Etsuko Maeshima

Massive gastrointestinal hemorrhage in a case of amyloidosis secondary to rheumatoid arthritis.

A case of a 60-year-old woman with secondary gastrointestinal amyloidosis to rheumatoid arthritis is reported. Biopsy findings in the mucosa of the stomach and lower gastrointestinal tract revealed amyloidosis. Endoscopic examination of the lower gastrointestinal tract revealed multiple nodular elevations. The patient showed massive melena. Emergency angiography was performed and an extravasation was found at branches of the jejunal artery. Embolization was performed and this lead to a good prognosis. Patients with massive hemorrhages following gastrointestinal amyloidosis generally have a poorer prognosis. Embolotherapy performed for the present case might represent an effective therapeutic method for gastrointestinal hemorrhage in gastrointestinal amyloidosis.

Successful pregnancy and delivery in a case of systemic lupus erythematosus treated with immunoadsorption therapy and cyclosporin A.

A 32-year-old woman diagnosed as systemic lupus erythematosus (SLE) became pregnant. During pregnancy she was treated with a daily dosage of prednisolone 15 mg. However, because the exanthema became worse, she was hospitalized on January 14, 1997 in order to receive immunoadsorption therapy. Before delivery we implemented the immunoadsorption therapy twice and cyclosporin A (CsA) was administered simultaneously. She gave birth in her 37th week. The baby weighed 2260 g at the time of delivery and had no deformities. The mother also had no side effects. The success of pregnancy and childbirth in our case, without any side effects, shows the possibility that the combination of CsA and immunoadsorption therapy may be considered safe to control a pregnancy complicated by SLE.

A screening test for capsaicin-stimulated salivary flow using filter paper: a study for diagnosis of hyposalivation with a complaint of dry mouth

OBJECTIVE The purpose of this study was to develop a simple screening technique for diagnosis of hyposalivation with dry mouth by estimation of capsaicin-stimulated salivary flow using filter paper. STUDY DESIGN An assay system comprising 5 spots containing starch and potassium iodide on filter paper incorporating or without capsaicin and a coloring reagent was designed. We investigated whether the number of colored spots using the filter paper incorporating capsaicin could distinguish between healthy subjects and subjects with hyposalivation and dry mouth. RESULTS In the healthy group (>200 μL/min; n = 33), the capsaicin-stimulated salivary flow significantly increased as compared with the resting salivary flow, from 1.2 ± 1.4 to 2.9 ± 1.3 colored spots (P < .05). In contrast, the hyposalivation group with dry mouth (<100 μL/min; n = 32) hardly changed (4.4 ± 1.0 vs 4.9 ± 0.2), except for 3 subjects who had considerable elevated secretion on capsaicin stimulation. CONCLUSION By measuring resting and stimulated salivary flows, this method should be useful for evaluating retained functional ability of salivary glands and screening of hyposalivation with dry mouth.

Portal vein thrombosis in a patient with hepatitis C virus-related cirrhosis complicated with antiphospholipid syndrome

We report a rare case of portal vein thrombosis (PVT) associated with antiphospholipid syndrome (APS) and hepatitis C virus-related cirrhosis. A 59-year-old woman with hepatitis C virus (HCV) infection was admitted because of coma. The blood test showed a typically cirrhosis pattern including an elevated serum ammonia level. Abdominal computed tomography showed liver cirrhosis and thrombus in the right branch of the portal vein. To elucidate the cause of PVT, antiphospholipid antibodies were examined. Both IgG anti-cardiolipin antibody (ELISA) and IgG anti-cardiolipin-β2 -glycoprotein I complex antibody (ELISA) were positive. When PVT is detected in a patient with cirrhosis, it might be necessary to examine antiphospholipid antibodies to clarify the cause of PVT.

