Objective Unlike arteriogenesis, little is known about the effects of vasculogenesis and its major effector cells, endothelial progenitor cells (EPCs) on collateral formation. In this study, we investigated whether or not the number and function of EPCs were associated with the development of collateral formation in patients with single-vessel coronary artery disease of chronic total occlusion (CTO). Methods and Results The subjects were patients (n=35) undergoing coronary angiography (CAG) who had CTO in one major coronary artery. EPCs were isolated from peripheral blood samples and cultured. Their phenotypes were confirmed by uptake of acetylated LDL and binding of fluorescein isothiocyanate (FITC)-labeled Ulex europaeus agglutinin 1 (UEA-1) lectin. The numbers of colony-forming units (CFUs) and the senescent cells, determined by acidic β-galactosidase staining, were counted. The angiogenic growth factors from the culture medium were also measured by ELISA. Patients with good collaterals (n=22, Rentrop class 2 and 3) exhibited an increased number of CFUs (p=0.023), reduced number of senescent cells (p=0.010), and higher concentration of b-FGF (0.036) in the culture medium, compared with subjects with poor collaterals (n=13, Rentrop class 0 and 1). Conclusion Our findings suggested that EPC-mediated angiogenesis might be associated with coronary collateral formation in humans.
Background Neuro-Sweet disease (NSD) has recently been identified as Sweet disease with central nervous system (CNS) involvement characterized by multisystem neutrophilic infiltration. However, the pathogenesis of this disease remains unknown. Neutrophil and other inflammatory cell activities are influenced by many cytokines and chemokines, but to date, no studies have examined the levels of these factors in patients with NSD. Patient and Methods The patient presented with encephalomeningitis twice in one year and was diagnosed with NSD. We measured the levels of cytokines (i.e., IL-2, IL-4, IL-6, IL-10, IFN-γ, and TNF-α) and chemokines (i.e., CCL2, CCL3, CCL5, CXCL8, CXCL10 and GM-CSF) in 10 CSF samples from the patient longitudinally for one year including those during two episodes of encephalomeningitis. Results The elevations of IL-6, IFN-γ, CXCL8 (IL8) and CXCL10 (IP10) were markedly higher than the levels in uninfected control subjects with neurological disorders. The levels of these cytokines and chemokines were statistically correlated with total CSF cell counts (p <0.01). Conclusion CD4+ helper T (Th) cells can be divided into the Th1 and Th2 subtypes according to their cytokine secretion patterns, and IFN-γ and IP10 are the Th1-type cytokine and chemokine indicating the involvement of Th1 cells in NSD. In addition, the level of IL8, a specific neutrophil chemoattractant, correlated well with the neutrophil cell counts in CSF. Our data suggest the important roles of Th1 cells and IL8 in the pathogenesis of NSD.
Objective The association between obesity and atherosclerotic disease is controversial. We examined whether common carotid intima-media thickness (IMT), a precursor to preclinical atherosclerosis, was associated with total body fatness or the accumulation of fat mass in the abdominal region in middle-aged and older persons. Methods Participants were consecutively enrolled from patients aged ≥50 years, and were 623 men aged 73±10 (mean±standard deviation) years and 835 women aged 76±10 years. Demographic data were collected and maximal preperitoneal fat thickness (PFTmax) and carotid intima-media thickness (IMT) were evaluated on B-mode ultrasonography. Subjects were divided into 3 groups on the basis of body mass index (BMI), a marker of general obesity. Results It was shown by multiple regression analysis for IMT that age, smoking status, hypertension and uric acid were significantly associated with IMT in subjects in the lowest BMI group (<20 kg/m2), and age, hypertension, dyslipidemia and uric acid in middle BMI group (20-22.9 kg/m2). Moreover, man sex, age, BMI, PFTmax, smoking status, hypertension and uric acid were significantly associated with IMT in subjects with highest BMI group (≥23 kg/m2). Analysis of covariance showed that interaction between BMI and visceral obesity (f=7.202, p=0.007) was significantly associated with IMT, in addition to age, visceral obesity, smoking status, hypertension, dyslipidemia and uric acid. Conclusion The present study indicates a graded and independent association between general and visceral obesity and preclinical carotid artery changes in patients aged ≥50 years with a BMI ≥23 kg/m2.
