2024-03-29T09:16:25Zhttp://ginmu.naramed-u.ac.jp/dspace-oai/request
oai:ginmu.naramed-u.ac.jp:10564/4142017-06-11T23:20:26Zhdl_10564_1522表紙、目次、投稿規定詳細、奥付(Vol.49 No.1)表紙目次投稿規定詳細奥付奈良医学会OtherOthersapplication/pdf奈良医学雑誌 Vol.49 No.10469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/414奈良医学雑誌, 49(1)http://hdl.handle.net/10564/414http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/414/1/000p.%e8%a1%a8%e7%b4%99%e3%80%81%e7%9b%ae%e6%ac%a1%e3%80%81%e6%8a%95%e7%a8%bf%e8%a6%8f%e5%ae%9a%e8%a9%b3%e7%b4%b0%e3%80%81%e5%a5%a5%e4%bb%98%28Vol.49_No.1%29.pdf04695550AN00180974奈良医学雑誌4911998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4162017-05-29T06:06:40Zhdl_10564_1522経皮的冠動脈形成術後再狭窄病変でのheparin-binding epidermal growth factor-like growth factorの血管平滑筋細胞内発現亢進 : 冠動脈アテレクトミー切除標本を用いたin situハイブリダイゼーション法による検討ENHANCED EXPRESSION OF HEPARIN-BINDING EPIDERMAL GROWTH FACTOR-LIKE GROWTH FACTOR OF SMOOTH MUSCLE CELLS IN THE RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY : IN SITU HYBRIDIZATION STUDY OF RESECTED SPECIMENS OBTAINED BY DIRECTIONAL CORONARY ATHERECTOMY齊藤, 精久angioplasty(percutaneous transluminal coronary)atherectomy(directional coronary)gene expressiongrowth factorsrestenosisHeparin-binding epidermal growth factor-like growth factor (HB-EGF) is
one of the growth factors for vascular smooth muscle cells (SMC) and is implicated in the
pathogenesis of human atherosclerosis. But there is no report for the role of HB-EGF in
the restenosis of human coronary arteries after percutaneous transluminal corohary angio-
plasty (PTCA).
To elucidate the role of HB-EGF in restenosis after PTCA using in situ hybridization in
specimehs obtained by directional coronary atherectomy (DCA), the expression of HB-
EGF mRNA in both restenosis and de novo stenotic lesions were investigated.
Histological findings and the expression of HB-EGF mRNA in 17 patients with coronary
stenotic lesions were examined : 7 with restenosis lesions after PTCA (the restenosis group)
and 10 with primary lesions (the de novo group). The intimal lesions were classified into
atherosclerotic plaques and intimal proliferation, and the area of each component were
measured.
There were no significant differences between the two groups with regard to age, gender,
number of diseased vessels, target lesion of DCA, coronary risk factor, or prevalence of
each intimal lesion. Percent area of intimal proliferation in the restenosis group was
significantly greater than that in the de novo group (66±22% vs. 21±27%, p<0.05). As
for in situ hybridization, expression.of HB-EGF mRNA was detected in the cytoplasm of
SMC in lesions showing intimal proliferation. Prevalence of HB-EGF mRNA expression
in the restenosis group was significantly greater than that in the de novo group (71% vs.
10%, p<0.05). In the restenosis group all patients, in whom HB-EGF mRNA expression
was detected, underwent DCA less than 6 months after angioplasty.
