A 64-year-old man developed non-Hodgkin's lymphoma of the chest wall, 37 yr after left plombage thoracoplasty. Late complications of plombage thoracoplasty are discussed as well as the pathogenesis of chest wall neoplasm...A 64-year-old man developed non-Hodgkin's lymphoma of the chest wall, 37 yr after left plombage thoracoplasty. Late complications of plombage thoracoplasty are discussed as well as the pathogenesis of chest wall neoplasms.
We report a case of a 61-year-old male without any predisposing factors. His X-ray film showed multiple nodular lesions in bilateral lung fields. Open lung biopsy revealed Zygomycetes in the granuloma. The patient was tr...We report a case of a 61-year-old male without any predisposing factors. His X-ray film showed multiple nodular lesions in bilateral lung fields. Open lung biopsy revealed Zygomycetes in the granuloma. The patient was treated with amphotericin B and miconazole, and remains alive more than 32 months later.
A 74-year-old female was diagnosed as having xanthinuria by measurement of the uric acid level in plasma, purine bases in urine and activity of xanthine oxidase in the duodenal mucosa. The determination of the urinary ex...A 74-year-old female was diagnosed as having xanthinuria by measurement of the uric acid level in plasma, purine bases in urine and activity of xanthine oxidase in the duodenal mucosa. The determination of the urinary excretion of purine bases in her family demonstrated a slightly increased urinary excretion of oxypurines in her younger brother, suggesting that he was a heterozygote. The pyrazinamide-loading test and allopurinol-loading test demonstrated that she could neither metabolize pyrazinoic acid into 5-hydroxypyrazinoic acid nor allopurinol into oxypurinol, although there was a slight metabolizing of prazinamide into 5-hydroxypyrazinamide. This suggested that she belonged to the subgroup which can neither metabolize pyrazinamide into 5-hydroxypyrazinamide, pyrazinoic acid into 5-hydroxypyrazinoic acid nor allopurinol into oxypurinol.
We investigated the prevalence of gallstones after gastrectomy by abdominal ultrasonography in 289 gastrectomized patients selected from 51,621 Automated Multiphasic Health Testing and Services (AMHTS) examinees after ba...We investigated the prevalence of gallstones after gastrectomy by abdominal ultrasonography in 289 gastrectomized patients selected from 51,621 Automated Multiphasic Health Testing and Services (AMHTS) examinees after barium meal studies. The results were compared with those of another group of 3,193 AMHTS patients who routinely underwent ultrasonography (control). Among the gastrectomized patients, the overall prevalence of gallstones was 16.6%, and in the control group, 4.7%, showing a statistically significant difference (p less than 0.001). The prevalence of gallstones increased with age in both the control and gastrectomized groups, but was greater in gastrectomized subjects in each (10-yr) age group. The characteristics of the gallstones were compared between gastrectomized patients and the control group according to the ultrasonographic classification proposed by Tsuchiya (Yazawa et al, Jpn J Gastroenterol 85: 708, 1988). In the control group, the percentages of types I, II, III and small stone of Tsuchiya's classification were 30.2, 14.5, 21.9 and 34.3, respectively. On the other hand, in the gastrectomized group, the percentages were 8.3, 6.3, 16.7 and 68.8, respectively. This difference was statistically significant (p less than 0.001). The differences in the prevalence of gallstones between groups with Billroth I and II anastomoses, and between diseases necessitating gastrectomy, were not statistically significant.
Imipenem-cilastatin (imipenem 1 to 4 g/day) was administered to patients with severe infections accompanying granulocytopenia in hematological malignancies. Monotherapy with imipenem-cilastatin was effective in 62.1% of...Imipenem-cilastatin (imipenem 1 to 4 g/day) was administered to patients with severe infections accompanying granulocytopenia in hematological malignancies. Monotherapy with imipenem-cilastatin was effective in 62.1% of the patients, and also effective even they were severely neutropenic. When imipenem-cilastatin was administered as the first-choice therapy, the efficacy was much better, at 73.3%. Both Gram-positive and Gram-negative infections were curable by the monotherapy with imipenem-cilastatin.
The goal of chemotherapy for acute myeloblastic leukemia (AML) may only be achieved by eradicating the self-renewal capacity of the blast progenitors. In this regard, chemotherapeutic drugs should be screened according t...The goal of chemotherapy for acute myeloblastic leukemia (AML) may only be achieved by eradicating the self-renewal capacity of the blast progenitors. In this regard, chemotherapeutic drugs should be screened according to their effects against self-renewal. The present report was aimed to study the effect of the vinca alkaloid, vincristine (VCR), on the terminal divisions and self-renewal of the blast progenitors. A primary colony assay was utilized to reflect the former and a secondary colony assay and suspension culture to reflect the latter in AML patients. The results indicated that in many of the cases studied, VCR was considered to be almost equally toxic to terminal divisions and self-renewal of the blast progenitors. An almost equivalent cytotoxicity of VCR was also noted against normal hematopoietic cells, assessed by colony-forming unit granulocyte-macrophage (CFU-GM) assay. This study suggested that successful chemotherapy with VCR may be more easily achieved in combination with other drugs that are highly inhibitory to the self-renewal of the blast progenitors.
