The recovery of the renal proximal and distal tubular sodium (Na) reabsorption was evaluated by analysis of the physiological metabolism of lithium reabsorbed by the renal tubules in a patient with toxic interstitial nep...The recovery of the renal proximal and distal tubular sodium (Na) reabsorption was evaluated by analysis of the physiological metabolism of lithium reabsorbed by the renal tubules in a patient with toxic interstitial nephropathy. Administration of glucocorticoid facilitated the rapid recovery of the proximal tubular Na reabsorption (-0.63 to 3 mmol/min for 2 wk) followed by recovery of phosphate reabsorption (51 to 82% for 2 months). Distal Na reabsorption was not altered for 2 months. Although Li clearance has been previously performed in healthy volunteers, we could differentiate the recovery of the proximal and distal renal tubular function even in a diseased patient.
A 38-year-old male myotonic dystrophy patient with left hemiblock, bradycardia and ventricular arrhythmias underwent electrophysiologic studies 19 months after he developed dizziness. Rapid and significant progression of...A 38-year-old male myotonic dystrophy patient with left hemiblock, bradycardia and ventricular arrhythmias underwent electrophysiologic studies 19 months after he developed dizziness. Rapid and significant progression of binodal disease required implantation of a permanent pacemaker, which responded favorably. We suggest that careful monitoring or electrophysiologic studies are indicated in patients with these findings.
Changes in plasma lipids and abnormal lipoproteins in a patient with ticlopidine hydrochloride-induced hepatitis were studied. Total cholesterol, free cholesterol and phospholipids increased markedly during cholestasis....Changes in plasma lipids and abnormal lipoproteins in a patient with ticlopidine hydrochloride-induced hepatitis were studied. Total cholesterol, free cholesterol and phospholipids increased markedly during cholestasis. Lipoprotein electrophoresis showed a large lipoprotein-X band and a relatively small alpha-lipoprotein band. As cholestatic hepatitis improved, all plasma lipids were progressively decreased. A broad band of abnormal alpha-lipoprotein appeared for the first time with the decrease in the lipoprotein-X band. Both abnormal lipoproteins decreased further and eventually disappeared. The appearance of abnormal alpha-lipoprotein was accompanied by changes in apoproteins. These findings suggest that abnormal alpha-lipoprotein might be an intermediate metabolite of lipoprotein-X.
A 54-year-old woman was treated for bronchial asthma for 14 yr. In March of 1989, chest roentgenography and computed tomography (CT) revealed development of bilateral pulmonary hilar lymph node enlargement. Positive 67Ga...A 54-year-old woman was treated for bronchial asthma for 14 yr. In March of 1989, chest roentgenography and computed tomography (CT) revealed development of bilateral pulmonary hilar lymph node enlargement. Positive 67Ga uptake was observed in bilateral pulmonary hili. Although levels of serum angiotensin converting enzyme (ACE) and lysozyme were within normal range, biopsy specimen of scalene lymph nodes showed noncaseating epitheloid-cell granuloma, leading to the diagnosis of sarcoidosis. Steroid therapy ameliorated both sarcoidosis and bronchial asthma. Although the association of sarcoidosis and bronchial asthma is uncommon, there may be an etiological relationship between them.
A case of recurrent Pneumocystis carinii pneumonia with a long interval between episodes and each episode showing a different radiographic appearance is reported. The radiographic finding in the initial infectious episod...A case of recurrent Pneumocystis carinii pneumonia with a long interval between episodes and each episode showing a different radiographic appearance is reported. The radiographic finding in the initial infectious episode was bilateral, patchy, alveolar infiltrate predominantly in the upper and middle lung zones and that in the second infectious episode, six and a half years later, showed bilateral interstitial infiltrate predominantly in the middle and lower lung zones. T cell immunity expressed by mitogen-induced T cell proliferation was clearly different in the two infectious episodes. These differences in radiographic appearance could be due, at least in part, to altered immunological states between the first and second infectious episodes.
A 38-year-old woman with pleural mesothelioma who had a history of neighborhood asbestos exposure during her childhood was demonstrated. She had no known history of occupational asbestos exposure. This is the first case...A 38-year-old woman with pleural mesothelioma who had a history of neighborhood asbestos exposure during her childhood was demonstrated. She had no known history of occupational asbestos exposure. This is the first case of mesothelioma with neighborhood asbestos exposure reported in Japan. Previously-reported cases of mesothelioma with neighborhood asbestos exposure in the English language literature were reviewed.
