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A 52-year-old female came to this institution complaining of a right leg mass lesion. Ultrasonography showed a 16 x 12 x 20mm hypoechoic solid mass lesion in the right leg. The patient underwent surgery during the diagnosis of Schwannoma. Preoperative diagnosis of Schwannoma is difficult by examination. Computerized tomography and magnetic resonance imaging, showed the origin of Schwannoma. However, the lesion was noted to be in a direct continuity with the cord-like echogenic structure consistent with a nerve by echography. We prefer to conduct preoperative examination by ultrasonography in patients with Schwannoma. In conclusion, we have reported a case of Schwannoma diagnosed by non-invasive ultrasonography.

We propose that carcinoembryonic antigen (CEA) may be a tumor marker for prostatic cancer in addition to prostate specific antigen (PSA), gamma-seminoprotein and prostate acid phosphatase (PAP). The tests were done on 15 sera and autopsy specimens of prostatic cancer. Eight of them were clinical cancers and the remaining seven were incidental ones. We measured serum PAP, PSA, CEA and CA 19-9 and immunohistochemically evaluated these specimens. In clinical cancers, serum PAP, PSA, CEA and CA 19-9 were 1272.9 +/- 3094.4, 146.7 +/- 233.6, 36.3 +/- 36.0 and 80.4 +/- 92.0. Immunohistochemically, all were positive for PAP, PSA, CEA and CA 19-9. In incidental cancers, serum PAP, PSA, CEA and CA 19-9 were 2.4 +/- 1.5, 7.9 +/- 16.9, 128.1 +/- 182.7 and 201.8 +/- 416.1. We conclude that the patients with higher levels of plasma PAP or PSA should go through CEA and CA 19-9 measurement in order to diagnose clinical prostatic cancer.

A 38-year-old Japanese male without any significant respiratory risk factors was admitted to our hospital because of an acute onset of fulminant pneumonia refractory to intravenous antibiotics administration and an unexplained creatine kinase elevation. He was intubated and under ventilator support on the second hospital day, but responded dramatically to i.v. pulse methylprednisone treatment. After exclusion of secondary etiologies including collagen diseases, we concluded this case as a probable acute (idiopathic) interstitial pneumonia, or Hamman-Rich syndrome, responding dramatically to the corticosteroid pulse administration.

In order to establish the age-adjusted standard values of lipids in both sexes in Japan, we examined the plasma levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride levels in 1262 healthy Japanese subjects (male 616, female 646). LDL-cholesterol levels in women increased significantly in relation to menopause as it rises from 112 mg/dL in 40 year olds to 131.2 mg/dL in 50 year olds. Menopause seems to affect the triglyceride levels as well. These age- and sex-dependent changes should be considered in evaluation of patients' lipid profiles.

We report a successful resection of an inflammatory aneurysm following treatment with steroids in a 23-year-old man. Suffering from fever and severe lumbago, he was admitted to our hospital. An ultrasound and computed tomography of the abdomen revealed an infrarenal abdominal aortic aneurysm surrounded by dense perianeurysmal fibrous tissue. We diagnosed it as an inflammatory abdominal aortic aneurysm based on a symptomatic inflammatory reaction and the findings of ultrasound and computed tomography. Since the aneurysmal wall strongly adhered to the surrounding tissues and surgery was ruled out when it proved impossible to expose the vessels sufficiently to obtain vascular control, steroid therapy was started to control fever and severe lumbago. Five months later, we undertook surgery. Our conclusion is that steroid therapy was very effective against a young patient with inflammatory abdominal aortic aneurysm.

The urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) was evaluated in terms of its ability to predict renal failure following open-heart surgery. Twenty-two patients were divided into three groups; 6 patients with post-operative renal failure (RF group), 9 without renal failure (non-RF group) and 7 who underwent non-cardiac surgery (non-ECC group). NAG levels during operation were significantly higher in the non-RF group than in the non-ECC group (2.28 +/- 0.50 U vs. 0.39 +/- 0.06 U, p < 0.01). NAG levels in the RF group were not significantly different from those in the non-ECC group (1.12 +/- 0.28 U/hr vs. 0.39 +/- 0.06 U/hr, p > 0.1), and in the non-RF group (1.12 +/- 0.28 U/hr vs. 2.28 +/- 0.50 U/hr, p > 0.1). Post-operative NAG levels were not significantly different between the RF and non-RF groups, whereas post-operative creatinine clearance values were significantly different (on 2, 6 and 7 post-operative day, p < 0.05). Our data suggest that the kidney is predisposed to renal failure by cardiopulmonary bypass and the chance of renal failure depends in some part on post-operative patient management.

