Iron and copper are essential transition metals that permit the facile transfer of electrons in a series of critical biochemical pathways. Recent work has identified the specific proteins involved in the absorption, transport, utilization, and storage of iron and copper. Remarkable progress is being made in understanding the molecular basis of disorders of human iron and copper metabolism. This review describes these proteins and examines the clinical consequences of new insights into the pathophysiology of genetic abnormalities affecting iron and copper metabolisms. Hereditary hemochromatosis is the most common genetic disorder of iron metabolism caused by mutations in the HFE gene. Aceruloplasminemia is a rare iron metabolic disorder that results from deficiency of ceruloplasmin ferroxidase activity as a consequence of mutations in the ceruloplasmin gene. Menkes disease and Wilson's disease are inherited disorders of copper metabolism resulting from the absence or dysfunction of homologous copper-transporting ATPases.
(Internal Medicine 41: 762-769, 2002)

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Recent progress in molecular biology has led to the identification of numerous molecular targets of cancer chemotherapy, and the strategies for new drug discovery have concentrated on target-based screening. In the development of target-based drugs, translational research is considered to be essential. In this review, the definition of translational research is clearly explained, and the points of misunderstanding of Japanese researchers are discussed and resolved. The primary goal of translational research is to integrate the advanced informations of molecular biology in moving forward from phase I and II trials to phase III trials of target-based drugs.
(Internal Medicine 41: 770-773, 2002)

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Objective Inflammatory liver damage and viral persistence after hepatitis C virus (HCV) infection are known to be related in host immunity. Suplatast tosilate is an immunomodulator that selectively inhibits type 2 cytokine production by helper T cells. We investigated the efficacy and safety of the administration of suplatast tosilate for patients with HCV infection by examining the level of serum alanine aminotransferase (ALT) and viremia.
Patients and Methods Thirty-eight patients who had shown resistance to Ursodeoxycholic acid (UDCA) therapy (600 mg/day tid) over 6 months for HCV-related chronic liver disease were randomized into two groups and received UDCA alone (600 mg/day tid) or UDCA (600 mg/day tid) plus suplatast tosilate (300 mg/day tid) by means of sealed envelopes.
Results After 24 weeks, serum ALT was decreased in the patients receiving UDCA plus suplatast tosilate, with the mean reduction being 40.2% (from 132 to 79 IU/l; p=0.001). In the patients receiving UDCA alone, ALT decreased by 8.3% (from 133 to 122 IU/l; ns). Multiple comparison of individual ALT changes showed that the UDCA plus suplatast tosilate achieved significantly greater improvement (p=0.001). However, serum HCV RNA was unchanged in both groups. Two patients developed adverse reactions to suplatast tosilate, which resolved promptly after the discontinuation of the therapy.
Conclusion These findings suggest that suplatast tosilate promotes biochemical improvement in the patients with chronic hepatitis C.
(Internal Medicine 41: 774-779, 2002)

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Objective Serological antibody test have been widely performed to detect the presence of H. pylori, but they have not been used to evaluate the status of H. pylori after eradication. In this study we evaluated the diagnostic accuracy of a new serological test kit (E-plate) after eradication.>Method Eradication of H. pylori was performed in 100 patients by proton pump inhibitor (PPI)+amoxicillin (AMPC)+clarithromycin (CAM) or PPI+AMPC therapy. Evaluation of H. pylori was done by culture, histology and rapid urease test before, and 8 weeks after, the treatment. Serological tests were also performed before and after treatment using the E plate. Cure was defined as no evidence of H. pylori at 8 weeks after the treatment. Receiver operating characteristic (ROC) analysis was performed to determine the ideal cut-off value for percentage change in the serological test.
Result Success was obtained in 73 patients, failure in 20 patients and there were 7 dropouts. Serological test value was significantly decreased after treatment (44.3±29.6 U/ml) compared to before treatment (94.8±73.2 U/ml) in the successful cases. In contrast, those with no significant change after treatment (62.7±31.3 U/ml) compared to before treatment (72.9±47.7 U/ml) were considered as failure cases. ROC analysis revealed that cut-off values of a 20%, 30%, and 40% decrease on E plate result yielded a sensitivity of 95.5%, 92.4%, 71.2% and a specificity of 73.3%, 84.2%, 94.7%, respectively.
Conclusion The new E plate serological test kit for H. pylori was useful for distinguishing success from failure 8 weeks after completion of eradication therapy for H. pylori.
(Internal Medicine 41: 780-783, 2002)

