Serum levels of soluble interleukin-2 receptor (IL-2R) were measured in patients with pulmonary tuberculosis, nontuberculous pulmonary diseases (bacterial pneumonia, lower respiratory tract infection, lung cancer), and i...Serum levels of soluble interleukin-2 receptor (IL-2R) were measured in patients with pulmonary tuberculosis, nontuberculous pulmonary diseases (bacterial pneumonia, lower respiratory tract infection, lung cancer), and in normal volunteers. Patients with tuberculosis had increased levels of soluble IL-2R compared to normal controls. Abnormally elevated levels were also shown in patients with nontuberculous pulmonary diseases, suggesting that elevations of soluble IL-2R are not specific for tuberculosis. In patients with tuberculosis, elevated levels of soluble IL-2R were steadily decreased to normal levels during successful treatment. Additionally, soluble IL-2R levels in tuberculosis were closely correlated with adenosine deaminase levels. Thus, it seems possible that measurements of soluble IL-2R may be beneficial in the diagnosis and the management of patients with tuberculosis. Furthermore, we demonstrated that elevated levels of soluble IL-2R in tuberculosis appear to be a consequence of cellular activation of mononuclear cells and not to be the result of cell death with subsequent IL-2R release.
Increased fibroblast growth-stimulating activity (FGA) was found in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients. For evaluation of the significance of FGA in disease activity and the pathophysiology of...Increased fibroblast growth-stimulating activity (FGA) was found in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients. For evaluation of the significance of FGA in disease activity and the pathophysiology of sarcoidosis, the FGA levels were compared with data on cellular analysis of BALF, serum angiotensin-converting enzyme (S-ACE) activity and chest radiograms. The FGA level was significantly higher in sarcoidosis patients with parenchymal involvement (radiological stages II and III) than in those without parenchymal involvement (radiological stage I). The FGA was positively correlated with albumin and fibronectin concentrations in BALF. However, it was not significantly correlated with the ratio of CD-4 + to CD-8 + T-lymphocytes in BALF or the S-ACE level, which are known to be useful in evaluating the disease activity of sarcoidosis. These results indicate that the diagnostic value of FGA is different from that of the lymphocyte subpopulations in BALF and S-ACE, and is useful in estimating the extent of parenchymal involvement in sarcoidosis.
Lymphocyte proliferation in dementia of the Alzheimer type (DAT) was evaluated by the level of mitogen response using phytohemagglutinin, pokeweed mitogen, concanavalin A and staphylococcal protein A. Lymphocyte subpopul...Lymphocyte proliferation in dementia of the Alzheimer type (DAT) was evaluated by the level of mitogen response using phytohemagglutinin, pokeweed mitogen, concanavalin A and staphylococcal protein A. Lymphocyte subpopulations in the peripheral blood were also investigated using a monoclonal antibody with a fluorescence-activated cell sorter. The mitogen response in DAT was not significantly different from that in the normal controls. Lymphocyte subpopulations (Pan T, helper T, suppressor T, B cell, HLA-DR positive cell and helper/suppressor ratio) in DAT were not significantly different from those in the normal controls. These results suggest that the lymphocyte proliferative response to mitogens and the subpopulations in DAT may be natural in the normal aging process.
A 24-year-old man showed thyrotoxic symptoms with hypokalemic periodic paralysis. Serum thyroid hormone levels were high and thyrotropin (TSH) was undetectable. 123I-thyroidal uptake was suppressed. TSH-binding inhibitor...A 24-year-old man showed thyrotoxic symptoms with hypokalemic periodic paralysis. Serum thyroid hormone levels were high and thyrotropin (TSH) was undetectable. 123I-thyroidal uptake was suppressed. TSH-binding inhibitor immunoglobulin (TBII) was positive. After a month without any treatment, he became hypothyroid. Thyroid hormone level was decreased and TSH was increased to above the normal range. 123I-thyroidal uptake was increased. TBII activity was still positive. From the clinical findings, a diagnosis of silent thyroiditis was made. Sera obtained in the hypothyroid state revealed the presence of thyroid-stimulation-blocking antibodies (TSBAb), but there were no thyroid-stimulating antibodies (TSAb). These results suggest that the hypothyroidism in this patient was due to the presence of TSBAb with TBII activity.
Serial somatosensory evoked potentials (SEPs) to median and posterior tibial nerve stimulation in a case with familial heterozygous hypobetalipoproteinemia and vitamin E deficiency were investigated over a period of 4 ye...Serial somatosensory evoked potentials (SEPs) to median and posterior tibial nerve stimulation in a case with familial heterozygous hypobetalipoproteinemia and vitamin E deficiency were investigated over a period of 4 years. In serial SEPs to posterior tibial nerve stimulation, interpeak latencies between N20 and P2 were delayed even in the early clinical stage, although the peak latency of N20 was normal. N20 latency was delayed when the patient noted paresthesia of the lower extremities. Interpeak latencies between N20 and P2 were progressively prolonged, and finally both peaks disappeared. Progressive dysfunctions of spinal posterior columns and peripheral somatosensory pathways were discovered by serial SEP studies.
We have followed 106 recipients of allogeneic bone marrow transplantation (BMT), and observed 47 episodes of interstitial pneumonitis (IP) in 37 patients. Cytomegalovirus (CMV) pneumonitis was seen in 18 episodes in 18 p...We have followed 106 recipients of allogeneic bone marrow transplantation (BMT), and observed 47 episodes of interstitial pneumonitis (IP) in 37 patients. Cytomegalovirus (CMV) pneumonitis was seen in 18 episodes in 18 patients, of whom 10 patients were diagnosed by bronchoalveolar lavage (BAL), 7 patients by autopsy, and 1 patient by sputum culture. There was one varicella-zoster virus pneumonitis diagnosed by autopsy. However, we could find no apparent etiology of pneumonitis in the other 18 patients. The median interval between BMT and episodes of IP was 74 days (range, 23-578 days) for CMV pneumonitis, and 180 days (range, 41-428 days) for idiopathic pneumonitis (p less than 0.05). BAL was more sensitive than transbronchial lung biopsy in the diagnosis of CMV pneumonitis, and CD4/CD8 ratio in BAL fluid was inverted in all episodes of CMV pneumonitis. Computed tomography (CT) scans were performed in 31 episodes in 26 patients, and all scans revealed abnormalities. CT scans were more sensitive than routine chest X-rays against micro- or small-nodular patterns, air bronchogram, and air alveologram (p less than 0.05). CT scan and arterial blood gas analysis were most useful and necessary in approaching the problem of pneumonitis in allogeneic marrow transplant patients. Based on these findings, when CMV pneumonitis is suspected, it is recommended to perform BAL for the final diagnosis of CMV pneumonitis.
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 examina...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, 16.6 micrograms/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.
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 showe...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.
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...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.
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 bed-tilting from 30 to 6...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 bed-tilting from 30 to 60 degrees, but his heart rate remained constant which indicated a diagnosis of acute autonomic neuropathy. With the tilting test, a decrease in serum catecholamine 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.
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 blo...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.
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 multi...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.
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 eleva...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.
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, b...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.
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 r...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.
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,...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.