In 45 patients with diabetes mellitus (DM) without cerebro-cardiovascular diseases (CCVD) the modified method of the tissue thromboplastin inhibition test (TTIT) was studied. TTIT is the method of detection of the lupus...In 45 patients with diabetes mellitus (DM) without cerebro-cardiovascular diseases (CCVD) the modified method of the tissue thromboplastin inhibition test (TTIT) was studied. TTIT is the method of detection of the lupus anticoagulant (LA), LA, first recognized in patients with systemic lupus erythematosus, is presented by a prolonged activated partial thromboplastin time (APTT), a slightly to moderately prolonged prothrombin time (PT), and high incidence of biological false-positive seroreactions for syphilis (BFP). In patients with LA, thrombotic events have been reported. Six of the 45 diabetic patients were TTIT-positive (13.3%). All control subjects were TTIT-negative. In the TTIT-positive diabetics APTT and PT were normal. BFP also were not observed. The difference between LA and these results in TTIT-positive diabetics remains unclear. Clinical profiles except for duration of DM between the TTIT-negative and TTIT-positive diabetics did not differ. Follow-up studies may resolve an association between the results of TTIT and DM.
We investigated the role cell-mediated immunity in minimal change nephrotic syndrome (MCNS) by measuring interleukin 2 (IL-2) production and the responsiveness to IL-2 of peripheral blood lymphocytes (PBL). PBL from pati...We investigated the role cell-mediated immunity in minimal change nephrotic syndrome (MCNS) by measuring interleukin 2 (IL-2) production and the responsiveness to IL-2 of peripheral blood lymphocytes (PBL). PBL from patients with MCNS, who were in the nephrotic stage prior to initiation of prednisolone (PSL) treatment or who were in remission for less than 1 yr, exhibited significantly lower levels of IL-2 production. In contrast, PBL from patients with MCNS, who were in remission for more than 1 yr or who could remit from the PSL regimen, showed normal IL-2 production. IL-2 production by CD4+ cells from patients with MCNS in the nephrotic stage was normal, but that by CD8+ cells was markedly reduced, however returned to normal when the disease was in remission. The responsiveness to exogenous IL-2 of concanavalin A-induced lymphoblasts from patients with MCNS was significantly lower, although the proportion of Tac antigen-positive cells did not differ from that of healthy volunteers. These findings suggest that defective IL-2 production and IL-2 responsiveness of PBL in patients with MCNS contribute to the pathogenesis of MCNS.
We report a fatal case of alcoholic hepatitis with hyperleukocytosis mainly consisting of mature granulocytes in a 43-year-old woman. White blood cell count was increased in parallel with clinical deterioration to 54,800...We report a fatal case of alcoholic hepatitis with hyperleukocytosis mainly consisting of mature granulocytes in a 43-year-old woman. White blood cell count was increased in parallel with clinical deterioration to 54,800/mm3 with no immature neutrophils on a differential count. The bone marrow aspirate revealed normal maturation and no evidence of hematological malignancy. It has been postulated that severe leukocytosis accompanied by alcoholic hepatitis may be provoked by release of high levels of colony stimulating factor from damaged hepatic cells. However, the present patient showed a normal level of serum granulocyte colony stimulating factor, and could not prove the above assumption.
A 71-year-old woman was clinically suspected of allergic granulomatous angiitis (AGA) because of preceding allergic diseases including bronchial asthma, remarkable eosinophilia (14,300/mm3), mononeuritis multiplex, posit...A 71-year-old woman was clinically suspected of allergic granulomatous angiitis (AGA) because of preceding allergic diseases including bronchial asthma, remarkable eosinophilia (14,300/mm3), mononeuritis multiplex, positive rheumatoid factor, elevated serum immunoglobulin E, and eosinophilic inflammation of the kidney. Autopsy findings, however, were characterized of polyarteritis nodosa (PAN). Necrotizing angiitis was present in several organs except for the lung; focal and segmental glomerular lesions with crescent formation were observed in the kidney, and granuloma formation was not found. This case may be an intermediate type between PAN and AGA (an overlap syndrome) and provide useful information on the clinical entities of systemic necrotizing vasculitis.
Two cases of Sjögren's syndrome accompanied by peripheral neuropathy are reported. The level of anti-endothelial cell antibody was increased in both patients. Immunofluorescent deposits of immunoglobulin and C3 component...Two cases of Sjögren's syndrome accompanied by peripheral neuropathy are reported. The level of anti-endothelial cell antibody was increased in both patients. Immunofluorescent deposits of immunoglobulin and C3 component were detected in the vasa nervorum of both cases. The pathological findings showed damage to the endothelial cells in the same vessels. The findings suggest that injury from immune complex and anti-endothelial cell antibody may be the immunological factor in the induction of peripheral neuropathy.
