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The present article documents a case of Fusobacterium sepsis with a transient anticardiolipin antibody increase in an otherwise healthy 24-year-old patient. He was presented to the emergency room with headache and fever. His temperature was 39.5°C, laboratory results revealed a white blood count of 15.2×10(3)/μl and C reactive protein 22.6 mg/dl. The patient was admitted. Chest X-ray showed the infiltrate in bilateral lower lung area. He received 400 mg of clarithromycin per day. His all symptoms did not change. On the 8(th) day in the hospital, the patient's antibiotics were switched to pazufloxacin. Chest and abdominal CT scan showed some irregular patchy nodules of around 1 cm in diameter in the bilateral lower lung fields and a round low density lesion 3 cm in diameter in the right upper segment (S8) in the liver. Blood culture revealed Fusobacterium necrophorum. On the 10(th) day, the antibacterial agent was changed from pazufloxacin to ampicillin sulbactam. On the 17(th) day, we added clindamycin. As a result his temperature gradually returned to normal. It is reported that the titer of anticardiolipin antibody increases in the sepsis patients caused by Fusobacterium necrophorum. As his symptoms disappeared, his titer of anticardiolipin antibody also decreased. So we considered he had a transient anticardiolipin titer increase.

We experienced a case of membranous nephropathy associated with argyria. The patient was a 78-year-old woman who had noticed blue skin of the face and azure lunulae for 8 years. She was admitted to our hospital for edema and proteinuria. She was diagnosed as membranous nephropathy by needle renal biopsy, and treated with prednisolone. Her proteinuria disappeared after 63 days. We investigated the blue skin of her face and azure lunulae. Skin biopsy was performed and black granules deposited in the upper layer of the corium were observed. The granules were identified with silver by EDS (energy-dispersive X-ray spectroscopy) analysis. Membranous nephropathy associated with gold or mercury has been reported, but association with silver has not been reported. We considered that this is a rare case of membranous nephropathy associated with silver.

To disclose the information for the risk in allogeneic hematopoietic stem cell transplantation (allo-HSCT), we propose a new concept of the risk in allo-HSCT. We analyzed all 94 allo-HSCT cases (86 patients) in our hospital since 1983. The overall survival rate was 56.4%. Among 27 patients considered to be at standard risk judged by conventional risk criteria who underwent initial transplantation from HLA-identical donors, 66.7% of them survived. Univariate statistical analyses among subgroups classified by conventional risk criteria and several reported prognostic factors show significant differences. However, all of them failed to show significant difference because of too much variation between cases in the same subgroup or a too small number of patients as compared with the U.S.A or European transplantation centers. We propose an alternative comprehensive classification of transplantation risk according to two newly-recognized distinct risks, disease state and transplantation risk. This comprehensive classification revealed significance in the multivariate statistical analyses in our hospital. We expect further discussion or the appearance of other beneficial nationwide proposals to evaluate and disclose the risk affecting survival following allo-HSCT.

Endoscopic transethmoidal.transsphenoidal surgery was performed on 30 patients with pituitary tumors, and the usefulness of this procedure was evaluated. As with conventional endoscopic intranasal surgery, the ethmoidal sinuses were opened and a broad window was created in the ethmoidal sinus from the directions of the middle meatus and the olfactory cleft. Then an endoscopic washing device was attached to a 0 degree or 30 degrees rigid endoscope and it was immobilized in the left nasal cavity with an endoscope immobilization apparatus. Removal of the tumor was then started from the right side by a bimanual technique. Based on the results, this surgical procedure was judged to be useful for the following reasons (1) it makes it easy to carry out the operative manipulations even in a narrowed nasal cavity, thereby reducing the overall time required for surgery, and (2) it is possible to prevent postoperative deformities of the nasal cavity morphology caused by pressure on its lateral wall. In additional, (3) the surgical wound can be observed, and CSF leakage can be repaired immediately after completion of the operation. Corrective surgery can be performed on an outpatient basis early after the initial operation to correct postoperative deformities of the nasal paranasal cavities, which might later cause nasal obstruction or an olfactory disturbance. Finally, (4) employing the route of endoscopic transethmoidal.transsphenoidal surgery facilitates the performance of a second operation soon, or even several months, after the first operation. A second operation may be necessary in the event of recurrence of the pituitary tumor or complication by chronic sinusitis. On the basis of our experience in the this study, we conclude that our method of endoscopic transethmoidal.transsphenoidal surgery will be useful for reducing invasiveness in the nasal cavities and achieving maximum prevention of postoperative complications. In order to fulfill its potential, neurosurgeons will need to master forceps techniques in the visual field provided by the endoscope and to cooperate with otorhinologists who are skilled in endoscopic techniques.

