We describe a rare case of hemoperitoneum secondary to spontaneous rupture of hepatic metastasis from lung cancer. A 72-year-old man with non-small cell lung cancer was admitted to our hospital with sudden onset of right upper abdominal pain and hypovolemic shock. Laboratory tests showed severe anemia. Abdominal contrast-enhanced computed tomography revealed massive ascites and multiple liver metastases. Rupture of a metastatic liver tumor was suspected. Only palliative therapy was performed. The patient's general condition gradually worsened, and he died 2 months after admission. Autopsy examination revealed hemoperitoneum due to a ruptured metastatic liver tumor originating from pulmonary squamous cell carcinoma.

Autonomic nervous system (ANS) dysfunction may be implicated in the subsequent development of cardiovascular disease in patients with obstructive sleep apnea syndrome (OSAS). To confirm the relation between OSAS and ANS dysfunction, we prospectively investigated ANS function in 7 patients with moderate or severe OSAS; 7 healthy age-matched volunteers were for control. We also studied ANS function before and after treatment in the patients with OSAS to evaluate the effect of OSAS treatment on ANS dysfunction. The body mass index of patients with OSAS was 32.2 (27.4-45) (median [range]) kg/m2. The patients were treated by nasal continuous positive airway pressure (n = 5) or uvulopalatopharyngoplasty (n = 2). The apnea/hypopnea index decreased markedly from 42.1 (30.6-77.2) events/hr of sleep before treatment to 2.3 (1.4-3.8) after treatment. To evaluate ANS function, the coefficient of variation of the RR interval (CV-RR) and corrected QT (QTc) interval on the electrocardiogram at rest and the heart rate (HR) responses to blood pressure (BP) changes during the Valsalva maneuver were studied. Baseline HR of OSAS patients was significantly higher than that of the control subjects (p < .05). The Valsalva ratio (VR), baroreflex sensitivity (BRS), and CV-RR values in patients with OSAS were significantly lower than those of the control subjects (all, p < .005). However, there were no significant differences in systolic and diastolic BP or QTc intervals. After treatment, VR, BRS, and CV-RR values increased significantly compared with those before treatment in patients with OSAS (all, p < .05). There were no significant differences in systolic and diastolic BP, HR, or QTc intervals measured before and after treatment. These results suggest that impaired ANS function is present in patients with OSAS and can be improved by successful treatment of OSAS.

Seasonal environmental changes have the potential to influence the genetic structure of species with a short generation time, such as Drosophila. We previously found the seasonal change in linkage disequilibrium (LD) between the chemoreceptor (Cr) genes in a local Japanese population (Kyoto [KY]). This could be caused by fluctuation in the population size or selection in temporally heterogeneous environments or both. Here, we analyzed the scale of LD between 51 X-linked polymorphisms (10 Cr and 41 non-Cr gene markers) in the 2 seasonal samples from the KY population and an autumn sample from 106 localities in and around Japan (Ja03au). Many of the non-Cr genes have receptor function but fewer functional connections to each other. The magnitude of LD in Ja03au did not significantly differ from that in the KY autumn sample. The lack of local differentiation was confirmed in an autumn sample from another local Japanese population. On the other hand, the magnitude of LD was significantly larger in spring than in autumn in the 2 independent KY samples. This suggests that reduction in the population size during winter increased the magnitude of LD in spring in the mainland population in Japan. Long-distance LD could be a useful measure for assessing seasonal fluctuation in effective population size.

A 52-year-old womanwas admitted because of highgrade remittent fever, erythema nodosum, and arthritis which had been lasting two months. Antibiotics did not improve her condition. A chest CT scan examination revealed bilateral hilar and mediastinal adenopathy and multiple nodular opacities in the bilateral lungs. The wedge biopsy of the right lower lobe using video-assisted thoracoscopy presented the histological findings of sarcoidosis.Finally, this case fulfilled the criteria of Lofgren's syndrome. Due to the uncovered cardiac involvement, the systemic glucocorticoid therapy had to be initiated.This case suggests that atypical forms of sarcoidosis should be kept in mind as well, when facing cases with unknown fever. (Internal Medicine 42: 534-537, 2003)

A 60-year-old woman with systemic sclerosis (SSc) was admitted because of severe anemia and Raynaud's phenomenon. Her anemia was associated with a low serum haptoglobin level and positive results of direct Coomb's tests, which indicated the presence of autoimmune hemolysis. Other laboratory investigations revealed positive anti-nuclear antibodies, anti-topoisomerase antibody, cold agglutinins, as well as low serum levels of IgM, C3, C4 and CH50. Bone marrow aspiration showed discrete hyperplasia of the erythropoietic system. She was diagnosed as low-titer cold agglutinin disease rousing secondarily to SSc. The anemia was alleviated with the oral administration of prednisolone. This case emphasized, in terms of pathogenesis, the close association between systemic rheumatic diseases and hematological abnormalities evoked by autoimmunity. (Internal Medicine 43: 139-142, 2004)