A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. Echocardiography revealed diffuse severe hypokinesis of the left ventricle (LV) and a pulmonary artery catheter showed Forrester subset II hemodynamics. Along with amelioration of sepsis and decrease of the serumconcentrations of tumor necrosis factor-a and interleukin-6, LV hypokinesis improved. It is suggested that the patient's heart failure mayhave been due to functional depression of myocardial contractility resulting from a direct effect of the cytokines towards the cardiomyocytes, the socalled "septic myocardial depression". (Internal Medicine 42: 60-65, 2003)

An obese 83-year-old woman with hypertension was managed to control severe progressive leg edema with recurrent leakage of exudates for two years (Picture 1). There was no evidence of an intrapelvic mass, deep venous thrombosis or congestive heart failure. A blood examination did not show any abnormalities, except for low-grade non-specific inflammation. Tests of the thyroid function and serological parameters were also normal.Elephantiasis nostras verrucosa is a rare dermatologic condition primarily attributed to the effects of chronic lymphedema with a variety of etiologies, including obesity (1). Affected patients present with a constellation of verrucose and hyperkeratotic papules exhibiting a typical cobblestonelike appearance (Picture 2, 3) that are often complicated by