These data suggest that HB-EGF might play an important role in the progression of
restenosis after PTCA through intimal proliferation and changes of SMC phenotype.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.1-90469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/416奈良医学雑誌, 49(1): 1-9http://hdl.handle.net/10564/416http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/416/1/01-09p.%e6%b8%88%e3%81%bf%e3%80%80%e7%b5%8c%e7%9a%ae%e7%9a%84%e5%86%a0%e5%8b%95%e8%84%88%e5%bd%a2%e6%88%90%e8%a1%93%e5%be%8c%e5%86%8d%e7%8b%ad%e7%aa%84%e7%97%85%e5%a4%89%e3%81%a7%e3%81%aeheparin-binding.pdf04695550AN00180974奈良医学雑誌491191998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4172017-05-29T06:06:40Zhdl_10564_1522C型肝炎ウイルス感染を認めた非ポジキンリンパ腫例および多発性骨髄腫例の検討 : 多施設共同研究の成績PREVALENCE OF HEPATITIS C VIRUS INFECTION IN PATIETS WITH NON-HODGKIN'S LYMPHOMA AND MULTIPLE MYELOMA吉川, 正英菊池, 英亮山尾, 純一栗山, 茂樹福居, 健一藤本, 正男菊川, 政次小嶌, 秀之植村, 正人松村, 雅彦高谷, 章福井, 博今津, 博雄浅田, 潔宮本, 洋二河田, 充弘中山, 雅樹松井, 勉上田, 重彦高木, 正博松本, 昌美森安, 博人玉川, 泰浩米田, 諭山根, 佳子岩澤, 秀中谷, 敏也西村, 公男山本, 浩治美登路, 昭三村, まゆみ餅, 忠雄豊原, 眞久辻田, 重信川本, 博久保, 良一池中, 康英松本, 真石井, 禎暢山中, 貴世中野, 博hepatitis C virusnon-Hodgkin's lymphomamultiple myelomaThe HCV infection is considered to sustain B-cell clonal expansion, and the
high prevalence of HCV infection in B-cell non-Hodgkin's lymphoma (B-NHL) has been
reported by several Italian groups. Recently, we also reported the possible linkage between
HCV infection and some B-cell proliferative disorders, especially B-NHL and multiple
myeloma (MM), in this country. In the present report, we summarize the individual cases
with B-NHL or MM, and then give an overview of the association between HCV infection
and B-NHL in the world and this country. HCV infection was observed in 9 (16.4%) out
of 55 patients with B-NHL, and in 5 (20%) out of 25 patients with MM. The nine HCV-
infected patients with B-NHL had either chronic hepatitis (7 patients) or liver cirrhosis (2
patients), and the histologies of B-NHL were all classified as intermediate grade according
to the Working Formulation : diffuse large in five patients, diffuse medium in three patients,
and diffuse mixed in one patient. The five HCV-infected patients with MM all had
cirrhosis. Although a firm agreement about the high prevalence of HCV infection in B-
NHL and MM has not been reached, HCV infection seems to play a pathogenic role in some
patients with B-cell proliferative disorders in Italy and Japan.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.10-150469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/417奈良医学雑誌, 49(1): 10-15http://hdl.handle.net/10564/417http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/417/1/10-15p.C%e5%9e%8b%e8%82%9d%e7%82%8e%e3%82%a6%e3%82%a4%e3%83%ab%e3%82%b9%e6%84%9f%e6%9f%93%e3%82%92%e8%aa%8d%e3%82%81%e3%81%9f%e9%9d%9e%e3%83%9d%e3%82%b8%e3%82%ad%e3%83%b3%e3%83%aa%e3%83%b3%e3%83%91%e8%85%ab%e4%be%8b%e3%81%8a%e3%82%88%e3%81%b3%e5%a4%9a.pdf04695550AN00180974奈良医学雑誌49110151998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4182017-05-29T06:06:40Zhdl_10564_1522一時的脳虚血におけるプリン代謝産物と脳軟膜動脈血管径 : 特に脳梗塞との関連についてPURINE CATABOLITES AND PIAL ARTERIOLAR DIAMETER IN TRANSIENT CEREBRAL ISCHEMIA : RELATION BETWEEN PURINE CATABOLISM AND CEREBRAL INFARCTION冨永, 正夫purine catabolitespial arteriolemicrodialysisfree radicalscerebral ischemiaTwenty adult cats were divided into 4 groups. Ischemia of 30 minutes and
1, 2 and 3 hours duration was respectively induced by unilateral occlusion of the left middle
cerebral artery. Extracellular purine catabolites in the gray matter at the ectosylvian gyrus
were analyzed with in vivo brain microdialysis technique. Simultaneously, diameter of the
pial arteriole was measured through the cranial window using an intravital microscope and
a width analyzer.