Unilateral nasal hemianopia is highly difficult to notice with bilateral vision intact, and only a few cases has been reported. There are several reported cases of quadrantic hemianopsia caused by cerebral lesions, but the defects were found bilaterally in all cases. There is only one reported case of which an aneurysm was believed to be the cause. We confronted 3 cases of unilateral nasal quadrantic hemianopia. In either case no ophthalmologic disorders could be found but magnetic resonance imaging revealed the compression of the optic chiasma by the A1 portion of the anterior cerebral artery. All three cases are presently under conservative therapy and receive routine evaluations. Nerve fibers from the upper and lower areas of the retina are routed complicatedly in the optic nerve in the periphery of the optic chiasma. From the presentation of the quadrantic hemianopia and from the radiological findings, we diagnosed that the visual defect was caused by vascular compression of the optic chiasma.

A 61-year-old man with multiple subcutaneous, ileocecal and neurologic manifestations was reported. Histological examination of subcutaneous and ileocecal mass showed non-Hodgkin's lymphoma (diffuse medium cell type [LSG classification]), B-cell type. Headache, somnolence and incontinence of urine were considered owing to the CNS involvement by lymphoma cells. The cranial CT findings showed diffuse spread involving the lateral and third ventricle and hypothalamus with adjacent edema. Then he was treated by VEMP regimen and repeated intrathecal MTX injections. The neurologic remission with improvement of cranial CT findings was obtained and he has been free of the disease for 15 years.

Thyrotropin (TSH)-secreting pituitary tumor (TSHoma) is a very rare condition and is characterized by elevated serum thyroid hormone and unsuppressed TSH levels. Although in most patients, TSH and thyroid hormone levels are high, in several cases they are within normal range. There are several similar conditions such as, TSH secreting pituitary hyperplasia. Refetoff syndrome and so on. It is very difficult to differentiate these conditions. Hypersecretion of alpha subunit is a characteristic commonly seen only in TSHoma. Surgical excision is the first choice of treatment for this tumor but the prognosis is not good. Octreotide is a very useful drug that suppresses the TSH level.

We report a 71-year-old woman who was initially admitted because of a ruptured internal carotid aneurysm, and found to have an aneurysm of the terminal portion (A5 portion) of pericallosal artery. Both of the aneurysms were surgically treated at one stage operation. A saccular aneurysm of the pericallosal artery was verified at operation. Right internal carotid angiography disclosed that medial part of the right anterior cerebral hemisphere was supplied by the right callosomarginal artery, and that unpaired pericallosal artery made a trifurcation at A5 portion, where the saccular aneurysm arose. According to Baptista's classification, anomaly of the anterior cerebral artery (ACA) in this patient was bihemispheric ACA type. Distal ACA aneurysms almost always locate at or near the genu of corpus callosum, either in pericallosal-callosomarginal or in pericallosal-frontopolar junction. In reviewing the literature, we were able to find 14 cases, including ours, of aneurysms located beyond either pericallosal-callosomarginal junction or the genu of corpus callosum. Also the possible role of hemodynamic stress caused by vascular anomaly for aneurysm formation are discussed.

Intracranial aneurysm rarely causes endocrinopathy clinically, however, many laboratory data show abnormality concerning endocrine function. To elucidate the reasons of these endocrine dysfunction, the authors investigated several representative patients in our department and the reported cases. The major part of reported cases suggests that the direct kinetic effect of aneurysms on the hypothalamopituitary system resulted in the endocrinopathy. The common features are described as follows. 1) Aneurysm were of large size. 2) Most aneurysms were located at the intracranial internal carotid artery. 3) They had no previous history of SAH usually. 4) Visual impairment was one of the common manifestation among them. 5) The higher frequency of the reported pituitary dysfunction in laboratory examination was shown in the following turn. However, some of our cases did not always agree with the reported ones. SAH operation etc. were considered to be the reasons of this discrepancy.