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Objective We examined the usefulness and the problems of epoprostenol (Epo) therapy in adult Japanese with primary pulmonary hypertension (PPH).
Subjects and Methods In eleven cases with PPH, both acute and chronic effects, and clinical effects of Epo were assessed.
Results In the acute challenge test (n=6), Epo reduced both systemic and pulmonary vascular resistance and increased the cardiac output, but did not change the ratio of pulmonary to systemic vascular resistance, while the systemic and pulmonary blood pressure also did not change. In the chronic study (n=9), Epo decreased the pulmonary blood pressure without changes in systemic blood pressure, and increased the cardiac output. Both systemic and pulmonary vascular resistance decreased with a decrease in the ratio of the pulmonary to systemic vascular resistance. The level of brain natriuretic peptide and atrial natriuretic peptide, NYHA functional class and 6-minute walking distance were improved by Epo therapy. In spite of Epo therapy, two patients did not improve and died. Another patient improved in terms of symptoms but then died suddenly from massive lung bleeding. Two patients who improved physically could not be discharged because of psychiatric problems. One patient underwent lung transplantation. Five out-patients have been continuing Epo therapy.
Conclusion We demonstrated that the chronic effect of Epo treatment is sufficient even at the dose used in our hospital. However, it was shown that there was resistance to this therapy in some of the cases and that we should pay attention to the severe adverse effects of Epo.
(Internal Medicine 41: 784-788, 2002)

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Objective In this study, clinical findings were evaluated in 16 patients with reversible left ventricular dysfunction (RLVD) who showed a clinical picture similar to that of acute myocardial infarction, in addition to akinesis or dyskinesis of the left ventricular apex without showing any abnormalities in the coronary artery.
Results The frequency of RLVD was markedly higher in women than in men in these 16 patients (men:women=l:7). In addition, these patients showed ECG changes similar to those observed in ischemic heart diseases, such as ST elevation or depression, negative T waves and QT prolongation. However, the serum cardiac markers were only slightly increased, and no specific changes were detected by histological examinations of the heart muscle.
Conclusion These patients also showed a clinical picture similar to the stunned myocardium caused by myocardial ischemia. However, the frequency of RLVD was higher in women than in men compared to the frequency of other coronary artery diseases, and there was no severe stenosis in the coronary artery. Moreover, most of these patients showed negative results for the coronary spasm provocation test. Therefore, RLVD may be an atypical ischemic heart disease if it is caused by coronary arteriosclerosis. Since RLVD developed during the course of other diseases or under severe mental stress, autonomic nerves may be involved in the etiology of RLVD. Furthermore, 2 patients who received the coronary spasm provocation test during the acute phase showed positive results. Therefore, other factors that transiently increase the sensitivity of the coronary artery may also be involved in the etiology of RLVD.
(Internal Medicine 41: 789-792, 2002)

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Objective The acute effects of the angiotensin II receptor antagonist losartan on uric acid and oxypurine metabolism were evaluated.
Methods Losartan (50 mg) was administered orally to 6 healthy males. Blood and urine samples for uric acid and oxypurine were collected before and up to 6 hours after losartan administration. The same examinations were performed later using enalapril (5 mg).
Results Losartan decreased the serum uric acid concentration (from 5.9±0.9 to 5.2±1.0 mg/dl) and increased its fractional clearance, which reached a maximum after 2 hours, while enalapril did not. Losartan also induced an increase in the plasma concentration of hypoxanthine, peaking in the fourth hour, and a decrease in its urinary clearance, while the plasma xanthine concentration and its urinary clearance were unchanged. The extent of uric acid excretion was much greater than that of the oxypurines.
Conclusions Losartan, which has a high affinity for the urate/anion exchanger, has a transient uricosuric effect. Our data indicate that losartan induces a significant decrease in the urinary excretion of hypoxanthine without changes in xanthine.
(Internal Medicine 41: 793-797, 2002)

