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We describe a case of fever of unknown origin (FUO), renal failure, and pancytopenia. Initially, lymph proliferative disorder was suspected; therefore, bone marrow biopsy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) were performed. Bronchoscopy and lung biopsy were performed because of abnormal FDG uptake in both lung fields. Imaging data and laboratory and histological results confirmed sarcoidosis with bone marrow invasion. The patient was discharged after favorable response to corticosteroid therapy. Sarcoidosis may present as FUO without typical specific presentations in the skin or lungs. Combined 18F-FDP PET/CT helped identify the biopsy site and confirmed the sarcoidosis diagnosis.

Noboru Saito, Yuhei Mori, Tomoya Komatsu Terumo Shonan Center, Kanagawa 259-0151, JapanCorrespondence: Noboru SaitoTerumo Shonan Center, 1500 Inokuchi, Nakai-Machi, Ashigarakami-Gun, Kanagawa 259-0151, JapanTel +81-465-81-4251Fax +81-465-81-4217Email noboru_saitou@terumo.co.jpPurpose: Stent flexibility can influence clinical outcome, especially in bifurcation lesions. For instance, an overly rigid stent can impose mechanical stress on the artery at the stent edges and alter both arterial geometry and blood flow dynamics in bifurcations. This study investigated the influence of stent flexibility on vessel geometry, histology, wall stress, and blood flow dynamics in arterial bifurcations.Materials and Methods: We compared arterial angulation, stenosis, histopathology, simulated wall shear stress (WSS), and simulated blood flow velocity distribution in swine coronary artery bifurcations following placement of the less flexible Multi-link 8 or more flexible Kaname stent (4.1 ± 0.5 vs 1.5 ± 0.1 mN, p < 0.05, t-test). Stents were implanted into six coronary artery bifurcations each using the single-stent crossover technique without side branch strut dilatation. Outcomes were examined after 28 days.Results: Implantation of both stents significantly increased site angulation (Multi-link 8: 148° ± 8° to 172° ± 2°, p < 0.05, paired t-test; Kaname: 152° ± 5° to 164° ± 4°, p < 0.05, paired t-test), but the change tended to be greater after Multi-link 8 stent implantation (24° ± 15° vs 11° ± 7°, p = 0.1, t-test), suggesting greater straightening of the bifurcation. The Multi-link 8 stent induced greater neointimal thickness than the Kaname stent (0.53 ± 0.3 mm vs 0.26 ± 0.1 mm, p < 0.05, t-test). The distribution of neointimal hyperplasia following stent implantation as revealed by longitudinal histopathology matched the distribution of WSS simulated using computational fluid dynamics (CFD). The endothelium at low WSS areas exhibited aberrant cell morphology and leukocyte adhesion. A CFD model of a curved bifurcation suggested that the region of low WSS is expanded by artery straightening.Conclusion: In bifurcated lesions, stent flexibility influences not only mechanical stress on the artery but also WSS, which may induce local neointimal hyperplasia.Keywords: bifurcation, stent flexibility, wall shear stress, neointimal hyperplasia

医学部外科学(第2)講座 亀岡信悟教授退任記念特別号

This review paper describes (1) establishment of an in vitro method for screening endocrine disrupting chemicals with estrogenic activity and (2) study on effects of nonylphenol (NP) and octylphenol (OP) on mRNA expression of vitellogenin (VTG) Ⅱ and very low density lipoprotein (apoVLDL) Ⅱ in the liver of quail embryos. For in vitro screening, the cDNA of the ligand binding domain of quail estrogen receptor (ER) α or quail β was ligated into the gluthathione S-transferase expression vector and expressed in E.coli. The fusion protein was used for competitive enzyme immunoassay. Among 20 substances examined, 9 and 5 showed binding to ER α and β, respectively. NP and OP showed the highest binding to ER α, and bisphenol-A to ER β, with binding affinities relative to that of diethylstilbesterol (10^{-9}M order) of 6 ％ and 16.2 ％, respectively. For the in vivo study, quail fertile eggs were treated with a single injection of either NP or OP(10 and 100 nmole/egg, in 20 μl) on day 13 of incubation. VTGⅡ and apo VLDLⅡ mRNA levels on day 15 of incubation were determined by RT-PCR. A weak but distinct expression of VTG Ⅱ and ApoVLDLⅡmRNA was observed after NP and OP. NP and OP could be endocrine disruptors in birds.

The aim of this study was to clarify the relationship between dietary intake or lifestyle and blood sugar control in diabetic outpatients. In this study 186 outpatients (136 males and 50 females) were recruited, who had been treated only with diet for controlling blood sugar. Three months to 12 years after a dietician counseled dietary therapy to diabetic outpatients, the effects were evaluated by both calculating the energy intakes and inquiring the questionnaires. By the criteria of Japan diabetic society for 75 g OGTT, diabetic, borderline and normal types were diagnosed. Outpatients brought themselves dietary records for the preceding 3 days every visiting the clinic.Fasting blood samples were obtained early in the morning for measuring biochemical parameters.Energy intakes of outpatients were calculated using both the exchangeable food table for diabetic patients and 5th revised Japan food table. Then, the questionnaires were inquired to outpatients by dieticians. During the observed periods until 36 months, good controls (100 to 119 mg/dl of FBS) were shown 6 months after in males and 9 months after in females. Poor control was more in males compared to females. In the cases of 1600 kcal per day of energy intakes, males ate more food rich in protein and energy, while females did more food rich in carbohydrate and vitamins with comparatively well-balanced nutrients. These well-balanced diets contributed to good control. Males drank alcohols very often, and females took sweets more, causing probably the disturbed control of blood sugar. The discrepancy of the calculated energy between above two food tables was approximately 70 kcal, showing more with Japan food table. Through counseling to outpatients by both physicians and dieticians, the frequency of physical movement increased from 25% in the initial to 60% in the final period. As an improvement of lifestyle, cigarette smoking decreased from 40 to 28% in frequency in males, and from 10 to 3% in females. From these findings, the counseling to outpatients in the clinic was beneficial to improve blood sugar control and lifestyle.

This article reports the effects of mechanical contacts on the growth behavior of a single seed crystal sodium chloride. Growth-rate enhancement and liquid-inclusion formation were observed. These experiments were made to simulate the actual collisions that frequently occur in an industrial suspension crystallizer.

浜野恭一教授退任記念論文集

An inflammatory response due to bioincompatibility of extracorporeal circuits is a major clinical issue during cardiopulmonary bypass (CPB). By using a swine model, we determined whether new polymer-coated circuits, the blood-contacting surfaces of which are coated with poly(2-methoxyethylacrylate) (PMEA), would reduce the inflammatory response during CPB. Plasma bradykinin levels and the percentages of CD35-positive monocytes in PMEA-coated circuits were significantly lower than those in uncoated circuits during CPB. The amount of proteins adsorbed on the PMEA-coated circuits was significantly lower than that on the uncoated circuits (0.30 microg/cm2 versus 3.42 microg/ cm2). Almost no IgG, IgM, or C3c/d was detected in proteins adsorbed on the PMEA-coated circuits although these proteins were clearly detected in proteins adsorbed on the uncoated circuits. We concluded that PMEA coating could reduce complement activation during CPB by suppressing the adsorption of IgG and IgM, which activate C3 via the classical pathway, on the surface of the circuits.