http://hdl.handle.net/10564/1530 1999-04 2026-04-10T15:42:04Z http://hdl.handle.net/10564/509 タイトル: PRIMARY SYSTEMIC AMYLOIDOSIS PRESENTING WITH SEVERE HYPERLIPIDEMIA : A CASE REPORT 著者: Mizuno, Reiko; Fujimoto, Shinichi; Hashimoto, Toshio; Nishino, Toshihiko; Shiiki, Hideo; Nakano, Hiroshi; Dohi, Kazuhiro 抄録: Primary systemic amyloidosis with severe hyperlipidemia, suspected to be secondary to hepatic involvement, is described. A 48-year-old man was admitted with pretibial edema and abdominal fullness. Laboratory data showed severe hyperlipidemia with lipoprotein X and nephrotic syndrome. Based on biopsy findings of the kidney and liver, he was diagnosed with primary systemic amyloidosis. Hyperlipidemia in this patient was too severe to result only from nephrotic syndrome. Moreover, with lipoprotein X present, we suggest that hepatic amyloidosis can be a cause of severe hyperlipidemia in primary systemic amyloidosis. 1999-04-29T15:00:00Z http://hdl.handle.net/10564/508 タイトル: インスリン依存型糖尿病を高齢で発症したⅢA型多腺性自己免疫疾患の1例 著者: 大江, 厚; 西浦, 公章; 川野, 貴弘; 金内, 雅夫; 土肥, 和紘 抄録: We report a rare case of insulin-dependent diabetes mellitus (IDDM) with chronic thyroiditis with elderly onset in a 72-year-old woman. Chronic thyroiditis was pointed out when she was 68 years old, and she was admitted to our hbspital because of hyperglycemia following a cold in February of 1998. Laboratory data on admission were as follows : fasting blood glucose, 417 mg/dl ; HbA₁🇨, 11.3% ; and glycoalbumin, 43.1%. High titer of anti-thyroglobulin antibody (60.6 U/ml) and anti-thyroid peroxydase anti- body (over 30.0 U/ml) was observed. Both anti-glutamic acid decarboxylase (GAD) antibody and islet cell antibody (ICA) were negative. She was diagnosed as having IDDM because urinary CPR was 4.1 μg/day, and insulin secretion was not induced with glucagon loading test. She was positive for HLA-A 24 and DR 9 which are typically present in IDDM patients. Polyglandular autoimmune disease is known to be a multiple endocrine gland disorder which is induced by autoimmune pathogenesis. This case is included in type ⅢA polyglandular autoimmune disease. It has been also reported that DR 9 was increased in type ⅢA polyglandular autoimmune disease. 1999-04-29T15:00:00Z http://hdl.handle.net/10564/507 タイトル: A CASE OF BILATERAL HIPPOCAMPAL ATROPHY AND CORTICAL DISTURBANCE OF THE BRAIN AFTER CARDIOPULMONARY RESUSCITATION 著者: Imanishi, Masami; Tabuse, Hisayuki; Miyamoto, Seiji; Sakaki, Toshisuke; Iwasaki, Satoru 抄録: The brain is the most vulnerable organ to ischemia, and the basal ganglia, cerebral cortex, hippocampus, and cerebellum are the areas most vulnerable to whole brain ischemia due to sudden cardiopulmonary arrest. Moreover, delayed neuronal death has been reported to occur in the hippocampus. We report here a case of a 50-year-old man, who was transferred to our department in sudden cardiopulmonary arrest caused by acute heart failure hypertrophic cardiomyopathy. He received cardiopulmonary resuscitation, and spontaneous circulation was restored. However, he fell into a persistent vegetative state. Disturbance of the cerebral cortex and atrophy of the hippocampus bilaterally were observed on MR imaging. Hypoperfusion in the cerebral cortex was observed on SPECT. The atrophy of the hippocampus bilaterally was believed to be caused by delayed neuronal death after whole brain ischemia. We consider that the comprehensive disturbance of the cerebral cortex was caused not only by the whole brain ischemia but also by disturbance of the intracranial venous circulation due to chest compression and increased intracranial pressure (thoracic pump theory). 1999-04-29T15:00:00Z http://hdl.handle.net/10564/506 タイトル: 骨盤部CTが術前診断に有用であった閉鎖孔ヘルニアの2例 著者: 櫻井, 伸也; 池中, 康英; 竹内, 洋司; 松下, 和広; 佐藤, 由美子; 諏訪, 好信; 松本, 真; 栗山, 茂樹; 岸田, 秀樹; 東野, 正; 玉川, 泰浩; 岡本, 新悟; 福井, 博; 松本, 宗明; 桜井, 隆久 抄録: Although obturator hernia is a relatively rare disease, it has been reported that the disease usually occurs in aged thin women who have experienced multiple deliveries. Patients with obturator hernia do not usually complain of severe abdominal pain due to Richter's hernia, resulting in delayed diagnosis and high mortality rates. We recently experienced two cases of obturator hernia diagnosed preoperatively by pelvic computed tomography (CT). Two women aged 87 and 77 years were admitted to our hospital due to vomiting and diagnosed immediately as ileus by abdominal X-ray examination. Because they did not complain of severe abdominal pain and no peritoneal irritation signs such as the Blumberg's sign and muscular defence were observed, they were treated conservatively by inserting a long tube. Ileus, however, did not improve despite the treatment. Pelvic CT was performed 5 and 6 days after the insertion of a long tube on the former case and the latter case, respectively. Pelvic CT clearly revealed the incarcerated intestine in the right obturator foramen in both cases, resulting in the preoperative diagnosis of obturator hernia. Upon operation obturator hernia was repaired and the hernia opening was closed. Although excision of the small intestine was required in both cases, they made satisfactory progress after the operation. It is not easy to make a definite diagnosis of obturator hernia and the resultant delay in diagnosis contributes to a high mortality rate of obturator hernia. Therefore, in the treatment of aged women presenting ileus, it is important to take obturator hernia into consideration. Furthermore, it should be noted that pelvic CT is very useful for early diagnosis of obturator hernia. 1999-04-29T15:00:00Z