Progressive systemic sclerosis-polymyositis overlap syndrome with eosinophilic pleural effusion

Pleural fluid rarely occurs in patients with progressive systemic sclerosis (PSS) or polymyositis (PM) with no lesions in the pulmonary area. Pleural fluids in patients with autoimmune diseases are mostly dominated by monocytes and lymphocytes but very rarely contain increased eosinophils. We report a 55-year-old male with PSS-PM overlap syndrome and eosinophilic pleural effusion. Air invasion into the pleural cavity and the antituberculous therapy could be ruled out as causes for the patients eosinophilic pleural effusion, because the differential eosinophil count was already as high as 19% from the first thoracentesis before the start of antituberculous therapy. Infections and malignant tumor also were unlikely causes based upon the negative pleural fluid results and the negative pleural biopsy findings, except for nonspecific inflammation. After the administration of corticosteroid, the pleural effusion decreased promptly, with normalization of serum creatine phosphokinase and C-reactive protein concentrations.

Fever and leucopenia with steroids

A 29-year-old woman was diagnosed with systemic lupus erythematosus in 1986 because she had butterfly erythema, lupus nephritis, pancytopenia, high anti-DNA antibodies, and the presence of anti-nuclear antibodies (ANA). Her family history and previous medical history were unremarkable. She had no history of drug allergies. In February, 1997, she developed fever and butterfly erythema after a cold. Because of associated high ANA titres, high antibodies to double stranded (ds) DNA, and raised complement she was admitted to hospital. At the time of admission, she was taking oral prednisolone, 10 mg per day. On admission, she was alert, with a temperature of 37·5oC and butterfly erythema. There were multiple painless ulcers on her soft palate, and multiple ulcers on the tips of her toes. She had no abnormal neurological findings. Her erythrocyte sedimentation rate (ESR) was 48 mm/h. Her red-cell count, haemoglobin concentration, and packed cell volume were 4·08 10/L, 106 g/L, and 0·33, respectively. White blood cell count (WBC) was 1·7 10/L, and platelet count 143 10/L. She had no abnormal findings on biochemical examination of blood. Urinary protein was mildly increased to 152 mg/24 h. An assay for C-reactive protein (CRP) was negative (<4·0 mg/L). CH50, C3, and C4 concentrations were 13·3 U/mL, 42 mg/dL, and 7 mg/dL, respectively, and there was hypocomplementaemia. ANA titre, DNA antibody titre, single stranded (ss) DNA antibodies, and ds-DNA antibodies were more than 2560 (peripheral pattern), more than 2560, more than 800 AU/mL, and more than 400 AU/mL, respectively. Assay for CL 2-GPI antibody was negative ( 1·2 U/mL). Immune complex concentration (C1q method) was mildly raised at 3·7 mg/mL (normal range: <3·0 g/mL). Treatment with 60 mg per day of prednisolone sodium succinate was started on the day after admission. Her fever resolved, and the butterfly erythema improved. On the 12th day in hospital she developed a fever of 38–39oC (figure). Because of low WBC, low CH50, and high DNA antibodies, pulse therapy with methylprednisolone sodium succinate was given. Her fever resolved. After the pulse therapy was stopped and prednisolone resumed at a dose of 60 mg per day, her fever recurred. A second course of pulse therapy was given. Despite treatment with immunoadsorption and cyclosporine A (CsA), her fever continued. Her WBC decreased to 1·3 10/L. Resistance to corticosteroids or an allergic reaction was suspected. She was given paramethasone on day 49 in hospital, and she was discharged on June 27, 1997. A drug lymphocyte stimulation test (DLST) was positive for prednisolone and methylprednisolone, but negative for paramethasone. This patient repeatedly developed fever and severe leucopenia during treatment with prednisolone and methylprednisolone. She was presumed to be allergic to these corticosteroids because, when they were replaced with paramethasone, the fever resolved and the leucopenia improved, and a DLST was positive for both

A simple test for salivary gland function measuring resting and stimulated submandibular and sublingual secretions

