To evaluate serum fructosamine as an indicator for diabetic control, serum fructosamine (FRA), glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) were simultaneously measured in 452 diabetics in stable diabetic control. We divided the measured FRA according to the degree of deviation from the expected FRA into three types, hyper-FRA, normo-FRA and hypo-FRA. In the hypo-FRA to HbA1c group, frequencies of male (70 vs 35, 43%) and of nephropathy (61 vs 30, 18%) were higher and mean total serum protein (6.5 vs 7.4, 7.4 g/dl) and albumin (3.4 vs 4.1, 4.0 g/dl) were lower than those in the other two corresponding groups. Correlation was also poorer in the insulin-treated group than the others. These results probably reflect conditions of diabetic control and complication, and protein metabolism. Similar tendencies were observed in case of FPG. Therefore, the discrepancy of FRA gives a clue to detect poor control and complications of diabetes.

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Clinical and immunological changes in patients with myasthenia gravis (MG) who had extended thymectomy(Tx) and/or corticosteroid therapy were examined to elucidate the mechanisms of improvement following the treatments. The changes found were: 1) After Tx and steroid therapy, in patients with MG who showed clinical improvement, the CD4/CD8 ratio and B lymphocyte subpopulations were markedly decreased. 2) Linear correlations between two T-cell subsets were evident in CD3 against CD4 and CD4/CD8 against CD4 after both Tx and steroid therapy. 3) T lymphocytes-CD8 decreased immediately after Tx and returned to pre-treatment levels within three weeks. 4) Cellular sensitization against a nicotinic acetylcholine receptor(AChR)-like protein isolated from fetal calf thymus decreased after steroid therapy. These results indicate that clinical improvement in MG after the treatments was accompanied by a decrease in helper/inducer T lymphocytes, B lymphocytes and specific lymphocyte sensitization against nicotinic AChR.

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A survey regarding the revelation of the diagnosis of cancer to patients was conducted on 116 medical doctors (MD), 206 paramedical personnel (PP) and 789 lay persons (LP) in June 1989 hi Toyama prefecture, Japan. When asked in the case that their parents or spouse had cancer, only 29.8% of all respondents answered that they would reveal the diagnosis of cancer to their family member. On the contrary, if they themselves had cancer, 56.3% of all respondents answered that they wished the diagnosis to be revealed, and 77.4% of these answered that they wished to be informed of the cancer diagnosis by the doctor in charge. They wanted to know the details of their condition from their medical doctor, and thought that they could receive this knowledge calmly. Thirty-one percent (34/108) of the doctors questioned reveal the diagnosis of cancer to their patients and 79.4% of these answered that they felt that telling the true diagnosis was good. A serious responsibility for the medical doctor was indicated.

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Pravastatin, a novel inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, was administered to nine hypercholesterolemic patients with diabetes mellitus to examine its effects on diabetic nephropathy. Pravastatin treatment resulted in lowering serum total cholesterol by 22.1% on the average (p<0.001), and led to a significant reduction in urinary excretion of albumin and β2-microglobulin in patients with an elevated urinary protein excretion rate at the baseline period. But glycemic control, blood pressure, urinary excretion of creatinine and that of N-acetyl-β-D-glucosaminidase showed no significant change during the study. These results suggest that reduction of atherogenic lipids and lipoproteins with pravastatin could alleviate diabetic glomerular injury.

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We measured the aryl hydrocarbon hydroxylase (AHH) activity in alveolar macrophages (AMs) and the AHH inducibility in peripheral blood lymphocytes (PBLs) of 56 subjects with and without lung cancer.
There were no differences in the AHH inducibility in PBLs whether or not the host had lung cancer, regardless of a smoking history. The AHH activity in AMs in the current smoker group was significantly higher than in the non-smoker group. The AHH activity in AMs in the lung cancer group was higher than that in the non-lung cancer group, and the central-type group was significantly higher than the peripheral-type group.
These results suggest that the AHH activity in AMs is associated with the development of lung cancer and a history of cigarette smoking.

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A case of congenital hemolytic anemia caused by pyruvate kinase (PK) deficiency variant designated PK 'Nichinan' is presented. A 29-old patient with a history of anemia and hepatosplenomegaly had an episode of aplastic crisis associated with fever, abdominal symptoms and worsening hepatosplenomegaly. Study of the family members revealed that his mother and two of three siblings showed decreased PK activity whereas his father showed normal PK activity with a normal level of glycolytic intermediates. The patient was assumed to be a double heterozygote with two separate mutant genes from the parents despite the apparent normality of his father's erythrocyte PK.

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To assess the dopaminergic regulation of blood pressure and the renin-angiotensin-aldosterone system in fourteen essential hypertension (EHT) and six normotensives (NT), intravenous injections of 10 mg of the dopamine antagonist, metoclopramide (MCP), were given. Essential hypertension patients were divided into two subgroups according to the basal values of plasma renin activity (PRA). Plasma prolactin (PRL), aldosterone (ALDO), norepinephrine (NE) and epinephrine (E) in seven high-renin EHT revealed significantly higher basal values than normal- and low-renin EHT. Intravenous injections of MCP caused significant increases in PRL and ALDO but not in NE, E and PRA in all subjects. However, in high-renin EHT the responses of PRL and ALDO were significantly marked compared to other subjects. In spite of these hormonal changes after MCP, blood pressure was unaltered. The present data suggest that "tonic inhibition" of PRL and ALDO by the dopaminergic system is partially regulated by the renin-angiotensin system regardless of the levels of blood pressure.

