Objective Very late stent thrombosis (VLST) remains an unresolved problem, and recent reports have indicated that VLST onset can occur in patients treated with both drug-eluting stents (DES) and bare metal stents (BMS). We evaluated the causes of VLST using optical coherence tomography (OCT).
Methods OCT was performed in 22 patients (12 DES-treated patients, 10 BMS-treated patients). Because two instances of VLST occurred simultaneously in one case in the DES group, the DES group comprised 13 lesions, while the BMS group comprised 10 lesions. All struts were counted in each frame, and the proportion of uncovered or malapposed struts was calculated based on the overall number of struts in the stent.
Results The interval from stent implantation to VLST onset was significantly longer in the BMS group. The proportion of uncovered struts and the ratio of malapposed struts were significantly higher in the DES group than in the BMS group. The OCT analysis demonstrated intimal hyperplasia or intimal disruption in all patients in the BMS group. However, in the DES group, severe hyperplasia and/or neoatherosclerosis was observed in only eight lesions (61.5%), while uncovered and malapposed struts were involved in the other lesions.
Conclusion In most BMS-treated lesions, it appeared that VLST was caused by the occurrence of neoatherosclerosis after stent implantation. The causes of VLST in DES-treated lesions are more various and complicated than those observed for BMS-treated lesions.

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Objective The purpose of this study was to evaluate the cardiac sarcoidosis (CS) activity according to the classified visual uptake pattern using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and assess the uptake pattern based on the free fatty acid (FFA) levels.
Methods Nineteen CS subjects who underwent ¹⁸F-FDG PET/CT examinations with heparin loading (HL) were recruited to evaluate their CS activity. The ¹⁸F-FDG uptake in the heart was classified into five categories ("none," "diffuse" and "diffuse at base," regarded as stable CS, and "focal" and "focal on diffuse," regarded as de novo or worsening CS). The subject data were compared with the ¹⁸F-FDG PET/CT findings in 13 healthy volunteers. The FFA serum levels were assessed in 10 patients with CS and all volunteers.
Results The sensitivity and specificity of ¹⁸F-FDG PET/CT with HL were 75% (6/8) and 73% (8/11), respectively. The major pattern of cardiac ¹⁸F-FDG uptake was "diffuse at base." Ten of the 32 subjects, including the control group, exhibited this pattern. The FFA serum levels before heparin administration were statistically significantly different between the patients with the "none" pattern and those with the "diffuse" and "diffuse at base" patterns. There were no significant correlations between the FFA serum levels after heparin administration and the ¹⁸F-FDG uptake patterns.
Conclusion "Diffuse at base" is the major ¹⁸F-FDG uptake pattern associated with inadequate physiologic ¹⁸F-FDG suppression. This pattern should be carefully interpreted when examining the ¹⁸F-FDG PET/CT images of CS patients. Additionally, increased FFAs levels associated with HL may not completely suppress the physiologic myocardial FDG uptake.

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Objective Impaired glucose tolerance (IGT) and diabetic glucose tolerance (DGT) are closely associated with vascular disease mortality and morbidity. This study was designed to determine whether routine stroke rehabilitation training can be used to improve the glucose status and whether IGT and DGT persist among nondiabetic stroke patients at discharge after such training.
Methods Eighty eligible subjects were evaluated using Oral Glucose Tolerance Tests (OGTTs) at entry and discharge at the rehabilitation medical departments of two large hospitals in China. Routine rehabilitation training was provided during hospitalization. The secondary outcome measurements were BMI, Fugl-Meyer motor score, Barthel index, HbA1c, triglycerides, HDL cholesterol and LDL cholesterol. Non-acute and nondiabetic stroke patients treated at the rehabilitation department.
Results Fifty-four patients had IGT or DGT at entry, while 61 patients exhibited abnormal glucose tolerance at discharge, accounting for 67.7% and 76.25% of all subjects respectively. The mean 2-hour plasma glucose level was 8.98 mmol/L at entry and 9.11 mmol/L at discharge. No changes were noted in the OGTT results or secondary outcomes after training (p>0.05), with the exceptions of significant improvements in the Fugl-Meyer motor score and Barthel index (p<0.05).
Conclusion These preliminary results suggest that IGT and DGT are present at a high frequency among nondiabetic stroke patients both before and after routine rehabilitation training. Routine stroke rehabilitation training, which greatly improves functional outcomes, may have no effect on the incidence of abnormal glucose tolerance.

