A 59-year-old man was admitted to our hospital, complaining of fever and left lumbago. He was diagnosed with primary left iliopsoas abscess and treated with draining the abscess percutaneously and antibiotics. Chest x-rays taken on admission showed multiple round nodules in both lung fields. CT scans of the chest revealed a wedgeshaped lesion abutting the pleura in the left lower lung field and multiple nodules of various sizes in both peripheral lung fields. Some nodules had cavities with thin walls and feeding vessels. Follow-up CT scans to the chest demonstrated that some old nodules had vanished and new nodules developed in both lung fields. The diagnosis of septic pulmonary embolism secondary to iliopsoas abscess was established, because organized pneumonia was detected in the transbronchial lung biopsy specimens and the cultures of the pus from the abscess and the sputum on admission showed Enterococcus faecium.

An 87-year-old woman with unknown fever origin was admitted to our internal department. We could not determine the fever origin from clinical findings, serious blood data, urine data, bacteriological data, and images obtained by ultrasonography, computed tomography and magnetic resonance. Body inflammatory findings did not respond to several antibiotics we used. Gallium scintiphotography revealed abnormal radioisotope uptake in the bilateral inguinal region. And ultrasonography and enhanced computed tomography showed tumors in front of the bilateral femur neck. Moreover, bone scintiphotography (^99mTc) revealed abnormal radioisotope uptake in the bilateral hip joints. We performed resection of the right inguinal tumor. The tumor was solid mass 30×20×20mm in size. It was covered with an articular capsule in front of the right femur neck. We identified the mass as bilateral tuberculous granulation with Langhans-type giant cells pathologically. It was only with difficulty that we firmly diagnosed the case as tuberculous arthritis of bilateral hip joints because the fever origin was unknown. It is important to diagnose tuberculous arthritis by use of various imaging techniques. We should take tuberculous infection into consideration when we encounter a case of arthritis of unknown fever origin or a case of antibiotics resistant arthritis.

Upper gastrointestinal endoscopy is an invasive examination. Cardiovascular and respiratory adverse effects are commonly observed in patients undergoing endoscopy. We investigated prospectively the cardiovascular and respiratory changes every oneminute before, during and after routine endoscopy. Sixteen healthy adult patients were enrolled in this study. Systolic blood pressure, diastolic blood pressure, pulse rate and percutaneous arterial oxygen saturation (SpO₂) were recorded every one-minute throughout the procedure. Systolic and diastolic blood pressure increased significantly one minute after the insertion of the endoscope. Increases in pulse rate were noted after the insertion of the endoscope. Rate pressure product increased significantly one minute after the insertion of the endoscope. No significant change in SpO₂ was observed during endoscopy. Our results indicated that upper gastrointestinal endoscopy might induce cardiovascular stress and abnormality. Therefore, we should carefully insert and manipulate upper gastrointestinal endoscope.