Nobuhiko Hayakawa

Malignant Hypertension with a Rare Complication of Pulmonary Alveolar Hemorrhage

A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and hemoptysis. Clinical diagnosis of malignant hypertension was given and antihypertensive therapy and hemodialysis were immediately started. Renal biopsy was performed on the sixth day in hospital to examine the underlying disease, such as microscopic form of polyarteritis, since the complaint of hemoptysis and pulmonary alveolar hemorrhage was noted by computed tomography of the lungs. Typical pathological changes of malignant hypertension, i.e. fibrinoid necrosis of the afferent arterioles and proliferative endoarteritis at the interlobular arteries were observed. There was no evidence of active necrotizing glomerulonephritis and crescent formation. Renal function was gradually recovered and pulmonary hemorrhage completely disappeared by treatment with antihypertensive agents. The authors report a case of malignant hypertension with a rare complication of pulmonary alveolar hemorrhage and speculate that it may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.

In vitro Macro-and Microautoradiographic Localization of V1 and V2 Receptors in the Rat Kidney Using OPC-21268 and OPC-31260

To elucidate the precise localization of vasopressin (VP) V1 and V2 receptors in the kidney, we utilized in vitro macroautoradiography (macro-ARG) and microautoradiography (micro-ARG) of these receptors in Wistar rat kidneys. This was done by using OPC-21268 and OPC-31260, two newly developed selective V1 (OPC-21268) and V2 (OPC-31260) receptor antagonists. For macro-ARG, 10-microm kidney sections were incubated with Tris-HCl buffer containing [3H]-VP with or without unlabeled ligand (VP, OPC-21268, or OPC-31260) at 20 degrees C for 40 min. These sections were then loaded into X-ray cassettes with Hyperfilm-[3H] and exposed in the dark for 2 months. The autoradiograms were quantitatively analyzed by using the research analysis system RAS 1,000; the V1 and V2 receptors were quantitated by subtracting the nonspecific binding (incubated with OPC-21268 and OPC-31260, respectively) from the total binding. To assess a more precise localization of the V1 and V2 receptors, we also investigated the micro-ARG of the renal V1 and V2 receptors by dipping the kidney section slides used for macro-ARG into a photographic emulsion and observing the receptors under light microscopy. [3H]-VP binding to the rat kidney was completely displaced by unlabeled excess VP, but not by unlabeled angiotensin II, indicating that [3H]-VP binding was specific for VP receptors. Computerized quantification showed that V2 receptors, visualized by OPC-31260, were the predominant type of VP receptor in the kidney. Conversely, V1 receptors, visualized by OPC-21268, were fewer in number. V1 receptors were partly localized to the glomerulus, cortical vessels, interstitial cells, and the medullary vessels. The V2 receptors localized to the collecting ducts and medullary tubules. Our findings indicated that renal V1 and V2 receptors can be detected by in vitro macro- and micro-ARG by using OPC-21268 and OPC-31260.

Optimal cut-off point of waist circumference for the diagnosis of metabolic syndrome in Japanese subjects.

Metabolic syndrome (MetS) has been redefined by a new criterion in Japan, in which waist circumference cut‐off points, that is 85 cm for men and 90 cm for women, are used; however, objections are rising against this criterion. The present study examined the criterion for waist circumference to predict the accumulation of the components of MetS. In the present study, we used data for 5972 Japanese people who received annual health examinations, and 621 men (16.3%) and 51 women (2.4%) were diagnosed as having MetS. A cut‐off point as a predictor for two or more components of MetS was evaluated by the sensitivity/specificity and a receiver operating characteristic analysis. The optimal point of waist circumference was estimated as being approximately 84 cm for men and 80 cm for women. We therefore recommend revising the cut‐off value for the criterion of MetS in women according to our results and studies from other investigators. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00020.x, 2010)

FDG-PET/CTが診断に有用であった大動脈炎症候群の1例

A 60-year-old female patient was admitted to our hospital in April, 2010 because of low-grade fever and malaise for several months. Physical examination on admission revealed no abnormalities except for a body temperature of 37.2℃. Blood examinations showed moderate anemia and a high erythrocyte sedimentation rate. There were no other specific abnormal findings. A systemic CT scan study disclosed diffuse thickening of the artery wall through the ascending, descending and abdominal aorta to the bilateral iliac arteries. In order to evaluate the quality of the vessel lesions, a FDG-PET/CT study was performed and revealed abnormal accumulation of 18F-FDG in the thickened wall, suggesting an inflammatory process in the lesion. Taking all these findings into consideration, we made the diagnosis of Takayasus arteritis, and treated the patient with prednisolone. The treatment was effective and her symptoms improved. A later CT scan revealed that the artery wall became somewhat thinner. Takayasus arteritis is a disease whose diagnosis is difficult to make because there are neither specific signs nor diagnostic laboratory findings in its early stage. We found that FDG-PET/CT was helpful in the diagnosis and evaluation of lesions in a patient with Takayasus arteritis.

FDG-PET/CT is useful in the diagnosis of early phase Takayasu's arteritis : A case report

A 60-year-old female patient was admitted to our hospital in April, 2010 because of low-grade fever and malaise for several months. Physical examination on admission revealed no abnormalities except for a body temperature of 37.2℃. Blood examinations showed moderate anemia and a high erythrocyte sedimentation rate. There were no other specific abnormal findings. A systemic CT scan study disclosed diffuse thickening of the artery wall through the ascending, descending and abdominal aorta to the bilateral iliac arteries. In order to evaluate the quality of the vessel lesions, a FDG-PET/CT study was performed and revealed abnormal accumulation of 18F-FDG in the thickened wall, suggesting an inflammatory process in the lesion. Taking all these findings into consideration, we made the diagnosis of Takayasus arteritis, and treated the patient with prednisolone. The treatment was effective and her symptoms improved. A later CT scan revealed that the artery wall became somewhat thinner. Takayasus arteritis is a disease whose diagnosis is difficult to make because there are neither specific signs nor diagnostic laboratory findings in its early stage. We found that FDG-PET/CT was helpful in the diagnosis and evaluation of lesions in a patient with Takayasus arteritis.