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A pyogenic granuloma (PG) is a capillary hemangioma that usually occurs on the skin or in the oral cavity; it is rarely observed in the gastrointestinal tract. We herein describe a case of a 86-year-old woman who presented with anemia. Esophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding focus, but capsule endoscopy revealed a bleeding focus in the small intestine. We performed double-balloon enteroscopy and identified a 7-mm-diameter, reddish, subpedunculated, hemispheric polyp with a smooth surface in the small intestine, approximately 100 cm from the ileocecal valve. The polyp was surgically removed, and the histological findings were consistent with a diagnosis of PG.

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An adolescent girl presented with inappetence. Upper gastrointestinal endoscopy showed rough and cracked mucosa at the gastric antrum with a scarred duodenal ulcer, and a biopsy sample demonstrated abundant eosinophils. We therefore diagnosed the patient as having eosinophilic gastroenteritis. Eradication therapy for Helicobacter pylori (H. pylori) did not improve her symptoms; however, proton pump inhibitor therapy was effective in resolving her chief complaints. There are several reports of eosinophilic gastroenteritis complicated with H. pylori infection in which the association between eradication therapy and the patient's symptoms is unclear. In the present case, the patient's symptoms did not improve with eradication therapy, and there appeared to be no relationship between the two.

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A histological examination of colonic biopsies of the longitudinal and irregularly-shaped ulcerative lesions of a 37-year-old man and 61-year-old man with ulcerative colitis showed so-called "fringe formation," a typical finding of Brachyspira infection. The antibody titer to Brachyspira aalborgi showed marked elevation in both cases, and the patients were each treated with 1,000 mg of metronidazole for 14 days. Colonoscopy performed after treatment showed an improvement in the ulcerative lesions in both patients. These results indicate the possibility that intestinal spirochaetosis infection should be considered as an infectious complication in patients with ulcerative colitis receiving long-term steroid therapy.

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An 80-year-old man was admitted to our hospital with a diagnosis of primary hepatic actinomycosis determined based on a percutaneous aspiration biopsy. The abscesses and state of liquefaction were easily and effectively visualized on contrast-enhanced ultrasonography. Ampicillin/sulbactam was administered; however, lesions of hepatic actinomycosis suddenly infiltrated the diaphragm and right thorax six months later. A drainage tube was inserted into the right thoracic space, and the pleural effusion gradually decreased. The patient received continuous antibiotic therapy for nearly two years and remained free of hepatic actinomycosis on follow-up more than one year later.

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Hepatosplenic gamma-delta T-cell lymphoma (HSTCL) is a rare, aggressive subset of peripheral T-cell lymphoma. It has been reported that Epstein-Barr virus (EBV) infection can cause HSTCL; however, such cases are extremely rare, with only a few cases having been reported to date. We herein report an autopsy case of HSTCL associated with EBV infection. The presence of EBV infection was confirmed in serum EBV DNA and on in-situ hybridization, and cytotoxic molecules, such as granzyme B, perforin and T-cell intracytoplasmic antigen (TIA)-1, were all positive in lymphoma cells. These findings indicate that stimulation of persistent EBV infection may have caused HSTCL in this patient.

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We herein report the case of a 29-year-old woman who was diagnosed with incomplete atrioventricular septal defect and extrinsic compression of the left main coronary artery (LMCA) with chest pain due to postpartum thyroiditis. She exhibited chest pain with ST elevation, and coronary computed tomography showed that the LMCA was compressed between the dilated pulmonary artery and aorta. After her hyperthyroidism was treated, her chest pain resolved. Surgical repair of endocardiosis and coronary bypass grafting were performed. On the one-year follow-up visit, the dilation of the pulmonary artery and right heart was decreased. It is important to consider the possibility of compression of the LMCA in patients presenting with pulmonary hypertension and chest pain.

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A 61-year-old man who was being treated with hemodialysis (HD) for end-stage renal disease presented with symptoms of severe congestive heart failure (CHF). Removing excess intravascular fluid during HD was difficult due to the patient's chronic hypotension induced by severe left ventricular (LV) dysfunction. The application of adaptive servo-ventilation (ASV) increased the patient's cardiac output and blood pressure during HD, thus resulting in the effective removal of excess intravascular fluid. Therefore, ASV may be effective for treating CHF in HD patients with LV dysfunction and chronic hypotension.

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Diabetic muscle infarction (DMI) is a rare complication of long-standing poorly controlled diabetes mellitus. We herein describe the case of a 56-year-old man with a 10-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular and macrovascular complications who presented with the sudden onset of left thigh pain and swelling. MRI suggested muscle infarction. A muscle biopsy demonstrated coagulation necrosis in the skeletal muscle with inflammation and infarction in the walls of small blood vessels. Physicians should consider DMI in the differential diagnosis of patients with diabetes who present with painful, swollen muscles without systemic signs of infection.

