxygen species, carbonyl stress from reactive carbonyl compounds, and nitrosative stress from reactive nitrogen species. Proteins are particularly attractive targets for product analysis. Protein modifications are much more specific and stable biomarkers of the disease than lipids and other metabolites, and thus serve as footprints of biochemical processes. Their quantitative analysis not only facilitates better understanding of the physiopathology but also offers new therapeutic insight. In this review, we delineate oxidative protein modifications existing in diabetic nephropathy and discuss therapeutic perspectives towards the development of new classes of renoprotective agents.
(Internal Medicine 42: 1165-1171, 2003)

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TT Virus-Positive Hepatocellular Carcinoma Arising from Non-Cirrhotic Liver in an Elderly Man

Nobuyuki TOSHIKUNI, Kouichi KAYANO, Satoshi NISHIOKA, Mikio MITSUNAGA, ...

2003 Volume 42 Issue 12 Pages 1172-1177
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1172

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A 43-mm hepatic tumor was incidentally detected by computed tomography in a 72-year-old man. Liver function test results were normal. Serum hepatitis B, C and G viruses were negative, while serum TT virus was positive. Autoantibodies were negative. The patient had no history of alcohol consumption. The tumor was found to be a moderately differentiated hepatocellular carcinoma (HCC) from a resected specimen. Neither lobular inflammation nor fibrosis was observed in the surrounding liver. Intrahepatic hepatitis B virus was not detected. This is a case of non-B, non-C HCC positive for only TT virus arising from a non-cirrhotic liver.
(Internal Medicine 42: 1172-1177, 2003)

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Heal Shwannoma in which Blood Loss Scintigraphy was Useful for Diagnosis

Takayuki NAGAI, Kenji FUJIYOSHI, Kenji TAKAHASHI, Ryutarou TORISHIMA, ...

2003 Volume 42 Issue 12 Pages 1178-1182
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1178

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An 85-year-old woman was hospitalized with severe melena of unknown origin. Upper gastrointestinal (GI) endoscopy and lower GI endoscopy did not detect the origin and we could not establish any diagnosis. To explore the bleeding site, ^99mTc-HSA blood loss scintigraphy was performed and a tumor of the small intestine was suspected. Fluoroscopic examination of the small intestine and abdominal CT scan confirmed an ileal tumor measuring 4×3 cm. The mass was a well-demarcated tumor about 80 cm proximal to Bauhin's valve. Partial resection of the ileum was carried out and the tumor was histologically diagnosed as schwannoma. Thereafter, there has been no recurrence of melena nor metastasis of the tumor. It is thought that blood loss scintigraphy is a useful method for unexplained exacerbation of melena.
(Internal Medicine 42: 1178-1182, 2003)

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Association of Intestinal Malignant Lymphoma and Ulcerative Colitis

Naoko WATANABE, Naoshi SUGIMOTO, Akiko MATSUSHITA, Akinori MAEDA, Keni ...

2003 Volume 42 Issue 12 Pages 1183-1187
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1183

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A 42-year-old woman with refractory ulcerative colitis (UC) developed ascites, pleural effusion, pretibial edema and severe anemia. Colonofiberscopic examination showed a bulky submucosal tumor in the sigmoid colon, which was histologically diagnosed as malignant lymphoma (diffuse large, B cell type). The lymphoma was resistant to chemotherapy. Autologous peripheral blood stem cell transplantation (PBSCT) was effective; however, she died of severe infection after the second PBSCT. Although the association of intestinal lymphoma with UC is rare, lymphoma should be taken into consideration when the clinical course of UC is atypical or when UC is refractory to therapy.
(Internal Medicine 42: 1183-1187, 2003)

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Three Cases of Liver Injury Caused by Sennomotokounou, a Chinese Dietary Supplement for Weight Loss

Kazuhito KAWATA, Yasunori TAKEHIRA, Yoshimasa KOBAYASHI, Mutsuo KITAGA ...

