Japanese journal of medicine最新文献

A 54-year-old man complained of burning pain, warm skin and erythema in his extremities. A diagnosis of primary erythromelalgia was made. Microneurography was used to clarify the role of skin sympathetic nerve activity in the pathophysiology of primary erythromelalgia. The patient showed normal skin sympathetic nerve activity but no vasoconstriction response. Aspirin activated the skin sympathetic nerve activity and improved vasoconstriction producing symptomatic relief. These results suggest that the lack of vasoconstriction following vasoconstrictor activity of the skin sympathetic nerves results in increased skin blood flow and burning pain.

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.

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.

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 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 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.

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 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.

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.