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We identified a rare follicular thyroid carcinoma (FTC) metastasis to the pancreas in a patient of FTC. A 65-year-old woman presented at our hospital for evaluation of a pancreatic mass. She had a history of FTC. After total thyroidectomy, I-131 whole body scan showed increased I-131 uptake in the thyroid bed, but there was no evidence of distant metastasis. However, F-18 FDG PET/CT showed a mass with FDG uptake in the pancreatic head. Follow-up PET/CT showed FDG uptake in the pancreatic head and thyroid bed. Pylorus preserving pancreaticoduodenectomy was performed. Histopathological examination supported the diagnosis of metastatic FTC to pancreas.

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A 69-year-old man presented with proteinuria and hematuria. He had received total parenteral nutrition for massive small bowel resection. However, due to the iatrogenic lack of trace elements for the next four years, he developed severe copper-deficiency anemia and neutropenia. In addition, his proteinuria and kidney dysfunction worsened concurrently with the development of nephrotic syndrome and end-stage kidney disease. After receiving trace elements, the patient's anemia and neutropenia improved, and the anuria dramatically resolved. Copper-containing enzymes, including ceruloplasmin have an antioxidant activity. In patients with various types of glomerular injuries, the ceruloplasmin expression is known to be increased. Copper deficiency can worsen nephrotic syndrome by decreasing the ceruloplasmin activity, which protects the glomeruli.

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We herein describe the first case of desquamative interstitial pneumonia (DIP) induced by waterproofing spray, which was proven by a surgical lung biopsy. A 45-year-old male smoker heavily used a waterproofing spray gas, and presented with chills and fever that was followed by progressive dyspnea. Because steroid pulse therapy did not improve his symptoms, he was referred to our hospital. High-resolution chest CT showed diffuse pan-lobular ground-glass opacities in both lungs. A video-assisted thoracoscopic lung biopsy revealed a DIP pattern. Acute short-time exposure to waterproofing spray can thus be a potential cause of DIP.

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A 73-year-old man with adultonset Still's disease developed a high fever, coughing, dyspnea and bloody sputum and was therefore admitted to our hospital. Thoracic X-ray and CT scans revealed oval lesions in the bilateral lungs. A bacterial isolate from the sputum was identified to be Nocardia elegans (N. elegans) on comparative 16S rRNA gene sequencing and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The patient recovered following treatment with imipenem/cilastatin and amikacin. To the best of our knowledge, this is the first case of nocardiosis caused by N. elegans identified on MALDI-TOF MS.

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We herein report the case of a 22-year-old woman with severe aplastic anemia who underwent allogeneic hematopoietic stem cell transplantation (HSCT). After HSCT, the Epstein-Barr virus (EBV)-DNA load in the peripheral blood gradually increased, and the patient presented with a fever and lymphadenopathy on day 56 post-HSCT. Although we administered rituximab, her clinical condition worsened. After rituximab treatment, CD8 T-cells emerged and became dominant in the peripheral blood, some of which were positive on an EBV-specific tetramer analysis. However, an open biopsy of the lymphadenopathy lesions revealed the CD8 T-cells to be infected with EBV, exhibiting proliferation with oligoclonality. The patient ultimately died of multiple organ failure on day 99 post-HSCT.

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Plasma cell leukemia (PCL) is a rare variant of multiple myeloma (MM) with a poor prognosis. Nonsecretory myeloma is also a rare form of MM characterized by the absence of detectable M-protein in the serum and urine. This report describes two cases of nonsecretory PCL. The first patient was an 85-year-old man in whom the lack of monoclonal immunoglobulins made it difficult to make a diagnosis because the malignant cells showed an atypical morphology. He died of rapid disease progression before starting chemotherapy. The second patient was a 78-year-old woman whose tumor cells displayed a typical plasma cell morphology. She was successfully treated with bortezomib-containing chemotherapy.

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Most human immunodeficiency virus (HIV)-related lymphomas are of B-cell origin, and the T-cell type is very rare. We experienced a Japanese case of HIV-associated peripheral T-cell lymphoma (HIV-PTCL). Sudden intestinal hemorrhage necessitated emergent surgical resection of the small intestine, in which an ulcerative lesion was detected. A histopathological examination revealed large tumor cells in the base of the ulcer, which were immunohistochemically CD30⁺, CD56⁺, granzyme B⁺, CD3⁺ (focally), CD4^-, CD8^- and EBER⁺. A diagnosis of PTCL, not otherwise specified, was therefore made. The differential diagnosis and significance of Epstein-Barr virus infection are also herein discussed.

