RESUMO
Micron-sized inorganic microparticles with hollow insides were prepared by interfacial reaction method, in which an ion exchange reaction between Na(+) and metal cations in internal and external aqueous phases, respectively, proceeded through the oil phase involving a cation carrier. The diameter of microballoons was approximately 10 microm and shell thickness was below 2 microm. The effects of preparation conditions against the formation of microballoons were examined. The factors examined were metal species in the external aqueous phase and the concentrations of metal chloride and cation carrier. The cross-section of microparticles formed was inspected by scanning electron microscope (SEM) and the inner space of some metal silicates was not hollow but filled-up. The increase of internal and external aqueous solution concentrations caused the increase of diameter and shell thickness of microballoons. Since the penetration of metal cation through the oil phase was promoted by the increase of carrier concentration, the formation of microballoons was completed in a short time of less than 30 min.
Assuntos
Composição de Medicamentos/métodos , Metais , Silicatos , Cátions , Emulsões , Microscopia Eletrônica de Varredura , Nanoestruturas , Sódio , Propriedades de Superfície , Fatores de TempoRESUMO
An autotrophic denitrification system was developed for nitrate contaminated industrial wastewater whose C/N ratio was very low. The microbes containing Thiobacillus denitrificans as a dominant species were attached on the surface of granular elemental sulfur packed in a column. Elemental sulfur was used as an electron donor for autotrophic denitrification. The granules of limestone were mixed with the granular sulfur to moderate the decrease of alkalinity during autotrophic denitrification. The stoichiometry and basic kinetics of denitrification were studied in column runs. The effects of minerals such as phosphorus on treatment performance were clarified. The wastewater from steel production plants was treated by the present biofilm process. Low extent of nitrogen removal was caused by the lack of minerals.
Assuntos
Acidithiobacillus thiooxidans/fisiologia , Resíduos Industriais , Nitrogênio/metabolismo , Eliminação de Resíduos Líquidos/métodos , Reatores Biológicos , Carbonato de Cálcio , Cinética , EnxofreRESUMO
Removal of mutagen precursors from wastewaters was investigated. Removal extent of mutagen precursor was evaluated by the mutagen formation potential (MFP) which is mutagenicity of pollutants capable of forming mutagens when chlorinated under the conditions of water purification processes. 77% of the MFP reduction extent for a wastewater from a university was achieved by activated sludge treatment. However, no significant reduction of the MFP was observed for wastewater from food industry, a landfill leachate and mold extract. The Fenton oxidation treatment and ozone treatment are able to remove mutagen precursors from the mold extract and the wastewater from a university, respectively. 90% of the MFP reduction extent was achieved for the mold extract by the Fenton treatment. 54% of the MFP reduction extent was achieved for a sewage by the ozone treatment. Using the oxidation treatments, biodegradability of mutagen precursors in the mold extract and sewage was improved. From the viewpoint of treatment cost, the oxidation treatments should be oriented to the improvement of biodegradability.
Assuntos
Mutagênicos/isolamento & purificação , Mutagênicos/metabolismo , Esgotos/química , Eliminação de Resíduos Líquidos/métodos , Purificação da Água/métodos , Biodegradação Ambiental , Bioensaio , Indústria Alimentícia , Fungos , Peróxido de Hidrogênio/farmacologia , Ferro/farmacologia , Testes de Mutagenicidade , Oxirredução , Salmonella/genéticaRESUMO
A new method, named the "Dilution method", is proposed to express the color of water. This method is based on the idea to define a color degree with the dilution times when it is hard to distinguish any difference between diluted colored water and distilled water as a standard. The Dilution method has the merits of a simple operation and wide applicability to any colored waters. Moreover, the results of the Dilution method are more understandable and sensitive than those of other conventional measurement methods.