2003 Volume 42 Issue 12 Pages 1188-1192
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1188

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Dietary supplements have become very popular worldwide because they are believed to be safe with few side effects. Here, we report three cases of liver injury caused by Sennomotokounou, a Chinese dietary supplement for weight reduction. All patients developed acute hepatotoxicity and recovered spontaneously after withdrawal of dietary product. This product contains fenfluramine, nnitroso-fenfluramine, and dried thyroid tissue powder. In Japan, the regulatory agency for drug and food safety received 120 reports of hepatotoxicity associated with Sennomotokounou between 2000 and 2002. Physicians should inquire about the use of dietary supplements whenever patients present with unexplained acute liver dysfunction.
(Internal Medicine 42: 1188-1192, 2003)

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Decrease of β-cells and Increase of α-cells in a Diabetic Patient with Mitochondrial DNA 3243 (A → G) Mutation

Toshihiro KOJIMA, Mayumi YAMAMOTO, Naoki FURUHASHI, Hiroshi SARUI, His ...

2003 Volume 42 Issue 12 Pages 1193-1196
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1193

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We report here a case of a 53-year-old woman with mitochondrial 3243 (A → G) mutation diabetes. Diabetes mellitus was diagnosed at 39 years of age. At 50 years of age, cardiomyopathy and hypothyroidism were noted. At 53 years of age, the patient was admitted to our hospital for treatment of necrotic ulceration of toes. However, she died of massive heart failure. Pathological examination at autopsy showed a decrease in size, number, and acidophilicity of islets in the pancreas. Immunohistochemical stain revealed a decrease in the β-cell population to 20.5± 9.2% and a relative increase in α-cell population to 48.6± 11.5%.
(Internal Medicine 42: 1193-1196, 2003)

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Ectopic ACTH Syndrome Due to Thymic Atypical Carcinoid Treated with Combination Chemotherapy of Cisplatin and Etoposide

Toru TAKAHASHI, Katsuhiro HATAO, Yoshimi YAMASHITA, Yukio TANIZAWA

2003 Volume 42 Issue 12 Pages 1197-1201
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1197

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A 21-year-old woman with Cushing's syndrome presented with a mediastinal tumor. Ectopic ACTH syndrome was diagnosed and the tumor was resected. The histopathological diagnosis was thymic atypical carcinoid. Despite all tumor lesions having been resected, the tumor relapsed and multiple metastatic lesions grew aggressively. Combination chemotherapy with cisplatin and etoposide (VP16) was administered to control tumor progression, and achieved marked therapeutic effects. Maintenance chemotherapy with carboplatin and VP16 achieved long-term tumor control. This case indicates that some patients with atypical carcinoid tumor are good responders to chemotherapy with platinum agents and VP16.
(Internal Medicine 42: 1197-1201, 2003)

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Topical Treatment with 22-oxacalcitriol (OCT), a New Vitamin D Analogue, Caused Severe Hypercalcemia with Exacerbation of Chronic Renal Failure in a Psoriatic Patient with Diabetic Nephropathy; A Case Report and Analysis of the Potential for Hypercalcemia

Sawako OHIGASHI, Ichiro TATSUNO, Daigaku UCHIDA, Mayumi HIGURASHI, Sao ...

2003 Volume 42 Issue 12 Pages 1202-1205
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1202

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Vitamin D has been used for topical treatment of psoriasis, and 22-oxacalcitriol (OCT), shown to be less calcemic, was developed for the topical treatment of psoriasis in Japan. Recently, we treated a psoriatic patient with diabetic nephropathy who developed severe hypercalcemia with exacerbation of chronic renal failure by the use of topical OCT. Analysis of the reported cases demonstrated that both the severity of psoriasis and renal dysfunction are critical factors in the induction of hypercalcemia in the topical treatment of psoriasis. Therefore, we must pay attention to the severity of psoriasis, especially when complicated by renal function impairment. Regular monitoring of Ca and renal function is essential to avoid life-threatening hypercalcemia from the topical treatment with vitamin D analogues.
(Internal Medicine 42: 1202-1205, 2003)

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Renal Cholesterol Embolic Disease Effectively Treated with Steroid Pulse Therapy

Toshiyuki TAKAHASHI, Tsuneo KONTA, Wakako NISHIDA, Akira IGARASHI, Kaz ...