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A 58-year-old woman developed agraphia and mild right hemiparesis approximately one month after undergoing coil embolization of an unruptured left internal carotid artery aneurysm. MRI performed on day 39 post-coil embolization showed multiple lesions in the white matter with signal hyperintensity on T2-weighted and FLAIR images in the left middle cerebral artery territory. The patient's cerebrospinal fluid exhibited an elevated protein level at 46 mg/dL; however, no other findings suggested another underlying disease. Corticosteroids were administered, and, by day 50 post-coil embolization, the clinical findings and abnormal features on MRI had improved. The patient was therefore diagnosed with contrast-induced encephalopathy after coil embolization.

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A 67-year-old man with a history of prostatic hypertrophy developed behavioral anomalies and a fever. At admission, diffusion-weighted brain magnetic resonance imaging (MRI) indicated a high-intensity signal lesion on both sides of the cerebral hemisphere. Immediately after hospitalization, he developed paralysis of the left side of the body. Diffusion-weighted MRI indicated hemorrhagic changes in the right and left parietal lobes and right occipital lobe. Magnetic resonance venography indicated superior sagittal sinus occlusion. The blood test results indicated transient eosinophilia. Cases of thrombosis with idiopathic eosinophilia have been reported, but this is the first known case of cerebral sinus thrombosis with transient eosinophilic leukocytosis.

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We herein report the case of an 81-year-old woman with midbrain infarction causing pupil-sparing oculomotor nerve palsy with ipsilateral cerebellar ataxia. The lesion was located at the rostral end of the decussation of the superior cerebellar peduncle touching the dorsal side, further caudal and dorsal to causal lesions of Claude's syndrome, which presented as oculomotor palsy and contralateral cerebellar ataxia. This is the third report of midbrain infarction causing partial oculomotor nerve palsy with ipsilateral cerebellar ataxia. It may be possible to establish this entity as a new syndrome following the accumulation of more cases.

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A 33-year-old man who had recently undergone surgery for cervical spondylotic myelopathy was prescribed pregabalin for neuralgia, and the dose was increased to 600 mg/day during hospitalization. However, the patient was diagnosed with a Clostridium difficile infection on day 34 after admission. A complete blood count showed agranulocytosis (neutrophil count: 105/μL). We did not observe any changes in vital signs, a relative increase in band cells, or intestinal edema. The patient's agranulocytosis resolved after withdrawing pregabalin. This is the first reported case of agranulocytosis associated with pregabalin. Periodic monitoring of the white blood cell count is therefore considered to be useful in patients receiving high-dose pregabalin therapy.

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A 52-year-old Indian man was hospitalized due to dyspnea and a high fever caused by influenza A(H1N1)pdm2009. Elevated cardiac enzymes, a chest X-ray showing bilateral infiltrative shadows, cardiomegaly and pleural effusion and echocardiography indicating diffuse hypokinesis of the left ventricle suggested cardiac failure due to acute myocarditis. Owing to the administration of combined modality therapy, including steroids and intravenous γ-globulin, the patient's clinical symptoms of influenza completely resolved. However, he suddenly complained of epigastric pain due to acute myocardial infarction and died. This report is an educational case, the results of which suggest that greater attention should be paid to the potential for myocardial infarction even after an influenza virus infection is found to improve.

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We herein report a case of persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia that was successfully treated with combination therapy consisting of high-dose daptomycin (DAP, 10 mg/kg) and rifampicin. The patient's condition was complicated with multiple infectious foci, including an iliopsoas abscess and epidural abscess, as well as discitis and spondylitis at the cervical, thoracic and lumbar levels. Monotherapy treatments with vancomycin, linezolid and usual-dose DAP were all ineffective. It has been shown that usual-dose DAP administration may result in the emergence of a resistant strain and treatment failure. We would like to emphasize the importance of high-dose DAP therapy for MRSA bacteremia, a condition with a potentially high mortality rate.

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Hepatic flares occurred in two patients with HBV/HIV coinfection following the commencement of antiretroviral therapy (ART). At that time, the HIV RNA and HBV DNA levels had decreased. The results of liver biopsies showed lymphocytic infiltration that was diffusely positive for CD8⁺ T cells in the portal areas and lobules. These findings suggested HBV-related immune reconstitution inflammatory syndrome (IRIS). The alanine aminotransferase levels of both patients gradually decreased with the continuation of ART. Because there are few reports of the liver histology of HBV-related IRIS, these cases provide a better understanding of the pathogenesis of HBV-related IRIS.

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