Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 43 , Issue 4
Showing 1-20 articles out of 20 articles from the selected issue
EDITORIALS
CASE REPORTS
Gastrointestinal Diseases
  • Tomoka ESAKI, Norihisa SUZUKI, Keiji YOKOYAMA, Kaoru IWATA, Makoto IRI ...
    2004 Volume 43 Issue 4 Pages 279-282
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A 70-year-old woman was admitted to our hospital because of a liver tumor. Laboratory data revealed mild liver dysfunction. Neither serum anti-HCV antibody nor HCV-RNA was detected. Computed tomography revealed a tumor lesion measuring 2 cm in diameter within the liver. Histological examination of the tumor revealed moderately differentiated hepatocellular carcinoma while the non-tumorous liver tissue demonstrated liver cirrhosis. By the RT-PCR method, HCV-RNA was detected from the non-tumorous liver tissue. We herein report a very rare case of hepatocellular carcinoma in a patient with liver cirrhosis associated with negative serum HCV findings, but positive finding for liver tissue HCV RNA.
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  • Jun UMINO, Eiji TANAKA, Tetsuya ICHIJOH, Takashi MURAKI, Koji ORII, Ka ...
    2004 Volume 43 Issue 4 Pages 283-288
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    Hepatic hydrothorax in the absence of ascites is a rare complication of liver cirrhosis. A 56-year-old woman was referred to our hospital because of a massive pleural effusion on the right side, requiring continuous drainage. Although the patient was known to have chronic hepatitis C, she had no signs of hepatic failure including ascites. A laparoscopic examination revealed a nodular liver and a small volume of ascites in the peritoneal cavity. Indocyanine green sprayed into the intraperitoneal cavity was excreted from the pleural drain just after the spraying, indicating an intraperitoneal origin of the pleural fluid. Discontinuation of pleural drainage and an introduction of standard treatment for ascites due to liver cirrhosis (including restriction of salt intake and diuretic administration) resulted in a marked decrease of pleural effusion.
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  • Keita FUJIKAWA, Kazuyuki OHATA, Takuya HONDA, Seiji MIYAZOE, Tatsuki I ...
    2004 Volume 43 Issue 4 Pages 289-294
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A 65-year-old woman was admitted to our hospital for an investigation of liver dysfunction. She had mild obesity with hyperlipidemia, but no history of alcohol abuse. Other known causes of liver dysfunction, such as viruses, autoimmunity and drug effects, were excluded. The liver histology was consistent with nonalcoholic steatohepatitis (NASH). After diagnosis of NASH, the patient started diet and exercise therapy and, in parallel with weight reduction, her liver function improved. One year after the therapy, a liver biopsy showed that steatosis, necroinflammation and even fibrosis were improved. Hence, here we report a case of NASH in which weight reduction was effective in improving both biochemical and histological findings.
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Cardiovascular Diseases
Endocrine-Metabolic Diseases
  • Shigenori NAKAMURA, Mako ISAJI, Masatoshi ISHIMORI
    2004 Volume 43 Issue 4 Pages 306-309
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A 28-year-old woman with thyroid hemiagenesis, who had been diagnosed as having Graves’ disease, became pregnant during the course of methimazole treatment. The treatment was terminated in the second trimester. She delivered a normal infant at full term. She became thyrotoxic 3 months after the delivery, hypothyroid 6 months after the delivery, and finally euthyroid 11 months after the delivery without undergoing any treatment. This clinical course indicates that she developed silent thyroiditis after the delivery. A diagnosis of thyroid hemiagenesis was made on the basis of ultrasonography of the thyroid and 99mTc-pertechnetate thyroid scintiscan.
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  • Munehiro HONDA, Toshihiko TSUKADA, Toshimitsu HORIUCHI, Reiko TANAKA, ...
