Objective We compared brain perfusion image using 3D-SSP analysis of ¹²³I-IMP SPECT between Parkinson's disease patients with auditory verbal hallucination and those without auditory hallucination.
Methods Eighty-three cases with Parkinson's disease were studied. In 6 of these patients, auditory hallucination was noted. Among them, four cases had verbal hallucination and two other cases had elementary hallucination. Auditory hallucination was not found in the other 77 cases.
Results Right thalamic perfusion was significantly increased in the verbal hallucination group compared to the group that lacked auditory hallucination.
Conclusion In Parkinson's disease, the right thalamic hyperactive state may be related to verbal hallucination.

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Objective To examine whether or not individuals with a normal body mass index (BMI) (18.5 kg/m²-24.9 kg/m²), but who also fulfill the criteria for the metabolic syndrome (MetS) class, can be associated with carotid atherosclerosis.
Methods The subjects were consecutive in-patients with a normal BMI (18.5 kg/m²-24.9 kg/m²) in the Medical Department of Seiyo Municipal Nomura Hospital enrolled between September 1996 and February 2006. The subjects were 452 men aged 69±15 (mean±standard deviation) years and 542 women aged 74±13 years. Carotid atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography.
Results Compared with men with BMI 18.5 kg/m² to 20.9 kg/m², the odds ratios of the MetS were 2.83 (95% confidence interval [CI], 1.69-4.76) for men with BMI 21 kg/m² to 22.9 kg/m² and 6.13 (95% CI, 3.57-10.5) for men with BMI 23.0 kg/m² to 24.9 kg/m² after controlling for age, smoking status, high low-density lipoprotein cholesterol, and uric acid. Using the same regression model and BMI categories in women, the odds ratios were 2.52 (95% CI, 1.42-2.83) and 4.38 (95% CI, 2.42-7.92), respectively. Multivariate-adjusted carotid IMT was significantly greater in men with than without MetS, especially in patients with BMI 23.0 kg/m² to 24.9 kg/m². Although in women, there were no inter-group differences in categories of normal BMI and MetS.
Conclusion Individuals in the upper normal BMI range have a relatively high prevalence and are at increased risk of having metabolic syndrome. Therefore, screening of individuals with normal or slightly elevated BMI is important in preventing atherosclerosis.

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We report a 67-year-old man who presented with sudden onset of pain in the left flank in association with anemia and hypotension. Imaging studies revealed hepatocellular carcinoma (HCC) at the right lobe of the liver with bilateral adrenal metastases and recent hemorrhage in the left adrenal gland. His serology for hepatitis C was positive. Abdominal exploration with left adrenalectomy was performed. The postoperative course of the patient was uneventful and three cycles of transarterial chemoembolization (TACE) were administered. His general condition gradually deteriorated, and he died 6 months after surgery. Spontaneous massive AH due to metastatic HCC is unusual. Considering the high incidence of HCC in Asia, clinicians should be aware of this atypical and fatal presentation.

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Two cases of primary gastric T-cell lymphoma associated with human T lymphotropic virus type 1 (HTLV-1) are presented. Case 1 was a 54-year-old man who had multiple ulcerating tumors in the lower corpus and gastric antrum. Case 2, a 60-year-old man, showed a large ulcerating tumor in the upper corpus. Both patients were positive for serum anti-HTLV-1 antibody and for the monoclonal integration of HTLV-1 proviral DNA in the tumor cells by Southern blot analysis. The patients were thus diagnosed as having primary gastric T-cell lymphoma associated with HTLV-1 of stage II₁. Case 1 underwent total gastrectomy followed by chemotherapy, while Case 2 was treated by chemotherapy and radiotherapy. Both patients have been in complete remission for more than 4 years (96 months in Case 1 and 50 months in Case 2) after the treatments. Although primary gastric T-cell lymphomas associated with HTLV-1 is characterized by an extremely poor prognosis, the present cases suggest that in the early stage, long-term survival can possibly be achieved with appropriate treatments.

