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Background The major concerns with coronary computed tomography angiography (CCTA) is the amount of contrast media (CM) injected and the radiation dose. Purpose To establish low radiation CCTA with low amount of contrast media. Methods Consecutive 60 patients (body weight ≤70mg or less and Agatston score ≤400) who were scheduled coronary computed tomography angiography were enrolled. Dual-source scanner (SOMATOM Force, Siemens, Germany) was used and CM used was Iopamidol 370mg/I (Bayer, Germany). Coronary CT angiography was performed with Turbo Flash Spiral and Sinogram Affirmed Iterative Reconstruction was done. The dose of contrast media was decided according to our original predicting system for 300HU. This study was approved by the local ethics committee and all patients gave written, informed consent. Exclusion criteria for CCTA were low Agatston score ( Results All patients successfully performed CCTA. Age averaged 46±15 yo (mean±S.D.) and body mass index averaged 22.5±3.0. Used CM was 12±7ml and intracoronary CT number 329±28HU. Dose-length product averaged 21.7±15.0 mGy cm and effective dose averaged 0.30±0.21mSv. Image quality averaged 4.8±0.7. CCTA with the lowest effective dose was 0.04mSv and CCTA with the lowest CM was 4ml. Conclusions Ultra-low dose 70kV-CCTA with low dose of contrast media can be performed using dual source computed tomography in patients with body weight ≤70mg or less and Agatston score ≤400.

Background Cholesterol crystals (CCs) have been recognized as only ghost images. Recently, free monolayer and multilayer CCs besides atheromatous materials from aortic ruptured plaque, obtained using nonobstructive angioscopy, were demonstrated using polarized light microscopy. Purpose The aim of the study was to detect free CCs from coronary slow flow. Methods A total of 86 patients with coronary artery disease underwent angioscopy with coronary artery sampling. Blood in the coronary artery with and without temporary slow flow was sampled. The blood sample was spread onto a filter paper, and the filter paper was rinsed with distilled water (filter paper-rinse method). The rinse water was scanned using polarized light microscopy, and CCs were detected. The dimensions of CCs from the coronary artery and aortic ruptured plaques were measured for 100 randomly selected samples. The lengths and widths of the CCs were measured. Results CCs were obtained in 31 of 86 patients (36.0%). CCs were detected in 38.4% of patients with acute coronary syndrome and in 31.9% of patients with stable angina. CCs were detected 47.1% with slow flow and in 25% without slow flow. Cholesterol Crystals in Coronary Artery Conclusions CCs from the coronary artery can be successfully obtained by using our original method. CCs were detected in patients with clinically stable angina and in those without coronary artery slow flow.

Background Non-obstructive general angioscopy has enabled to demonstrate high incidence of various types of spontaneous ruptured aortic plaques/injuries (SRAPIs). Purpose The aim of the study is to clarify the relationship between SRAPI and cardiovascular risk factors. Methods A total of 439 consecutive patients who had or suspected coronary artery disease were performed angioscopy and were screened SRAPI from ascending aorta to iliac artery. The incidence and the number of SRAPI were analyzed. Association between the total number of total SRAP and patients' characteristics were analyzed. Results The total number of SRAPI detected was 2211, 10 [4,22](median [IQR]) per patient. The numbers of high incidence of representative SRAPI, such as erosion, intramural bleeding, puff-chandelier rupture, puff rupture, fissure, flap, bleeding from fissure, and subintimal bleeding were 327, 313, 268, 262, 224, 167, 120, and 91, respectively. Stepwise multiple linear regression analysis indicated that age, smoking, HbA1c, and coronary heart disease significantly affected the numbers of overall SRAPI (Table). Conclusions SRAPIs were associated with cardiovascular risk factors.

Background In patients with cardiovascular disease (CVD), renal dysfunction is a risk factor for the prognosis, but substantial evidence is still lacking about the relationship between clinical characteristics and renal histology. The aim of our study was to evaluate the relationship between the extent of renal parenchymal damage, renal artery stenosis (RAS) and clinical characteristics in autopsy subjects with stroke. Methods During the 17-year period 1980-1997, 2167 subjects were autopsied at the National Cardiovascular Center. We studied retrospectively all the autopsy cases aged 40 years and older who had a history of stroke. Thus, 346 subjects remained and they were classified into two groups. Thirty-six subjects had RAS (group A). Three hundred and ten subjects had no RAS, and we randomly chose 102 subjects among them (group B). We evaluated renal parenchymal damage using a semi-quantitative chronic damage score. Results The average overall chronic damage score was significantly higher in the stenosed kidneys of group A than in the non-stenosed kidneys of group B (9.0+/-2.6 vs 7.0+/-2.7). The contralateral kidneys of group A had a tendency to have milder renal damage than stenosed kidneys. Furthermore, the total score was higher in the subjects with hypertension, diabetes mellitus, proteinuria, renal insufficiency and CVD than in the subjects without such complications. The total score had a significant association with RAS, proteinuria, renal insufficiency, CVD and weight of the kidney. Conclusions In autopsy subjects with stroke, we demonstrated that co-existing renal parenchymal damage was more severe in the subjects with RAS, hypertension, diabetes mellitus, proteinuria and renal insufficiency than those without such complications. The presence of RAS, impaired renal function and proteinuria was closely correlated with the severity of renal parenchymal damage.

Primary cardiac malignant fibrous histiocytoma is extremely rare and its pathophysiological characteristics remain largely unknown. We treated a female patient with persistent fever and disseminated intravascular coagulation. Since ultrasonic echocardiography revealed the presence of a cardiac tumor and her serum interleukin-6 level was elevated, we speculated she had a cardiac myxoma. Histological examination of the surgically resected specimen, however, revealed that the tumor was malignant fibrous histiocytoma. Although her disseminated intravascular coagulation and heart failure were transiently improved after operation, local recurrence and systemic metastasis occurred and she died 7 weeks after operation. Using the autopsied specimen, we examined whether the malignant fibrous histiocytoma constitutively synthesized interleukin-6. The interleukin-6 content in the tumor was high, consistent with interleukin-6 production by the tumor. This was confirmed by immunohistochemical analysis. To our knowledge, this is the first report demonstrating interleukin-6 production by a cardiac malignant fibrous histiocytoma.

By means of a new rapid and small scale purification method, human kidney renin has been purified from a single kidney in a homogeneous state, as judged on SDS-PAGE. The kidney which showed unusually high renin activity was from a patient with cardiomyopathy. 8,000-fold purification was attained by means of only pepstatin-aminohexyl-Sepharose chromatography and FPLC on a Mono Q column, and the yield was 34%. The specific activity was 5.63 mg angiotensin I per mg protein per h at 37 degrees C and pH 6.5 with porcine angiotensinogen as the substrate. The molecular weight was estimated to be 37,000 by SDS-PAGE and 38,000 by HPLC on a TSK G-3000 SW column. The preparation showed three bands on isoelectric focusing. The molecular weight and the profile on isoelectric focusing of the purified renin agreed with those found for the extracts of both the patient's kidney and a kidney with the usual low renin activity.