To assess determinants of muscle strength in-patients with hemiplegia, steps were counted using a pedometer. Isokinetic muscle strength and muscle thickness in the lower extremity was compared between 66 hemiplegic patients and 34 healthy male controls. A significant correlation was observed between the number of steps and muscle strength as well as muscle thickness in the lower extremity of the unaffected side. No significant correlation was observed between the number of steps and muscle strength or muscle thickness on the dominant side in healthy subjects. Hemiplegic patients with a low grade of palsy revealed greater muscle strength and muscle thickness in the lower extremity. Walking steps were more numerous than those with source paralysis.

Disseminated intra-vascular coagulation (DIC) is associated with severe bleeding tendency and organ failure, the extent of which is thought to be related to the prognosis of DIC patients. Thrombomodulin (TM) is a high-affinity thrombin receptor on vascular endothelial cells. Clinical importance of soluble TM is still controversy as a diagnostic and prognostic indicator in patients with disseminated intravascular coagulation (DIC). We compared plasma levels of TM with fibrin degradation product (FDP) in patients with DIC through the clinical course. The significant elevation of circulating TM in nonsurvivors with DIC compared with survived patients with DIC(TM 3.1+/-1.52 vs 8.1+/-3.89 FU/ml), as well as FDP (12.9+/-12.12 vs 49.8+/-55.42 microg/ml) but the levels of FDP were not different between the two groups. The measurement of circulating TM was a relatively good prognostic marker of patients with DIC.

We compared the interpretation of an electrocardiogram (ECG) made by computer with that made by physicians in training, as well as with the diagnosis made by cardiologists. ECGs were collected from 1058 Japanese adults (812 men and 246 women, mean age 49 +/- 19 years). With the computer program, the incidence of false-negative reports was 10.5% while that of false-positive reports was 16.5%, when compared with the physician's diagnosis. The incidence of a false-positive diagnosis with the computer was 18 times higher than that found by the physicians in training. The results show the advantages and the limitations in the use of computers for analysis of ECGs.

Cardiomegaly is one of the commonest findings encountered in daily clinical practice, and its differential diagnosis is a common clinical problem. There are many electrocardiological (ECG) criteria known for left ventricular hypertrophy (LVH), but its limitations have also been suggested. We evaluated 102 patients fulfilling the ECG criteria of precordial and limb lead for LVH with echocardiographic findings as a gold standard. Among these 102 patients, the echocardiogram revealed 38 subjects with LVH, 26 subjects with left ventricular dilatation (LVD), 7 subjects with both findings, and 31 subjects with neither findings. Precordial criteria such as SV1+RV5 or RV6 > 30 mm, SV1 or SV2+RV5 > 35 mm, R+S > 40 mm, SV1 or SV2+RV5 or RV6 > 35 mm, SV2+RV4 or RV5 > 35 mm, high in sensitivity and low in specificity for LVD and LVH, are appropriate for screening LVD and LVH. Cornell limb lead criterion, SV3+RaVL > 28 mm (male), SV3+RaVL > 20 mm (female), high in sensitivity and specificity only for LVH, is the best elecrocardiographic criterion to evaluate LVH. Precordial and limb lead criteria such as R> 13 mm, RaVL > 12 mm, RaVF > 20 mm, onset of intrinsicoid deflection in V5 or V6> 0.05 sec, left axis deviation -30 degrees to -90 degrees, low in sensitivity, and high in specificity, are useful to rule out LVH and/or LVD. Our findings suggest LVD and LVH can be evaluated by ECG, but similar sensitivity and specificity for both LVH and LVD makes separation of LVH from LVD unattainable.

We report the unusual case of an 87-year-old woman with cardiac myxoma and adenomatous goiter. She exhibited slight elevations of serum interleukin-6 (IL-6), but levels of thyroid hormones such as T3, free T3 and free T4 were all abnormally low. Interleukin-6 may potentiate the alteration of thyroid metabolism.

