Background Low-density lipoprotein (LDL) cholesterol and chronic kidney disease (CKD) are both well-known risk factors for cardiovascular disease. However, few studies have examined the associations between LDL cholesterol and CKD.
Methods In the present study, we investigated the associations between LDL cholesterol and CKD using medical check-up data from 2,449 Japanese men and 1,448 Japanese women. Metabolic syndrome (MetS) was defined according to the revised National Cholesterol Education Program (NCEP) criteria for Japanese people. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or proteinuria.
Results Blood levels of LDL cholesterol were higher in CKD subjects than in non-CKD subjects only in men and the frequency of antihyperlipidemic medication and MetS was higher in CKD subjects than in non-CKD subjects, regardless of gender. The frequency of CKD was significantly higher in male subjects with the highest quartile of LDL cholesterol than in those with the lowest quartile of LDL cholesterol. LDL cholesterol levels were significantly higher in subjects with eGFR corresponding to CKD stages 2 and 3 than in those with eGFR corresponding to CKD stage 1 both in men and women. LDL cholesterol was independently associated with CKD, eGFR <60 mL/min/1.73 m², and proteinuria in Japanese men, but not in women.
Conclusion LDL cholesterol is cross-sectionally associated with preclinical CKD in Japanese men.

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Objective Metabolic syndrome (MetS) and decreased adiponectin level have been reported to be clinically associated with type 2 diabetes mellitus and coronary artery disease (CAD). However, it has not been fully defined whether they are associated with the severity of CAD, independent of hyperglycemia. In the current study, we investigated the clinical relationship between serum adiponectin level and MetS, and its association with the severity of CAD in patients with good glycemic control.
Patients and Methods In this study, we enrolled 97 subjects with an HbA1c concentration of <7.0% (5.5±0.6%), who underwent coronary angiography. We measured serum adiponectin levels and various metabolic variables, and assessed the severity of CAD by angiography.
Results Multivariate analysis revealed that the number of MetS components was not correlated with adiponectin level, despite their significant correlation in the univariate analysis. Low adiponectin levels (<4.5 μg/mL) or ≥3 of 5 MetS components showed significant association with the severity of CAD (adiponectin, p=0.002; MetS, p=0.049). The correlation of adiponectin levels (divided by tertiles or quartiles) with the severity of CAD was not significant after adjustment for age and gender. On the other hand, two models of combined scores from adiponectin levels and the number of MetS components showed a significant correlation with the severity of CAD even after adjustment for age and gender (model 1, p=0.023; model 2, p=0.018).
Conclusion Our findings suggest that the combination of adiponectin levels and the number of MetS components is linked to the severity of CAD in subjects with good glycemic control.

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Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005.
Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients.
Results The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients.
Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

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Objective Hypoadiponectemia was observed to correlate with the prevalence or extent of coronary artery disease (CAD), the relationship between metabolic syndrome and fasting serum adiponectin concentration in CAD patients are not well elucidated.
Patients and Methods Fasting blood samples were obtained from 98 CAD patients. Metabolic syndrome and its components were defined using the diagnostic criteria of the International Diabetes Federation. Adiponectin concentrations were measured using a commercial enzyme immunosassay kit.
Results Fifty patients with CAD (51.0%) had metabolic syndrome. For this group of patients, fasting adiponectin concentrations were found to correlate inversely with metabolic syndrome (p=0.009). Fasting adiponectin values for these subjects also tended to decrease as the number of diagnostic criteria for metabolic syndrome increased (p=0.024). CAD patients with hyperlipidemia (p=0.002), obesity (p=0.030) or receiving statin therapy (p=0.005) had lower serum adiponectin values. By univariate linear regression analysis, fasting serum adiponectin values were positively correlated with age (r=0.242; p=0.017) and high density lipoprotein-cholesterol concentration (HDL-cholesterol; r=0.267; p=0.008) but were negatively correlated with triglyceride concentration (TG; r=-0.251; p=0.013). Multivariate forward stepwise linear regression analysis of the significant variables revealed that HDL-cholesterol concentration (R square=0.071, p=0.008) and age (R square=0.039, p=0.044) are the independent predictors of fasting serum adiponectin concentration for patients with CAD.
Conclusion Serum adiponectin concentration is inversely correlated with metabolic syndrome and the number of metabolic syndrome criteria in patients with CAD. For these patients HDL-cholesterol concentration and age are independent predictors of the serum adiponectin value.

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A 61-year-old man was admitted to the hospital because of orthopnea and was diagnosed with heart failure with a continuous heart murmur. A transthoracic echocardiogram revealed turbulent flow from the right coronary sinus of Valsalva to the right atrium throughout the cardiac cycle. Aortography confirmed the presence of a shunt jet from the right coronary sinus of Valsalva to the right atrium. Cardiac catheterization revealed a left-right shunt rate of 47% and a pulmonary to systemic blood flow ratio of 1.81. Transesophageal echocardiography confirmed the existence of the shunt jet and revealed no deformity of the sinus of Valsalva. We report a rare case of sinus of Valsalva-right atrium fistula without typical aneurysmal formation.

