A case of acute interstitial nephritis associated with uveitis is presented, An 18-year-old man developed uveitis followed by renal dysfunction. Moderate renal dysfunction (sCr 3.0 mg/dl), and increased levels of urinary...A case of acute interstitial nephritis associated with uveitis is presented, An 18-year-old man developed uveitis followed by renal dysfunction. Moderate renal dysfunction (sCr 3.0 mg/dl), and increased levels of urinary beta 2 microglobulin (over 8,000 micrograms/I) were observed. Renal tissue obtained by open renal biopsy revealed severe infiltration of mononuclear cells in the tubulo-interstitial area. The majority of infiltrating cells were CD4-positive T cells demonstrated by immunoperoxidase staining, suggesting the involvement of T cell-mediated delayed hypersensitivity. Corticosteroid was effective against both uveitis and renal dysfunction. The possible pathogenesis of this syndrome is reviewed from the literature.
The dopamine system may be involved in three situations: the nigral projection to the basal ganglia, the mesocortical projection to the anterior cingulate gyrus, or the medial forebrain bundle projection to cortical and...The dopamine system may be involved in three situations: the nigral projection to the basal ganglia, the mesocortical projection to the anterior cingulate gyrus, or the medial forebrain bundle projection to cortical and limbic sites. Because of the close association of dopamine systems with the known neurological syndromes of akinesia, we elected to treat a patient with akinesia due to rupture of anterior communicating artery (ACA) aneurysm with the dopamine agonist, bromocriptine. This case has important implications for the understanding of brain/behavior relationships as well as for the development of new therapies for patients who have sustained neurological injury.
The geographic distribution and clinical features of patients with HTLV-I-associated myelopathy (HAM) in Tokushima prefecture were investigated. Nine patients were found prior to December 1990. The minimal prevalence was...The geographic distribution and clinical features of patients with HTLV-I-associated myelopathy (HAM) in Tokushima prefecture were investigated. Nine patients were found prior to December 1990. The minimal prevalence was estimated as 1.1 per 100,000 in the general population, and 1 per 1,309 in HTLV-I-seropositive persons. Seven patients were found in the southern district facing the Pacific Ocean, but only 1 patient each was found in the northern and western districts. The age at disease onset ranged from 15 to 53 yr (average 33 yr). The ratio of male to female patients was 1:8. Adult T cell leukemia was associated with HAM in 1 patient, and Hashimoto's disease in 2 patients. These cases have not been reported previously. The route of transmission of HTLV-I was concluded to be vertical in 4 patients and horizontal in 4 patients, but was uncertain in 1 patient. No evidence of transmission by blood transfusion was found in these patients.
Immunohistochemical studies were performed on muscle biopsy specimens of polymyalgia rheumatica (PMR) to evaluate the extent of muscle and peripheral nerve involvement. The routine histochemistry revealed a mild variatio...Immunohistochemical studies were performed on muscle biopsy specimens of polymyalgia rheumatica (PMR) to evaluate the extent of muscle and peripheral nerve involvement. The routine histochemistry revealed a mild variation of fiber size, type 2 fiber atrophy and type 2A or 2B fiber deficiency. In 63% of the PMR cases small angular fibers, pyknotic nuclear clumps or target-targetoid fibers were observed, suggesting neurogenic changes, although abnormalities were mild in degree. In immunocytochemical studies, neither major histocompatibility complex (MHC) class 1 nor class 2 products were expressed on the muscle surface membrane of PMR. But regarding intramuscular vessels, MHC class 2 products were distinctly visualized. On serial sections, combined deposits of IgG and Clq in perimysial arteries were seen in 38% of PMR. These results suggest that arteries of small caliber might be involved in immunopathological processes, causing muscle and peripheral nerve damage.
