http://hdl.handle.net/10564/1518 1997-06 2026-04-10T15:42:01Z http://hdl.handle.net/10564/374 タイトル: 転移性骨腫瘍で発症した細小肝細胞癌の1例 著者: 西本, 和央; 西野, 俊彦; 椎木, 英夫; 金内, 雅夫; 土肥, 和紘; 夏目, 由美子; 廣橋, 伸治; 市島, 國雄 抄録: A 68-year-old male was referred to our clinic because of pain of left tuber of ischium. Bone roentgenogram of pelvis showed destructive change of the left pubic bone. Laboratory data on admission showed positive anti-HCV antibody, elevation of protein induced by vitamin K antagonists-Ⅱ (PIVKA-Ⅱ), elevation of GOT and GPT, depression of cholinesterase, and hypergammaglobulinemia. Biopsy of the pubic bone suggested metastasis of hepatocellular carcinoma, whereas no masses were detected by computerized tomographic (CT) scan and ultrasound (US) scan of liver. He underwent 60 Gly of irradiation for bone lesion. Three months later, PIVKA-Ⅱ was increased and US scan of liver showed hypoechoic masses that were clearly enhanced on both CT and MRI. This is an extremely rare case with hepatocellular carcinoma that manifested with bone metastasis and elevation of PIVKA-Ⅱ before detectable liver mass. 1997-06-29T15:00:00Z http://hdl.handle.net/10564/373 タイトル: グルコースクランプ法でインスリン抵抗性の増大が確認された筋緊張性ジストロフィーの1例 著者: 辻本, 伸麸; 金内, 雅夫; 尾崎, 博基; 木村, 俊明; 藤井, 謙裕; 土肥, 和紘; 村田, 顕也; 高柳, 哲也 抄録: We report a case of myotonic dystrophy with diabetes mellitus. A 37-year -old man was admitted for further examination of liver dysfunction, diabetes mellitus, and myotonic dystrophy. His father, his mother and his sister had been previously diagnosed as having myotonic dystrophy. He had been mentally retarded since childhood, and suffered from muscle weakness and hardness of hearing. He was diagnosed as having bilateral cataracts at the age of 30, when loss of hair gradually started to be noticed. Physical examination revealed atrophy of bilateral sternocleidomastoid muscles and muscle weak- ness. Laboratory investigations showed hyperlipidemia, liver dysfunction, hyperglycemia and primary hypogonadism. ECG showed lst degree of AV block, EMG myotonic discharge dominantly in distal side. The microscopic findings of muscle biopsy showed hypertrophy of muscle fibers, predominantly in type 1 fibers. These findings were compatible with the diagnosis of myotonic dystrophy. DNA analysis of this patient showed an abnormal band of 6.2 Kb and 3.6 Kb (control; 3.4Kb). His glucose infusion rate by the glucose clamp technique was decreased to about 6.0 mg/kg/min (normal range : 8.9±1.1). We discuss the pathogenesis of insulin resistance in patients with myotonic dystrophy based on relevant studies published in the literature. 1997-06-29T15:00:00Z http://hdl.handle.net/10564/372 タイトル: 高度の問質病変を示した非ネフローゼ型巣状糸球体硬化症の1例 著者: 尾崎, 博基; 金内, 雅夫; 藤井, 謙裕; 西野, 俊彦; 椎木, 英夫; 土肥, 和紘 抄録: A 24-year-old man with primary focal segmental glomerulosclerosis (FSGS) with severe tubulo-interstitial change is reported. He was first noticed to have proteinuria on an annual medical checkup at his school in June, 1986. He was referred to our hospital for evaluation of proteinuria. The laboratory tests revealed moderate proteinuria (1.8 g/day) and normal renal function. The renal biopsy showed mild mesan- gial proliferative glomerulonephritis with mild tubulo-interstitial change. As his renal function gradually declined, the second biopsy was performed in November, 1990. Tubulo -interstitial change got worse compared to the first biopsy. Because creatinine clearance was gradually decreasing (57ml/min in July 1993), the third biopsy was performed. The biopsy specimen contained 12 glomeruli, of which only one showed segmental sclerosis. Then a diagnosis of idiopathic focal segmental glomerulosclerosis was made 7 years after manifestation of proteinuria. This case suggests that in FSGS tubulo-interstitial change advances more conspicuously than glomeruli do, and that it takes long duration to make a diagnosis. 1997-06-29T15:00:00Z http://hdl.handle.net/10564/371 タイトル: IMMUNOGLOBULIN A NEPHROPATHY ASSOCIATED WITH DIABETES MELLITUS : A SUMMARY OF 10 CASES AND REVIEW OF LITERATURE 著者: Kanauchi, Masao; Kawano, Takahiro; Uyama, Hideto; Iwano, Masayuki; Shiiki, Hideo; Fujii, Yoshihiro; Dohi, Kazuhiro 抄録: Case reports of 10 patients with IgA nephropathy associated with diabetes mellitus are presented. The clinical characteristics of each of the patients are summarized. We determined the incidence of IgA nephropathy in a total of 313 patients with diabetes mellitus who underwent renal biopsy between 1982 and 1996 : it was 3.2% for the group of all diabetic patients, and 10.8% for diabetic patients with overt proteinuria. Clinicopath- ologic features of IgA nephropathy observed in diabetic patients are discussed in the context of a review of the literature. 1997-06-29T15:00:00Z