In January 2007, an 80-year-old man was admitted to our hospital for treatment of a pancreatic tumor. He had been diagnosed with autoimmune pancreatitis (AIP) in December 2003 for which steroid therapy had induced remission. In November 2006, tumor marker levels rapidly increased, and the patient was suspected of having pancreatic cancer based on imaging studies. The diagnosis was later confirmed by endoscopic ultrasound-guided fine-needle aspiration biopsy. Distinguishing AIP from pancreatic cancer is crucial; however, few previous reports have described any cases of pancreatic cancer associated with AIP. While several reports have speculated on the prognosis of AIP, natural courses of the disease remain uncertain. This report emphasizes that AIP can coexist with cancer.
A 74-year-old woman with rheumatoid arthritis was referred for a mass incidentally noted on chest radiograph. Chest CT scan showed cystic lesions in the right lower lobe. The lesion was evaluated as bronchiectasis, and she was followed up. Three years after the initial presentation, the appearance of the lesion had changed significantly and an elevated air-fluid level in the cystic structures was shown on chest CT scan. The preoperative serum progastrin-releasing peptide (proGRP) level was elevated (108.0 pg/ml; normal: <50 pg/ml). Histopathological specimen obtained by standard lower lobectomy confirmed that the lesion was an intralobar pulmonary sequestration. In the resected lobe, there was no malignant finding, but there were neuroendocrine tumorlet cells, which were positive for proGRP. One month after the resection, the serum proGRP level returned to normal. No pulmonary sequestration with high levels of proGRP has been reported, and this is the first case with elevated serum levels of proGRP.
In 2005, a 46-year-old woman consulted our department for an evaluation of a chest radiographic abnormality. She had undergone a successful living renal transplantation in 1999 after being treated by dialysis for four years. A chest computed tomographic scan revealed progressive bilateral fluffy, poorly defined small nodules and the bronchoscopic study revealed a unique linear and nodular lesion pattern. Based on the findings of these modalities, we confirmed the diagnosis of metaplastic pulmonary calcification. This is the first report of these bronchoscopic findings and submucosal calcification in a case of metastatic pulmonary calcification.
We describe a 56-year-old woman with histiocytic sarcoma involving the bone marrow. The neoplastic cells proliferated diffusely and showed occasional erythrophagocytosis. Immunohistochemically, the neoplastic cells were positive for CD68, lysozyme, CD4 and CD163, but negative for B- and T-cell markers, S100 protein and epithelial markers. The patient received multi-agent chemotherapy and is living at 22 months after diagnosis without recurrence. Histiocytic sarcoma is an exceedingly rare hematopoietic neoplasm and the prognosis is poor due to its rapid progression, widespread disease and poor response to therapy. It is important to recognize this rare neoplasm and to confirm the diagnosis using specific immunohistochemical markers.
Soft tissue involvement is an uncommon complication of brucellosis. We report a rare case of gluteal abscesses caused by brucellosis. The patient was a housewife living in a city. There was no history of systemic complaints or other organ involvement. Diagnosis was made by positive pus culture and serological tests. Histopathological examination of the abscess wall revealed granulomatous inflammatory reaction. The patient was treated successfully with abscess drainage and a 6-week course of oral doxycycline and rifampicin. Brucellosis should be kept in mind in the diagnosis of gluteal abscess, especially in endemic areas.
The advantages of diagnosing legionellosis by urinary antigen detection are widely recognized, and include early detection, rapidity of testing, and ease of specimen collection. However, the persistence of Legionella urinary antigen excretion has been suggested in some selected patients, although the clinical features of these patients have not yet been clearly described. Here, we describe the clinical features of two patients with Legionnaires' disease with persistence of Legionella urinary antigen excretion (117 days and 247 days). One patient had an underlying disease, adult T-cell leukemia, and the other patient had ulcerative colitis and was receiving oral corticosteroids. Unusual clinical and radiological findings as well as a review of the literature are presented.
We encountered a case where treatment with olanzapine resulted in the elevation of serum triglyceride level despite the absence of weight gain and abnormal glucose metabolism. Elevation in serum triglyceride levels as seen in non-obese individuals does not fall under the category of metabolic syndrome which has recently been highlighted as an adverse reaction to second-generation antipsychotics. In some individuals treated with antipsychotics, metabolic abnormalities develop with an initial sign of elevated serum triglyceride levels instead of weight gain.