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Objective To evaluate osteoporosis in asthmatic patients.
Methods Bone mineral density (BMD) was measured using three different methods, namely computed X-ray densitometry (CXD), digital image processing (DIP), and dual energy X-ray absorptiometry (DXA). The BMD data were standardized using the sex- and age-matched mean value of BMD.
Patients One hundred and twenty-eight patients with persistent asthma.
Results The standardized BMD expressed as Z-score in asthmatic patients was significantly lower than the norm (Z-score -0.48±1.17, mean±SD). In patients who had been continuously treated with oral corticosteroids (OCS), the standardized BMD was significantly lower than that in patients treated without OCS. In addition, the standardized BMD in patients 60 years and over (Z-score -0.71±1.10, mean±SD, n=58) had decreased to a greater extent than the decrease seen in patients under 60 years (Z-score -0.30±1.21, n=70). Moreover, BMD in these older patients decreased after a 6- month treatment protocol involving the use of an inhaled corticosteroid, fluticasone propionate (FP). During the 6 months, the treatment did not affect BMD in patients who were receiving FP for the first time. Although the BMD did not decrease in patients treated with FP without OCS, the BMD in patients treated with both FP and OCS decreased during the 6 months.
Conclusion These results indicate that the continuous administration of OCS in patients with severe persistent asthma, particularly in older patients, may affect BMD in the short term even at a low OCS dose.
(Internal Medicine 41: 798-804, 2002)

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Objectives To compare the effect of respiratory muscle stretch gymnastics (RMSG), proposed as a possible additional form of rehabilitation for patients with chronic obstructive pulmonary disease (COPD), with that of inspiratory muscle training (IMT).
Patients Twelve naive outpatients with COPD at a university hospital.
Method The patients performed IMT (2 sessions of 10 minutes of training at 30% of PImax, daily) for 4 weeks and RMSG (3 sessions of 5 RMSG patterns 4 times each, daily) for 4 weeks, in randomized order, with a 4-week washout period between the two interventions.
Measurements and Results PImax increased with IMT (mean 66.1 to 79.1 cmH₂O), but not with RMSG (mean 66.0 to 69.4 cmH₂O). RMSG and IMT similarly increased maximum chest wall expansion. FRC was significantly decreased by 158 ml with RMSG, but not with IMT. There were no significant changes in VC, FEV₁, or PEF nor in arterial blood gases with either form of rehabilitation. Six-minute walking distance was more significantly increased with RMSG (mean 383 to 430 m), than with IMT (mean 386 to 412 m).
Conclusions RMSG may have clinically significant benefits, which may be somewhat different from the benefits of IMT, in patients with COPD.
(Internal Medicine 41: 805-812, 2002)

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Objectives Monocyte chemoattractant protein (MCP)-1 and macrophage inflammatory protein (MIP)-1α exhibit chemotactic activity toward macrophages/monocytes and induce the production of inflammatory cytokines affecting granuloma formation. Recently, a single nucleotide polymorphism (SNP) in the MCP-1 distal regulatory region and a dinucleotide repeat in the MIP-1A gene promoter region were identified. We investigated the relationships between the polymorphisms and susceptibility to sarcoidosis, clinical manifestations, and BALF findings of sarcoidosis.
Methods The polymorphisms of the MCP-1 and MIP-1A genes in 118 patients with sarcoidosis and 145 healthy control subjects were examined. The MCP-1 polymorphism was genotyped by a PCR-restriction fragment length polymorphism method and the MIP-1A genotype was determined using PCR.
Results No significant difference in the genotype distribution or in the allele frequency between the patients and control subjects was observed. We found no relationship between the polymorphisms and the serum ACE level, organ involvement, roentgenographic stages, or deterioration in chest radiographs during the follow-up. A significant difference in the absolute counts of AMs in BALF of 51 patients among the genotypes of the MCP-1 gene was found (p=0.048). The AM counts in BALF of the G/A and G/G genotypes were significantly increased compared with that of the A/A genotype (p<0.05).
Conclusion The polymorphisms of the MCP-1 and MIP-1A genes do not play a substantial role in genetic predis-position for sarcoidosis or in clinical manifestations of sarcoidosis in this Japanese population. The MCP-1 SNP might be related to the recruitment of monocytes/macrophages to the alveolar spaces in sarcoidosis.
(Internal Medicine 41: 813-818, 2002)

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Objective Correlation between current perception threshold and sympathetic skin response was investigated in patients with diabetic or alcoholic polyneuropathy.
Methods Current perception threshold was measured using Neurometer CPT/C, and the sympathetic skin response was measured using Neuropack Σ.
Patients Fourteen patients with diabetic polyneuropathy and 10 patients with alcoholic polyneuropathy were studied.
Results There was a significant negative correlation between the current perception threshold to 5 Hz stimulation and the amplitude of sympathetic skin response.
Conclusion Since both current perception threshold to 5 Hz stimulation and sympathetic skin response are related to C fibers, these two are considered to be impaired concurrently in diabetic and alcoholic polyneuropathies.
(Internal Medicine 41: 819-822, 2002)