OBJECTIVE This study examined the application of a simple screening test for salivary gland function by measuring resting and stimulated submandibular and sublingual secretions. STUDY DESIGN An assay system was designed to use filter paper incorporating the chromophore of melanoidin or stimuli such as capsaicin and citric acid. We investigated the relationship between resting and stimulated secretions and melanoidin migration at 2 minutes for healthy and dry mouth groups. RESULTS The healthy group showed a significant increase in the migration of melanoidin in the paper after citric acid or capsaicin stimulation. In contrast, patients with Sjögren syndrome showed no significant migration in spite of the stimulation. However, some participants with Sjögren syndrome or dry mouth showed a significant increase in the migration of melanoidin after stimulation. CONCLUSIONS These results show that the newly developed method should be useful for evaluation of residual salivary gland function and screening for hyposalivation with dry mouth.

Behçet's disease complicated by IgA nephropathy and interstitial nephritis

A 46-year-old man presenting with pharyngodynia and fever was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, without initial improvement. Conjunctival injection in the left eye appeared soon thereafter, followed by an ulcer on the glans penis 2 weeks later. On admission to our hospital, his urine was positive for protein and occult blood. Multiple folliculitis-like eruptions were noted over the lumbar region to the abdomen. Based on these mucocutaneous symptoms and a positive reaction for HLA-B51 antigen, a diagnosis of Behçets disease was made. Renal biopsy revealed IgA nephropathy and interstitial nephritis. Urinary and other symptoms were alleviated with continued anti-inflammatory therapy. A lymphocyte stimulation test was performed to determine whether there was any relationship of the interstitial nephritis to drugs used in his treatment (ciprofloxacin, cefazolin sodium, or the NSAIDs), but results were not conclusive. Behçets disease complicated by nephropathy, notably interstitial nephritis, is rare; this valuable experience is now reported.

Cognitive function in middle-aged and older adults participating in synchronized swimming-exercise

[Purpose] The purpose of the present study was to examine cognitive function in middle-aged and older adults regularly engaging in synchronized swimming-exercise. [Subjects and Methods] Twenty-three female synchronized swimmers ranging in age from 49 to 85 years were recruited for the present study. The duration of synchronized swimming experience ranged from 1 to 39 years. The control group consisted of 36 age- and gender-matched community-dwelling middle-aged and older adults (age range: 49 to 77 years). Cognitive function was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and compared between the synchronized swimmers and control participants. [Results] No significant differences in mean total MoCA-J scores were observed between the synchronized swimmers and control participants (23.2 ± 3.1 and 22.2 ± 3.6, respectively). Twenty-nine subjects in the control group and 17 in the synchronized swimming group scored below 26 on the MoCA-J, indicative of mild cognitive impairment. Significant differences in delayed recall—but not in visuospatial/executive function, naming, attention, language, abstraction, or orientation—were also observed between the two groups. [Conclusion] The results of the present study suggest that synchronized swimming has beneficial effects on cognitive function, particularly with regard to recent memory.

Influence of detraining on temporal changes in arterial stiffness in endurance athletes: a prospective study.

[Purpose] We examined the effects of detraining on temporal changes in arterial stiffness in endurance athletes. [Subjects] Eighteen female university athletes requiring high endurance exercise capabilities were classified into 2 groups: 10 retired players (detraining group) and 8 active players (training group). [Methods] Brachial-ankle pulse wave velocity, an index of arterial stiffness, was measured a total of 6 times: immediately before retirement of the detraining group and at 1, 2, 3, 6, and 12 months after retirement. [Results] Brachial-ankle pulse wave velocity was measured in the training group at the same 6 points to allow comparison with the detraining group. The brachial-ankle pulse wave velocity in the detraining group increased significantly at 3 and 12 months as compared with that at 0 months and showed a significant increase at 12 months compared with that at 1 month. Moreover, the brachial-ankle pulse wave velocity in the detraining group was significantly higher at 3, 6, and 12 months than in the training group. [Conclusion] These results revealed that detraining may result in increased arterial stiffness from 3 months onward in endurance athletes.