Extracellular concentrations of adenosine, hypoxanthine and xanthine were found to be
0.86±0.16μM, 4.01±2.73μM, and 3.93±2.39μM, respectively. During ischemia, the
concentration of adenosine increased 8.7-fold and arterioles dilated in diameter to 170% in
comparison with the resting values. These findings in extracellular adenosine concentration
and pial arteriolar dilatation during ischemia support a role of adenosine in regulation of
cerebral blood flow and protection of the brain tissue.
After reperfusion, arteriolar diameter had returned to 120%o of the resting state. But 50
minutes after reperfusion, pial arteriole began to dilate. This late arteriolar dilatation was
coincident with the increasing of the xanthine concentration in 1-3 hours ischemia animals.
These results suggest that free radicals might be produced and could affect pial arterioles
and brain tissue 50 minutes after reperfusion in 1-3 hours ischemia animals.
In the 30 minutes ischemia, pial arterioles did not dilate again and the xanthine concentra-
tion was unchanged. We speculate that D-to-O conversion might not be promoted in the
30 minutes ischemia animals.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.16-240469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/418奈良医学雑誌, 49(1): 16-24http://hdl.handle.net/10564/418http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/418/1/16-24p.%e4%b8%80%e6%99%82%e7%9a%84%e8%84%b3%e8%99%9a%e8%a1%80%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%e3%83%97%e3%83%aa%e3%83%b3%e4%bb%a3%e8%ac%9d%e7%94%a3%e7%89%a9%e3%81%a8%e8%84%b3%e8%bb%9f%e8%86%9c%e5%8b%95%e8%84%88%e8%a1%80%e7%ae%a1%e5%be%84.pdf04695550AN00180974奈良医学雑誌49116241998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4192017-05-29T06:06:40Zhdl_10564_1522喀疾中サイトカイン測定による慢性閉塞性肺疾患患者の気道炎症に関する研究A STUDY OF AIRWAY INFLAMMATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ASSESSED BY SPUTUM LEVELS OF CYTOKINES山本, 智生chronic obstructive pulmonary diseaseairway inflammationsputum, interleukin-8To assess the characteristics of airway inflammation in patients with
chronic obstructive pulmonary disease (COPD), I measured the sputum concentration of
interleukin-8 (IL-8), tumor necrosis factor α (TNFα), interleukin-5 (IL-5), and
RANTES, which are cytokines involved in the migration and activation of neutrophils and
eosinophils. I also measured myeloperoxidase (MPO) as a parameter of neutrophil activity
and eosinophil cationic protein (ECP) as a parameter of eosinophil activity. Spontaneous
sputum samples were obtained from 33 patients with stable COPD and 30 patients with
asthma. Induced sputum samples were obtained from 12 healthy controls.
The sputum concentrations of IL-8 and TNFα were significantly higher in the patients
with COPD than in the patients with asthma (p<0.0001, p<0.001, respectively) or in the
controls (p<0.0001, p<0.001, respectively). Concentrations of IL-5, RANTES, MPO and
ECP were significantly higher in the patients with COPD than in the controls (p<0.01, p<
0.05, p<0.0001, p<0.0001, respectively) but did not differ significantly betweenn the
patients with COPD and those with asthma. In the patients with COPD, the sputum
concentration of IL-8 was significantly correlated with the concentration of TNFα (r=
0.45, p<0.01), of MPO (r=0.55, p<0.001) and of ECP (r=0.53, p<0.01). The sputum
concentration of IL-8 was negatively correlated with FEV1/FVC(r=-0.78, p<0.0001) in
these patients. In conclusion, these results suggest the activation of both neutrophils and
eosinophils in the airway of patients with COPD. It appears that IL-8 is mainly involved