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Objective We sought to establish an association between sporadic Alzheimer's disease (AD) and presenilin 1 (PSEN1) gene polymorphisms in the Japanese population.
Methods A 5 kb fragment containing the putative promoter of the PSENl gene for randomly selected control subjects was subcloned into plasmid and sequenced to screen novel polymorphisms in this region. Patients and controls were genotyped for five polymorphic markers in the PSEN1 region. We then constructed haplotypes using the computer program HAPLO and compared the frequencies between cases and controls.
Subjects A total of 189 AD cases (NINCDS-ADRDA criteria) and 240 controls were studied.
Results We discovered a novel polymorphism with high heterozygosity on -4, 752 of the PSEN1 promoter region. A significant association was observed between the -4, 752 C/T polymorphism and late-onset AD. The odds ratio for AD associated with the CC vs non-CC genotype was 1.59 (95% CI=1.01-2.51), while that of ε 4 vs non-ε 4 in APOE gene was 4.41 (95% CI=2.72-7.16). The C allele was associated with a further increase in the risk of AD in APOE ε 4 carriers. We found 12 major haplotypes using five polymorphisms. The distribution pattern was significantly different between cases and controls.
Conclusion The PSEN1 gene -4, 752 C/T polymorphism modifies the risk for AD.
(Internal Medicine 41: 823-828, 2002)

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A 69-year-old man with a history of transient chest pain was diagnosed takotsubo cardiomyopathy. In I-123-β-metyliodophenyl pentadecanoic acid myocardial scintigraphy, decreased uptake of apex was seen in the acute phase, and it recovered in 3 months. In I-123-meta-iodobenzyl-guanidine myocardial scintigraphy, decreased uptake of apex persisted for 6 months, and there was a discrepancy between apical and total washout rate in the acute phase and after 3 months, which disappeared after 6 months. We speculate that the discrepancy of sympathetic innervation between the apical and basal region is the cause of the characteristic left ventricular apical akinesia of takotsubo cardiomyopathy.
(Internal Medicine 41: 829-833, 2002)

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We report a case of cerebral hemorrhagic infarction after radiation for pituitary adenoma. A 55-year-old woman was hospitalized to check for aldosteronism, post-operative pituitary function, and recurrence of thyroid cancer. She had short-term memory disturbance beginning two months prior to admission. Brain MRI showed a T1 and T2 high intensity lesion of her left anterolateral thalamus. Brain MRA revealed a narrowing in her left middle cerebral artery. The abnormal brain lesion was diagnosed as cerebral hemorrhagic infarction. She had received radiation therapy for pituitary adenoma 20 years earlier. It was considered that her cerebral hemorrhagic infarction was caused by radiation therapy.
(Internal Medicine 41: 834-838, 2002)

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A 76-year-old woman suffered from somnolence while fasting for almost 2 years. Fasting plasma glucose (FPG) (40 mg/dl) and the immunoreactive insulin (IRI) level (8.8 μU/ml) were not compatible with Fajan's ratio or Turner's ratio observed in typical insulinoma. The secretin test showed no response to insulin secretion, suggesting the presence of insulinoma. Abdominal dynamic computed tomography (CT) revealed a 12-mm hypervascular lesion in the head of the pancreas. A selective arterial calcium infusion test (SACI) was performed, during which IRI in the hepatic venous blood was measured following selective intraarterial calcium infusion. An increase in IRI levels in the gastroduodenal and superior mesenteric arteries suggested the presence of a functional insulinoma in the head of the pancreas. Enucleation of the tumor improved FPG and IRI levels to 138 mg/dl and 3.8 μU/ml, respectively. After surgery, a secretin test showed a 5-fold increase in IRI levels, suggesting normal β cell function. This case illustrates the value of the secretin test for the diagnosis of insulinoma and for the postoperative assessment of β cell function. It further illustrates the value of the SACI for localizing an insulinoma.
(Internal Medicine 41: 839-841, 2002)

