Japanese Journal of Medicine
Online ISSN : 1881-123X
Print ISSN : 0021-5120
Volume 29, Issue 5
Displaying 1-22 of 22 articles from this issue
  • Mitsuo HOMMA
    1990 Volume 29 Issue 5 Pages 459-461
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
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  • Takao FUJINAMI, Hiroyuki HIRATA, Junichiro HAYANO, Nobuyuki OHTE, Masa ...
    1990 Volume 29 Issue 5 Pages 462-468
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    Coronary risk factors were assessed in 186 consecutive patients who received coronary angiography. The severity of coronary luminal narrowing was scored as the coronary sclerosis index (CSI). Patients were divided into normal coronary arteries (N, n = 72), coronary sclerosis without infarction (C, n = 73) and previous myocardial infarction (MI, n = 41). The CSI increased with age. A significant difference in serum triglycerides, HDL cholesterol and atherogenic index was observed between Groups C or MI and N. Multivariate analysis revealed that CSI had correlated with total- and HDL-cholesterol, uric acid and age in subjects under 55 years; and with age, blood sugar, factor H and HDL cholesterol in those of 55 years or over. When patients were classified by their total and LDL cholesterol level, a significantly different CSI was found between the desirable and high cholesterol levels in subjects under the age of 55, but it was not significant in those over 55. Therefore, disorders in lipid metabolism should be corrected in early middle age.
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  • Masanobu MIYAZAKI
    1990 Volume 29 Issue 5 Pages 469-477
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    We examined several immunological parameters such as the number of T cells with CD4 antigen and the receptor for the Fc portion of IgA (T α cells), in vitro immunoglobulin production by peripheral blood lymphocytes with or without pokeweed mitogen and serum levels of immune complexes in 19 healthy family members of patients with IgA nephropathy (IgAN). It was shown that the levels of serum IgA, T4 cells, CD4/CD8 ratio of T α cell subsets, T α cells, IgA circulating immune-complexes and spontaneous synthesis of immunoglobulins were significantly increased in family members of patients with IgAN. No family members had proteinuria or hematuria. It was concluded that immunological abnormalities, including abnormalities of T cells and B cells, were found not only in patients with IgAN but also in their healthy family members. It was suggested that some factors in addition to these immunological abnormalities may be involved in the development of IgAN.
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  • Akira SEYA, Tom OEDA, Takashi TERANO, Masao OMURA, Kazuo TAHARA, Tetsu ...
    1990 Volume 29 Issue 5 Pages 478-480
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    The clinical usefulness of ultrasound scanning in the assessment of thyroid nodule was examined. The total diagnostic accuracy for aspiration biopsy cytology (ABC) in the differentiation of benign from malignant thyroid nodules was 92.4% in 26 patients, which is similar to that of previous reports when compared with the findings of pathological examination by surgery. Additionally, the diagnostic efficacy of high resolution ultrasonography was evaluated based on the results of ABC. When the echogram of 90 patients with a thyroid nodule was divided into eight patterns according to Obara's classification, only 64.3% of the carcinoma exhibited the typical malignant pattern of ultrasonography and 21.4% of the carcinoma exhibited the ultrasonographically homogenous nodule with a clear margin, which was often observed in the benign nodules. Therefore, it is necessary to be very careful when differentiating malignant from benign thyroid nodules by ultrasonography. In conclusion, although high resolution ultrasonography provides useful information for the assessment of most thyroid nodules, all ultrasonography (including high resolution ultrasonography) should be combined with ABC for the final diagnosis.
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  • Masanori ADACHI, Seiji MITA, Mitsuo OBANA, Yasuo MATSUOKA, Keiichi HAR ...
    1990 Volume 29 Issue 5 Pages 481-486
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    In order to detect diagnostic clues to identify patients with chronic immune thrombocytopenia which is likely to develop systemic lupus erythematosus (SLE), a retrospective study was conducted. Of 39 patients with chronic immune thrombocytopenia, 4 fulfilled the diagnostic criteria being between 4.5 and 14 years after the initial diagnosis of "idiopathic" thrombocytopenic purpura. The remaining 35 patients were found to be idiopathic thrombocytopenic purpura (ITP) after at least a 5-year follow-up. It was noted that in patients with SLE who had thrombocytopenia at presentation, only 4 or 5 findings of diagnostic criteria were observed. Of particular interest, all patients who developed SLE were positive for anti-SS-A antibody, in contrast none of the patients with ITP had this antibody. Furthermore, despite the few clinical manifestations, we noted lupus peritonitis in 1 patient and pulmonary hypertension in another patient. In conclusion, the anti-SS-A antibody is an excellent clue for the early detection of SLE occurring as "idiopathic" thrombocytopenic purpura.