    2004 Volume 43 Issue 4 Pages 310-314
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A rare case of primary hyperparathyroidism associated with primary aldosteronism and breast cancer is reported. A 44-year-old woman was admitted to our hospital to undergo surgical removal of breast cancer. She had hypertension with low serum potassium, and slightly but significantly elevated serum calcium levels. Further studies demonstrated an enlarged left superior parathyroid gland and a left aldosterone-producing adrenocortical adenoma. Blood pressure was controlled with spironolactone and nifedipine, and left mastectomy was done for breast cancer. The pathological diagnosis was scirrhous breast carcinoma. Although the postoperative course was uneventful, her serum calcium gradually and progressively rose to higher levels. Left superior parathyroidectomy and left adrenalectomy were then performed simultaneously. The pathological diagnoses of the resected parathyroid gland and adrenal gland were parathyroid chief cell adenoma and adrenocortical adenoma with hyperplasia of zona glomerulosa, respectively. To clarify if the occurence of these tumors may be related to MEN1 gene mutations, we analyzed MEN1 gene in this patient, and found a loss of heterozygosity of the MEN1 locus in the parathyroid adenoma and breast cancer. Thus, we conclude that an alteration of the MEN1 gene and/or another tumor suppressor gene located at the MEN1 locus on chromosome 11q13 may be responsible for the development of parathyroid adenoma and breast cancer in our patient suggesting that the clinical spectrum of MEN1 might include breast cancer. In addition, serum calcium should be interpreted with caution in primary aldosteronism, because hypercalcemia may be masked in the presence of aldosterone excess.
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Renal Diseases
  • Fumie SAKAMOTO, Hideki TAKI, Toshiaki YAMAGATA, Sayaka TSUKURIMICHI, M ...
    2004 Volume 43 Issue 4 Pages 315-318
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A 48-year-old woman suffering from hematuria was admitted to our hospital due to conscious disturbance. She had lower abdominal phantom tumor, anemia, renal dysfunction, hyperglycemia, metabolic acidosis and electrolyte abnormalities. Because of pelvocaliceal dilatation noted on abdominal ultrasonography, we first diagnosed her as having postrenal failure. With massive blood clots and gas emission from her urethra upon attempting cystoscopy, the remarkable expansion of the urinary bladder and a three-layered structure of gas, urine and complex of blood and debris inside her urinary bladder noted on abdominal CT scan, as well as the increased white blood cell count, we finally concluded our diagnosis as emphysematous cystitis.
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Respiratory Diseases
  • Atsuko YUKI, Toshinori TANAKA, Yoshifumi KIYONO, Akihiro TSUKADA, Mine ...
    2004 Volume 43 Issue 4 Pages 319-322
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    We report a 29-year-old man with a rare left lumbar subcutaneous cold abscess complicated by tuberculous spondylitis during the treatment of pulmonary tuberculosis. Pulmonary tuberculosis was rapidly improved by anti-tuberculous drugs, however curative operation for tuberculous spondylitis was necessary after 18 months because tuberculous spondylitis was overlooked. Imaging techniques are important in helping to establish a diagnosis of tuberculous spondylitis. It should be stressed that a high clinical index of suspicion for tuberculosis is needed to correctly diagnose this disease.
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  • Motohiro KOBAYASHI, Makoto ITO, Kenji SANO, Takayuki HONDA, Jun NAKAYA ...
    2004 Volume 43 Issue 4 Pages 323-326
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    Lymphoepithelioma-like carcinoma (LELC) of the lung is an undifferentiated carcinoma with prominent lymphoid stroma. We encountered a case of synchronous primary lung cancers of LELC and papillary adenocarcinoma in a 67-year-old Japanese woman. By in situ hybridization, Epstein-Barr virus (EBV) genome was detected in malignant epithelial cells of LELC but not in the papillary adenocarcinoma. Tumor-infiltrating lymphocytes in LELC were predominantly CD8+ and T cell intracytoplasmic antigen (TIA-1)+ cytotoxic T cells with closely associated with HLA-DR-positive LELC cells by double immunostaining. These data indicate that the exaggerated lymphoid infiltration in and around the EBV-infected carcinoma cells may represent the enhanced tumor immunity, suggesting a better prognostic indicator.