Assuntos
Técnica de Diluição de Corante , Poluentes da Água/análise , Cor , Monitoramento Ambiental/métodosRESUMO
The authors evaluated partial anomalous pulmonary venous return by magnetic resonance (MR) images. Seven patients with this congenital anomaly underwent MR imaging examination. Conventional spin-echo and gradient-echo imaging were performed. In addition, during acquisition of gradient-echo images, saturation pulses were imposed on the affected lung. Spin-echo images showed the anatomical situation of the anomalous veins, and gradient-echo images revealed the blood flow in the veins. With saturation technique, the direction and drainage of blood flow in the anomalous veins were well defined. The study suggests that MR imaging with spin-echo method and gradient-echo method with or without saturation pulses is a useful and noninvasive method of diagnosing partial anomalous pulmonary venous return. MR images with spin- and gradient-echo methods were useful in defining the anatomical situation and blood flow in the anomalous veins. By imposing saturation pulses on the affected lung field, the direction and drainage of blood flow in the anomalous veins were clearly demonstrated.
Assuntos
Imageamento por Ressonância Magnética/métodos , Veias Pulmonares/anormalidades , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Átrios do Coração/anormalidades , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Fluxo Sanguíneo Regional , Veia Cava Superior/anormalidadesRESUMO
Although Fas-mediated cell death may play a role in atherogenesis, causal data in support of this hypothesis are lacking. The present study investigated the possibility that endothelial cells are involved in vascular smooth muscle cell (VSMC) apoptosis via the Fas-FasL pathway, and hence in atherogenesis. FACS analysis detected FasL on the surface of human umbilical vein endothelial cells (HUVECs) and immunofluorescence staining of the HUVECs demonstrated high levels of FasL in the intracellular compartment. FasL was down-regulated 4 h after tumor necrosis factor (TNFalpha) treatment, coinciding with maximal surface expression of the adhesion molecules vascular cell adhesion molecule-1 and E-selectin. However, the down-regulation of FasL expression was transient, as surface expression returned within 24 h of TNFalpha treatment. When cocultured with VSMCs, the FasL-expressing EC could kill the VSMCs in a manner that could be blocked by recombinant Fas-Fc, deployed as a soluble receptor for Fas. Moreover, when human coronary arteries were studied with immunohistochemistry using G247-4 monoclonal antibody for the detection of FasL, few FasL positive EC were observed in diffuse intimal thickening. In contrast, endothelium overlying the plaque showed prominent and uniform expression of FasL. These findings suggest that the Fas/FasL pathway can be used by EC to induce VSMC apoptosis in the atherosclerotic lesion.
Assuntos
Apoptose/efeitos dos fármacos , Endotélio Vascular/química , Glicoproteínas de Membrana/farmacologia , Músculo Liso Vascular/efeitos dos fármacos , Adulto , Idoso , Técnicas de Cocultura , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/patologia , Regulação para Baixo/efeitos dos fármacos , Endotélio Vascular/patologia , Proteína Ligante Fas , Feminino , Humanos , Imuno-Histoquímica , Masculino , Glicoproteínas de Membrana/metabolismo , Glicoproteínas de Membrana/fisiologia , Pessoa de Meia-Idade , Músculo Liso Vascular/citologia , Fator de Necrose Tumoral alfa/farmacologiaRESUMO
Obesity is often accompanied with hypertension and increases cardiovascular events. Japanese new guideline on identification of obesity includes a modified BMI categories and a method of detection of visceral fat obesity in Japanese. Hyper-insulinemia and leptin released from adipose tissue play an important role in the development of hypertension in obese patients. Insulin and leptin increase sympathetic tone which results in sodium retention and hyper-responsiveness of blood vessels. As leptin has also a direct vasodilative and diuretic action, its effect on blood pressure is bidirectional. Life style modification, especially diet and physical exercise are important to obtain the body weight loss and the improvement of insulin resistance. Dynamic exercise at the level of fifty percent of max VO2 for 30 to 60 minutes over three times a week should be recommended for hypertensive patients with obesity. ACE inhibitors improve the hypersympathetic tone and impaired insulin sensitivity in obese patients. Calcium antagonist is also useful for these patients.