A 28-year-old woman with recurrent pneumonia was found to have selective IgG2, 4 subclass and IgE deficiencies. She had a history of repeated episodes of otitis media and sinusitis in childhood. Her total immunoglobulin...A 28-year-old woman with recurrent pneumonia was found to have selective IgG2, 4 subclass and IgE deficiencies. She had a history of repeated episodes of otitis media and sinusitis in childhood. Her total immunoglobulin level was slightly below the normal range, and selective deficiencies of IgG2, 4 and IgE were found. Although lymphocyte responses to several mitogens were within the normal ranges, peripheral blood mononuclear cells produced only IgM when stimulated by Staphylococcus aureus Cowan 1 and interleukin-2. Gene deletion of the IgG2, 4 subclass was not found, but polymorphism of the IgG gene was detected by DNA analysis of the patient's lymphocytes.
An 80-year-old man with Ebstein's anomaly and ductus arteriosus aneurysm is reported. He was admitted with bradycardiac atrial fibrillation and right ventricular failure. For the control of brady-arrhythmia, a permanent...An 80-year-old man with Ebstein's anomaly and ductus arteriosus aneurysm is reported. He was admitted with bradycardiac atrial fibrillation and right ventricular failure. For the control of brady-arrhythmia, a permanent pacemaker was implanted. Two-dimensional echocardiogram revealed distal displacement of the septal tricuspid valve. Aortography and computed tomography showed ductus arteriosus aneurysm. This is the first report of the association of Ebstein's anomaly and non-patent ductus arteriosus aneurysm.
A case of autoimmune hemolytic anemia associated with myasthenia gravis in a 33-year-old female is presented. The association of autoimmune hemolytic anemia and myasthenia gravis is a very rare event, with only eight cas...A case of autoimmune hemolytic anemia associated with myasthenia gravis in a 33-year-old female is presented. The association of autoimmune hemolytic anemia and myasthenia gravis is a very rare event, with only eight cases reported. The known association of these two diseases is reviewed. To our knowledge, this is the first reported case in which autoimmune hemolytic anemia preceded systemic myasthenia gravis.
The interrelation between endoscopic findings in esophageal varices, and systemic and hepatic hemodynamic abnormalities was studied in 76 male patients with compensated cirrhosis. Observation of these patients revealed a...The interrelation between endoscopic findings in esophageal varices, and systemic and hepatic hemodynamic abnormalities was studied in 76 male patients with compensated cirrhosis. Observation of these patients revealed a hyperdynamic systemic circulation, represented by an increased cardiac output and reduced total systemic vascular resistance with an enlarged circulating plasma volume and without an increase in heart rate, in comparison with 23 male patients with chronic hepatitis. In patients with cirrhosis and esophageal varices, the hyperdynamic circulatory state was closely related to the condition of the varices, in which a progress in the form was accompanied by an advance in the degree of hyperdynamism with an increase in circulating plasma volume. Whereas the extent of the varices as indicated by the location was closely related to a rise in the wedged hepatic venous pressure. The shunt volume through the portal-systemic collaterals requires further study to elucidate the mechanism of hyperdynamic circulation.
The febrile reaction that occurs on reinfusion of ascites was studied. Intravenous reinfusion of ascites was performed 213 times in 63 cases of ascites, which were refractory to treatment with various drugs including diu...The febrile reaction that occurs on reinfusion of ascites was studied. Intravenous reinfusion of ascites was performed 213 times in 63 cases of ascites, which were refractory to treatment with various drugs including diuretics. In order to prevent fever on reinfusion of ascites, a screen filter and a depth filter were used; the results were more favorable with the screen filter. Fibrin was considered to be one of the substances removable by the screen filter. HPLC analysis of the filtered and concentrated ascites, after passage through the screen filter, revealed a fraction corresponding to albumin. Intravenous injection of this fraction into rabbits caused fever. Although the screen filter cannot completely prevent fever on reinfusion of ascites, it appears useful to prevent fever in some patients.
To study the present status of TB in a general hospital, we reviewed the records of 186 patients with TB at the Saga Medical School Hospital. Ninety-two patients (49.5%) had extrapulmonary tuberculosis and 59 patients (3...To study the present status of TB in a general hospital, we reviewed the records of 186 patients with TB at the Saga Medical School Hospital. Ninety-two patients (49.5%) had extrapulmonary tuberculosis and 59 patients (31.7%) had complicated severe diseases. The variety of TB lesions and underlying diseases often caused diagnostic delay and misdiagnosis. In fact, 16 cases were not identified to be TB until after death. The TB prevalence was significantly high in malignant disease, diabetes mellitus, collagen disease and chronic renal failure among the total number of patients discharged. Twenty-one patients developed TB while on an intensive therapy for underlying diseases. Unfortunately, 22 patients with TB died in our hospital. These findings suggest that special care must be taken to prevent TB in a general hospital. We emphasize that early diagnosis of TB depends on the suspicion of this infection on the part of the physician.