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  • Qing LI, Mineharu SUGIMOTO, Fumiya IMAMURA, Toshio MATSUSHITA, Shukuro ...
    1990 Volume 29 Issue 5 Pages 487-492
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    Ten patients with human T lymphotropic virus type I-associated myelopathy (HAM), 5 asymptomatic HTLV-I carriers and ll healthy normal volunteers were studied to determine if peripheral blood lymphocytes spontaneously release IL-2 and soluble IL-2 receptors. Peripheral blood lymphocytes obtained from HAM patients proliferated spontaneously when cultured for 5 days in vitro. Proliferating cells were CD3+ lymphocytes and both CD4+ cells and CD8+ cells as shown by morphologic and immunohistochemical observations. These T cell responses were also found in asymptomatic carriers, but the responses were not as marked as those of HAM patients. IL-2 activity in the culture supernatants was much higher in HAM patients than in asymptomatic carriers; IL-2 activity correlated well with the intensity of spontaneous proliferation of lymphocytes. Furthermore, soluble IL-2 receptors in the cell-free supernatants from HAM patients were markedly increased compared to those from asymptomatic carriers. These results indicate that spontaneous proliferation of T cells is intimately related to HTLV-I infection and is probably due to autocrine or paracrine pathways which involve IL-2 and IL-2 receptor system.
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  • Hiroyuki MIYAKODA, Hideyuki KITAMURA, Toru KINUGAWA, Makoto SAITO, Hir ...
    1990 Volume 29 Issue 5 Pages 493-499
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    To evaluate the cardiovascular and plasma catecholamine responses to dynamic exercise in patients with cardiac neurosis (CN), treadmill testing was performed. Thirty-four patients with CN were chosen for this study based on exercise tolerance and the results were compared with those in 31 patients with organic heart disease and 12 normal subjects. Patients with CN showed an augmentation of cardiovascular and plasma catecholamine responses. The augmentation of the norepinephrine response in patients with CN was not as remarkable as that in patients with organic heart disease. On the other hand, the augmentation of the epinephrine response was greater in patients with CN than in those with organic heart disease. Administration of metoprolol (40 mg/day) for two weeks improved exercise tolerance in patients with CN. We suggest that anxiety augments both sympatho-neural and sympatho-adrenal activity and that it is the symptoms induced by the augmented cardiovascular response which reduce exercise tolerance in patients with CN.
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  • Michio OKADA, Fumiaki NISHIMURA
    1990 Volume 29 Issue 5 Pages 500-505
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    To study the respiratory function and acid-base status in hypothermia, we retrospectively reviewed data of arterial blood gas analysis obtained from 63 patients with accidental hypothermia on admission. Twenty-nine showed acidemia and 16 showed alkalemia. The following results were obtained from 57 patients in whom blood gas analysis was performed in room air. PaCO2 was 46 mmHg or more in 2 and 34 mmHg or less in 46. Most of the patients exhibiting acidemia had metabolic acidosis except 2 with severe pneumonia or subdural hematoma. PaCO2 was low even in the patients with alkalemia. PaO2 was 60 mmHg or less in 8, of whom 7 had pneumonia, and 70 mmHg or more in most of the patients without pneumonia. We found that patients with accidental hypothermia generally showed a respiratory function proportionate to their decreased metabolism or hyperventilation, and most of the patients with acidemia exhibited metabolic acidosis.
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  • Nobuhiro YUKI, Shuzo SATO, Tatsuhiko YUASA, Jusuke ITO, Tadashi MIYATA ...
    1990 Volume 29 Issue 5 Pages 506-511
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    We investigated computed tomographic (CT) films of 4 pathologically documented cases of progressive supranuclear palsy (PSP) in which the clinical presentations were atypical and compared the findings with those of 15 patients with Parkinson's disease (PD). Dilatation of the third ventricle, atrophy of the midbrain tegmentum, and enlargement of the interpeduncular cistern toward the aqueduct were found to be the characteristic findings in PSP. Thus, radiological findings can be useful when the differential diagnosis between PSP and PD is clinically difficult.
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  • Shuji YONEKURA, Tadami NAGAO, Shigeru ARIMORI, Masao MIYAJI, Kouji OGO ...
    1990 Volume 29 Issue 5 Pages 512-515
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    We report a case of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura (Evans' syndrome) associated with gastric plasmacytoma. Recognition of this rare entity is important because surgery and chemotherapy together may achieve a cure. Possible mechanisms causing the hemolytic anemia and thrombocytopenia are discussed.
