We present a 70-year-old man with gastric carcinoma developing multiple metastasis in skeletal muscle. He had a right supraclavicular lymph node swelling. Brain, chest and abdomen CT scans revealed ...metastatic lesions in the brain, lung, liver and bilateral adrenal glands. Further, CT showed a ring enhanced soft-tissue mass in the left lumbar muscle. Needle aspirate of the mass in both the left lumbar muscle and the right enlarged supraclavicular lymph node revealed cells suggestive of poorly differentiated adenocarcinoma. Upper gastrointestinal endoscopic evaluation demonstrated an advanced gastric carcinoma. Two months after admission, the tumor in the left lumbar muscle had grown and some new lesions in the left iliopsoas muscles appeared. Intramuscular metastasis from gastric carcinoma is an extremely rare phenomenon.
A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of ...acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with α-glucosidase inhibitors.
During the influenza epidemic of 1998-1999, we observed two elderly patients with influenza-like symptoms who had evidence of acute myositis with elevated serum enzymes. Influenza A infection was ...confirmed serologically in either case. The present cases suggest that it is important to distinguish influenzal myositis from other forms of myopathy in the elderly patients.
To examine the relationship between the concentrations of urinary NAG and age, we measured ratios of urinary N-acetyl-β-D-glucosaminidase (NAG) to urinary creatinine (NAG index) in 137 healthy ...subjects, aged from 19 to 88 years. The study is also designed to evaluate the relationship between urinary NAG and blood pressure. The subjects were divided into 7 subgroups, according to their age (<30, 30-39, 40-49, 50-59, 60-69, 70-79, 80 or more years). There was a positive correlation between NAG index and age (r=0.36 ; P<0.001). The regression equation relating NAG index (y) to age (x) was y=0.065x+0.97. The mean NAG indexes for the 7 subgroups divided by age were significantly different (P<0.01). There was a positive correlation between NAG index and systolic blood pressure (r=0.18 ; P<0.05), but was not between diastolic blood pressure and NAG index. In multiple regression analysis, age and BUN significantly correlated with NAG index (r=0.32 ; P<0.01, r=3.3 ; P=0.07, respectively), although there was no correlation between systolic blood pressure and NAG index. This cross-sectional study showed a clear elevation in NAG index with age. The rate of elevation was 0.65 per decade. Urinary excretion of NAG may be unrelated to blood pressure. (J Nippon Med Sch 1999 ; 66 : 33-36)
During the influenza epidemic of 1998-1999, we observed two elderly patients with influenza-like symptoms who had evidence of acute myositis with elevated serum enzymes. Influ-enza A infection was ...confirmed serologically in either case. The present cases suggest that it is important to distinguish influenzal myositis from other forms of myopathy in the elderly patients. (J Nippon Med Sch 2000： 67： 126-129)
We present a 70-year-old man with gastric carcinoma developing multiple metastasis in skeletal muscle. He had a right supraclavicular lymph node swelling Brain, chest and abdomen CT scans revealed ...metastatic lesions in the brain, lung, liver and bilateral adrenal glands. Further, CT showed a ring enhanced soft-tissue mass in the left lumbar muscle Needle aspirate of the mass in both the left lumbar muscle and the right enlarged supraclavicular lymph node revealed cells suggestive of poorly differentiated adenocarcinoma Upper gastrointestinal endoscopic evaluation demonstrated an advanced gastric carcinoma Two months after admission, the tumor in the left lumbar muscle had grown and some new lesions in the left iliopsoas muscles appeared Intramuscular metastasis from gastric carcinoma is an extremely rare phenomenon.
To clarify the influence of elevated serum lipoprotein (a) (Lp (a)) concentration on ischemic heart disease (IHD) and the perforating artery occlusion type of cerebral infarction (CI) in elderly ...patients with type 2 diabetes, we measured the serum levels of Lp(a) of type 2 diabetic patients (n=158, 81 men and 77 women). The group was followed up prospectively for 4 years and the incidence of IHD or CI was monitored. The diagnosis of CI was confirmed by computed tomography and that of IHD, which includes myocardial infarction and angina pectoris, was diagnosed by electrocardiogram and blood chemistry examination. Lp (a) concentrations of 20mg/dl or more were identified as elevated Lp (a) levels and Lp (a) concentrations of less than 20mg/dl were identified as normal Lp (a) levels. A Kaplan-Meier survival analysis (log-rank test) assessed the time to event rate stratified by an Lp (a) cutoff point of 20mg/dl. The predictive value for CI or IHD events was assessed by multiple logistic regression analysis. The probability of IHD events was significantly higher in the elevated Lp (a) group than in the normal Lp (a) group without a history of IHD but was similar in the two groups for those patients with a history of IHD. There was no significant difference between the elevated Lp (a) group and the normal Lp (a) group with regard to CI events in patients without a history of CI and with a history of CI. On multiple logistic regression analysis, Lp (a), hyperlipidemia and a history of IHD were significant predictors of IHD and hypertension, hyperlipidemia and a history of CI were significant predictors of CI. These results show that elevated serum Lp (a) concentrations is an independent risk factor for IHD, but not for the perforating artery occlusion type of CI in type 2 elderly diabetic patients.
A 70-year-old woman was referred to our hospital for treatment of cholelithiasis. A giant liver cyst (6cm in diameter) had been diagnosed three years earlier. On admission, she had low grade fever ...and hepatomegaly. High values were observed for WBC (9900/μl), CRP (8.9mg/dl), GPT (45IU/l), ALP (1399IU/l), γ-GTP (333IU/l) and LAP (249IU/l). The diagnosis of infected liver cyst (8cm in diameter) was made based on contrast-enhanced CT scan. Endoscopic retrograde cholangiopancreaticography showed no communication between the cyst and the intrahepatic bile duct. She was successfully managed with antibiotics and discharged without percutaneous aspiration the cyst. On abdominal CT scan 4 months after the discharge, the liver cyst had decreased dramatically in size (1cm in diameter). The patient remains healthy without symptoms.
PDF
