Acute heart failure syndrome associated with snow shoveling.

There have been only a few reports regarding the relation between snow shoveling and acute heart failure syndromes (AHFS). We present a case series of 5 patients who presented with AHFS, all within 5 days after shoveling snow. Although all patients underwent examination at a regular out-patient clinic, no patient had prior signs or symptoms of heart failure. The condition of all patients had gradually deteriorated, with no abrupt onset of dyspnea after shoveling snow. Four of the 5 patients demonstrated a preserved ejection fraction on echocardiography. Snow shoveling may lead to AHFS in patients who are at risk for developing heart failure.

[A case of multiple sclerosing hemangiomas of both lungs].

A 16-year-old Chinese girl was found to have abnormalities on chest roentgenography at a school health checkup in 2004, and she visited our outpatient clinic for the first time on July 2. Based on the imaging, there were multiple nodules ranging in size up to 5cm in the longest dimension, with regularly shaped clear margins, in both lungs. We considered lung metastases of a malignant neoplasm as the most likely diagnosis and performed a systemic workup but failed to make a clinical diagnosis. We therefore performed an open lung biopsy on November 8. Microscopically, the tumors consisted of a mixture of areas with a papillary pattern, a solid pattern and a sclerosing pattern. Component tumor cells were of two types: epithelial-like cells that covered the surface of the papillary structures and round or polygonal cells that showed a solid pattern of growth underneath. Immunohistochemical examinations revealed that these tumor cells were positive for an alveolar epithelium marker. From these results, we made a diagnosis of sclerosing hemangioma. Here we report a rare case of multiple sclerosing hemangiomas together with a review of the literature.

[A case of acute exacerbation of chronic pulmonary thromboembolism with essential thrombocythemia during treatment for hemoptysis].

An 89-year-old woman with essential thrombocythemia and chronic respiratory failure was admitted for treatment of hemoptysis. She stopped taking aspirin and was given tranexamic acid. Though her hemoptysis improved, respiratory failure suddenly worsened. As a result of various examinations and laboratory findings, acute exacerbation of chronic pulmonary thromboembolism was diagnosed. Though there was the risk of recurrence of hemoptysis, she started taking aspirin again. Her respiratory failure improved but hemoptysis did not reappear. Thrombosis and hemorrhage are common complications of essential thrombocythemia, however, pulmonary thromboembolism is a rare complication. There is a possibility that the exacerbation of this case was caused by tranexamic acid as well as rest and cessation of aspirin. If a patient with essential thrombocythemia bleeds, we should be careful when using tranexamic acid.

[Two cases of meningeal carcinomatosis during gefitinib therapy for non-small cell lung cancer].

"Case 1" A 56-year-old woman who suffered from postoperative recurrent non-small cell lung cancer received gefitinib therapy. Approximately 7 months after the therapy was begun, although the intrathoracic disease responded to the treatment, she developed meningeal carcinomatosis and died of rapidly progressive central nervous system disease. "Case 2" A 46-year-old man with stage IV non-small cell lung cancer started gefitinib therapy after chemotherapy. The pulmonary lesions markedly improved responding to gefitinib therapy, however, approximately 6 months after the therapy was begun, multiple brain metastasis and meningeal carcinomatosis were detected. Approximately 4 months after the diagnosis of meningeal carcinomatosis, he died of disease progression and disturbance of consciousness. It has been reported that the central nervous system is a frequent metastatic site of non-small cell lung cancer in patients treated with gefitinib. We report two cases of meningeal carcinomatosis that occurred during the period in which their intrathoracic disease was responding to gefitinib therapy. We should consider the possibility of metastatic central nervous system disease, even in patients in whom gefitinib therapy is apparently successful.

A case of Wegener's granulomatosis complicated with seropneumothorax.

Abstract We report the case of a 52-year-old man with Wegener's granulomatosis complicated with seropneumothorax. Pneumothorax or seropneumothorax has previously been reported as a rare complication of Wegener's granulomatosis. The patient was successfully treated with prednisolone and cyclophosphamide, and seropneumothorax was resolved without tube drainage. This case suggests that the pathogenesis of seropneumothorax may be associated with the disease activity of Wegener's granulomatosis because it developed spontaneously before treatment with immunosuppressive agents and without being complicated by infection.