2003 Volume 42 Issue 12 Pages 1206-1209
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1206

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A 65-year-old man developed acute renal failure with eosinophilia two weeks after a coronary bypass operation and angiography. Renal biopsy revealed cholesterol crystal embolism (CCE) in glomeruli and arterioles. Lowdose corticosteroid therapy failed to recover the renal function; further deterioration of renal function and peripheral ischemic symptoms such as livedo reticularis and blue toes occurred. However, steroid pulse therapy successfully attenuated CCE-induced renal failure and eosinophilia. It is suggested that steroid pulse therapy might be effective to treat CCE-induced renal failure and eosinophilia could be a useful marker for activity of CCE.
(Internal Medicine 42: 1206-1209, 2003)

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Mixed Cryoglobulinemia Due to Chronic Hepatitis C with Severe Pulmonary Involvement

Ryuji SUZUKI, Hiroyuki MORITA, Daisuke KOMUKAI, Takeshi HASEGAWA, Naoy ...

2003 Volume 42 Issue 12 Pages 1210-1214
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1210

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Pulmonary involvement in cryoglobulinemia usually is mild. We present a rare case of severe lung involvement in mixed cryoglobulinemia. A 73-year-old woman with cryoglobulinemic glomerulonephritis was admitted. Dyspnea appeared suddenly two days later. She received the diagnosis of acute lung injury according to the concept proposed by the American-European Consensus Conference. Management required corticosteroid pulse therapy and plasma exchange. This case is the first description of successful early and long-term management of severe lung involvement observed in cryoglobulinemia. Although she has been free of chest symptoms for seven months, further follow-up may be necessary to assess the potential danger of relapse.
(Internal Medicine 42: 1210-1214, 2003)

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Two Cases of Endobronchial Neurilemmoma and Review of the Literature in Japan

Kei KASAHARA, Kazuya FUKUOKA, Mitsura KONISHI, Kaoru HAMADA, Koichi MA ...

2003 Volume 42 Issue 12 Pages 1215-1218
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1215

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Neurilemmomas are benign tumors which originate from Schwann cells. They rarely occur in the trachea or bronchus. We encountered two cases of endobronchial neurilemmoma and in this context, reviewed 48 cases previously reported in Japan. Neurilemmomas can occur in all regions of the bronchial tree and they often progress into both intraluminal and extraluminal spaces. Incomplete resection results in a local recurrence, despite being rare. As for appropriate therapies, surgery, bronchofiberoptic removal and yttrium aluminum garnet (YAG) laser resection can be chosen depending on the patient's status.
(Internal Medicine 42: 1215-1218, 2003)

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Hericium Erinaceum (Yamabushitake) Extract-induced Acute Respiratory Distress Syndrome Monitored by Serum Surfactant Proteins

Munehide NAKATSUGAWA, Hiroki TAKAHASHI, Chikako TAKEZAWA, Kazutaka NAK ...

2003 Volume 42 Issue 12 Pages 1219-1222
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1219

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This is the first report suggesting a causal relationship between acute respiratory distress syndrome and Hericium erinaceum extract, which is commercialized as a diet food. A 63-year-old man was admitted to our hospital for intensive care of severe acute respiratory failure with diffuse infiltration in both lungs. Bronchoalveolar lavage fluid revealed a high percentage of lymphocytes. Lymphocyte stimulation test showed a strong reactivity against extract formulation of Hericium erinaceum (Yamabushitake), which he had taken four months before onset. He recovered with successful steroid pulse therapy under mechanical ventilation. Concentrations of surfactant protein (SP)-A and SP-D in sera reflected the clinical features.
(Internal Medicine 42: 1219-1222, 2003)

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Successful Treatment of Limited Disease-Small Cell Lung Cancer with Multimodality Treatment Consisting of Concurrent Chemoradiotherapy, High-Dose Chemotherapy with Autologous Peripheral Blood Stem Cell Transplantation and Surgical Resection

Katsuyuki HOTTA, Hiroshi UEOKA, Katsuyuki KIURA, Masahiro TABATA, Eise ...

