Objective High-normal, the intermediate category between normal fasting glucose (NFG) and impaired fasting glucose (IFG), was introduced in the criteria of the disordered glucose metabolism in 2008. The aim of this study was to investigate the risk for future incidence of type 2 diabetes of the subjects with high-normal and to examine how other metabolic variables could be useful for their risk stratification.
Methods A historical cohort study was conducted from 2001 to 2008, inclusive, in 4,165 non-diabetic employees at public schools (2,229 men and 1,936 women; age 45.8±5.9 years, range 25-55 years). They were classified at baseline as NFG with fasting plasma glucose (FPG)<100 mg/dL, high-normal with FPG 100-109 mg/dL, and IFG with FPG 110-125 mg/dL. The incidence of type 2 diabetes (defined either by FPG≥126 mg/dL or by receiving treatments) was measured.
Results The cumulative incidence during a mean follow-up of 5.1 years were 16/3,364 (0.5%), 40/613 (6.5%), and 53/188 (28.2%) in subjects with NFG, high-normal, and IFG, respectively. Multivariate-adjusted odds ratios for the incidence were still significant both in high-normal and IFG compared to NFG. Body mass index (BMI) and alanine aminotransaminase (ALT) were associated with the incidence of type 2 diabetes independently of FPG categories (p<0.05).
Conclusion The future incidence of type 2 diabetes in subjects with high-normal was significantly higher than in those with NFG in this population. BMI and ALT can improve risk stratification in high-normal subjects.

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Background JAK2V617F, a somatic gain-of-function mutation involving the JAK2 tyrosine kinase gene, occurs in nearly all patients with polycythemia vera (PV). JAK2 is also essential in hypothalamo-pituitary-adrenal (HPA) axis system which is known to play a role in subsequent steroid secretion. The purpose of this study was to determine whether or not PV induces subclinical hypercortisolism (SH).
Design Cross-sectional study. In order to compare the prevalence of SH in PV and matched control individuals, we performed a case-controlled study, enrolling 31 PV and 20 age- and body mass index-matched patients.
Methods and Results Adrenal endocrine function was assessed in a cohort of 31 patients with PV. Baseline serum cortisol levels and 2-day 2 mg DST (dexamethasone suppression test, 0.5 mg dexamethasone orally every 6 hours for two days) showed a trend for higher serum cortisol levels in PV patients than in control subjects. Among the 31 patients, 6 had biological abnormality of the hypothalamic-pituitary-adrenal axis and were diagnosed as subclinical hypercortisolism. None of the subjects in the control group exhibited cortisol responses to DST higher than 50 nmol/L.
Discussion In conclusion, a relatively high prevalence of hypercortisolism was found in PV patients. As these observations were in a small cohort of PV, further studies are needed to evaluate HPA axis in PV patients.

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Background To analyze Fetuin-A levels and soluble cellular adhesion molecules in patients with acute coronary syndrome.
Methods and Results Serum Fetuin-A and intercellular adhesion molecule-1 (sICAM-1), vascular cellular adhesion molecule-1 (sVCAM-1) levels were examined in 127 patients who presented with chest pain. These patients were classified in three groups: stable angina (SA, n=51), myocardial infarction (MI, n=34) and non-cardiac group (n=42). Logarithmic transformations were made for Fetuin-A levels. Log-Fetuin-A levels were higher in non-cardiac subjects compared to MI and SA patients (p<0.05). Patients with SA showed lower levels than controls but higher levels as compared to MI patients. After controlling for age and gender, levels of sVCAM-1 and sICAM-1 in patients with coronary atherosclerosis were not different from those in non-cardiac subjects.
Conclusion Serum levels of soluble VCAM-1, ICAM-1 were not related to coronary artery disease (CAD), but fetuin-A levels seems to be decreased in SA and MI patients. Low fetuin-A may play a role in the pathophysiology of CAD.