Assuntos
Hipertensão/terapia , Obesidade/complicações , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Dieta , Exercício Físico , Humanos , Hiperinsulinismo/complicações , Hipertensão/etiologia , Insulina/fisiologia , Leptina/fisiologia , Estilo de Vida , Guias de Prática Clínica como AssuntoRESUMO
A novel water quality index, the mutagen formation potential (MFP) is proposed for use in evaluation of the quality of drinking water which may contain pollutants capable of forming mutagens when chlorinated under the conditions used in water purification processes. A method for measuring MFP was established as follows. The water sample to be tested is diluted until the TOC reaches 3-4 mg l-1, the pH is adjusted to 7.0 +/- 0.2, sodium hypochlorite is added to obtain conditions where Cl/TOC = 3-4 mg Cl (mg C)-1, and the water sample is left standing for 24 +/- 2 h at room temperature. Thereafter, 21 of the chlorinated water sample at pH 2.0 +/- 0.1 is passed through a Sep-Pak Plus CSP-800 cartridge to adsorb any mutagens formed, and DMSO is applied to the cartridge to desorb the mutagens. Then, a 2 ml sample of the eluate is collected after the DMSO had begun to flow out of the cartridge and evaluated by the Ames Salmonella mutagenicity assay (preincubation method).
Assuntos
Purificação da Água , Água , Compostos Clorados/toxicidade , Mutagênicos/toxicidade , Controle de QualidadeRESUMO
To evaluate the mechanism of neurally mediated syncope (NMS), we investigated basal autonomic nerve function using a conventional pharmacological method and [123I]-metaiodobenzyl-guanidine (MIBG) single photon emission computed tomography (SPECT). Nine patients with NMS, whose syncope was induced by head-up tilt test with or without isoproterenol, underwent [123I]-MIBG SPECT. Eight of nine NMS patients showed reduced myocardial uptake (two patients, diffuse; four patients, anteroseptal and inferior; one patient, anteroseptal; one patient, inferior). In the study of pharmacological autonomic nervous function test, atropine sulfate (atr.) (0.04 mg/kg), isoproterenol (isp.) (5 x 10(-3) microg/kg/min), propranolol (prop.) (0.2 mg/kg), phenylephrine (phenyl.) (0.4 microg/kg/min), and phentolamine (phent.) (0.2 mg/kg) were successively administered to patients with NMS (n = 5) and control subjects (n = 5). The heart rate (HR) after atr. and prop., and systolic blood pressure (SBP) after phent. were defined as intrinsic HR (IHR) and intrinsic SBP (ISBP). Parasympathetic activity (increase in HR by atr.), beta-sympathetic tone (HR after atr. minus IHR), beta-sensitivity (change in HR by 1 microg isp./kg/min), beta-secretion (beta-tone/beta-sensitivity), alpha-sympathetic tone (SBP before phenyl. minus ISBP), alpha-sensitivity (change in SBP by 1 microg phenyl./kg/min) and alpha-secretion (alpha-tone/alpha-sensitivity) were also calculated. The beta-secretion was decreased (0.0027+/-0.0008 versus 0.0060+/-0.0004 microg/kg/min/isp.; p < 0.05), while the beta-sensitivity was increased (5850+/-947 versus 3150+/-292 beats/microg/kg/min isp.; p < 0.05) in NMS compared with control subjects. In the other indexes, there were no significant differences between two groups. The results of the present study suggest that increased beta-sensitivity may contribute hypercontraction of left ventricles, which might partially explain the mechanism of NMS.
