Japanese journal of medicine最新文献

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.

A 61-year-old housewife had complained of unilateral facial pain and had been treated as prolonged trigeminal neuralgia by a dentist. When she came to our clinic, the III-X cranial nerves of the right side were involved. A base view of the skull indicated destructive lesions of the right side middle cranial fossa, and a diagnosis of Garcin syndrome was made. Neurosurgical operation, X-ray radiation and chemotherapy improved to some extent the neurological condition temporarily. Postmortem examination showed an epipharyngeal rhabdomyosarcoma occupying the maxillary sinus, and extradural space of the cranial base on the right side.

A 30-year-old man with left thalamic infarction developed severe amnesia. The positron emission tomography showed a decrease in cerebral blood flow and oxygen metabolism in the left thalamus and the ipsilateral frontal cortex (-20% to -12% of asymmetry index) both at day 11 and at 5 months after onset, although amnestic symptoms certainly improved during that period. The selective hypometabolism of the cerebral cortex suggested the remote effects of neuronal fiber disconnection between the left thalamus and the ipsilateral frontal cortex, which did not parallel the clinical course.

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.

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.

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.

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.

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.