Toxic hepatitis has been reported as a major cause of acute hepatitis, but its potential induction by herbal remedies and/or health foods is usually neglected. We experienced a case of toxic hepatitis associated with Polygoni multiflori, a Chinese herb commonly known as Ho-Shou-Wu. A 54-year-old woman consumed Ho-Shou-Wu for 1 month, after which she experienced fatigue and overall weakness. A diagnosis of toxic hepatitis was made based on her clinical history, the findings for viral markers and other laboratory data, and ultrasonography. Her condition improved considerably after she stopped taking Ho-Shou-Wu. However, she resumed taking Ho-Shou-Wu immediately after discharge from hospital, which aggravated her symptoms and liver function. She was immediately readmitted and stopped taking Ho-Shou-Wu. Her relapse into hepatitis immediate after resuming consumption of the herb is strongly indicative of the validity of Koch's postulate in this case.
Drug-Induced Liver Injury/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Middle Aged ; Plant Extracts/toxicity ; Polygonum/*toxicity

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.
Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Humans ; Myocardial Infarction

The myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis associated with multilineage cytopenias leading to serious morbidity or mortality, and the additional risk of leukemic transformation. The management of patients with MDS can be very complex and varies according to both the clinical manifestations in individual patients as well as the presence of complicating medical conditions. However, therapeutic dilemmas still exist for MDS due to the multifactorial pathogenetic features of the disease, its heterogeneous stages, and the elderly patient population. For these reasons, proper guidelines for management are necessary. This review describes the proper diagnosis for MDS, decision-making approaches for optimal therapeutic options that are based on a consideration of patient clinical factors and risk-based prognostic categories, and the use of recently available biospecific drugs such as hypomethylating agents that are potentially capable of abrogating the abnormalities associated with MDS. Proper indications and methods for transplantation, response criteria, management for iron overload for highly transfused patients and specific considerations for MDS in childhood are also described. All of these topics were discussed at the third symposium of AML/MDS working party on 3 March, 2007.
Aged ; Diagnosis ; Hematopoiesis ; Humans ; Iron Overload ; Mortality ; Myelodysplastic Syndromes* ; Transplantation