Japanese journal of medicine最新文献

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.

We report a 29-year-old male with pelvic lipomatosis that presented with edema of the lower extremities. The patient visited our department because of the marked edema of the lower extremities with body weight gain. The pelvic region was generally radiolucent on plain abdominal radiogram. Excretory urogram and pelvic computed tomography scan revealed compression of the bladder by an adipose tissue mass. On lymphograms, lymph vessels were compressed from the inguinal area in the common iliac region. The edema of the lower extremities was thought to be caused by lymph vessel obstruction.

Co-trimoxazole (trimethoprim-sulfamethoxazole) and pyrimethamine-sulfadoxine have been recommended for treatment and prophylaxis, respectively, of Pneumocystis carinii pneumonia (PCP). However, toxic epidermal necrolysis (TEN) occurred in three of four patients with acquired immunodeficiency syndrome (AIDS) during the course of treatment or prophylaxis of PCP with these agents. On the other hand, 14 patients with PCP treated with pentamidine never developed TEN. Because the incidence of adverse skin reactions is higher among patients with AIDS than those without AIDS, and TEN is a severe, potentially fatal skin reaction, sulfonamide-containing drugs should be given cautiously to patients with AIDS.

We report a case of HAM/TSP presenting with short stature, mental retardation, skin eruptions, uterine and ovarian hypogenesis and nephropathy. Skin erythema was noted since from the age of three years old and spasticity of lower extremities from elementary school age. Serum calcium level showed 4.1 mEq/l. Recombinant human PTH infusion resulted in no response of phosphate excretion. The persistent proteinuria prompted renal needle biopsy, which revealed IgA and C1q deposits in glomerular mesangium. A diagnosis of pseudohypoparathyroidism and IgA nephropathy was entertained. This patient with pseudohypoparathyroidism who has a deficient immune system was seized with the early onset of HAM/TSP and IgA nephropathy.

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.

A 59-year-old male with acute myocarditis presenting symptoms resembling acute myocardial infarction underwent urgent coronary angiography due to difficulties in determining a diagnosis. Coronary artery spasm was demonstrated in the proximal right and left anterior descending coronary arteries. The spasm varied from time to time and lesion to lesion. But no fixed occluded lesion was observed. Predischarge coronary angiography showed no abnormal findings. Histological findings of the biopsy specimen from the left ventricle were consistent with myocarditis. The findings of this case indicate that a coronary artery spasm may aggravate the myocardial damage occurring in acute myocarditis. Urgent coronary angiography and endomyocardial biopsy are important to make the diagnosis of myocarditis in patients presenting symptoms resembling acute myocardial infarction.