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The prognosis for secondary amyloidosis is better than that for the primary form. With arrest of the triggering disease, clinical improvement can be expected. Dramatic resolution of amyloid deposits, as proven by repeated biopsies, has been reported. We report on the effectiveness of amputation of the left thigh with chronic osteomyelitis in a patient with AA amyloidosis presenting with extensive amyloid involvement of the gastrointestinal tract and kidneys. Clinical improvement associated with reversibility of gastric amyloid deposition was observed in accordance with disappearance of the serum component of amyloid A protein.

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A case of Cushing's disease is reported. The administration of bromocriptine was extremely effective in reducing excessive adrenocorticotrophic hormone (ACTH) and cortisol in the blood, which were previously not suppressed by 8 mg dexamethasone and persisted even after removal of the ACTH-producing adenoma in the hypophysis.

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A 31-year-old female developed severe aplastic anemia following acute non-A non-B hepatitis. Because of the impossibility of bone marrow transplantation, bolus methylprednisolone therapy was done. Soon after the therapy, pancytopenia improved. She has since taken mepitiostane and no longer needs blood transfusions. Good response to the immunosuppressive therapy suggests that the pathogenesis of this anemia is related to the immune system. In vitro culture demonstrated that the patient's serum contained a factor which suppressed hematopoietic activity, possibly gamma-interferon.

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We report herein a case of acute eosinophilic pneumonia induced by minocycline, confirmed by TBLB and re-challenge test. Re-challenge test suggested that Arthus-type reaction was pathognomonic, and prominent Kerley B lines represented a local hypersensitivity reaction in this patient.

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A 65-year-old man experienced syncope associated with advanced atrioventricular (AV) block upon swallowing. Continuous electrocardiogram (ECG) monitoring revealed first and second degree AV block. ECG revealed advanced AV block (Max R-R 6.38 s) upon swallowing, a cold drink. Demand ventricular pacing alleviated his symptoms. In this patient, the advanced AV block might have been precipitated by a vagovagal reflex triggered by expansion of the esophagus, resulting in selective suppression of the atrioventricular node.

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Acute myeloblastic leukemia (AML) was diagnosed in a 54-year-old male, a chronic hepatitis B surface antigen (HBsAg) carrier, in June, 1983. Prompt remission was achieved, and maintenance and intensification chemotherapy were given for five years. He was readmitted in March, 1988 because of a mass in the liver and was diagnosed as having hepatocellular carcinoma (HCC). Curative right segmentectomy was performed in May, 1988. In December, 1988, transitional cell carcinoma of the bladder was discovered, and resected transurethrally. These secondary neoplasms, HCC and bladder cancer, were thought to be associated with the long-term chemotherapy given for the AML.

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We investigated the changes of the glomerular filtration rate (GFR) that occurred when the right hand was soaked in 7°C water. The subjects were 5 patients with progressive systemic sclerosis who did not have clinical evidence of renal involvement. The clearance rate constant of 99mTc-DTPA, which is excreted by glomerular filtration, was measured with a cadmium telluride detector placed over the chest wall. In response to the cold exposure, the constant rose in 2 patients and remained unchanged in the remaining 3 patients. After termination of cold exposure, the constant fell in all 5 patients, suggesting renal Raynaud's phenomenon. These findings suggest that the renal vasculature in these patients has an abnormal response to cold exposure.

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IgD multiple myeloma is a unique type of multiple myeloma which is characterized by increased serum IgD and IgD type M-component in immunoelectrophoresis. It frequently shows renal involvement but it is a rare form of myeloma. The distinctive features of IgD myeloma are the dominance in males, high frequency in younger persons, and the uncertain appearance of M-componentin serum electrophoresis. We experienced 3 cases of IgD multiple myeloma with renal failure which required hemodialysis before IgD myeloma was diagnosed. It is important to consider IgD myeloma when treating the patients with renal involvement of unknown origin.

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We report a case of massive pulmonary hemorrhage which emerged in the course of polyarteritis nodosa (PN). Pulmonary hemorrhage was the major manifestation which determined the mortality of this patient, though severe renal failure concurrently developed. The diagnosis of PN should be considered in all cases of pulmonary hemorrhage coexisting with renal failure. As pulmonary hemorrhage can be life-threatening, early diagnosis is essential for the prompt start of adequate therapy.

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The effects of intravenously administered prostaglandin E₁ (PGE₁) on diabetic mononeuropathy was investigated in three patients with diabetic oculomotor palsy. PGE₁ (1.0-1.5 μg/day) was intravenously administered every morning for 4 or 6 weeks. Diplopia, blepharoptosis and decreased range of ocular movement, which were observed on admission, immediately began to improve at 1-4 days after the beginning of the treatment. On the final day of the treatment, none of the above signs remained in the three cases. The present study suggests that improvement of intraneural microcirculation by PGE₁ administration results in an immediate recovery from diabetic oculomotor nerve palsy.

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Primary myelofibrosis terminating in megakaryoblastic crisis is uncommon. A case with this condition is reported. The patient, a 62-year-old female, having had primary myelofibrosis for 13 years and a splenectomy 4 years before, was admitted because of high fever, hepatomegaly, thrombocythemia and leukocytosis. On admission, blasts appeared in the peripheral blood and thereafter gradually increased in number. The blasts were proven to be of megakaryocytic lineage. To our knowledge this is the third case of primary myelofibrosis terminating in megakarayoblastic crisis to be reported in Japan.

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