2003 Volume 42 Issue 12 Pages 1223-1227
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1223

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A 65-year-old man with limited disease-small cell lung cancer was treated with concurrent chemoradiotherapy which resulted in a partial response. He further received high-dose chemotherapy with autologous peripheral blood stem cell transplantation. Development of non-small cell carcinoma was, however, suspected at a site of the residual nodule in cytological examination using bronchoscopy. He then underwent lobectomy, which revealed that the nodule was composed of necrotic tissue. He has been alive without recurrence for seven years. This multimodality treatment appeared to be effective for this patient. However, further investigation is necessary to clarify the role of multimodality treatment.
(Internal Medicine 42: 1223-1227, 2003)

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Ischemic Colitis as a Manifestation of Thrombotic Microangiopathy Following Bone Marrow Transplantation

Yukiko KOMENO, Seishi OGAWA, Tateru ISHIDA, Kengo TAKEUCHI, Shiho TSUJ ...

2003 Volume 42 Issue 12 Pages 1228-1232
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1228

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Thrombotic microangiopathy (TMA) is a microvascular disorder characterized by platelet aggregation and hemolytic anemia. In the setting of bone marrow transplantation (BMT), ischemic colitis due to TMA is difficult to differentiate from acute graft-versus-host disease. We report a 32-year-old man who presented ischemic colitis due to TMA after unrelated BMT for myelodysplastic syndrome. He suffered from treatment-resistant bloody diarrhea, and died of renal failure and Aspergillus pleuritis on day 253 post-BMT. Autopsy revealed endothelial injuries of arterioles and ischemic changes in the intestines and kidneys. Clinical and pathological characteristics of ischemic colitis due to BMT-associated TMA are described.
(Internal Medicine 42: 1228-1232, 2003)

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Dermatomyositis with Peripheral Nervous System Involvement: Activation of Vascular Endothelial Growth Factor (VEGF) and VEGF Receptor (VEGFR) in Vasculitic Lesions

Naoko MATSUI, Takao MITSUI, Itsuro ENDO, Yasushi OSHIMA, Makoto KUNISH ...

2003 Volume 42 Issue 12 Pages 1233-1239
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1233

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We describe two cases of dermatomyositis (DM) with nervous system involvement. Poly neuropathy was observed in both patients, and cerebral vasculitis was suspected in one patient. Histological examination of biopsied specimens of skeletal muscles, skin and sural nerves revealed vasculitis. Furthermore, vascular endothelial growth factor (VEGF) and VEGF receptors (VEGFRs) were overexpressed in vasculitic lesions. Although, VEGF and VEGFRs were not detected in biopsied specimens of skeletal muscle from normal subjects, they were observed in one of two patients with DM who did not exhibit neuropathy. These findings suggest the possibility that VEGF overproduction is associated with development of vasculitis in some cases of DM complicated with peripheral neuropathy.
(Internal Medicine 42: 1233-1239, 2003)

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Predictive Value of Serial Platelet Count and VEGF Determination for the Management of DIG in the Crow-Fukase (POEMS) Syndrome

Takashi TOKASHIKI, Teruto HASHIGUCHI, Kimiyoshi ARIMURA, Nobutaka EIRA ...

2003 Volume 42 Issue 12 Pages 1240-1243
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1240

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We report a case of a 62-year-old man diagnosed as Crow-Fukase syndrome (POEMS syndrome), in which the serial platelet count and vascular endothelial growth factor (VEGF) concentration were determined before and during the state of disseminated intravascular coagulation (DIC). The serum VEGF concentration was noted to be gradually decreased prior to DIC, after which it abruptly decreased with a corresponding drop in platelet count upon the onset of DIC. The physiological effects of VEGF are viewed as one of the causative factors in DIC and its abrupt and excessive release may have caused the exacerbation of the patient's clinical symptoms.
(Internal Medicine 42: 1240-1243, 2003)

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Infectious Endocarditis Associated with Subarachnoid Hemorrhage, Subdural Hematoma and Multiple Brain Abscesses