Assuntos
Receptores Adrenérgicos beta/fisiologia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/fisiopatologia , 3-Iodobenzilguanidina , Adolescente , Adrenérgicos/farmacologia , Fibras Adrenérgicas/efeitos dos fármacos , Fibras Adrenérgicas/fisiologia , Adulto , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/fisiologia , Feminino , Testes de Função Cardíaca/efeitos dos fármacos , Testes de Função Cardíaca/métodos , Testes de Função Cardíaca/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
OBJECTIVE: c-FLIP is a natural homologue of caspase 8, and may antagonize activation of death pathways mediated by FADD. c-FLIP is highly expressed in the heart, and a recent report suggests that c-FLIP may protect against certain types of myocyte death. The present study was designed to define the expression patterns of c-FLIP in the heart. METHODS: The expression pattern of c-FLIP in end-stage human hearts, and rat cardiomyocyte grafting models was analyzed by in situ hybridization, immunohistochemistry and TUNEL assay. In addition, to determine whether Fas-dependent pathway is active in cardiomyocytes in vitro, we examined whether activated monocytes can kill neonatal cardiomyocytes in a co-culture system. RESULTS: c-FLIP mRNA and protein were abundantly expressed in normal cardiomyocytes from failing human heart. In animal models, c-FLIP protein was absent in TUNEL-positive grafted cardiomyocytes. Double staining demonstrated that c-FLIP-positive cells rarely had fragmented DNA, while TUNEL-positive cells rarely contained c-FLIP. Finally, activated monocytes induced death of neonatal rat cardiomyocytes via the Fas/FasL system. CONCLUSIONS: Loss of c-FLIP expression correlates with cardiomyocyte cell death. We hypothesize that diminished c-FLIP expression may predispose cardiomyocytes to apoptotic death.
Assuntos
Caspases/metabolismo , Insuficiência Cardíaca/metabolismo , Miocárdio/metabolismo , Adulto , Animais , Animais Recém-Nascidos , Apoptose , Western Blotting , Transplante de Células , Técnicas de Cocultura , Fragmentação do DNA , Cães , Inibidores Enzimáticos/metabolismo , Proteína Ligante Fas , Feminino , Expressão Gênica , Humanos , Imuno-Histoquímica , Hibridização In Situ , Marcação In Situ das Extremidades Cortadas , Leucócitos Mononucleares , Ativação Linfocitária , Masculino , Glicoproteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Modelos Animais , RNA Mensageiro/análise , Ratos , Ratos Endogâmicos F344 , Receptor fas/metabolismoRESUMO
A 37-year-old woman was admitted in a comatose state, after exhibiting fever and diarrhea. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (672 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fifth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from dysphagia, hypesthesia and motor weakness, followed by respiratory failure. Cerebrospinal fluid analysis was suggestive of Guillain-Barre syndrome (GBS). Autonomic dysfunction was manifested as tachycardia and mild hypertension in the acute stage. Marked orthostatic hypotension persisted long after paresis was improved, indicating an atypical clinical course of GBS.
Assuntos
Doenças do Sistema Nervoso Autônomo/complicações , Cetoacidose Diabética/complicações , Síndrome de Guillain-Barré/complicações , Adulto , Doenças do Sistema Nervoso Autônomo/terapia , Cetoacidose Diabética/terapia , Feminino , Síndrome de Guillain-Barré/terapia , HumanosRESUMO
Leptin is a polypeptide, mainly produced in white adipose tissue, and increases sympathetic nerve activity. A few studies investigated leptin's effect on peripheral vessels. We examined the vasorelaxant effects of human leptin on rat arteries. Arterial rings were precontracted with 1 x 10(-6) mol/l of phenylephrine, and leptin was superfused. Leptin relaxed phenylephrine-precontracted arterial rings in a dose-dependent manner. ED50 was calculated to 8.4 microg/ml. Removal of endothelium abolished the effects of leptin. Indomethacin (1 x 10(-5) mol/l) did not affect the vasorelaxation by leptin, whereas 1 x 10(-4) mol/l of N(omega)-nitro-L-arginine methyl ester (L-NAME) completely suppressed it. The inhibition was antagonized by 1 x 10(-4) mol/l of L-arginine. Leptin normally relaxed arterial rings during superfusion of K channel blockers, including 3 x 10(-5) mol/l of glibenclamide, 1 x 10(-6) of mol/l apamin, and 5 x 10(-7) mol/l of charybdotoxin. Low Cl(-) solution (8. 3 mmol/l) inhibited leptin-induced relaxation, but endothelium-independent vasodilatation by nitroprusside was not impaired at low Cl(-) solution. These results suggest that arterial relaxation by leptin is mediated by nitric oxide released from endothelium, and Cl(-) plays an important role in leptin-induced nitric oxide release.
