Since gastric mucosal lesions are frequently encountered in patients with renal disease, we measured the gastric mucosal hexosamine (Hx) content in 51 patients with renal disease. Endoscopic examination revealed that nearly half of the patients had erosive gastritis, and that duodenal ulcers (Dus) were more common than gastric ulcers (Gus). The gastroduodenal lesions were increased in patients with advanced renal dysfunction. The relationship between Hx content and various indicators of renal function, including creatinine clearance (Ccr), serum creatinine (cr), blood urea nitrogen (BUN), and 24-h urine protein excretion, were also evaluated. The Hx content decreased in the early stage of renal dysfunction. However, it returned to normal to near normal levels in advanced renal disease and patients who underwent hemodialysis. Since the Hx content was decreased in the early stage of renal dysfunction, careful follow-up appears to be necessary in patients with renal disease.

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Separation of basophilic granulocytes from peripheral blood was carried out by counter flow centrifugation elutriation using a JE-6B roter. The release of histamine and heparin-like substance from basophilic leucocytes was estimated in healthy and asthmatic subjects. 1. The number of basophils was maximal (0.74×10⁵) at a flow rate of 4.5 ml/min, and the purity reached a peak (11.8±2.0%) at a flow rate of 9 ml/min. 2. The content of histamine paralleled the number of basophils in each fraction. 3. The release mechanism of histamine induced by anti-IgE was similar to that of the heparin-like substance. 4. The release of histamine and the heparin-like substance was significantly higher in atopic asthmatics than in non-atopic cases.

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We investigated the efficacy of interferon-alpha (IFN- α) treatment in 5 patients with human T-lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM). Treatment with IFN- α yielded clinical improvement of gait, and sensory and/or sphincter disturbance in 4 out of the 5 HAM patients. IFN- α treatment did not bring about uniform changes in lymphocyte subsets or anti-HTLV-I antibody titer of peripheral blood. Although the stimulation indexes to phytohemagglutinin, concanavalin A, and pokeweed mitogen were decreased in the culture of the peripheral blood lymphocytes (PBL) in the 5 HAM patients before the treatment, the stimulation indexes to these mitogens were significantly increased except in 1 case after the IFN- α treatment. These changes were based primarily on the depression of the spontaneous proliferation of PBL without mitogen. These results appear to point out a very important phenomenon for the investigation of the pathogenesis of HAM.

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Serum magnesium (Mg) was measured in 6, 252 patients; in 1, 246 (19.9%) the value was abnormal. Hypermagnesemia (serum Mg ?? 3.9 mg/dl) was observed in 51 patients (0.8%) and hypomagnesemia (Mg ?? 1.5 mg/dl) in 165 (2.6%). Hypermagnesemia was found in patients with renal failure treated with Mg-containing antacids or cathartics, or with eclamptic convulsions treated with Mg sulfate. The most frequent clinical finding of hypermagnesemia was urinary disturbance, although various other neurological signs and symptoms were observed. Hypomagnesemia was seen in patients with various diseases such as cancer, hepatic cirrhosis, cerebrovascular disease, and generally poor condition. Abnormalities of electrolytes other than Mg were also frequently observed. The most common clinical findings of hypomagnesemia were personality changes and depression. The differentiation from psychiatric disease is important.

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Bromodeoxyuridine (BrdU) labeling indices (LI) of liver biopsied specimens from 27 control liver cirrhosis patients (control LC) without hepatocellular carcinoma (HCC), 26 cirrhotic patients with HCC, and from 6 control subjects were examined using an in vitro BrdU labeling technique. The mean BrdU LI±S.E. of HCC cancerous portion, HCC non-cancerous cirrhotic portion, control LC, and control subjects were 6.6±0.8%, 2.7±0.3%, 1.7±0.3% and 0.25±0.09%, respectively. Interestingly, there was a significant difference (p <0.025) between the non-cancerous LC portion and control LC. While 25 of 26 non-cancerous LC portion of HCC patients were in the high LI group ( ?? 1.4%), 15 of 27 in the control LC were in the low LI group (<1.4%) (p<0.001). Of the 12 control LC with high LI, 6 developed HCC within 2 years, whereas only one of the 15 control LC with low LI developed HCC (p <0.05). In conclusion, HCC may develop in cirrhotic patients with high DNA synthetic potency.

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We studied 25 Japanese patients with hairy cell leukemia (HCL) and found a manner in which HCL can be divided into two subtypes. In each patient, hairy cells (HC) showed striking surface hairs and reacted with HC-specific antibodies (α Leu-M5 and α HC-M). Twenty of the 25 patients had HC characterized by round nuclei with dense nuclear chromatin, weak tartrate-resistant acid phosphatase (TRAP) activity and the phenotype of low density surface immunoglobulin (SIg)⁺, Tac^-. In this group of 20 patients, the male to female ratio was low, and there was frequent leukocytosis. On the other hand, the remaining 5 patients showed a high male to female ratio and a normal or decreased leukocyte count. HC had folded nuclei, strong TRAP activity and the phenotype of high density SIg⁺, Tac⁺. The features of the latter patients are consistent with those of HCL in Western countries, while those of the former group appear to indicate a unique variant of HCL.