with this activation. The sputum concentration of IL-8 appears to be closely associated
with the degree of airflow obstruction in patients with COPD and may serve as a marker
in evaluating the severity of airway inflammation, which is a risk factor for COPD.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.25-3304695550http://ginmu.naramed-u.ac.jp/dspace/handle/10564/419奈良医学雑誌, 49(1): 25-33http://hdl.handle.net/10564/419http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/419/1/25-33p.%e5%96%80%e7%96%be%e4%b8%ad%e3%82%b5%e3%82%a4%e3%83%88%e3%82%ab%e3%82%a4%e3%83%b3%e6%b8%ac%e5%ae%9a%e3%81%ab%e3%82%88%e3%82%8b%e6%85%a2%e6%80%a7%e9%96%89%e5%a1%9e%e6%80%a7%e8%82%ba%e7%96%be%e6%82%a3%e6%82%a3%e8%80%85%e3%81%ae%e6%b0%97%e9%81%93%e7%82%8e%e7%97%87%e3%81%ab%e9%96%a2%e3%81%99%e3%82%8b%e7%a0%94%e7%a9%b6.pdf04695550AN00180974奈良医学雑誌49125331998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4202017-05-29T06:06:40Zhdl_10564_1522髄液中アデノシンデアミナーゼ活性の上昇から早期に診断された結核性髄膜炎の1例A CASE OF TUBERCULOUS MENINGITIS WITH ELEVATED ACTIVITY OF ADENOSINE DEAMINASE IN CEREBROSPINAL FLUID IN THE EARLY STAGE齊藤, 精久小泉, 和昭田宮, 正章佐藤, 弘章高瀬, 栄司池田, 祐貴子有方, 一夫真井, 久夫高比, 康臣adenosine deaminasecerebrospinal fluidtuberculous meningitisWe report a case of tuberculous meningitis in a patient who was diagnosed
with elevated activity of adenosine deaminase (ADA) in the cerebrospinal fluid (CSF) in
the early stage of the disease. The patient was a 25-year-old female who was admitted to
our hospital on Dec 10, 1996 because of fever, nausea, and headache. Tuberculous meningi-
tis was strongly suspected based on clinical findings (including nuchal rigidity and de-
creased deep tendon reflexes in the lower extremites) and CSF findings (initial pressure 280
mmH2O, cell count 493/μl, protein 116 mg/dl, glucose 41 mg/dl, tryptophan reaction posi-
tive). Isoniazid, streptomycin, and rifampicin were administered. During treatment, no
bacteria, fungi, or mycobacteria were detected in the CSF by both smear and culture
examination. No mycobacterium tuberculosis RNA was detected using the Gen-ProbeTM
Amplified Mycobacterium Tuberculosis Direct Test. However, the patient was diagnosed
as having tuberculous meningitis based on the increased activity of ADA (9.9 IU/l) in the
CSF in the early stage of the disease and she recovered completely. Thus, measurement of
ADA in the CSF is a useful tool for early diagnosis and follow-up of tuberculous meningitis.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.34-380469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/420奈良医学雑誌, 49(1): 34-38http://hdl.handle.net/10564/420http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/420/1/34-38p.%e9%ab%84%e6%b6%b2%e4%b8%ad%e3%82%a2%e3%83%87%e3%83%8e%e3%82%b7%e3%83%b3%e3%83%87%e3%82%a2%e3%83%9f%e3%83%8a%e3%83%bc%e3%82%bc%e6%b4%bb%e6%80%a7%e3%81%ae%e4%b8%8a%e6%98%87%e3%81%8b%e3%82%89%e6%97%a9%e6%9c%9f%e3%81%ab%e8%a8%ba%e6%96%ad%e3%81%95%e3%82%8c%e3%81%9f%e7%b5%90%e6%a0%b8%e6%80%a7%e9%ab%84%e8%86%9c%e7%82%8e%e3%81%ae1%e4%be%8b.pdf04695550AN00180974奈良医学雑誌49134381998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4212017-05-29T06:06:40Zhdl_10564_1522ネフローゼ症候群を呈した糖尿病性腎症の臨床病理学的研究CLINICOPATHOLOGICAL STUDY OF DIABETIC NEPHROPATHY ASSOCIATED WITH NEPHROTIC SYNDROME金内, 雅夫川野, 貴弘椎木, 英夫土肥, 和紘diabetic nephropathynephrotic syndromerenal biopsyWe determined the clinical and pathological characteristics of diabetic
patients with nephrotic syndrome who underwent renal biopsy between January 1982 and
December 1996. The subjects were 19 males and 7 females, aged 43 to 74 (mean 58) years.