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A 51-year-old woman was hospitalized with a high fever, occipital pain, blepharoptosis, and trismus. Enhanced CT showed thrombophlebitis of her left cavernous sinus, maxillary vein, and multiple pulmonary nodular lesions. ¹⁸F-FDG PET/CT showed significant uptakes in the same lesions. Streptococcus constellatus was detected in her blood. Therefore, she was diagnosed as a Lemierre syndrome variant. After administration of antibiotics, all symptoms, inflammatory reactions, and thrombi disappeared. Since Lemierre syndrome has life-threatening potential, early diagnosis and initiation of appropriate therapy are important. In this case, ¹⁸F-FDG PET/CT was useful to detect the focus and extent of infection.

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Lugol's solution is an iodinated agent used for treating thyroid crisis. It is primarily used in diagnostic tests for esophageal diseases. However, Lugol's solution can cause local mucosal injury and hemorrhage. We report, for the first time, a case of 34-year-old man who exhibited severe duodenal hemorrhage induced by Lugol's solution that was used to treat thyroid crisis. The quantity of Lugol's solution used for treating thyroid crisis is much higher than that used for mucosal disease investigation. Clinical practitioners should be aware of gastrointestinal hemorrhage when using Lugol's solution for the treatment of thyroid crisis.

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A 68-year-old woman developed Cushingoid features three months prior to admission. She was found to have a markedly elevated plasma ACTH-cortisol level. Magnetic resonance imaging (MRI) revealed a mass in the left sphenoidal sinus, which had become enlarged to a point where it could not be removed by transsphenoidal surgery. We decided to proceed with radiation therapy to shrink the tumor. However, it was ineffective. Despite a reduction in serum cortisol levels using metyrapone, she died of septic shock. We describe a rare case of an ACTH-secreting pituitary adenoma within the sphenoid sinus.

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Clinical symptoms and findings of familial Mediterranean fever (FMF), occur as a result of autoimmune inflammation of the serous membrane which is also seen in systemic lupus erythematosus (SLE). Difficulties are sometimes encountered in the differential diagnosis of FMF because of similar clinical features with other autoimmune inflammatory diseases, and very rarely it can be seen with SLE. The association of FMF and SLE has been reported in one childhood case in Turkey. As far as we know, there is no report in the adult age group. Here, we present the first FMF and SLE association in an adult and discuss the pertinent literature in Turkey.

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Primary mediastinal liposarcoma was observed in a 73-year-old man. Because of tight adhesions to adjacent tissues, neither complete resection nor surgical debulking of the tumor was possible. A T-tube was inserted into the patient's trachea for severe dyspnea, and he was treated with radiotherapy and an oral peroxisome proliferator-activated receptor-γ agonist. The patient died 6 years after the initial diagnosis. Autopsy revealed liposarcoma composed of 3 subtypes in the primary tumor: well-differentiated, dedifferentiated, and round cell components. Round cell and dedifferentiated liposarcomas were predominantly observed in the metastatic nodules.

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A 60-year-old woman was diagnosed with pulmonary metastasis with endobronchial spread of sinonasal melanoma 9 years after the initial treatment. She had originally been diagnosed with sinonasal malignant melanoma and received chemotherapy combined with carbon ion radiotherapy. During routine follow-up, chest CT showed a nodular lesion on the left upper lung lobe. Bronchoscopic examination showed diffuse melanosis without intrinsic masses from the left main bronchus to the peripheral bronchial mucosa. Transbronchial biopsy was performed for both the pulmonary lesion and endobronchial melanosis lesions. Melanoma cells were histologically detected in both the mucosal and submucosal layers.

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We report the case of a woman with intracranial metastasis from an esophageal gastrointestinal stromal tumor (GIST) with the mutation site in the 3' end of exon 11. Frontal craniotomy was performed with complete resection of the mass, followed by postoperative stereotaxic radiotherapy (SRT). Intracranial metastasis from GISTs is extremely rare; we found only seven case reports in the literature.

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We present two cases of inoperable advanced lung cancer in which the main lesions were mediastinal lymph nodes detected with positive positron emission tomography (PET). Drug therapy was very effective, and post-treatment PET results were negative. Restaging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed on the mediastinal lymph nodes with a short axis≤10 mm measured by computed tomography (CT). Cancer cells were detected, which helped determine the therapeutic strategy. Re-evaluation of mediastinal lymph nodes using EBUS-TBNA appears to be useful, even among patients with inoperable advanced lung cancer.

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Systemic capillary leak syndrome (SCLS) is a rare disease characterized by leakage of plasma from blood vessels into the interstitial space due to increased capillary permeability. We describe a 24-year-old man who was hospitalized with systemic edema, hypoalbuminemia, and disseminated intravascular coagulation. After extensive investigative procedures, he was diagnosed with chronic SCLS and made a gradual recovery after starting on prednisolone, terbutaline, and theophylline. We measured the patient's serum vascular endothelial growth factor (VEGF) over time and found a relationship between serum VEGF and the clinical course.

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