Pulse wave velocity as an indicator of atherosclerosis in obstructive sleep apnea syndrome patients.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular morbidity and mortality. We investigated the values of brachial-ankle pulse wave velocity as an indicator of atherosclerosis in obstructive sleep apnea syndrome patients. MATERIALS AND METHODS: Brachial-ankle pulse wave velocity (baPWV) was measured in 104 OSAS patients and 104 healthy control subjects matched for age, sex, and body mass index (BMI). BaPWV values were compared in both groups and investigated with respect to the number of risk factors for atherosclerosis, including hypertension, hypercholesterolemia, impaired glucose tolerance, smoking, and obesity. Comparisons were also made between 48 OSAS group cases and 90 control group cases free from hypertension, which has a major impact on baPWV. RESULTS: As compared to the control group, the OSAS group had significantly higher baPWV (1,645+/-349 cm/s vs 1,436+/-278 cm/s, p<0.0001), and values obtained for baPWV were significantly higher in the OSAS group than in the control group even in groups free from hypertension (1,453+/-216 cm/s vs 1,374+/-213 cm/s, p<0.05). In both groups, baPWV rose as the number of risk factors for atherosclerosis increased, but baPWV was higher in the OSAS group than in the control group even in a comparison of individuals entirely free from risk factors (1,400+/-200 cm/s vs 1,198+/-79 cm/s, p<0.05). CONCLUSION: The condition of OSAS itself is considered a possible risk factor for atherosclerosis. We believe that the usefulness of baPWV as an index of atherosclerosis merits further study in the frequently observed cases of OSAS complicated by cardiovascular disease.

[A case of Farmer's lung accompaign with caseous granuloma, monitored with serum KL-6 and SP-D].

A 65-year-old man was admitted to our hospital with a productive cough, fever, and dyspnea; his chest radiographs revealed diffuse nodular and ground-glass opacities. He had worked on a farm for 11 years. Six months earlier, he had presented with similar symptoms at another hospital, and was admitted with suspected atypical pneumonia. After treatment with antibiotics, his condition improved and he was discharged. Examination on admission to our hospital revealed markedly elevated serum KL-6 levels. Histological findings from specimens obtained by video-assisted thoracic surgical lung biopsy showed caseating and non-caseating epitheloid cell granuloma, lymphocyte infiltration, and alveolitis. Bacteriological tests for mycobacteria and fungi were all negative. Farmer's lung was diagnosed in accordance with the criteria for hypersensitive pneumonia. It is generally accepted that the distinguishing histological finding for Farmer's lung disease is non-caseating epitheloid cell granuloma, but in this case, caseous granuloma was also present.

[A case of sarcoidosis exacerbated after acute hepatitis C].

We describe a case of sarcoidosis exacerbated after acute hepatitis C, with particular reference to past case reports. A 30-year-old woman was admitted to our hospital in June 1997 because of cough and chest discomfort. Sarcoidosis was diagnosed as a result of chest radiography findings, transbronchial lung biopsy and bronchoalveolar lavage. A month later she was re-admitted because of fatigue. Acute hepatitis C was diagnosed from the findings of liver histology and HCV RNA. On the 42 nd day of hospitalization she complained of a severe cough, and a chest radiograph showed aggravation of bilateral reticulonodular shadows. This case suggested that acute hepatitis C may lead to an exacerbation of sarcoidosis. On August 4, 1999, the bilateral reticulonodular shadows had disappeared from the chest radiographs. Acute hepatitis C became chronic, but subsequently resolved spontaneously.