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Ambulatory electrocardiographic monitoring and psychological testing were performed in 100 patients with chronic stable myocardial infarction. These patients were divided into four groups according to their chest pain and transient ST-segment depression by Holter monitoring during the follow-up period: group A, 40 patients without complications; group B, 20 patients with silent myocardial ischemia; group C, 14 patients with episodes of chest pain alone; and group D, 26 patients with postinfarction angina. Whereas group B had silent myocardial ischemia and extroversion, groups C and D were characterized by introversion and neuroticism. The frequency of multi-vessel disease was 41% for group A, 53% for group B, 8% for group C and 70% for group D. The patients of group B not only received treatment for coronary artery disease but also behavioral counseling and those of group C received psychotherapy. The results support the view that a combination of Holter monitoring and psychological testing is clinically useful for the development of therapeutic strategies for coronary artery disease.

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Ras gene family (c-Ha, Ki, N ras) and c-myc proto-oncogenes were analyzed in seven colonic and three gastric adenomatous polyps obtained from a patient with Turcot's syndrome. The rearrangement and amplification as well as overexpression of c-Ha ras gene in one colonic adenomatous polyp were determined. The amplified c-Ha ras gene in this polyp revealed larger fragments of BamHI, PstI and Sad than those in the normal colonic mucosa from the same patient. But, such abnormalities were not observed in other polyps. No abnormalities of c-Ki ras, c-N ras or c-myc gene were observed in any polyps. These results suggest that the alternations of c-Ha ras gene in this patient may not be responsible for the adenomatous change, but may be related to the transition from adenoma to carcinoma of the colon.

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Herpes zoster is known to exhibit various neurological complications. Guillain Barré syndrome following herpes zoster is rare and only 25 cases have been reported to date. In this report, a case is presented and the pertinent literature is reviewed.

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A 27-year-old man had symptoms of hyperthyroidism and periodic paralysis. While hyperthyroid, his serum thyrotropin (TSH) level was inappropriately elevated at 6.4μU/ml. The serum alpha subunit level was also elevated. MR imaging revealed a pituitary tumor and transsphenoidal adenomectomy was performed. Immunocytochemistry with an antibody directed against the beta-subunit of TSH revealed a TSH-secreting tumor.
This is the first case of hyperthyroidism due to a TSH-secreting pituitary tumor complicated by periodic paralysis. This association indicates that thyrotoxicosis may induce paralysis in susceptible persons by a mechanism which is not autoimmune.

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A 60-year-old man was diagnosed as Hand-Schüller-Christian disease due to the triad of exophthalmus, decalcification of the bone, and diabetes insipidus. He had xanthogranuloma on the face and a nuchal region, and unusual complications of ADH-resistant diabetes insipidus due to renal dysfunction, and chronic cardiac failure. Urine osmolality was hypotonic, but urine volume was within the normal limit, despite the presence of central diabetes insipidus. Hypophyseal, adrenal and thyroid function were not remarkable. The skin biopsy showed the infiltration of eosinophilic granuloma cells. Treatment with vincristine was effective to regress the xanthogranuloma. Diabetes insipidus was not treated because of the absence of polyuria and polydipsia.

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A successful pregnancy and delivery in a patient with neurogenic orthostatic hypotension and a past medical history of achalasia is described. Surprisingly, she was free from orthostatic hypotension during the last trimester, though the evaluation of adrenergic function by measurements of changes in plasma norepinephrine on standing and by the response of blood pressure to infused norepinephrine revealed no difference between function before pregnancy and that during the last trimester. Orthostatic hypotension started again just after delivery.

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A 32-year-old female was suffering from intractable lupus nephritis (LN). Prednisolone at 30 mg per day had been prescribed for two months because of massive proteinuria and edema. After that, anasarca and orthopnea were induced, and hypoproteinemia, hypercholesteremia, and anti-cardiolipin antibody were observed. Prednisolone at a dose of 60 mg per day was necessary. However, there was no improvement of the nephrotic state and renal pathological changes shown as diffuse proliferative lupus nephritis were followed by moderate crescent formation as determined by serial needle biopsy. Cyclophosphamide (CYP) pulse therapy was started and marked improvement of LN was obtained clinically and serologically without significant adverse effects.

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Danazol was administered to two patients with paroxysmal nocturnal hemoglobinuria (PNH) with a dramatic effect on the hematological findings. The patients, 31- and 41-year-old females, were initially diagnosed as having aplastic anemia, and were initially treated with anabolic steroid and immunosuppressive therapy, respectively. Sugar water and Ham tests turned positive at the start of danazol therapy in the former patient and after two months in the latter patient. This drug produced a dramatic improvement in the hemoglobin level and the platelet count and showed few side effects in the patients. A possible mechanism of action of danazol for PNH is briefly discussed.