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  • Shin-ichiro MORI, Yasunobu HIROTSU, Akira MIZOGUCHI, Masaharu KAWABATA ...
    2004 Volume 43 Issue 4 Pages 327-330
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    An asymptomatic patient with a pulmonary coin lesion surgically diagnosed with pulmonary dirofilariasis caused by infection with Dirofilaria immitis (D. immitis) is presented. The preoperative stored serum of the patient was positive for D. immitis by enzyme-linked immunosorbent assay (ELISA). A family study showed that three of five family members were seropositive for D. immitis. These results suggest that family members of a patient with pulmonary dirofilariasis were frequently exposed to D. immitis and serodiagnostic methods are useful for detecting subclinical infection of D. immitis.
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Rheumatic Diseases
  • Jangchul PARK, Shogo BANNO, Yoshiki SUGIURA, Kosho YOSHIKAWA, Taio NAN ...
    2004 Volume 43 Issue 4 Pages 331-335
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    There are several case reports of systemic vasculitis associated with chronic suppurative lung diseases. We describe a 46-year-old female, previously diagnosed as having diffuse panbronchiolitis (DPB), presenting with hemosputum and dyspnea. Her serum titer of MPO-ANCA was positive together with a high titer of BPI-ANCA. Chest X-ray and chest CT scan showed pulmonary hemorrhage, and the renal biopsy specimen revealed necrotizing, crescentic glomerulonephritis. She was diagnosed as having ANCA-associated vasculitis, and more specifically, microscopic polyangiitis accompanied by DPB. She was treated with methylprednisolone pulse therapy, followed by intravenous cyclophosphamide. This case suggested a possible association with chronic bacterial infection, which may play a role in the pathogenesis of ANCA-associated vasculitis.
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  • Michi WATANABE, Noriaki MATSUI, Syuji HAMADA, Jiro OHUCHI, Naoya SHIMO ...
    2004 Volume 43 Issue 4 Pages 336-339
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    We report the rare case of HES involving oral cavity associated with esophagus, and gastrointestinal tract, which we succeeded in diagnosing precisely through a biopsy specimen obtained from the lip. A 64-year-old man had dysphagia, swelling of the oral mucosa and the posterior cervical muscles, accompanied by an abdominal pain and diarrhea. Peripheral blood cell count showed marked eosinophilia. Computed tomography showed thickening of posterior wall of the pharynx, esophagus, and gastrointestinal tract. Histologic specimen obtained from the lower lip demonstrated a moderate infiltration of eosinophils. His clinical condition was improved by oral prednisolone therapy.
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Infectious Diseases
  • Takahiro ZENDA, Yuji ITOH, Yoshihiro TAKAYAMA, Takaharu MASUNAGA, Sato ...
    2004 Volume 43 Issue 4 Pages 340-343
    Published: 2004
    Released: February 04, 2005
    JOURNALS OPEN ACCESS
    A 35-year-old man was admitted because of significant hepatic dysfunction with mild splenomegaly and intra-abdominal lymphadenopathy of unknown cause. Infectious mononucleosis was suggested by subsequently detected high fever, pharyngotonsillitis and cervical lymphadenopathy, but IgM to Epstein-Barr virus (EBV) and cytomegalovirus (CMV) showed dual positivity. A definite diagnosis of EBV-induced infectious mononucleosis was established 3 months later on the basis of seroconversion to Epstein-Barr nuclear antigen (EBNA)-IgG positivity and reduced CMV-IgM titer with persistently negative CMV-IgG. This case highlights the initial diagnostic difficulties of EBV-induced infectious mononucleosis particularly in older patients, due to concomitant abnormal humoral immunity and unusual initial manifestations such as significant liver injury and extensive intra-abdominal lymphadenopathy.
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SHORT COMMUNICATION
Cardiovascular Disease
PICTURES IN CLINICAL MEDICINE
Endocrine-Metabolic Disease
LETTERS TO THE EDITOR
Neurologic Disease
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