Mean duration of diabetes was 13.2 years. Urinary protein excretion was 3.5 - 26.4 (mean
7.5) g/day, serum total protein concentration 3.8 - 6.4 (mean 5.3) g/dl, serum albumin
concentration 1.9 - 3.3 (mean 2.8) g/dl, serum creatinine concentration 0.6 - 3.0 (mean
1.4) mg/dl, and creatinine clearance 13 - 87 (mean 46) ml/min. Hypercholesterolemia was
present in 54% of patients, and hypertension in 77%. Almost all of the patients had both
diabetic retinopathy and neuropathy, whereas macroangiopathy was noted in only 4
patients. Advanced changes in diffuse and nodular glomerular lesions accompanied by
vascular lesions were found in most of the patients. We conclude that diabetes with
nephrotic syndrome is associated with advanced morphological changes in both glomerular
and vascular lesions.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.39-440469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/421奈良医学雑誌, 49(1): 39-44http://hdl.handle.net/10564/421http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/421/1/39-44p.%e3%83%8d%e3%83%95%e3%83%ad%e3%83%bc%e3%82%bc%e7%97%87%e5%80%99%e7%be%a4%e3%82%92%e5%91%88%e3%81%97%e3%81%9f%e7%b3%96%e5%b0%bf%e7%97%85%e6%80%a7%e8%85%8e%e7%97%87%e3%81%ae%e8%87%a8%e5%ba%8a%e7%97%85%e7%90%86%e5%ad%a6%e7%9a%84%e7%a0%94%e7%a9%b6.pdf04695550AN00180974奈良医学雑誌49139441998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4222017-05-29T06:06:41Zhdl_10564_1522糸球体基底膜にびまん性の菲薄化を示した進行期アルポート症候群の1例AN UNUSUAL CASE WITH ADVANCED STAGE OF ALPORT'S SYNDROME EXHIBITING DIFFUSE THINNING OF THE GLOMERULAR BASEMENT MEMBRANE井澤, 鉄之久保, 篤史岩野, 正之西野, 俊彦椎木, 英夫土肥, 和紘Alport's syndromecollagen Ⅳ α 5 chainnephrotic syndromethin glomerular basement membraneA 16-year-old boy was admitted to our department because of facial and
pretibial edema. Laboratory data revealed moderate renal impairment (Ccr 36.8 ml/min),
hypoalbuminemia (2.5g/dl), and hypercholesterolemia (303mg/dl). Audiometry demon-
strated bilateral and high tone sensorineural deafness. Renal biopsy showed mesangial
proliferation, diffuse tubulo-interstitial damage, and clusters of foam cells. Electron
microscopic examination disclosed splitting of the glomerular basement membrane (GBM).
Most of the GBM was thin; about 200 nm or less in thickness. Lack of collagen Ⅳ α 5
chain was confirmed by using monoclonal antibody to collagen Ⅳ α 5 chain. Accordingly,
the patient was diagnosed as having advanced stage of Alport's syndrome (type Ⅲ)
associated with nephrotic syndrome. In general, patients with advanced Alport's syndrome
show diffuse thickening of the GBM. Therefore, we think that this patient is an unusual
case of clinically advanced Alport's syndrome exhibiting diffuse thinning of the GBM. Here
we report the details of this case and discuss the relevant literature.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.45-490469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/422奈良医学雑誌, 49(1): 45-49http://hdl.handle.net/10564/422http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/422/1/45-49p.%e7%b3%b8%e7%90%83%e4%bd%93%e5%9f%ba%e5%ba%95%e8%86%9c%e3%81%ab%e3%81%b3%e3%81%be%e3%82%93%e6%80%a7%e3%81%ae%e8%8f%b2%e8%96%84%e5%8c%96%e3%82%92%e7%a4%ba%e3%81%97%e3%81%9f%e9%80%b2%e8%a1%8c%e6%9c%9f%e3%82%a2%e3%83%ab%e3%83%9d%e3%83%bc%e3%83%88%e7%97%87%e5%80%99%e7%be%a4%e3%81%ae1%e4%be%8b.pdf04695550AN00180974奈良医学雑誌49145491998-02-28jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4232017-06-11T23:20:26Zhdl_10564_1522A MALE CASE OF KALLMANN'S SYNDROME : FERTILITY INDUCED BY GONADOTROPIN (hCG/hMG) THERAPYOkamoto, ShingoMayumi Mimura, MayumiMoch, TadaoSakamoto, TakemiIzumi, YukikoMatzui, YuhjiHosokawa, AkikoKuriyama, ShigekiFukui, HiroshiKallmann's syndromehypogonadotropic hypogonadismgonadotropin therapypulsatile LH-RH therapyKAL geneA 24-year-old male patient with Kallmann's syndrome who fathered two
