[Plasma exchange in the treatment of myasthenia gravis].
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Biomedical subjects
Publications and source records attributed to H Nishitani.
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In order to study the prognosis of Graves' disease, 236 patients, who had been diagnosed as having had Graves' disease more than 10 years before, were examined. Although one patient had died of leukemia and 2 patients had been operated on for breast cancer after 131I therapy, and another 6 patients had died between the ages of 20 and 50, the patients were doing quite well. Generally, the prognosis of Graves' disease is not considered to be serious if the thyroid function is controlled. Among the 72 patients who had been treated with 131I therapy, 15 patients (21%) showed low serum levels of both T3 and T4 and were considered to be suffering from late-onset hypothyroidism. About 67% of the 131I-treated patients were considered to be almost euthyroid, but serum TSH levels were high in half of them, suggesting latent hypothyroidism. The incidence of hypertension seemed to be significantly higher in the TSH-elevated euthyroid group compared with the TSH-nonelevated patients. An excessive reaction of the hypothalamus and/or pituitary gland might have an unfavorable effect not only on the apparent hypothyroidism, but also on the latent hypothyroidism after the therapy for Graves' disease.
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Gm typing and acetylcholine receptor antibody assay were performed on serum samples from 74 patients with myasthenia gravis (31 male, 43 female) and from 236 unrelated normal blood-donors. The haplotype Gm1,2,21 was significantly more common in patients with myasthenia gravis (relative risk = 3.24), especially those with thymoma (relative risk = 6.99). The frequency of haplotype Gm1,2,21 was further increased in patients with severe generalised myasthenia gravis (relative risk = 10.52). The frequency of Gm1,2,21 was also increased in patients with high acetylcholine receptor antibody titres (greater than 5 pmol/ml). The results indicate the presence of a pathogenic gene close to the IgG heavy-chain gene complex in the 6th chromosome in the patients with myasthenia gravis, especially those with thymoma.
A case of afferent loop syndrome demonstrated by computed tomography (CT) is described. To our knowledge, no CT findings of this syndrome have been illustrated in the literature. This syndrome can be definitely diagnosed by CT when a U-shaped cystic mass continuous with the biliary system is demonstrated behind the superior mesenteric artery.
To elucidate the nature of beta-endorphin-like immunoreactivity in human cerebrospinal fluid (CSF) and its relationship with plasma beta-endorphin, plasma and CSF specimens were obtained simultaneously. Gel chromatography revealed that beta-endorphin-like immunoreactivity in CSF consisted of two components with elution positions compatible to those of beta-endorphin and beta-lipotropin (beta-LPH), respectively, and an additional larger molecule. The beta-endorphin level in CSF obtained from four nonendocrine patients was 17.9 +/- 2.3 pg/ml (mean +/- SE) and corresponded to 20% of beta-endorphin-like immunoreactivity. The predominant componet in CSF was either beta-LPH or the larger molecule. beta-Endorphin levels in CSF were consistently higher than those in plasma, and there seemed to be no relationship between them. One patient with Nelson's syndrome had a CSF beta-endorphin level of 14.8 pg/ml, although the plasma level was 784 pg/ml. On the other hand, one patient under glucocorticoid treatment had a CSF beta-endorphin level of 13.0 pg/ml and an undetectably low plasma level. It is concluded that 1) beta-endorphin-like immunoreactivity consists of beta-endorphin, beta-LPH, and possibly the precursor molecule; and 2) there exists marked dissociation between plasma and CSF beta-endorphin levels, suggesting the possible central nervous system origin of beta-endorphin in CSF.
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Serum samples from 100 patients with myasthenia gravis, 322 with Graves' disease, 113 with Hashimoto's disease, 132 with systemic lupus erythematosus (SLE), 192 with insulin-dependent juvenile diabetes mellitus, 83 with Behçet's syndrome, 73 with psoriasis vulgaris, 258 with leprosy, 112 with Duchenne progressive muscular dystrophy and 343 non-related normal controls were studied for Gm allotypes. The incidence of Gm phenotypes with Gm(2) was significantly increased in patients with myasthenia gravis. Graves' disease, Hashimoto's disease, and high in SLE patients. The Gm1,2,21 haplotype was increased in patients with myasthenia gravis (chi 2 = 34 . 08, corrected P less than 0 . 001), Hashimoto's disease (chi 2 = 12 . 39, corrected P less than 0 . 05), Graves' disease (chi 2 = 8 . 65, corrected P less than 0 . 05), and SLE (chi 2 = 6 . 41, 0 . 1 greater than corrected P greater than 0 . 05). The total chi-square for the four different Gm haplotypes was significantly increased in patients with myasthenia gravis (chi 2 = 44 . 46, corrected P less than 0 . 001), SLE (chi 2 = 20 . 70, corrected P less than 0 . 005), Hashimoto's disease (chi 2 = 17 . 03, corrected P less than 0 . 025), and Graves' disease (chi 2 = 11 . 87, corrected P less than 0 . 025). Our data suggest the presence of Gm-associated pathogenic polygenes in certain autoimmune disorders.
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Both serum cholylglycine (CG) and sulfolithocholylglycine (SLCG) levels were radioimmunoassayed by PEG method in 209 samples (204 hepatobiliary diseases, 5 normal controls). 1) The results revealed that serum bile acid levels were excellent indicators for hepatic dysfunction in comparison with the conventional liver function tests. 2) Means of 19.4 +/- 9.3 microgram/dl for CG and 21.7 +/- 6.7 microgram/dl for SLCG were obtained in controls. Most hepatobiliary diseases demonstrated abnormally high bile acid levels, with extremely high CG values in conditions with bile stasis. 3) To differentiate various hepatobiliary diseases more clearly, the ratio of the primary and secondary bile acids (CG/SLCG ratio) was introduced (1.0 +/- 0.6 for controls). In cases of bile stasis, CG/SLCG ratios ranged from 7.8 +/- 4.8 for intrahepatic cholestasis to 34.8 +/- 27.6 for congenital biliary atresia, while other hepatic disorders demonstrated relatively low values. We conclude that the CG/SLCG ratio is a useful index for cholestasis. Diagnosis of the congenital biliary atresia could be possible.
An asymptomatic, posterior mediastinal mass first appeared in a routine chest X-ray film of a 43-year-old woman. Computed tomography (CT) permitted the diagnosis of intrathoracic kidney to be advanced. Intravenous urography confirmed the CT diagnosis.
Non-infected urine samples of twenty six preoperative bladder cancers were examined by urinary CEA radioimmunoassay and exfoliative cytology. There were 65% of urinary CEA positivity and 58% of cytological positivity (class III, IV, V). CEA measurements were positive in 8 of 11 negative cytology cases (class I and II). Exfoliative cytological examination failed to detect most of well differentiated transitional cell carcinomas, while urinary CEA study detected 4 of 6 such cases. Combination of both urinary CEA measurement and cytology resulted in 85% of positivity. Therefore we recommend routine use of this combination as a screening system of bladder cancer.