During the 12 years from 1977 to 1988 in Tottori University Hospital, 6 cases (4.2%) with chronic active "lupoid" hepatitis were encountered among 143 patients with histologically proven chronic active hepatitis. HLA ant...During the 12 years from 1977 to 1988 in Tottori University Hospital, 6 cases (4.2%) with chronic active "lupoid" hepatitis were encountered among 143 patients with histologically proven chronic active hepatitis. HLA antigens were studied; BW 22 and CW 1 were strongly associated, and A 11 was rather associated with the rare disorder in Japan. These results suggested that Japanese patients with chronic active "lupoid" hepatitis have different HLA markers from those in Caucasian patients, which may be attributable to rare specificity in the HLA system rather than different mechanisms of pathogenesis.
Recombinant interleukin (IL-2) was administered to 16 patients with HBe antigen-positive chronic active hepatitis in which the diagnosis was ascertained histologically. In 7 of the 16 patients, a decrement of the serum H...Recombinant interleukin (IL-2) was administered to 16 patients with HBe antigen-positive chronic active hepatitis in which the diagnosis was ascertained histologically. In 7 of the 16 patients, a decrement of the serum HBe antigen value was observed (Group A). In group A, the findings showed an increment of peripheral Leu 11-positive cells and NK and LAK cell activity, an acute exacerbation during and after IL-2 administration, disappearance of HBc antigen observed in liver biopsy histology, and decrement of serum DNA-p activity. However, seroconversion of HBs antigen was not observed and no case showed the elimination status of continuous HB virus infection. On the other hand, in the other 9 patients (Group B), these changes were not observed and the existence of a HLA type difference between Group A and B was shown by HLA analysis. These results indicated that the immune responses mediated by IL-2 may play an important role in the development of chronic hepatitis B, and these results may be regulated genetically.
Human trophoblastic cells (T3M-3) metabolized 25-hydroxyvitamin D3 into two more polar metabolites during in vitro incubations. A two-step high pressure liquid chromatography system revealed two unique elution positions...Human trophoblastic cells (T3M-3) metabolized 25-hydroxyvitamin D3 into two more polar metabolites during in vitro incubations. A two-step high pressure liquid chromatography system revealed two unique elution positions of those trophoblastic cell-derived metabolites that exactly co-migrated with the elution positions of 5(Z)-19-nor-10-oxo-25-hydroxyvitamin D3 and 5(E)-19-nor-10-oxo-25-hydroxyvitamin D3, respectively. These unique metabolites did not bind specifically to a protein receptor for 1,25-dihydroxyvitamin D3.
A 25-year-old female meeting all six criteria for Kawasaki disease is reported. A total of 22 reported cases of adult Kawasaki disease, including the present case, are reviewed. In adult Kawasaki disease, arthralgia, gas...A 25-year-old female meeting all six criteria for Kawasaki disease is reported. A total of 22 reported cases of adult Kawasaki disease, including the present case, are reviewed. In adult Kawasaki disease, arthralgia, gastrointestinal complications and hepatic dysfunction are seen more frequently than in childhood cases. Cardiac complications are rarely seen in adult Kawasaki disease. Two cases have been positive for anti-nuclear antibody (ANA). The present patient had increased levels of serum IgE and was positive for ANA, suggesting involvement of an immune mechanism. Adult Kawasaki disease is rare but appears to be on the increase; internists treating adults must be aware of this disease.
A 28-year-old woman developed central pontine myelinolysis (CPM) following severe hyponatremia. Radiological examinations demonstrated a characteristic pontine lesion of CPM. Her neurological symptoms (drowsiness, emotio...A 28-year-old woman developed central pontine myelinolysis (CPM) following severe hyponatremia. Radiological examinations demonstrated a characteristic pontine lesion of CPM. Her neurological symptoms (drowsiness, emotional lability, dysarthria, dysphagia, and quadriparesis) were improved dramatically by treatment with thyrotropin-releasing hormone (TRH) and rehabilitation. However, results of repeat computed tomographic (CT) scans of the brain remained unchanged. This case therefore suggests that TRH may be beneficial for the treatment of CPM, and that CT findings appear to be a limited prognostic indicator for CPM.
A 51-year-old female was admitted to the hospital due to liver dysfunction. She had suffered from arthralgia, Raynaud's phenomenon, dry mouth and dry eyes. Laboratory data showed positive LE cells and anti-RNP. The diagn...A 51-year-old female was admitted to the hospital due to liver dysfunction. She had suffered from arthralgia, Raynaud's phenomenon, dry mouth and dry eyes. Laboratory data showed positive LE cells and anti-RNP. The diagnosis of mixed connective tissue disease (MCTD) was made according to the criteria of the international symposium on MCTD and Antinuclear Antibodies (August 1986, Tokyo). Liver biopsy showed chronic active hepatitis. The results of sialography, lip biopsy and rose-bengal test were compatible with Sjögren's syndrome (SjS). This is the report of a rare case with MCTD associated with SjS and autoimmune hepatitis.