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  • Kazuma IKEDA, Nobuyuki ABE, Akira MORIOKA, Masayuki INOO, Masami NAGAI ...
    1990 Volume 29 Issue 5 Pages 516-518
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A patient with plasma cell myeloma refractory to both MP (melphalan-prednisolone) and VAD (vincristine-adriamycin-dexamethasone) was treated with a combination chemotherapy consisting of VP-16, ifosfamide and dexamethasone (VID). A partial remission of 12-month duration was achieved. VID combination might be considered for myeloma patients who are refractory to both MP and VAD, and not eligible for high-dose melphalan with bone marrow transplantation.
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  • Hideyuki TSUBOI, Takahito SONE, Hiromi SASSA, Takeshi ITOH, Tomio KOYA ...
    1990 Volume 29 Issue 5 Pages 519-522
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A previously well 53-year-old man with fulminant myocarditis is presented. Cardiogenic shock and medically refractory low cardiac output syndrome were unsuccessfully treated using an intraaortic balloon pump. A percutaneous extracorporeal bypass system improved hemodynamics, DIC and other multiorgan injuries following acute myocarditis.
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  • Shu-ichi YAMASHITA, Motohisa NAGAMINE, Tadanobu KURIBAYASHI, Shigeru M ...
    1990 Volume 29 Issue 5 Pages 523-526
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    Graves' disease was found in a 41-year-old, married male patient with Klinefelter's syndrome. The patient began having finger tremor 5 years previously, and developed palpitation and weight loss 3 months prior to examination. He had a diffuse goiter, exophthalmos, and atrial fibrillation. Plasma levels of T3, T4 and free T4 were 2.8 ng/ml, 16.6μg/dl and 4.5 ng/dl respectively. [123I] uptake was 53%, and TSH receptor antibody was 75%. Although he had no gynecomastia, his general physical appearance was that of typical eunuchoism. Chromosome studies showed a karyotype of 47, XXY. A diagnosis of Graves' disease associated with Klinefelter's syndrome was made.
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  • Hiroyuki KOBAYASHI, Hayato MIYACHI, Tetsuhei OGAWA, Masahito JIMBO
    1990 Volume 29 Issue 5 Pages 527-532
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A 66-year-old woman with acute monoblastic leukemia with t(11;22)(q23;q11), which was subsequently transformed into myeloblastic leukemia is reported. Such karyotype abnormality has not been reported in acute monoblastic leukemia. Cytogenetic analysis revealed 47, XX, +8, t(11;22)(q23;q11) in 19 out of 20 metaphases and 46, XX, del(7)(q22-q36), t(11;22)(q23;q11) in the remaining metaphase. Variant Ph1 was ruled out due to the absence of chimeric bcr-abl mRNAs. In remission cytogenetic findings showed normal karyotype. After 4 months, the patient relapsed with 20% myeloblasts replacing monoblasts in bone marrow. Cytogenetic analysis revealed 46, XX, del(7)(q22-q36), t(11;22)(q23;q11) in all metaphases. A possible explanation for this lineage switch may be the involvement of myelomonocytic progenitor cells.
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  • Toshiaki SHIBASAKI, Takashi SHIMADA, Takashi MORITA, Osamu SAKAI
    1990 Volume 29 Issue 5 Pages 533-536
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    Two family cases of primary biliary cirrhosis (PBC) followed by the existence of autoantibodies such as anti-mitochondrial antibody, anti-nuclear antibody and anti-thyroid antibody are reported. Case O M has typical PBC, however case H E is complicated by asymptomatic polymyositis. Common haplotypes of human leukocyte antigen (HLA) were observed as A24-Bw61 in the family members of case O M who had autoantibodies. Only the mother of case H E had identical HLA haplotypes such as A2, Aw31, Bw46, Bw61, DRw8, DRw52 and DQw1. From these results, it can be suggested that immunogenetic penetrance might be associated with the occurrence of familial PBC.
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  • Masanobu NAMURA, Hohnin KANAYA, Hiroto SANADA, Taketsugu TSUCHIYA, Tak ...
    1990 Volume 29 Issue 5 Pages 537-541
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A 58-year-old man with left atrial myxoma complicated with acute myocardial infarction is presented. On coronary arteriography, 50% stenosis and a saccular aneurysm was found just below the stenosis at segment 1 of the right coronary artery. Ergonovine provocation study was negative. It was proposed that the myocardial infarction probably was caused by coronary embolization from the left atrial myxoma.
