Shinsuke Iwashita

Inherited adrenocorticotropin-independent macronodular adrenal hyperplasia with abnormal cortisol secretion by vasopressin and catecholamines : Detection of the aberrant hormone receptors on adrenal gland ()

ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare disorder and an unusual cause of Cushing’s syndrome, of which familial transmission has rarely been reported. In this study, a mother and her son, the former affected with definite AIMAH and the latter with possible AIMAH, are described. Although the mother manifested overt Cushing’s syndrome, her son remained with no stigmata of Cushing’s syndrome except for bilateral adrenal tumor and mild hypertension, and a full suppression of plasma cortisol by low-dose dexamethasone was observed in him. Recently, aberrant expression of adrenal receptors for various ligands has been noted in AIMAH patients. In our cases, provocation tests in vivo suggested that AVP and catecholamines promoted cortisol production through V1a and/or V1b receptors and via β-adrenergic receptor, respectively. Reverse transcriptional-PCR analysis of the operated adrenal tissues of mother revealed the abnormal expression of mRNA of receptors for V1b, V2, and LH/hCG, none of which was observed in a normal control. Inherited AIMAH is very rare, and the son might be at the earliest developmental stage of AIMAH among the cases reported so far. An intervention could be tried to prevent the development of overt Cushing’s syndrome by suppression of the possible endogenous ligands or by blockade of the receptors that may be aberrantly expressed in his adrenal glands.

Comparison of the McGrath MAC video laryngoscope and the Pentax Airwayscope during chest compression: a manikin study

We tested the utility of the McGrath MAC® (McG) video laryngoscope during chest compression compared with the Pentax Airwayscope® (AWS). We recruited 59 participants into the simulation study. The difference in the time to intubation (TTI [sec]) between without and with chest compression was significant for the AWS attempts (median 13, range 6–28 vs. median 15, range 6–72, p = 0.0247) but not significant for the McG attempts (median 16, range 6–75 vs. median 16, range 6–71); however, the difference of the TTIs is not serious clinically. The utility of the two devices during chest compressions is almost similar although their characteristics are different.

Comparison of the efficacy of sitagliptin and glimepiride dose‐up in Japanese patients with type 2 diabetes poorly controlled by sitagliptin and glimepiride in combination

The goal of the study was to examine the effects of sitagliptin dose‐up or glimepiride dose‐up in Japanese patients with type 2 diabetes who were controlled inadequately by sitagliptin and glimepiride in combination.

A resuscitated case of cardiopulmonary arrest due to massive hemoptysis caused by a ruptured thoracic aortic aneurysm

Dear Editor, We report a resuscitated case of cardiopulmonary arrest (CPA) following massive hemoptysis due to a ruptured thoracic aortic aneurysm (TAA). A 73-year-old man was admitted with a sudden onset of hemoptysis. He presented with atrial fibrillation, and he had been taking warfarin (1 mg/day). He had not been previously diagnosed as having a TAA and had had no episode of hemoptysis. On admission, he was lucid with the following vital data: blood pressure, 143/107 mmHg; pulse rate, 90–110 b.p.m.; respiratory rate, 20/min. His breathing sound was reduced in his left lung field. Laboratory tests showed: hemoglobin, 14.7 g/dL; total leukocyte count, 10,800/mm; platelet count, 135,000/mm; PT (INR), 1.17; d-dimer, 29.4 μg/mL. A chest X-ray revealed a hazy shadow in the patient’s left lung field (Fig. 1A). A contrast-enhanced chest computed tomography scan showed a leakage of the contrast material from the TAA and consolidated lung tissue adjacent to the TAA (Fig. 1B). He was diagnosed as having a ruptured TAA into the tracheobronchial trees or the lung, and an emergent endovascular stent-grafting was scheduled. Just before the induction of general anesthesia, CPA following sudden massive hemoptysis occurred. He was intubated immediately, and we started cardiopulmonary resuscitation (CPR). An endovascular intervention was also started under the CPR. We inserted the stent-graft through the femoral artery with fluoroscopy guidance. After the dilation of the stent-graft with an endovascular balloon, the patient was resuscitated. The duration of the CPR was 67 min; however, we had to interrupt the chest compression several times during the fluoroscopy guidance. During the CPR, his electrocardiogram revealed pulseless electrical activity and mechanical ventilation was continued with 100% oxygen; however, the lowest PaO2 was 52 mmHg and the highest PaCO2 was 98 mmHg. The lowest value of

Comparison of the conventional Macintosh laryngoscope, the Pentax Airwayscope, and the McGrath MAC video laryngoscope under restricted cervical motion: a manikin study

We compared the utility of the conventional Macintosh laryngoscope, the Pentax Airway Scope, and the McGrath MAC video laryngoscope under restricted cervical motion using a manikin.

Comparison of the utility of the Pentax Airway Scope (AWS) with that of the conventional Macintosh laryngoscope during chest compression: is the AWS an easy‐to‐use device for a novice?

The Pentax Airway Scope occasionally contacts the arm of the chest compressor at insertion because of its large body. Here, we test the Airway Scopes ease of use compared to that of the conventional Macintosh laryngoscope during chest compression, when operated by a novice.

Electrocardiogram findings of patients with serum potassium levels of nearly 10.0 mmol/L: a report of two cases

In Case 1, a 63‐year‐old woman was admitted with muscular weakness. She had hypertension, diabetes mellitus, and chronic renal failure on hemodialysis. She was taking a beta‐blocker. Her pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 9.8 mmol/L; electrocardiogram revealed widening of the QRS complex (0.256 s). In Case 2, a 59‐year‐old man was admitted with muscular weakness. He had hypertension and chronic renal failure, and was taking a renin–angiotensin–aldosterone system inhibitor. His pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 10.1 mmol/L; electrocardiogram revealed widening of the QRS complex (0.180 s).