Assuntos
Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiologia , Leptina/farmacologia , Óxido Nítrico/fisiologia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia , Acetilcolina/farmacologia , Animais , Arginina/farmacologia , Cloretos/metabolismo , Humanos , Técnicas In Vitro , Indometacina/farmacologia , Leptina/fisiologia , Masculino , NG-Nitroarginina Metil Éster/farmacologia , Bloqueadores dos Canais de Potássio , Ratos , Ratos WistarRESUMO
Fas and its ligand, FasL, are a receptor-ligand pair identified as promoting cell death in several tissues. Vascular smooth muscle cells (VSMCs) are resistant to FasL or anti-Fas antibody (Ab) signal, and a number of in vitro studies show that VSMC death can only be induced by anti-Fas Ab or FasL in the presence of protein inhibitor or additional inflammatory mediators. It remains to be clarified whether known, constitutively expressed cytoprotective molecules are reduced by protein inhibitor, thereby accounting for sensitization to cell death by Fas/FasL signaling. We found that Fas mRNA and protein exist in several primary VSMCs, as previously reported. We also demonstrated (1) that critical death-signaling molecules, such as FADD, caspase-1/ICE, and caspase-3/YAMA, are present in these VSMCs, (2) that human VSMCs contain high concentrations of c-FLIP (3) and that following treatment with the protein inhibitor, CHX, cell extracts showed a decrease in c-FLIP protein that was dose- and time-dependent on the degree of apoptosis and inversely correlated with both caspase-8 and -3 activity. In contrast, there was neither a change nor an even modest upregulation of Bcl-2 family, even after 12 h of treatment with CHX. Taken together, these results may provide a novel insight into atherogenesis and suggest that c-FLIP may contribute to an apoptosis-resistant state of VSMC, and that a downregulation of c-FLIP may render VSMCs susceptible to apoptosis.
Assuntos
Apoptose , Proteínas de Arabidopsis , Proteínas de Transporte/fisiologia , Peptídeos e Proteínas de Sinalização Intracelular , Músculo Liso Vascular/efeitos dos fármacos , Receptor fas/fisiologia , Apoptose/efeitos dos fármacos , Arteriosclerose/fisiopatologia , Proteína Reguladora de Apoptosis Semelhante a CASP8 e FADD , Proteínas de Transporte/biossíntese , Proteínas de Transporte/genética , Caspase 1/biossíntese , Caspase 1/genética , Caspase 3 , Caspase 8 , Caspase 9 , Caspases/biossíntese , Caspases/genética , Células Cultivadas , Cicloeximida/farmacologia , Indução Enzimática , Ensaio de Imunoadsorção Enzimática , Proteína Ligante Fas , Ácidos Graxos Dessaturases/biossíntese , Ácidos Graxos Dessaturases/genética , Regulação da Expressão Gênica , Genes bcl-2 , Humanos , Marcação In Situ das Extremidades Cortadas , Glicoproteínas de Membrana/fisiologia , Músculo Liso Vascular/citologia , Inibidores da Síntese de Proteínas/farmacologia , Proteínas Proto-Oncogênicas c-bcl-2/biossíntese , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Recombinantes de Fusão/farmacologia , Transdução de Sinais , Proteína bcl-X , Receptor fas/biossíntese , Receptor fas/genéticaRESUMO
Voltage-dependent calcium channels are crucially important for calcium influx and the following smooth muscle contraction. Beta subunits of these channels are known to modify calcium currents through pore-forming alpha subunits. Among the four reported independent beta subunits, the beta3 subunit is expressed in smooth muscle cells and thought to compose L-type calcium channels in the tissue. To determine the role of the beta3 subunit in the cardiovascular system, we have analyzed beta3-null mice. Electrophysiological examinations proved the existence of dihydropyridine (DHP)-sensitive. L-type calcium channels in the smooth muscle cells. Beta3-null mice show no apparent changes in smooth muscle contraction and sensitivity to DHP, and normal blood pressure when they are raised on a normal diet, but the 13 subunit deficient mice show elevated blood pressure in response to a high-salt diet, with significant reductions in plasma catecholamine concentrations. Our finding strongly suggests a close relationship between voltage-dependent channels and high blood pressure.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Canais de Cálcio/fisiologia , Músculo Liso Vascular/fisiologia , Cloreto de Sódio na Dieta/administração & dosagem , Vasoconstrição/efeitos dos fármacos , Animais , Frequência Cardíaca , Técnicas In Vitro , Camundongos , Subunidades ProteicasRESUMO