Strains of methicillin-resistant Staphylococcus aureus (MRSA) are potential pathogens in patients undergoing major surgery and in patients who are immunocompromised. Some MRSA produce a viscous extracellular slime that may interfere with immune function. In this study, slime formation by MRSA was examined in cases of nosocomial infection by this pathogen at a single hospital. The antibacterial resistance, phage and enterotoxin characteristics of strains isolated from patients with fatal infections were determined. MRSA strains were classified as those associated with fatal infection; causing progressive infection; causing superficial infection; and those isolated from the nasal cavity of the health-care professionals as a control group. The incidence of slime formation was highest in the MRSA associated with fatal infection. The incidence of slime formation in the control group was significantly lower than that in the other groups. Results suggest that slime formation by MRSA may be associated with a more severe infection. Rapid identification of slime-forming MRSA may facilitate the initiation of appropriate treatment and improve the patient's prognosis.

The relationship between the pituitary-thyroid axis and the cardiovascular system in patients with congestive heart failure (CHF) remains unknown. Therefore, we attempted to determine serum levels of thyroid hormones in relation to plasma atrial natriuretic peptide (ANP) levels and left ventricular (LV) function in patients with CHF. The echocardiographic ejection fraction significantly correlated with the thyroid stimulating hormone (TSH) (p < 0.005) and free triiodothyronine (FT3)/free thyroxine (FT4) ratio (p < 0.005), respectively, in patients with CHF but not in control subjects. TSH was positively correlated with the FT3/FT4 ratio (p < 0.01) in CHF. In patients with CHF, TSH and thyroid hormones may participate in regulatory mechanisms of the cardiovascular system and altered thyroid hormone metabolism, which was characterized by a euthyroid sick syndrome.

An activated partial thromboplastin time (APTT) based method was developed to determine the anticoagulant response in patient plasma to added purified activated protein C (APC). On the other hand, Bertina et al. (1994) reported that one point mutation of amino acid 506 in the factor V was observed in such APC resistance patients. APC resistance for blood samples with known abnormal findings on the coagulation test also may be determined. Coagmaster II for the APTT assay system (Sankyo, Tokyo, Japan) was employed. The APC resistance assay system was a useful reagent as a screening test for lupus anticoagulant (LA), in addition to APC resistance.

The serum level of alpha-fetoprotein (AFP) is a marker for primary liver tumors. To evaluate the relationship between the serum level of AFP and the positivity of liver tissue for this marker, specimens of liver were obtained at autopsy from patients with hepatocellular carcinoma (HCC). Tissues were fixed with formalin or Kryofix and immunostained for AFP. Serum AFP titer at autopsy was positively correlated with AFP staining in tissue fixed by Kryofix and stained with monoclonal antibody against AFP. The correlation was significant for plasma levels of AFP above 5,000 ng/ml. Results suggest that elevated serum AFP levels are an indicator of the progression of HCC.

We encountered a 78-year-old female with jaundice induced by Lutembacher's syndrome, which, to our knowledge, is the first such case to be reported. Laboratory data and ultrasonographic examination revealed liver congestion with dilatation of the inferior vena cava and hepatic veins. A large atrial septal defect was found using two-dimensional echocardiography; the mitral valve area measured 1.6 cm2 by planimeter. Clinicians should be aware of congenital heart disease as an underlying cause of jaundice.

We report an autopsy case of a central nervous system (CNS) B-cell type lymphoma followed by cardiac tamponade. In this case, lymphoma cells which occurred primarily in the pericardium appear to metastasize to the brain and gradually increase in size in spite of control of the CNS lesion. The serum carbohydrate antigen 125 (CA 125) level was highly elevated and the autopsy findings showed the involvement of lymphoma only in the pericardium rather than the CNS, and the pericardium, not the tumor cells, was immunohistochemically positive for CA 125. Through this rare case, two things are suggested: first, the serum CA 125 level is elevated when B-cell type lymphoma infiltrates the coelomic epithelium; second, CA 125 is overproduced and secreted by the pericardium but not the lymphoma cells. Measurement of the serum CA 125 level may become a diagnostic marker for the infiltration of malignant lymphoma in the coelomic epithelium such as the pericardium, peritoneum or pleura.

Atrial natriuretic peptide (ANP) may be an important factor in myocardial infarction and subsequent congestive heart failure. In the failing heart, ANP is expressed in both the atrium and the ventricle. ANP has now been localized with 125I-labeled monoclonal antibodies (MAbs) in vivo in a rat model of myocardial infarction. Myocardial infarction was produced in 3-month-old Wistar rats by ligating the left anterior coronary artery. Two MAbs to rat alpha-ANP accumulated in the infarcted left ventricles of treated rats to a significantly greater extent (p < 0.01) than in the noninfarcted left ventricles of control rats. However, an irrelevant MAb also accumulated to a significantly greater extent in infarcted myocardium than in control myocardium. Thus, the accumulation of the two MAbs to ANP in infarcted tissue seems to be nonspecific and may be due to increased permeability of the injured myocardium.

