Objective To determine if EE/CA and EE/CA plus metformin treatment have any effect on adhesion molecules in cases with PCOS.
Methods Among 40 patients diagnosed with PCOS, one study arm was administered EE/CA (n=20, cyproterone acetate 2 mg, ethinylestradiol 35 μg) and the other was administered metformin (1,700 mg) combined with EE/CA (n=20, cyproterone acetate 2 mg, ethinylestradiol 35 μg). Soluble intercellular adhesion molecule-1 (sICAM-1), soluble endothelial leukocyte adhesion molecule-1 (sE-selectin), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble leukocyte endothelial cell adhesion molecule-3 (sP-selectin), lipid profile, androgens, insulin, and HOMA-IR values were assessed prior to treatment and after 3 months of therapy.
Results The comparison of the groups receiving EE/CA and EE/CA+metformin revealed a significant reduction in sVCAM (1,445±614 vs 1,167±482, p<0.05) and sICAM (442±141 vs 345±118, p<0.05) values relative to pre-treatment values while no significant changes were detected in sE-selectin and sP-selectin levels relative to pre-treatment levels in the EE/CA+metformin group (p>0.05). In the post-treatment period, sVCAM, sICAM, sE-selectin values did not significantly change compared to the pre-treatment values in EE/CA group (p>0.05). sP-selectin levels were also decreased but missed the significance in EE/CA group (229.4±68.0 vs 189.6±65.0, p=0.08).
Conclusion These results demonstrate that EE/CA+metformin treatment reduced inflammation markers in cases with PCOS compared to EE/CA treatment. The clinical relevance of this conclusion may be clarified by longer metformin treatment and clinical follow-up.

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Background There is no study examining the relationships between vital capacity and diabetes or metabolic risk factors in lean subjects.
Methods Cross-sectional relationships between % vital capacity (%VC) and diabetes and metabolic risk factors were examined in Japanese subjects using medical check-up data from 2,079 men and 1,215 women. Subjects were divided into lean (BMI <23 kg/m²) and obese (BMI ≥23 kg/m²) groups and then subdivided into lower %VC (≤95%) and higher %VC (≥96%) subgroups by gender. Metabolic risk factors and prevalence of diabetes and MS were compared between the subjects in each group, and then excluding current smokers and between subjects with the lowest quartile of %VC and those with the highest quartile of %VC in the lean men group. Spearman's correlation coefficients between %VC and metabolic risk factors were calculated separately in obese subjects and in lean subjects by gender.
Results The prevalence of diabetes, but not metabolic syndrome, was significantly higher in subjects with the lower %VC than in those with the higher %VC in the lean men despite the fact that age, obesity parameters, systolic and diastolic blood pressures were significantly lower in subjects with the lower %VC than in those with the higher %VC and triglycerides, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, white blood cell count, and heart rate were not significantly different between the two groups.
Conclusion Low vital capacity was significantly associated with diabetes in lean Japanese men despite inverse relationships with metabolic risk factors.

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Objective Rheumatoid arthritis (RA) is associated with numerous pulmonary manifestations. However, the inflammatory mechanism remains undetermined. We studied the features of inflammatory cells in bronchoalveolar lavage (BAL) fluid and biopsy lung tissue from patients with RA-associated lung disease.
Methods BAL findings were statistically compared between diseases. We divided RA patients into two groups, airway lesion group (AW) and interstitial lesion group (INT) according to predominant HRCT findings and compared the BAL findings. We immunohistochemically stained lung tissue for CD4, CD8, CD20, and CD163 and counted the immunopositive cells in five different regions.
Patients Twenty patients fulfilling the Japanese criteria for RA, 13 patients with systemic sclerosis (SSc), and 21 patients with polymyositis and dermatomyositis (PM-DM) with pulmonary disease detected by high-resolution CT (HRCT) were enrolled in this study.
Results As for BAL in RA, we found a lower lymphocyte frequency with higher CD4/8 ratio compared with PM-DM and a higher neutrophil percentage than both PM-DM and SSc. Nine and eleven patients with RA were classified into AW and INT groups, respectively. BAL findings did not differ between the two groups. Immunohistochemically, most CD4⁺ and CD20⁺ lymphocytes were accumulated in lymphoid follicles and in the alveolar wall and T-lymphocytes; in particular CD8⁺ lymphocytes were predominant in lung interstitium.
Conclusion These results suggest that 1) neutrophils may play an important role, 2) the inflammatory mechanism may be similar between airway lesion and interstitial pneumonia, and 3) CD8⁺ lymphocytes may be major inflammatory cells in lung interstitium in RA-associated interstitial lung disease.