Two-color immunofluorescence using multiparameter flow cytometry was employed to examine the antigenic characteristics of peripheral blood lymphocytes in whole blood of healthy Caucasians and Japanese. The CD4/CD8 ratio...Two-color immunofluorescence using multiparameter flow cytometry was employed to examine the antigenic characteristics of peripheral blood lymphocytes in whole blood of healthy Caucasians and Japanese. The CD4/CD8 ratio in Japanese was significantly decreased compared with that in Caucasians, because of the increased number of CD8+ cells. Although the proportions of suppressor-inducer T cells (CD4+, Leu-8+) and helper-inducer T cells (naive T cells) (CD4+, CD45RA-) were low in Japanese subjects, there were no differences in the absolute numbers of suppressor-inducer T cells and helper-inducer T cells (naive T cells) in circulation. The level of activated T cells in Japanese was similar to that in Caucasians. NK cells, CD57+, CD8+ cells and CD57+, CD3+ cells were high in Japanese. Regarding B cell subsets, CD5+ B cells and activated B cells remained unchanged. However, there were slight differences in Leu-8+ B cells and Fc epsilon R+ B cells (CD20+, CD23+) between the two groups. Thus, a differing influence of racial and environmental background between healthy Caucasians and healthy Japanese on human lymphocyte subsets is present in the lymphocyte immunophenotype.
Sex and age differences of ventricular gradient (G) were analyzed and normal ranges were determined in normal Japanese subjects (120 men and 74 women), whose resting heart rate was within the range of 65 to 75 beats/min....Sex and age differences of ventricular gradient (G) were analyzed and normal ranges were determined in normal Japanese subjects (120 men and 74 women), whose resting heart rate was within the range of 65 to 75 beats/min. Women showed a larger Z component in AT and a smaller Y and larger Z component in G than men. The common trend in age differences was a decrease in Y component of G in both men and women. The ranges obtained in the present study can be applied in automatic VCG analysis, in particular for the differentiation of primary and secondary ST-T changes.
IgA1(kappa)-transferrin complex was ascertained in a case of multiple myeloma with hypersiderinemia. On gel filtration, this complex disclosed an orange-colored protein with two peaks between the 19S and 7S fractions. On...IgA1(kappa)-transferrin complex was ascertained in a case of multiple myeloma with hypersiderinemia. On gel filtration, this complex disclosed an orange-colored protein with two peaks between the 19S and 7S fractions. On polyacrylamide gel electrophoresis and Western blotting analysis, the complex migrated at molecular weights of 430 and 700 kD in the non-reducing condition. A small amount of free transferrin was detected simultaneously. The complex was further separated into monoclonal IgA1(kappa) and transferrin at pH 4.5; these recombined at pH 7.2 after incubation (37 degrees C, 2 h). We also showed that the pepsin-digested F(ab')2 fragment of IgA1(kappa) combined with the transferrin. From these results it can be suggested that monoclonal IgA1(kappa) has an antibody activity for the transferrin. Clinically, this complex distributed the iron transport to erythroid cells in the bone marrow, resulting in hypersiderinemia, anemia, and iron deposits in the liver.
Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein hormone which stimulates the proliferation and differentiation of a subset of granulocyte precursors and enhances some functional activities of mature neutr...Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein hormone which stimulates the proliferation and differentiation of a subset of granulocyte precursors and enhances some functional activities of mature neutrophils. We tested the effects of G-CSF on a patient with intractable infective endocarditis. The white blood cell count was increased 3-fold and the inflammatory reactions such as C-reactive protein and erythrocyte sedimentation rate were completely normalized without any side effects. This is the first report describing the use of G-CSF for infective endocarditis. Administration of G-CSF might be suitable for treating intractable infections which cannot be controlled by antibiotics alone.
A patient with hypophosphatemic vitamin D-resistant rickets developed secondary erythrocytosis during treatment with large doses of vitamin D2 and phosphate. Erythrocytosis was accompanied by a fall in circulating plasma...A patient with hypophosphatemic vitamin D-resistant rickets developed secondary erythrocytosis during treatment with large doses of vitamin D2 and phosphate. Erythrocytosis was accompanied by a fall in circulating plasma volume and appeared to have developed as a consequence of nephrocalcinosis because it occurred after the appearance of nephrocalcinosis following several episodes of hypercalcemia and hyperphosphatemia. Nephrocalcinosis and erythrocytosis did not disappear even after recovery of renal function. Thus, the present observations point to the importance of preventing these irreversible complications that could cause renal failure, erythrocytosis, and thrombotic events during the management of hypophosphatemic vitamin D-resistant rickets.
