Objective: It is unclear whether the reduction of coronary restenosis by statins is due to a decrease in low-density lipoprotein (LDL) cholesterol and/or pleiotropic effects. Therefore, we performed quantitative coronary angiography (QCA) and analyzed the lipid profile and changes in adhesion molecules and chemokines caused by statin in patients with acute myocardial infarction (AMI). Methods: The subjects included AMI patients who had initial coronary angiograms and significant coronary stenosis and were implanted with a stent. After stent implantation, patients were treated either with (n=36) or without (n=14) statin. The primary end-point for this study was the absolute changes in the lipid profile, C-reactive protein (CRP), adhesion molecules, chemokines and stenosis measured by QCA between the post-stent and follow-up angiogram at 6 months after stenting. Results: Treatment with statin reduced % coronary diameter stenosis (DS) and was associated with a greater reduction in LDL cholesterol at 6 months after stenting in patients with acute myocardial infarction (AMI), while there were no differences in adhesion molecules, chemokines, CC chemokine receptor or CXC chemokine receptor. Interestingly, changes in % DS between before and after statin treatment at 6 months (Δ%DS) were positively correlated with ΔLDL cholesterol, and patients who had an LDL cholesterol level of less than 80 mg/dl had a significantly lower Δ%DS. In addition, Δ%DS was significantly related only to the reduction in LDL cholesterol as assessed by a stepwise multivariable regression analysis. Conclusion: These results suggest that the lower level of LDL cholesterol is the most critical factor in preventing coronary restenosis.
Objective: Simplified sleep polysomnography was performed in 207 adult men to examine the relationship between the frequency of sleep-disordered breathing (SDB) and lifestyle-related illness. Methods: Each subject was checked for SDB using a simplified sleep polysomnograph (Auto-Set Portable; Teijin Limited, Tokyo, Japan). Apnea and hypopnea were detected with a nasal cannula type airflow sensor. Hypoxemia was checked with a percutaneous oxygen saturation (SpO2) monitor. We analyzed the relationships between SDB and body mass index (BMI) and hypertension, hyperlipidemia, liver dysfunction, fatty liver, and abnormal glucose metabolism. Results: Fifty-nine subjects (29%) showed SDB with apnea hypopnea index (AHI) over 15 times/h. The frequency of obesity (BMI≥25), hypertension, hypercholesterolemia, fasting blood glucose level, and HbA1c were significantly higher in patients with SDB than in normal individuals (AHI<5 times/h). The frequencies of hypertension, hyperlipidemia, and abnormal glucose metabolism were compared between the obesity-free normal AHI group and the SDB group, and only that of hypertension was significantly different between the two groups. Conclusions: The present study revealed a high frequency of SDB among Japanese individuals. The results also suggest that as SDB becomes severe, it becomes more closely linked to the onset of lifestyle-related illnesses, such as hypertension, hypercholesterolemia and abnormal glucose metabolism.
A 65-year-old man underwent transurethral resection of the prostate on a diagnosis of benign prostatic hypertrophy. Almost simultaneously, a diagnostic resection of minor salivary glands was performed. After the resections he suffered from obstructive jaundice. Laboratory examinations revealed an increase in eosinophils and an elevation of serum IgG4. Pancreaticoduodenectomy was performed because of the possibility of pancreatic cancer. The prostate, salivary glands and pancreas showed common histological characteristics, namely, infiltration of lymphocytes and plasma cells accompanying dense fibrosis. Most of the infiltrating plasma cells showed strong immunoreactivity to IgG4. This is the first case with IgG4-associated prostatitis complicating autoimmune pancreatitis.
A 33-year-old man with a 4-year history of Behçet's disease was hospitalized with acute myocardial infarction. Percutaneous coronary intervention (PCI) treated 99% stenosis of the right coronary artery but follow-up coronary arteriography clearly revealed a coronary artery aneurysm (CAA) at the lesion proximal to the PCI site and intravascular ultrasound confirmed that it was a true aneurysm. We speculated that Behçet's disease might be involved in coronary lesion, especially in CAA formation. We decided to increase the dose of prednisolone and to add warfarin. The size of the CAA was not altered after 6 months.
A 72-year-old man was admitted to our hospital with a renal infarction. On admission, computed tomography (CT) of the abdomen revealed total occlusion of the right renal artery, which was found to be recanalized with residual thrombus 7 days later. Transesophageal echocardiography and chest CT demonstrated crescent-shaped thrombus in the non-coronary sinus of Valsalva without evidence of aneurysm. After coumadin treatment the patient did not experience recurrent episodes of systemic embolization. Five months after the initiation of anticoagulation, transesophageal echocardiography and chest CT demonstrated disappearance of the thrombus. This is a rare case of renal infarction caused by a thrombus in the non-coronary sinus of Valsalva without aneurysm.
A 20-year-old woman with no history of pulmonary disease had no symptom and her chest CT scans demonstrated adhesive small multiple nodules in the bronchial lung biopsy specimen showed epithelioid cell granuloma containing Langhans giant cells, therefore she was diagnosed as pulmonary mycobacteriosis caused by M. szulgai. This is the youngest case of this rare condition occurring in a healthy subject without underlying pulmonary diseases.
A 73-year-old man with silico-asbestosis responded to steroid therapy. Chest CT scans showed diffuse micronodular opacities and ground glass opacities bilaterally throughout the entire lung fields, as well as progressive massive fibrosis in the bilateral upper lung fields. Diagnostic thoracoscopic biopsy revealed mixed dust pneumoconiosis with silicotic nodules, as well as fibrosis similar to that of Usual Interstitial Pneumonia (UIP) with many fibroblastic foci and alveolitis. Many asbestos bodies were also detected by iron staining.
A 73-year-old man with fever, lumbago and hemosputum showed ground-glass opacity around multiple lung nodules on chest computed tomography. Examination of the man revealed anemia. Specimens obtained by video-assisted thoracic surgery revealed angiosarcoma, but the primary site of angiosarcoma could not be detected before autopsy. Angiosarcoma is a rare malignant neoplasm with rapid proliferation and they can arise at any region of the body. It can originate in the skin, soft tissue, liver or heart. Their multicentric and local recurrence easily leads us to misdiagnosis, and we have struggled to reach diagnosis and its origin. Angiosarcoma should be included in the different diagnosis of diffuse pulmonary hemorrhage with multiple lung nodules.