Enteroviral myocarditis is often a relatively benign condition in adults. Physicians, therefore, may not always record detailed clinical and laboratory data in such patients. As such, they may not recognize viral involvement in organs beyond the heart. The purpose of this study was to examine the hepatic involvement of enteroviral peri-myocarditis and to compare the other diseases with congestive heart failure. We analyzed 18 patients (ages 15-64) who were diagnosed as having enteroviral myocarditis (n = 16) or pericarditis (n = 2). Serology was positive for coxsackie viruses in 11 patients and echoviruses in six patients. A diagnosis of hepatic involvement was made by the following laboratory data: rising levels of alanine amino transferase (ALT), aspartate amino transferase (AST) and exceeded serum ALT compared with AST levels. A ratio of ALT/AST more than 1.0 was greatly frequent in patients with peri-myocarditis (72%; 13/18) compared with acute myocardial infarction (0%; 0/10) and idiopathic dilated cardiomyopathy (3%; 3/10). In summary, hepatic involvement in the setting of acute enteroviral peri-myocarditis may be considerably more common in adults than previously suspected. The recognition of hepatic involvement in association with enteroviral peri-myocarditis may allow improvement of diagnostic sensitivity and alter approaches to treatments of acute viral myocarditis.

The increasingly long survival of cancer patients raises the question whether there might be an association between myocardial infarction (MI) and different types of cancer, especially since these different diseases share some of the same risk factors, like smoking. We describe a retrospective study in which we examined the autopsied hearts of 1642 cancer patients to determine the incidence of MI in different types of cancer and then studied the records of 106 of these cancer patients with complicated of fatal MI to determine their risk factors. The incidence of MI among the 1642 cancer patients was 6.5%. It was significantly higher in patients with squamous cell type cancers of the lung, head and neck, and urothelial tract cancer as compared with other types of cancers. The major coronary artery disease (CAD) risk factors in these patients were smoking, hypertension and left ventricular hypertrophy. Before therapy begins, cancer patients, especially those with squamous-cell-type cancer, should be screened for CAD risk factors, such as smoking, hypertension and left ventricular hypertrophy, and treated accordingly.

We determined the serum concentration of interleukin-8 (IL-8) in patients with chronic sarcoidosis and assessed its value as a marker of disease activity. The serum concentrations of IL-8 and tumor necrosis factor-alpha (TNF-alpha) were determined by enzyme-linked immunosorbent assays. Serum angiotensin-converting enzyme (ACE) activity was measured by a colorimetric assay in 16 patients with chronic sarcoidosis. Thirteen of the 16 patients with chronic sarcoidosis showed a serum IL-8 concentration higher than the normal range. The mean (+/- S. E.) serum IL-8 concentration in patients with active sarcoidosis (n = 6) was 18.7 +/- 1.3 pg/mL and that in patients with inactive sarcoidosis (n = 10) was 8.0 +/- 1.1 pg/mL; the difference was statistically significant (p = 0.002). An overall positive correlation between serum IL-8 concentration and serum ACE activity was apparent; however, only four of the 16 patients with sarcoidosis had a serum ACE activity greater than the normal range. TNF-alpha was detected in the serum of only two patients. The serum concentration of IL-8 may prove a useful marker for monitoring disease activity in sarcoidosis, especially in the chronic stage.

A 56-year-old Japanese male patient with Down's syndrome was bitten by a hepatitis B envelope antigen (HBeAg) carrier and become an asymptomatic HBeAg carrier without seroconversion. His mitogen response of T cells was poor compared with that of healthy controls. An impaired T cell response to hepatitis B virus infection may be responsible for the HBeAg carrier with Down's syndrome.

The combination of an atrial septal defect (ASD) and constrictive pericarditis (CP) is rare and difficult to diagnose, since the signs of ASD may be masked by those of CP. We report a patient in whom the diagnosis was made by color Doppler echocardiography and magnetic resonance imaging (MRI), and confirmed by cardiac catheterization. Open heart surgery was successfully performed to close the defect.