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Acetylcholinesterase inhibitors (AChIs) are widely used in the treatment of mild-to-moderate Alzheimer's disease (AD), but their cholinergic effects could generate adverse side effects in the cardiovascular system. This report presents the cases of 2 patients who experienced adverse side effects of cardiac rhythm with QT prolongation caused by Donepezil. Both of them improved to the original rhythm and shortened QT intervals after the discontinuation of Donepezil.
The present cases suggest that the cholinergic effects of Donepezil could induce adverse side effects on cardiac rhythm and careful consideration is needed for the patients treated by Donepezil.

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Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. We report a case of nasocerebral aspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Magnetic resonance imaging (MRI) showed contrast enhancement surrounding the brainstem and cerebellum with intramedullary pontine and cerebellar T2-hyperintense lesions. The patient's symptoms and MRI abnormalities improved after voriconazole and corticosteroid treatment; however, discontinuation of the corticosteroid caused a worsening of the T2-hyperintense lesions, whereas resuming it resulted in its improvement. This suggested that these T2-hyperintense lesions may be due to secondary inflammation caused by aspergillosis and not the aspergillosis itself. We conclude that treatment with a combination of voriconazole and a corticosteroid appears to be effective for the treatment of some patients with CNS aspergillosis.

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Antiphospholipid antibodies (aPL) have been reported to occur in numerous viral infections. We report a 24-year-old Japanese woman, who developed multiple venous thrombosis associated with the elevation of anticardiolipin IgM after acute viral infection presenting a mononucleosis-like illness. Two months later, aPL and thromboses disappeared. In this case both parvovirus B19 and cytomegalovirus antibodies IgM were elevated, which indicated the possibility of cross-reaction.

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The first case was a 68-year-old woman who had acute migratory pain from back to anterior chest and the second case was 66-year-old man with a cardiac tamponade. Two cases were demonstrated with a low density area of the left ventricular postero-lateral wall with conventional contrast-enhanced computed tomography (CE-CT) performed to differentiate the diagnosis of acute coronary syndrome and acute aortic dissection. Subsequent coronary angiograms showed the lesions of left circumflex. These cases of early contrast-defect corresponded to a decreased myocardial blood flow with AMI. CE-CT image facilitated the diagnosis of AMI preceding CAG examination.

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We report an 82-year-old Japanese woman with multiple myeloma (MM). She developed disorientation due to hyperammonemia after melphalan and prednisolone therapy and abruptly died with a rapid clinical course. Karyotypic analysis of bone marrow showed complex abnormalities including a variant Burkitt-type translocation, t(2;8)(p12;q24), but the patient had IgG-λ type M-proteinemia. Although patients with MM associated with hyperammonemia have been sporadically reported and their prognosis is poor, specific chromosomal abnormalities in the lesion have not been well characterized. It is, therefore, important to accumulate such patients to find a possible relationship between hyperammonemia and chromosomal abnormalities.

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A 36-year-old man was admitted to our hospital because of general fatigue and dysphagia. He had experienced progression of thyrotoxic symptoms of weight loss, palpitation and sweating for several months. On admission, he showed thyroid storm associated with dysphagia and aspiration pneumonia. Dysphagia was restored completely with 2 months after intensive treatment with anti-thyroid agent, beta-blocker, potassium iodide and glucocorticoid for thyroid storm. Although dysphagia is an uncommon manifestation, we should keep in mind that dysphagia may be one of symptoms of thyrotoxic myopathy.

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Infective endocarditis is occurring more and more frequently in elderly persons and it has been associated with various clinical, bacteriological, and prognostic features. We present a 63-year-old woman with infective endocarditis which is the first reported case with cerebral hemorrhage, splenic and renal embolisms.

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