Chie YANAGIHARA, Yuko WADA, Yo NISHIMURA

2003 Volume 42 Issue 12 Pages 1244-1247
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1244

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Hemorrhagic stroke is a complication of infectious endocarditis (IE), and severe hemorrhage accompanies Staphylococcus aureus IE during early uncontrolled infection. However, subarachnoid hemorrhage (SAH) or subdural hematoma is rare. A case of S. aureus IE associated with SAH and subdural hematoma in the early stage is reported. A 54-year-old man with a history of mitral valve prolapse presented with fever. Two days after the onset, he fell into a confused state with convulsion and left hemiparesis. He became comatose and brain CT and MRI demonstrated SAH and subdural hematoma with severe right hemisphere swelling. Multiple brain abscesses were also observed. No septic aneurysm was detected by cerebral angiography.
(Internal Medicine 42: 1244-1247, 2003)

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Severe Pulmonary Hypertension Associated with Primary Sjögren's Syndrome

Naoki NAKAGAWA, Shinobu OSANAI, Hiroshi IDE, Yutaka NlSHIGAKI, Saori T ...

2003 Volume 42 Issue 12 Pages 1248-1252
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1248

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Severe pulmonary hypertension is one of the fetal complications in various connective tissue diseases. We report a case of severe pulmonary hypertension associated with primary Sjögren's syndrome. In a lung biopsy specimen, there were findings of intimal and medial hypertrophy with narrowing vessel lumina and plexiform lesions. Moreover, deposits of immunoglobulin M, immunoglobulin A and complement protein Clq were found in the pulmonary arterial walls. Although pulmonary hypertension was refractory to oral prostacyclin, steroid therapy improved the clinical and hemodynamic conditions. In the present case, the immunological etiology may be related to the mechanisms of pulmonary hypertension associated with Sjögren's syndrome.
(Internal Medicine 42: 1248-1252, 2003)

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Intractable Skin Necrosis and Interstitial Pneumonia in Amyopathic Dermatomyositis, Successfully Treated with Cyclosporin A

Yasuhiro SHIMOJIMA, Wataru ISHII, Takashi KATO, Kenichi HOSHI, Masayuk ...

2003 Volume 42 Issue 12 Pages 1253-1258
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1253

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We report a patient with amyopathic dermatomyositis (DM) who mainly showed interstitial pneumonia and intractable skin necrosis in bilateral elbows and soles with a poor response to immunomediated therapy, including corticosteroid and high-dose intravenous immunoglobulin. Soon after starting oral cyclosporin A (CyA) the skin lesions healed completely and the interstitial pneumonia promptly improved in parallel with a decrease in serum KL-6. Since fatal interstitial pneumonia is frequently associated with amyopathic DM as in this case, administration of CyA should be actively considered as a therapeutic option when clinical symtoms are progressive and resistant to conventional treatments.
(Internal Medicine 42: 1253-1258, 2003)

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Ursodeoxycholic Acid Therapy Attenuated Expression of Adhesion Molecule in Primary Biliary Cirrhosis

Hiroaki YOKOMORI, Masaya ODA, Go WAKABAYASHI, Masaki KITAJIMA, Hiromas ...

2003 Volume 42 Issue 12 Pages 1259-1261
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1259

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Hemophagocytic Syndrome, a Possible Association with Aplastic Anemia?

Shunichi KUMAKURA, Hiroto ISHIKURA, Shotai KOBAYASHI

2003 Volume 42 Issue 12 Pages 1262-1264
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1262

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Acute Immune Thrombocytopenic Purpura in a 90-year-old Woman Treated with Immunoglobulin as well as Glucocorticoid

Takeshi KAMIMURA, Makio HATAKEYAMA, Kimiaki TORIGOE, Seiji MINOTA

2003 Volume 42 Issue 12 Pages 1265-1266
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1265

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Meningioma in a Woman Receiving Hormone Therapy

Yoriko MURATA, Seisho TAKEUCHI, Shoji YOSFFIDA, Isao MIYOSHI

2003 Volume 42 Issue 12 Pages 1267
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1267

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Nonreactive Miliary Tuberculosis

Yoshito YOSHIDOME, Kazutaka NISHITARUMIZU

2003 Volume 42 Issue 12 Pages 1268
Published: 2003
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2169/internalmedicine.42.1268

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