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Cases with proximal pulmonary artery aneurysm (PAA) sometimes have severe complications. We report 4 cases of proximal PAA complicated by pulmonary hypertension. Three cases had proximal PAA and one had both proximal and peripheral PAA. Complications associated with proximal PAA are compression of the bronchus, dissection and/or rupture of the pulmonary artery, and thrombus of the pulmonary artery. The available medical treatments have limitations. Two of our patients with proximal PAA are awaiting lung transplantation.

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We present a case of pleural effusion with encapsulation that was observed in the right thorax of a patient. PCR analysis of the patient's pleural effusion showed positivity for Mycobacterium tuberculosis. After six months, his chest CT showed the development of niveau and pulmonary consolidation. We definitively diagnosed him as having chronic pulmonary tuberculosis with tuberculous empyema drainage. At the time of his hospital admission, his serum carcinoembryonic antigen (CEA) level was elevated. After we started treatment using antituberculosis drugs, the infiltration shadow in his lung fields disappeared, and the serum CEA level decreased. The results suggest that the serum CEA level reflects the extent of the development of pulmonary tuberculosis lesions.

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Adenoid cystic carcinoma arising from the peripheral lung is rare. Here, we describe adenoid cystic carcinoma that developed in the peripherally in S⁹ of the right lower lobe of an 84-year-old woman. Cell blocks prepared from the bronchial wash specimens exhibited the cribriform formation. An immunohistochemical examination of the surgically resected tumor revealed positive thyroid transcription factor-1 and c-kit staining. Exons 9 and 11 of c-kit in tumor cells were not mutated. We compared the clinical features of this patient with those of 10 others described in the English-language literature.

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A 29-year-old woman was admitted to our hospital because of hemoptysis and dyspnea. A chest radiographic study revealed an enlargement of the right lung hilum, and the left pulmonary artery could not be clearly visualized on contrast-enhanced CT scan. Both perfusion scintigraphy and pulmonary angiography confirmed the absence of the left pulmonary artery, and agenesis of the right upper pulmonary artery. Her clinical status has been stable for the previous two years of follow-up, even though she required long-term oxygen therapy. This is a rare case of a young woman with the unilateral absence of the left pulmonary artery incidentally found after an episode of hemoptysis.

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We report a patient with rheumatoid arthritis (RA) who showed bicytopenia with hyperferritinemia and hepatic dysfunction ascribable to hemophagocytic syndrome (HPS) 2 weeks after commencement of bucillamine. Pathology of the bone marrow showing infiltration of macrophages confirmed the diagnosis of HPS. On the basis of renal dysfunction with an increase in fibrin degradation products, disseminated intravascular coagulation was considered to be concurrent with HPS. Oral prednisolone and cyclosporine A were started right after cessation of bucillamine, and yielded complete normalization of hepatic and renal function and hematology. As there was neither disease activity of RA nor associated infection throughout the clinical course, bucillamine was suspected of being the cause of HPS in our patient. HPS is a very rare complication in RA, but should be actively considered when abnormalities in laboratory data, especially pancytopenia and hepatic dysfunction, quickly worsen.

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We report a patient with Buerger's disease (BD) who showed painful nodular erythema with livedo reticularis as an initial symptom. The patient developed this cutaneous manifestation in both lower extremities, and a skin biopsy demonstrated perivascular infiltration of mononuclear cells in the border zone between the dermis and subcutaneous tissue. Both nodular erythema and livedo reticularis were successfully treated with oral prednisolone, but both feet developed necrosis with ulcerations and had to be amputated 1.5 years later because of acute gangrene. Histopathology of the amputated tissue showed acute inflammation and multiple thrombi with recanalization in the posterior tibial arteries, leading to a diagnosis of BD. This disease should be considered as a possible diagnosis in refractory patients with nodular erythema and livedo reticularis, particularly when ulcerations and necrosis rapidly worsen.

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