Japanese journal of medicine最新文献

The patient, a 51-year-old man, was receiving immunosuppressants for 2 yr after renal allotransplantation. He had heart failure with aortic regurgitation, fever, anemia and a history of odontectomy on admission. He was resistant to medical treatments and died from cerebral emboli. On autopsy, vegetation of the aortic valve was identified. Progression of atherosclerosis, which may have been due to steroids and chronic rejection, was prominent. This report is the first case of infective endocarditis following organ transplantation in Japan. Such complications as infective endocarditis and atherosclerosis will be on the rise with the increase of numbers or organ transplantations.

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.

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.

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.

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.

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.

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.