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We report a case of Klinefelter's syndrome in a 48-year-old man who had diabetes mellitus associated with severe insulin resistance. We diagnosed him with Klinefelter's syndrome from his atrophic testicles, primary hypogonadism in hormonal examination, and a chromosomal aberration of 47, XXY. He showed severe decreased insulin sensitivity in a hyper-insulinemic euglycemic clamp test. He had injected over 100 units of insulin per day, however, testosterone replacement and administration of pioglitazone improved his glycemic control, which resulted in a decrease of insulin dose to less than 50 units per day. Here, we discuss the characteristics of diabetes mellitus associated with Klinefelter's syndrome in Japanese patients including this case.
(Internal Medicine 41: 842-847, 2002)

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A 52-year-old woman with early-onset diabetes mellitus, severe diabetic retinopathy, and a family history of a dominant inheritance pattern was referred to our hospital. Direct sequencing revealed a novel mutation in the HNF-4α gene (R244Q). The position of the mutation in the aminoacid sequence of the gene is well conserved among species and transcriptional activity of the mutant gene was significantly reduced. Therefore, a diagnosis of maturity-onset diabetes of the young (MODY)-1 was made. Genetic testing enabled early diagnosis of diabetes in the patient's 20-year-old daughter, which we consider to be important for the prevention of diabetic complications.
(Internal Medicine 41: 848-852, 2002)

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A 78-year-old Japanese man was admitted with a complaint of slight fever and weight loss. At admission, he tested positive for myeloperoxidase (MPO)-ANCA and had renal failure. An abdominal angiography revealed atrophy of the right kidney, two or more arteriovenous fistulae (AVF) in the right renal interlobular arteries, and multiple ancurysms in both kidneys. A renal biopsy specimen showed diffuse crescentic glomerulonephritis accompanied by tubulo-interstitial changes. This case suggests the possibility of some relationship between ANCA-associated vasculitides and the formation of aneurysms and AVFs.
(Internal Medicine 41: 853-858, 2002)

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A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted DNA of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.
(Intrenal Medicine 41: 859-863, 2002)

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A 33-year-old woman was referred from an outside dialysis clinic to our hospital because of severe abdominal pain during hemodialysis. She had been on chronic hemodialysis for the past 11 years due to chronic glomerulonephritis. Nafamostat mesilate was used as an anticoagulant for hemodialysis, because it was during her menstrual period with hypermenorrhea. On admission, she had no abdominal pain or gynecological abnormalities. On the second day, she had similar abdominal pain during hemodialysis with nafamostat mesilate in our dialysis unit. The abdominal pain disappeared within 60 minutes after discontinuing the hemodialysis. We re-started dialysis using heparin instead of nafamostat mesilate and she had no symptoms. The titer of total immunoglobulin E was high. The drug lymphocyte stimulation test was positive for nafamostat mesilate and antigen specific immunoglobulin E to nafamostat mesilate was highly positive in her blood. Although an allergic reaction to nafamostat mesilate is a rare complication, it should be one of the differential diagnoses of abdominal pain occurring during hemodialysis.
(Internal Medicine 41: 864-866, 2002)

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Nonspecific interstitial pneumonia/fibrosis (NSIP) was first described by Katzenstein and Fiorelli in 1994 (Am J Surg Pathol 18:136-147). Many reports have described that corticosteroids are effective for NSIP. We describe a case of group II idiopathic NSIP in whom cyclophosphamide was administered since the initial response to corticosteroids had been insufficient. Lung biopsy was performed by video-assisted thoracoscopic surgery and NSIP was diagnosed pathologically, clinically and radiologically. Although the initial response to corticosteroids was insufficient, interstitial infiltrates on chest computed tomography improved dramatically after adding intravenous cyclophosphamide followed by oral cyclophosphamide. This case demonstrates that the addition of cyclophosphamide to corticosteroids might be a useful treatment for patients with NSIP.
(Internal Medicine 41: 867-870, 2002)

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When a 63-year-old man was hospitalized with nephrotic syndrome due to focal segmental glomerulosclerosis, a mediastinal mass was discovered. A biopsy specimen obtained by mediastinoscopy showed findings compatible with the plasma cell type of Castleman's disease. Fever, anemia, and anti-nuclear antibody were present. Serum concentrations of gamma globulin, acute phase proteins, and, most strikingly, interleukin-6 (IL-6) were elevated. Methylprednisolone pulse therapy resulted in no clinical improvement. Pathologic examination of the resected thymic tumor showed a squamous cell carcinoma immunoreactive for IL6. To our knowledge, this case represents the first reported IL-6-producing thymic squamous cell carcinoma associated with Castleman's disease and nephrotic syndrome.
(Internal Medicine 41: 871-874, 2002)