children after gonadotropin therapy is reported here. He was diagnosed with Kallmann's
syndrome because of hypothalamic hypogonadism associated with anosmia. The
gonadotropin therapy was initiated which involved treatment with human chorionic
gonadotropin (hCG) and human menopausal gonadotropin (hMG). After 3 years of
treatment, his secondary sexual characteristics developed to near the adult level and sperm
were detected in his semen. Although pulsatile luteinizing hormone releasing hormone (LH
-RH) injection using a mini-pump was tried for 4 months, it did not maintain the plasma
testosterone at normal levels. At 29 y the patient was switched to gonadotropin therapy.
His sperm count reached 6×10(6/mm3, and his wife became pregnant ; they had a female
baby. His second child was born when the patient was 32 y. The sequence of the KAL gene
was normal in all 14 exons of the patient's DNA. Here we describe the clinical benefits of
gonadotropin therapy and LH-RH therapy.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.50-560469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/423奈良医学雑誌, 49(1): 50-56http://hdl.handle.net/10564/423http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/423/1/50-56p.A_MALE_CASE_OF_KALLMANN%27S_SYNDROME.pdf04695550AN00180974奈良医学雑誌49150561998-02-28engpublisher
oai:ginmu.naramed-u.ac.jp:10564/4242017-06-11T23:20:26Zhdl_10564_1522A CASE OF TYPE II POLYGLANDULAR AUTOIMMUNE DISEASE (SCHMIDT'S SYNDROME) ASSOCIATED WITH A MYOPATHY OF UNKNOWN ETIOLOGYOkamoto, ShingoUmemoto, NorieKumata, KeiichiMurata, KenyaIzumi, YukikoNishiyama, ToshimasaSakamoto, TakemiKuriyama, ShigekiFukui, HiroshiSchmidt's syndromepolyglandular autoimmune diseaseAddison's diseasemyopathyA 44-year-old female with Schmidt's syndrome associated with a myopathy
of unknown etiology is reported. The myopathy, characterized by general muscle weakness
and extensive atrophy and loss of muscle fibers, developed since the age of 23 y and
progressed. The myopathy could not be diagnosed by immuno-histochemistry nor ser-
ological examination. Skin pigmentation developed since 40 y. At 44 y, she was diagnosed
with Schmidt's syndrome due to the association of autoimmune Addison's disease and
Hashimoto's disease. Although the supplemental therapy of hydrocortisone and thyroxin
improved adrenal insufficiency and hypothyroidism, the therapy could not improve the
muscle weakness of the myopathy. This is the first case of Schmidt's syndrome with a
myopathy of unknown etiology like this case.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.57-630469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/424奈良医学雑誌, 49(1): 57-63http://hdl.handle.net/10564/424http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/424/1/57-63p.A_CASE_OF_TYPE_II_POLYGLANDULAR_AUTOIMMUNE_DISEASE.pdf04695550AN00180974奈良医学雑誌49157631998-02-28engpublisher
oai:ginmu.naramed-u.ac.jp:10564/4252017-06-11T23:20:26Zhdl_10564_1522A CASE OF CUSHING'S SYNDROME ASSOCIATED WITH ISOLATED ADRENOCORTICOTROPIN (ACTH) DEFICIENCY AFTER THE REMOVAL OF CORTISOL-PRODUCING ADRENAL ADENOMAOkamoto, ShingoUmemoto, NorieNakatani, YoshihiroHosokawa, AkikoIzumi, YukikoNishiyama, ToshimasaSakamoto, TakemiKuriyama, ShigekiTsumatani, KenichiHirao, YoshihikoFukui, HiroshiIsolated adrenocorticotropin deficiencyIsolated ACTH deficiencyCushing's syndrome pituitary autoantibodyA 45-yr-old woman with Cushing's syndrome who could not be withdrawn