To assess the degree of the differential ability of serum angiotensin-converting enzyme (ACE) activity as compared with 13 conventional biochemical tests, we studied 76 healthy subjects and 107 patients with chronic live...To assess the degree of the differential ability of serum angiotensin-converting enzyme (ACE) activity as compared with 13 conventional biochemical tests, we studied 76 healthy subjects and 107 patients with chronic liver diseases. It was found that the mean values of serum ACE activity were significantly different between the healthy group and groups with liver disease. According to discriminant function analysis, the diagnostic accuracy reached 82.2% in 14 tests. In order to analyze the extent of contribution of each test to the entire diagnostic accuracy, we made an indicator of the relative decrease rate expressed as a percentage, which is 100-100 x (13-test diagnostic accuracy less one test/14-test diagnostic accuracy). The relative decrease rate of serum ACE activity was 11.4%, the largest in value. In conclusion, serum ACE activity may be one of the best discriminators to characterize chronic liver disease.
A 46-year-old man developed neuroleptic malignant syndrome with acute myoglobinuric renal failure after the discontinuation of sulpiride and maprotiline treatment. He showed the characteristic features of hyperpyrexia, a...A 46-year-old man developed neuroleptic malignant syndrome with acute myoglobinuric renal failure after the discontinuation of sulpiride and maprotiline treatment. He showed the characteristic features of hyperpyrexia, altered consciousness, muscle rigidity, and autonomic dysfunction. Laboratory data showed lysis of skeletal muscle cells and renal impairment. Muscle biopsy revealed necrosis and regenerative changes in muscle fibers. Renal biopsy showed focal tubulitis and interstitial infiltration of small inflammatory cells. The combination of sulpiride and maprotiline has not previously been reported to be the cause of neuroleptic malignant syndrome and acute myoglobinuric renal failure.
We describe a neurological disease, seen in the elder sister of identical twins, with dysarthria, involuntary movements, spastic gait, slightly low serum copper, borderline low to normal serum ceruloplasmin, normal urina...We describe a neurological disease, seen in the elder sister of identical twins, with dysarthria, involuntary movements, spastic gait, slightly low serum copper, borderline low to normal serum ceruloplasmin, normal urinary copper, and a high hair copper concentration. This neurological disorder appears to differ from others associated with abnormal copper metabolism such as Wilson's or Menkes' kinky hair disease.
A 61-year-old housewife had complained of unilateral facial pain and had been treated as prolonged trigeminal neuralgia by a dentist. When she came to our clinic, the III-X cranial nerves of the right side were involved....A 61-year-old housewife had complained of unilateral facial pain and had been treated as prolonged trigeminal neuralgia by a dentist. When she came to our clinic, the III-X cranial nerves of the right side were involved. A base view of the skull indicated destructive lesions of the right side middle cranial fossa, and a diagnosis of Garcin syndrome was made. Neurosurgical operation, X-ray radiation and chemotherapy improved to some extent the neurological condition temporarily. Postmortem examination showed an epipharyngeal rhabdomyosarcoma occupying the maxillary sinus, and extradural space of the cranial base on the right side.
A 68-year-old woman had an abrupt onset of severe headache, nausea, vertigo, difficulty in standing and dysarthria. A CT scan of the brain disclosed bilateral symmetrical round infarctions involving the middle cerebellar...A 68-year-old woman had an abrupt onset of severe headache, nausea, vertigo, difficulty in standing and dysarthria. A CT scan of the brain disclosed bilateral symmetrical round infarctions involving the middle cerebellar peduncles. She exhibited marked limb ataxia, gait ataxia, dysarthria and transient gaze nystagmus. Occlusion of the right vertebral artery associated with a stenosis of the basilar artery just proximal to the origin of the anterior inferior cerebellar arteries shown in angiograms were thought to be the cause.
Mexiletine was administered in two patients suffering from multiple sclerosis with severe dysesthesia and painful tonic seizures. In both patients the painful tonic seizures disappeared and dysesthesia improved as well....Mexiletine was administered in two patients suffering from multiple sclerosis with severe dysesthesia and painful tonic seizures. In both patients the painful tonic seizures disappeared and dysesthesia improved as well. The effects of mexiletine on painful symptoms have been previously reported in diabetic neuropathy, but not in diseases of the central nervous system.
A 30-year-old man with left thalamic infarction developed severe amnesia. The positron emission tomography showed a decrease in cerebral blood flow and oxygen metabolism in the left thalamus and the ipsilateral frontal c...A 30-year-old man with left thalamic infarction developed severe amnesia. The positron emission tomography showed a decrease in cerebral blood flow and oxygen metabolism in the left thalamus and the ipsilateral frontal cortex (-20% to -12% of asymmetry index) both at day 11 and at 5 months after onset, although amnestic symptoms certainly improved during that period. The selective hypometabolism of the cerebral cortex suggested the remote effects of neuronal fiber disconnection between the left thalamus and the ipsilateral frontal cortex, which did not parallel the clinical course.