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A 39-year-old man was admitted to our hospital for further evaluation of a consolidated shadow and clarification of the cause of serum tumor marker elevation (CA19-9 496.2 U/ml, CA125 160.6 U/ml). Chest computed tomography revealed a well-defined homogeneous nodule in the left S¹⁰. Angiography showed one aberrant artery, branching from the ascending aorta. Intralobar pulmonary sequestration was diagnosed and the sequestrated lung was resected. Microscopic findings of the sequestrated lung showed a mucus-containing cystically dilated bronchus, which was covered with ciliated cylindrical epithelium. Immunohistochemical staining showed positive staining for CA19-9 and CA125 in both the ciliated cylindrical epithelium and mucus. Serum values of tumor markers returned to their normal range after surgery.
(Internal Medicine 41: 875-878, 2002)

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A 44-year-old woman was admitted to our hospital in August 1999 for multiple large nodules detected on chest roentgenogram in an annual health check. Chest CT scans showed bilateral large nodules (>10 mm in diameter) with irregular margins and multiple thin walled cystic lesions. From these radiologic examinations, we suspected pulmonary Langerhans cell histiocytosis. Histological examination of the biopsy specimen by video-assisted thoracoscopy revealed a marked proliferation of the spindle cells, which were immunologically positive for alpha-smooth muscle actin and HMB-45, in the cyst walls and lung parenchyma. The large nodules consisted of proliferation of the smooth muscle cells surrounded by a dense layer of hemosiderinladen macrophages. During the two years subsequent to these 1999 examinations, the opacities have gradually diminished and the patient was found to have pulmonary lymphangioleiomyomatosis. This case exhibited rare radiologic manifestations of multiple large nodules mimicking Langerhans cell histiocytosis.
(Internal Medicine 41: 879-882, 2002)

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It is well known that a subgroup of germ cell tumors, embryonal carcinoma of extra-gonadal origin have a poor prognosis. We have encountered five cases of mediastinal embryonal carcinoma treated with high-dose chemotherapy (HD-CT) supported by auto-PBSCT in four, and resection in three. Our cases indicated that normalization of the α-FP tumor marker level during standard chemotherapy is a very important factor for cure, and the resection of the residual mass after chemotherapy is indicated due to the great risk of remnant malignant cells despite HD-CT.
(Internal Medicine 41: 883-888, 2002)

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A 21-year-old man developed rapid progression of tetraplegia, bulbar palsy, and respiratory paralysis after Campylobacter jejuni enteritis. Based on the diagnosis of Guillain-Barré syndrome, he received plasmapheresis and intravenous immunoglobulin. Serum anti-GT1a IgG antibody which lacked cross-reactivity with GQ1b was detected. Four months after the onset, the patient still had severe muscle weakness of the lower limbs. This case suggests that anti-GT1a IgG antibody can be associated with severe paralysis in Guillain-Barré syndrome after C. jejuni enteritis.
(Internal Medicine 41: 889-891, 2002)

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A rare case of polyarteritis associated with a solid tumor is presented. A 66-year-old man was referred to our hospital, because of gangrene in the bilateral fingers and toes, right pleural effusion, and an abnormal sensation in the throat. A diagnosis of polyarteritis was made based on pleuritis, digital gangrene and the arteriography findings. He also had a hypopharyngeal carcinoma. After being treated with intermittent intravenous cyclophosphamide, oral corticosteroid, alprostadil and aspirin, the pleural effusion rapidly disappeared, while the digital gangrene gradually improved. For the treatment of hypopharyngeal carcinoma, radiation therapy was initiated and resulted in complete disappearance.
(Internal Medicine 41: 892-895, 2002)

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A 21-year-old hemophiliac with human immunodeficiency virus (HIV) infection was admitted to our hospital because of bilateral pneumothoraces associated with Pneumocystis carinii pneumonia (PCP). He underwent chest tube drainages and intravenous pentamidine therapy, resulting in clinical improvement. Two months after treatment for PCP, cystic lesions that had existed before treatment disappeared on chest computed tomography. We concluded that Pneumocystis carinii infection might be associated with lung destruction and cyst formation, and that inflammatory exudates in the small bronchioles might act as a ball-valve with subsequent spontaneous pneumothoraces.
(Internal Medicine 41: 896-898, 2002)

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