Interactions of lipoproteins containing apolipoprotein (apo) A-I with or without apoA-II with human hepatoma cell line HepG2 were studied to investigate the ligand specificity for high density lipoprotein receptor on hum...Interactions of lipoproteins containing apolipoprotein (apo) A-I with or without apoA-II with human hepatoma cell line HepG2 were studied to investigate the ligand specificity for high density lipoprotein receptor on human hepatic cells and their metabolism. The two types of lipoproteins were isolated by immunoaffinity chromatography, in which apoE-containing lipoproteins were removed. Specific binding kinetics at 0 degrees C were observed for the apoA-I-containing lipoproteins with or without apoA-II (Kd = 18 or 20 micrograms protein/ml, Bmax = 110 or 120 ng/mg cell protein, respectively). The binding of these lipoproteins to HepG2 cells was competitively inhibited by excess unlabeled apoA-I-containing lipoproteins or apoA-I-phospholipid complexes, but not by apoA-II.phospholipid complexes. Interactions of these lipoproteins with HepG2 cells at 37 degrees C were further examined. These results suggested that HepG2 cells have a specific binding site for apoA-I-containing lipoproteins, and that apoA-I might be a crucial component in the binding of these lipoproteins to human hepatic cells.
We tested for antibodies to hepatitis B virus (HBV), hepatitis C virus (HCV), and human T lymphotropic virus type-I (HTLV-I) in 629 normal inhabitants of an adult T cell leukemia (ATL) endemic area and in patients with A...We tested for antibodies to hepatitis B virus (HBV), hepatitis C virus (HCV), and human T lymphotropic virus type-I (HTLV-I) in 629 normal inhabitants of an adult T cell leukemia (ATL) endemic area and in patients with ATL, HTLV-I associated myelopathy (HAM), and hepatocellular carcinoma (HCC) from the same district. The prevalence of serological positivity for each virus was 28.0, 6.4, and 32.6%, respectively, among the 629 inhabitants. There was a positive association between the presence of anti-HCV and serological HTLV-I positive or negative status of these subjects (9.3% vs 5.0%). Conversely, there was no correlation between HBV and HTLV-I serologic prevalence. Only inhabitants positive for anti-HCV showed significantly high serum aminotransferase levels. The levels were not affected by superimposed HTLV-I infection among anti-HCV positives. Fifty three percent of HCC patients were positive for anti-HCV; 35% of whom were simultaneously positive for antibody to HTLV-I. On the other hand, only 2 ATL patients (4.2%) and 2 HAM patients (7.7%) had anti-HCV. These findings suggest that high serum aminotransferase levels are mainly caused by HCV infection and persons with HCV and HTLV-I double infections are at a high risk for the development of HCC but not ATL or HAM.
A case of cellular schwannoma originating from the retroperitoneum is reported. The histological features of the tumor resembled those of a smooth muscle tumor. However, the tumor cells were positive for S-100 protein, w...A case of cellular schwannoma originating from the retroperitoneum is reported. The histological features of the tumor resembled those of a smooth muscle tumor. However, the tumor cells were positive for S-100 protein, which is almost exclusively identified within nerve sheath tumor cells. This finding confirmed the diagnosis of cellular schwannoma. This type of tumor is generally considered to be benign but is sometimes mistaken for a malignant tumor. These findings indicate that it is important to prove whether or not S-100 protein is present in the cells of a tumor of unknown origin especially arising in the mediastinum or retroperitoneum.