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A 67-year-old man with submaxillary lymphadenopathy diagnosed as reactive follicular hyperplasia of the lymph node was referred to us for pulmonary evaluation. Pathological findings of the lung and hilar lymph node biopsies showed the histological feature of Castleman's disease (CD). Interestingly, infiltrated plasma cells had strong immunoreactivity for IgG4. In addition, this patient had coexisting lung cancer. We believe this is the first described case of IgG4-related lung disease associated with multicentric CD (MCD) and lung cancer. To establish a therapeutic strategy for IgG4-related lung disease, the association between IgG4-related disease and MCD needs to be clarified.

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Primary endobronchial actinomycosis is a very rare condition. We report herein the case of a healthy 66-year-old woman who presented with right lower lobe endobronchial actinomycosis associated with aspiration of a foreign body, which was presumed to be a fish bone swallowed 28 months previously. The patient achieved complete clinical and radiological recovery after removal of the foreign body and 1-month antibiotic therapy of oral amoxycillin. Our experience in the management of this patient should help clinicians to realize the importance of bronchoscopic investigation and the management of this rare but treatable condition.

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Chronic myeloid leukemia (CML) is generally diagnosed in the chronic phase. We have recently encountered two CML-blastic phase (BP) cases, a 71-year-old woman and a 74-year-old man, who resembled de novo acute leukemia. The complete blood count was normal at least 11 and 13 months before the presentation, respectively. The leukemic cells showed predominant lymphoid phenotype. The blasts and granulocytes were positive for BCR-ABL, indicative of CML-BP. Both patients were successfully treated with prednisone and vincristine, followed by Imatinib. Our cases indicate rare presentations of CML-BP with an extremely short chronic phase. Ph-positive de novo acute leukemia should be carefully distinguished from CML-BP.

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We describe a 62-year-old man infected with human immunodeficiency virus (HIV)-1 who developed primary effusion lymphoma (PEL). Pleural effusion contained atypical lymphoid cells with human herpesvirus (HHV)-8 latent nuclear antigen (LANA)⁺. Radiological examination revealed pleural and pericardial effusion, but no evidence of tumor mass or lymph node enlargement. The patient was administered with highly active anti retroviral therapy (HAART) and THP-COP therapy, resulting in complete remission. The prevalence of HHV-8 infection among HIV positive individuals is higher than in the general population in Japan. Although PEL is extremely rare in Japan, the incidence might increase in the future.

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Gliomatosis cerebri (GC) is a specific entity defined as diffuse infiltration of neoplastic glial cells into at least three cerebral lobes and preservation of the surrounding neuronal architecture. We report a patient with secondary GC that mimicked clinicoradiological features of limbic encephalitis (LE). A 72-year-old man had developed headache and disorientation insidiously 2 weeks previously. On admission, neurological examination showed confusion and hyperreflexia in the right extremities. Brain magnetic resonance imaging (MRI) revealed T2-hyperintensity in bilateral frontal, the left parietal, the left temporal lobes and bilateral posterior periventricular zones. Slight enhancement existed in the left lower temporal region. Cerebral angiography exhibited no tumor stains. Repeated cerebrospinal fluid studies showed mild pleocytosis and cytology of class I. There were no infectious pathogenic agents. His neurological symptoms were ameliorated at 7 days after treatment with dexamethasone and glycerol. Follow-up MRI showed no pathognomonic changes. Mild memory dysfunction remained. He was diagnosed as LE of unknown cause. Three months later he became disorientated. Brain CT revealed a hemorrhagic mass with surrounding edema in the left temporal, frontal and parietal lobes. MRI displayed marked enhancement in these regions. Urgent neurosurgery was performed and glioblastoma multiforme (GM) was confirmed pathologically. The early clinicoradiological course of this patient suggested similarities to LE. At 3 months after clinical onset, the neuroradiological features reflected rapid transformation from secondary GC to massive GM. Thus, it is important to pay more attention to the differential diagnoses of GC and LE in patients who have memory deficits and widespread MRI lesions.

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