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  • Hiroyuki KATO, Hideyuki WAKASUGI, Toshio MUKUTA, Masayuki FURUKAWA, Ma ...
    1990 Volume 29 Issue 5 Pages 542-544
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A case of Campylobacter fetus subspecies fetus meningitis is reported. The patient had underlying diseases, namely chronic alcoholism and diabetes mellitus. The infection did not respond to Piperacillin and Cefotaxime, but did respond to Ampicillin and Moxalactam. The patient was discharged on the 33rd hospital day showing no neurological deficit complications, and has remained free of recurrent disease for one month after the discontinuation of therapy.
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  • Naoki HATTORI, Akira SHIMATSU, Masahito NISHIMURA, Hiroyuki MURABE, Hi ...
    1990 Volume 29 Issue 5 Pages 545-547
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    Acute muscle pain with stiffness developed in a patient with latent hypothyroidism after administration of clofibrate. Serum creatine kinase (CK), aspartate aminotransferase, and lactate dehydrogenase were markedly elevated, but returned to normal one and a half months after the discontinuation of clofibrate. Clofibrate challenge (750 mg/day) for three days caused muscle pain and an elevation in serum CK. Hypothyroidism may be a predisposing factor in the development of clofibrate-induced myopathy.
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  • Kaori ABE, Satoru OHTA, Tadatoshi KOMIYA, Naotaka SAKAMOTO, Yoshikuni ...
    1990 Volume 29 Issue 5 Pages 548-554
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A patient with fibromuscular dysplasia associated with primary thrombocythemia is reported. The patient, a 46-year-old female, had recurrent episodes of ischemic cerebrovascular accidents. Cranial CT scans revealed multiple low density areas in the right frontal and parietal lobes, and cerebral angiograms showed evidence of multiple embolisms. In addition, occlusion of the right internal carotid artery developed. To our knowledge, this is the first report on fibromuscular dysplasia complicated by essential thrombocythemia. The pathogenesis of the severe thrombotic tendency is discussed.
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  • Yoshitaka TAKASE, Kiyoshi YAMAMOTO, Hiroshi NOGAKI, Toshihiro FUKUSAKO ...
    1990 Volume 29 Issue 5 Pages 555-559
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    We report observations in a 32-year-old man with the following characteristics of rigid spine syndrome: humero-peroneal muscular atrophy and weakness; bradycardia, dilated cardiomegaly and complete cardiac conduction block; and severe fatty degeneration of the paravertebral and calf muscles. The latter showed a predominance of type 1 fibers, a deficiency of type 2A fibers, and an increase in type 2C fibers.
    The patient had no familial background of the disease. There was no contracture of the elbows. These findings, especially the severe cardiac involvement, suggest that the rigid spine syndrome can be difficult to distinguish from the Emery-Dreifuss form of muscular dystrophy.
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  • Koroku OTOKIDA, Hiroaki YOSHIDA, Norio SATO, Shigeo KUTSUZAWA, Shigeak ...
    1990 Volume 29 Issue 5 Pages 560-565
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A hypotensive 37-year-old man developed the problems of impotence, lack of sweating, orthostatic hypotension, and convulsive syncopal attack. His blood pressure fell to 53 mmHg systolic following bedtilting from 30 to 60°, but his heart rate remained constant which indicated a diagnosis of acute autonomic neuropathy. With the tilting test, a decrease in serum cathecholamine levels and an increase in bradykinin levels were observed. Four months after admission, anti-nuclear antibody, anti-DNA antibody, and the LE test became positive. The acute autonomic neuropathy appeared to be associated with SLE, and the hyperbradykinism, consequent on orthostatic hypotension.
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  • Yuichiro SAKAMAKI, Ryuichi NAKAMURA, Mitsue UCHIDA, Takeshi SAITO, Shi ...
    1990 Volume 29 Issue 5 Pages 566-570
    Published: 1990
    Released on J-STAGE: March 27, 2006
    JOURNAL FREE ACCESS
    A patient with nephrotic syndrome developed pseudotumor cerebri following glucocorticoid therapy. Diagnosis of pseudotumor cerebri was based on satisfaction of four criteria proposed by Ahlskog and O'Neill. The symptoms of pseudotumor cerebri disappeared within 10 days. After a three-week interval of remission, relapse occurred. Glycerol and urokinase produced rapid resolution of the symptoms and warfarin prevented further recurrence of pseudotumor cerebri for one year. These results suggest that the pathogenesis of pseudotumor cerebri might be associated with the hypercoagulable state which was induced by glucocorticoid therapy and nephrotic syndrome.
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