We describe a case of multiple myeloma associated with myelofibrosis. This patient had hepatosplenomegaly, moderate anemia with anisocytosis and nucleated red blood cells, and Bence-Jones protein (kappa) in the urine. A...We describe a case of multiple myeloma associated with myelofibrosis. This patient had hepatosplenomegaly, moderate anemia with anisocytosis and nucleated red blood cells, and Bence-Jones protein (kappa) in the urine. A bone marrow biopsy showed extensive marrow fibrosis and proliferation of numerous immature plasma cells containing kappa light chain in the cytoplasm. Melphalan-prednisolone therapy not only facilitated the disappearance of the immature plasma cells but also resulted in an improvement of myelofibrosis in the bone marrow. The immature plasma cell proliferation and marrow fibrosis in the bone marrow were seen again after interruption of chemotherapy. Therefore, this myelofibrosis may be secondary to the coexistent multiple myeloma.
A 50-year-old man developed myoglobinuric renal failure after taking pyrazinamide. Both serum and urine myoglobin levels were elevated and tubulo-interstitial nephropathy was demonstrated on renal biopsy. After pyrazinam...A 50-year-old man developed myoglobinuric renal failure after taking pyrazinamide. Both serum and urine myoglobin levels were elevated and tubulo-interstitial nephropathy was demonstrated on renal biopsy. After pyrazinamide was discontinued, the myoglobin concentrations were normalized and his renal function ameliorated. The rhabdomyolysis was considered to be caused by pyrazinamide. To our knowledge, this is the first reported case of rhabdomyolysis associated with pyrazinamide.
We report a case of hypocalcemic heart failure without underlying myocardial disease. Two-dimensional and Doppler echocardiography revealed dilatation and impaired contraction of the left ventricle, but did not show any...We report a case of hypocalcemic heart failure without underlying myocardial disease. Two-dimensional and Doppler echocardiography revealed dilatation and impaired contraction of the left ventricle, but did not show any valvular dysfunction. Cardiac catheterization showed a normal coronary artery, and cardiac muscle biopsy showed morphological changes in mitochondoria and endoplasmic reticulum, which may be due to metabolic changes. This patient was asymptomatic after the serum calcium concentration was normalized.
The patient, a 51-year-old man, was receiving immunosuppressants for 2 yr after renal allotransplantation. He had heart failure with aortic regurgitation, fever, anemia and a history of odontectomy on admission. He was r...The patient, a 51-year-old man, was receiving immunosuppressants for 2 yr after renal allotransplantation. He had heart failure with aortic regurgitation, fever, anemia and a history of odontectomy on admission. He was resistant to medical treatments and died from cerebral emboli. On autopsy, vegetation of the aortic valve was identified. Progression of atherosclerosis, which may have been due to steroids and chronic rejection, was prominent. This report is the first case of infective endocarditis following organ transplantation in Japan. Such complications as infective endocarditis and atherosclerosis will be on the rise with the increase of numbers or organ transplantations.
A patient with orthostatic hypertension of neurogenic origin is reported. The Schellong and head-up tilt tests produced a sudden moderate to marked increase of the blood pressure, but the plasma renin activity and plasma...A patient with orthostatic hypertension of neurogenic origin is reported. The Schellong and head-up tilt tests produced a sudden moderate to marked increase of the blood pressure, but the plasma renin activity and plasma aldosterone level showed a normal response. The cold pressor test also produced a moderate to marked increase in the blood pressure. Pharmacological cardiovascular autonomic nervous function tests showed a decrease of parasympathetic tone and denervation hypersensitivity of the sympathetic nerve terminals. These findings suggest that the orthostatic hypertension in this patient was mainly due to sympathetic denervation hypersensitivity.
A young male patient with myositis associated with Crohn's disease is reported. His serum creatine phosphokinase (CPK) level was markedly elevated, but he had no muscle symptoms. The serum CPK level was not correlated wi...A young male patient with myositis associated with Crohn's disease is reported. His serum creatine phosphokinase (CPK) level was markedly elevated, but he had no muscle symptoms. The serum CPK level was not correlated with the activity of Crohn's disease. Muscle biopsy showed myositis with only degeneration of the muscle fibers and infiltration of inflammatory cells. The etiology of myositis in this case was not clear. Diagnosis of myositis based on a muscle biopsy in patients with Crohn's disease showing an elevated serum CPK level without any discernible cause has not been reported previously. Careful attention to the serum CPK and muscle symptoms in patients with Crohn's disease is suggested.