from postoperative hydrocortisone supplement for over 3 years after the removal of an
adrenocortical adenoma is presented. This was diagnosed as associating with isolated
ACTH deficiency. She had suffered from persistent severe general fatigure since 5 years
prior. However, after 2 years, obesity, hypertension and moon face developed, while the
malaise improved. She was then diagnosed as having Cushing's syndrome and underwent
the extirpation of right adrenal adenoma. The dosage of supplementary hydrocortisone
was gradually reduced after surgery. However the hydrocortisone dose could not be
reduced lower than 10mg/day after several trials of dose reduction as severe general
fatigue would ensue. The pituitary function tests at postoperative 2 years and a half-year,
revealed an association of isolated ACTH deficiency. It was unknown whether the isolated
ACTH deficiency arose before or after the surgery.
In the present report, we discuss the association of isolated ACTH deficiency and
Cushing's. syndrome.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.64-730469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/425奈良医学雑誌, 49(1): 64-73http://hdl.handle.net/10564/425http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/425/1/64-73p.A_CASE_OF_CUSHING%27S_SYNDROME_ASSOCIATED_WITH_ISOLATED.pdf04695550AN00180974奈良医学雑誌49164731998-02-28engpublisher
oai:ginmu.naramed-u.ac.jp:10564/4262017-06-11T23:20:26Zhdl_10564_1522A CASE OF OCCULT ECTOPIC CORTICOTROPIN (ACTH) SYNDROME MAITAINING REMISSION STATE OVER 4 YEARS AFTER BILATERAL ADRENALECTOMYOkamoto, ShingoHokaze, YohichiMatsumoto, MakotoIzumi, YukikoHosokawa, AkikoSaka, MunehisaYoshida, KatsunoriHirao, YoshihikoKuriyama, ShigekiFukui, HiroshiEctopic corticotropin syndromeectopic ACTH syndromeCushing's syndromebilateral adrenalectomyA long-lasting state of remission of over 4 years of occult ectopic cor-
ticotropin (ACTH) syndrome in a 68-year-old female is reported. She presented with
general malaise, muscle atrophy and weakness of extremities, general petechiae and
hypokalemia. Although ectopic ACTH syndrome was suspected due to marked hypercor-
tisolism and ACTH elevation, the source of ACTH secretion could not detected by any
diagnostic technique. Because of that effective suppression of plasma cortisol levels by
torilostane, a 3 β-hydroxy-steroid-dehydrogenase inhibitor, could not obtained, so bilateral
adrenalectomy was performed. After the operation, supplemental therapy of hydrocor-
tisone and Florinef, 9 α-fluorohydrocortisone, was initiated and the plasma ACTH levels
decreased gradually. At the 6th postoperative month, the levels of ACTH remained within
the normal range and her general status markedly improved. At the 4th postoperative year,
the plasma ACTH still maintained normal levels with no recurrence. Cases of occult
ectopic ACTH syndrome which remain in remission for a long period after bilateral
adrenalectomy are rare and interesting. Bilateral adrenalectomy may be the first choice of
treatment for occult ectopic ACTH syndrome with the support of chemical therapy.奈良医学会ArticleDepartmental Bulletin Paperapplication/pdf奈良医学雑誌 Vol.49 No.1 p.74-830469555013450069http://ginmu.naramed-u.ac.jp/dspace/handle/10564/426奈良医学雑誌, 49(1): 74-83http://hdl.handle.net/10564/426http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/426/1/74-83p.A_CASE_OF_OCCULT_ECTOPIC_CORTICOTROPIN.pdf04695550AN00180974奈良医学雑誌49174831998-02-28engpublisher