[Pulmonary involvement, pleural effusion, and electrocardiographic abnormality in hypereosinophilic syndrome]

A 47-year-old man was admitted to our hospital with complaints of cough and shortness of breath. Chest radiography showed infiltration of the right lung and left pleural effusion, the eosinophil count increased notably in the peripheral blood, sputum, and pleural effusion. Transbronchial lung biopsy revealed the invasion of eosinophils like eosinophilic pneumonia. Heart failure easily developed in this patient after the intravenous infusion. Myocardial involvement was suspected, and hypereosinophilic syndrome was diagnosed. After prednisolone was administered, the peripheral blood eosinophil count normalized rapidly, and subsequently, the pleural effusion and infiltration shadows in the lung disappeared.

Relationship between serum tumor necrosis factor-alpha and insulin resistance in obese men with Type 2 diabetes mellitus

We analyzed serum concentrations of tumor necrosis factor-alpha (TNF-alpha) for their role in insulin resistance in 12 obese men with untreated Type 2 diabetes mellitus and in 6 age-and BMI-matched obese controls. Insulin resistance was expressed using the homeostasis model assessment (HOMA-R). Six of the patients were insulin-resistant (HOMA-R>5.0), while six were not (HOMA-R</=3.0). Serum levels of TNF-alpha were higher in patients with insulin resistance (4.19+/-0.96 pg/ml) than in patients without insulin resistance (2.52+/-1.64 pg/ml) and in controls (2.03+/-1.21 pg/ml). Fasting serum concentrations of insulin and HOMA-R were higher in patients with insulin resistance (16.2+/-5.0 and 6.30+/-1.0 IU/ml, respectively) than in patients without insulin resistance (7.3+/-2.2 and 2.4+/-0.6 IU/ml) and in controls (8.0+/-2.9 and 1.8+/-0.6 IU/ml). These data suggest that high levels of serum TNF-alpha in patients with insulin resistance are related to high levels of fasting insulin and HOMA-R. We conclude that TNF-alpha may be involved in the pathogenesis of Type 2 diabetes mellitus in obese men. The importance of this investigation is that the subjects recruited in the study are BMI matched, because human obesity is associated with an increased TNF-alpha mRNA expression in adipose tissue.

Relationship between serum tumor necrosis factor-alpha and insulin resistance in obese men with Type 2 diabetes mellitus

We analyzed serum concentrations of tumor necrosis factor-alpha (TNF-alpha) for their role in insulin resistance in 12 obese men with untreated Type 2 diabetes mellitus and in 6 age-and BMI-matched obese controls. Insulin resistance was expressed using the homeostasis model assessment (HOMA-R). Six of the patients were insulin-resistant (HOMA-R>5.0), while six were not (HOMA-R</=3.0). Serum levels of TNF-alpha were higher in patients with insulin resistance (4.19+/-0.96 pg/ml) than in patients without insulin resistance (2.52+/-1.64 pg/ml) and in controls (2.03+/-1.21 pg/ml). Fasting serum concentrations of insulin and HOMA-R were higher in patients with insulin resistance (16.2+/-5.0 and 6.30+/-1.0 IU/ml, respectively) than in patients without insulin resistance (7.3+/-2.2 and 2.4+/-0.6 IU/ml) and in controls (8.0+/-2.9 and 1.8+/-0.6 IU/ml). These data suggest that high levels of serum TNF-alpha in patients with insulin resistance are related to high levels of fasting insulin and HOMA-R. We conclude that TNF-alpha may be involved in the pathogenesis of Type 2 diabetes mellitus in obese men. The importance of this investigation is that the subjects recruited in the study are BMI matched, because human obesity is associated with an increased TNF-alpha mRNA expression in adipose tissue.

[Improvement of a case of broncholithiasis after spontaneous lithoptysis]

A 53-year-old woman was admitted for recurrent hemoptysis and cough. The chest radiograph showed an infiltrative shadow in the left upper region. Chest tomogram and CT scan showed a small calcification and consolidation in the left upper lobe. Fiberoptic bronchoscopy revealed fresh hemorrhage from the left upper bronchus but no broncholith or bleeding point were detected. Since the symptoms had disappeared by 10 days after admission, the patient was discharged and followed up as an outpatient. Three weeks later, she spontaneously expectorated a stone 3 mm in maximum diameter, with an irregular surface. Analysis revealed that the stone's composition was 56% of calcium phosphate and 44% of calcium carbonate. Hemoptysis seemed to have been caused by the broncholith, which had originated as a calcification of a peribronchial lymph node that subsequently eroded its way into the airway. After lithoptysis, no recurrence has been observed.

Successful treatment of primary adrenal non-Hodgkin's lymphoma associated with adrenal insufficiency

We report a case of primary adrenal NHL associated with adrenal insufficiency which was successfully treated with steroid replacement and chemotherapy. A 69-year-old woman hospitalized with fatigue and weight loss developed shock and recovered with steroid therapy. Adrenal insufficiency was confirmed by an elevated plasma adrenocorticotropic hormone level and low cortisol. Computed tomography revealed large bilateral adrenal masses. Needle biopsy showed a diffuse, mixed B cell lymphoma. CHOP therapy accompanied by steroid replacement was begun, and she achieved a complete remission after 4 cycles. She received additional 4 cycles of chemotherapy. Although adrenal insufficiency was irreversible, she has continued in complete remission for 50 months at this reporting.

[Experience with surgery for synchronous double cancer of rectum and lung detected after long-term follow-up for pneumoconiosis]

A 60-year-old man has been followed up for pneumoconiosis for 7 years. He was admitted to our hospital because of melena. He was undergone a colonofiberscopy and was diagnosed as rectal cancer. We performed anterior resection of the rectum (Stage I). About 5 months after the first operation, abnormal shadows of the both lungs were growing in size. Bronchoscopic examination revealed adenocarcinoma, we performed left upper lobectomy (Stage I) and this case was judged a synchronous double cancer.