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An 18-year-old womanwith systemic lupus erythematosus developed neuropsychiatric disorders, including aseptic meningoencephalitis, organic brain syndrome and seizure. Aseries of computedaxial tomography scans revealed the progression of marked atrophy of the right cerebral hemisphere for a period of 3 years without occlusion or stenosis of large vessels on cerebral angiography. 1-123 IMP single photon emission computed tomography disclosed a markedly decreased uptake of 1-123 IMP in the right cerebral hemisphere, and also in the left cerebellar hemisphere (crossed cerebellar diaschisis), which disappeared within 2 years.

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A case of primary aldosteronism associated with renovascular hypertension is reported. The patient, a 46-year-old woman, developed hypertension to the level of 210/110 mmHg. Laboratory data included serum potassium 3.4mEq/l, plasma renin activity 25ng/ml/h and plasma concentration of aldosterone 330 pg/ml. Occlusion of the left renal artery and left adrenal aldosteronoma was diagnosed by radiographic and hormone analysis findings. Left adrenalectomy and nephrectomy corrected the hypertension. The possibility of tertiary aldosteronism is discussed.

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Cytomegalovirus (CMV)-induced interstitial pneumonitis is a well-known lethal complication in bone marrow recipients. CMV is also known to cause gastroenteritis. We report the first case of a bone marrow recipient who developed CMV-induced gastritis which is verified both histologically and virologically. The gastritis preceded the interstitial pneumonitis which was detected in an early stage and was successfully treated. We propose that bone marrow recipients who show signs and symptoms of gastritis undergo an endoscopic examination, and that biopsied specimens should be scrutinized for CMV by both histological examination and culture investigation.

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A patient with paratyphoid fever relapsed bacteriologically during the treatment with chloramphenicol, and was treated with daily doses of 600 to 800 mg of ofloxacin for 14 days. Salmonella paratyphi A was eradicated. Ofloxacin appears to be an effective drug for the eradication of S. paratyphi A.

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We report a case of a 43-year-old woman with pseudocoarctation of the aorta manifested by a superior mediastinal mass on the chest roentgenogram.
Evaluation was made using computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). No other congenital anomalies or aneurysms below the kinked area of the aorta could be found. The characteristic "kink" of the aorta and the absence of true coarctation were evident in the sagittal plane by MRI. MRI is of great value for examining disorders of the aorta.

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Disseminated mycobacterial infection was found at autopsy in a male patient with hemophilia B and acquired immunodeficiency syndrome (AIDS). In May 1986, 23 months before death, the patient had encephalitis for one month and in July he developed a fever, malaise and generalized lymphoadenopathy. Human immunosuppressive virus (HIV) was positive and the CD 4/8 ratio of lymphocyte surface markers was 0.1, but mycobacterium was not detected. In September 1986, he had severe dyspnea due to interstitial pneumonia and he was treated with high-dose methylprednisolone. He died after a 23-month course of fever, severe weight loss and terminal progressive deterioration, although he was treated with antibiotics, antifungal agents, γ-globulin, steroid and a Azidothymidine.

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Anautopsy case of hypertrophic obstructive cardiomyopathy (HOCM), in which the clinical features of dilated cardiomyopathy (DCM) developed after 10 years is described. Three serial left ventriculograms (LVG) and bi-ventriculograms (BVG) were performed during the 10-year follow-up.
At the time of the first observation, the ECG revealed a giant negative T wave (GNT) in V₅ (-1.5mV) and high voltage (SV₁+RV₅=8.1mV). The LVG and BVG showed concentric left ventricular wall hypertrophy and a pressure gradient in the left ventricular out-flow tract. However, follow-up studies disclosed resolution of the GNT with decreased high voltage. All wall thicknesses and the ejection fraction were significantly decreased and the wall motion was reduced serially. These findings were consistent with the clinical profile of DCM.
At autopsy, the heart weighed 610 g and showed dilated change of the left ventricular cavity. Significant myocardial fibrosis, bizarre myocardial hypertrophy with disorganization (BMHD) and severe narrowing of the intramural small arteries due to intimal thickening were found in the left ventricular wall, especially in the anterior and interventricular septal wall.
This autopsy case suggests that some cases of HCM, with serial disappearance of the deep negative T wave and high voltage, deteriorate to the clinical profile of DCM.

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A 74-year-old man complained of a cough and left chest pain. Chest X-ray showed marked pleural effusion and a large mass in the left lower lobe, and air bronchograms within the mass were observed by tomography and computed tomography (CT).
About 3 months later, the patient died of left atelectasis and pneumonia. Autopsy revealed a localized tumor in the lower lobe of the left lung. Histologically, proliferation of lymphoma cells was noted. Immunoglobulin staining showed B cell-type monoclonality. No metastasis was evident except for a very small nodular area in the left renal cortex.

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