The aim of this study was to evaluate arterial relaxation mediated by endothelium-derived hyperpolarizing factor (EDHF) during chronic inhibition of nitric oxide (NO) synthase. We measured the isometric tension of isolated mesenteric arteries of Wistar rats administered Nomega-nitro-L-arginine methyl ester (L-NAME, 100 mg/Kg/day) for 3 weeks. Relaxation to acetylcholine (ACh) was reduced in L-NAME treated rats (maximum relaxation, 52% versus 79% ). After acute superfusion of 1x10(-4) M L-NAME, half the relaxation was inhibited in controls, while the relaxation was not changed in L-NAME treated rats. In contrast, relaxation to nitroprusside was normal in L-NAME treated rats. Superfusion of 1x10(-6) M apamin, which inhibits the effects of EDHF, reduced the relaxation. The relaxation inhibited by apamin was not significantly different between the two groups. These findings suggested that in endothelial cells, the synthesis of EDHF is unchanged during a chronic deficiency of relaxation influence of NO.
Assuntos
Fatores Biológicos/farmacologia , Hipertensão/fisiopatologia , Artérias Mesentéricas/fisiopatologia , Óxido Nítrico Sintase/antagonistas & inibidores , Potássio/metabolismo , Vasodilatação/efeitos dos fármacos , Acetilcolina/farmacologia , Animais , Apamina/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Inibidores Enzimáticos/toxicidade , Hipertensão/induzido quimicamente , Hipertensão/metabolismo , Técnicas In Vitro , Masculino , Artérias Mesentéricas/efeitos dos fármacos , Artérias Mesentéricas/metabolismo , NG-Nitroarginina Metil Éster/toxicidade , Óxido Nítrico/biossíntese , Nitroprussiato/farmacologia , Fenilefrina/farmacologia , Canais de Potássio/efeitos dos fármacos , Canais de Potássio/metabolismo , Ratos , Ratos Wistar , Vasoconstritores/farmacologia , Vasodilatadores/farmacologiaRESUMO
A 65-year-old woman was admitted to the coronary care unit because of acute pulmonary edema. Immediate 2-dimensional and Doppler echocardiograms revealed extensive left ventricular wall motion abnormalities and left ventricular hypertrophy with extreme outflow obstruction. Although an ECG showed ST-segment elevation in the anterolateral leads, a coronary arteriogram revealed normal epicardial arteries. Heart failure was relieved after diminishing the dynamic outflow obstruction with disopyramide administration. An endomyocardial biopsy from the right ventricle on the 8th hospital day showed borderline myocarditis. Wall motion abnormalities gradually normalized within 2 weeks. It is speculated that her pulmonary edema would not have been relieved so readily without the immediate reduction in ventricular afterload by disopyramide. These clinical changes over time were observed with serial echo-Doppler examinations.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Miocardite/complicações , Disfunção Ventricular Esquerda/etiologia , Obstrução do Fluxo Ventricular Externo/etiologia , Doença Aguda , Idoso , Angiografia Coronária , Disopiramida/uso terapêutico , Ecocardiografia Doppler , Feminino , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Disfunção Ventricular Esquerda/tratamento farmacológico , Obstrução do Fluxo Ventricular Externo/tratamento farmacológicoRESUMO
A premenopausal female patient presented with acute myocardial infarction of 3 different coronary vessels at different times within 1 year. These events were caused not by restenotic lesions after balloon angioplasty but by new lesions, which were successfully treated by primary angioplasty. Although she had a history of hypertension, type IIB hyperlipidemia, and diabetes, they had been well-controlled on medication. An elevated serum lipoprotein(a) level may have played a role in this rapid angiographic progression.