Pulmonary arterial hypertension in an 80-year-old man with long-term use of cyclophosphamide.

An 80-year-old man diagnosed with primary macroglobulinemia 7 years earlier had been treated with cyclophosphamide, following which he developed dyspnea on exertion. Cyclophosphamide was discontinued. The patient's dyspnea, however, failed to improve. Right heart catheterization (RHC) revealed precapillary pulmonary hypertension (PH). He was transferred to our institution for further examination. Prior use of cyclophosphamide was the patient's only risk factor for PH, and cyclophosphamide use was considered as a possible cause of PH in this case. He was treated with tadalafil and dyspnea gradually improved. A follow-up RHC exhibited improvement in mean pulmonary arterial pressure and pulmonary vascular resistance.

Acute eosinophilic pneumonia caused by composter vapor inhalation: A case report.

A 65-year-old woman presented to a local hospital with a 4-day history of cough, fever, and dyspnea. She had started using a composter and had been exposed to the vapor for 18 days before her first visit. She was diagnosed with acute eosinophilic pneumonia (AEP) based on her symptoms, the presence of bilateral pulmonary opacities on computed tomography, and alveolar eosinophilia confirmed by bronchoalveolar lavage. Inhalation of the composter vapor was thought to be the cause of AEP. Aspergillus fumigatus was cultured from the composter soil and the bronchoalveolar lavage fluid. She fully recovered without systemic corticosteroid administration by avoiding the composter.

A Case of Hb Aalborg (HBB: c.223G>C) with Chronic Obstructive Pulmonary Disease: A First Familial Presentation in Japan.

The proband was a male in his seventies who came to our facility because of shortness of breath. He was not anemic but presented dissociation between oxygen saturation (SpO2) and partial pressure of oxygen (PaO2) by blood gas analysis, and also demonstrated hemoglobinopathy after measurement of Hb A1c using high performance liquid chromatography (HPLC). Twenty-three percent of unknown hemoglobin (Hb) bands were detected. After sequencing the ß-globin gene, we noted a missense mutation at codon 74 (GGC>CGC) (Gly→Arg) of the ß-globin chain and he was diagnosed with Hb Aalborg (HBB: c.223G>C). One of the proband's siblings was diagnosed to have a low SpO2 level and also diagnosed to carry Hb Aalborg; she was also mildly anemic. This is the first known familial case of Hb Aalborg in Japan. In addition to Hb Aalborg, our case had underlying chronic obstructive pulmonary disease (COPD). Herein we present this case as a rare addition to the hematological literature.

New mechanistic insights into intramolecular aromatic ligand hydroxylation and benzyl alcohol oxidation initiated by the well-defined (µ-peroxo)diiron(iii) complex.

A (µ-peroxo)diiron(iii) complex [Fe2(LPh4)(O2)(Ph3CCO2)]2+ (1-O2) with a dinucleating ligand (LPh4), generated from the reaction of a carboxylate bridged diiron(ii) complex [Fe2(LPh4)(Ph3CCO2)]2+ (1) with dioxygen in CH2Cl2, provides a diiron(iv)-oxo species as an active oxidant which is involved in either aromatic ligand hydroxylation or benzyl alcohol oxidation.

Argentivorous molecules: structural evidence for Ag(+)-π interactions in solution.

Tetra-armed cyclens bearing aromatic side arms were prepared by the reductive amination of cyclen with substituted benzaldehydes. When equimolar amounts of Ag(+) ions were added to the ligands, the aromatic rings covered the Ag(+) ions incorporated in the ligand cavities, as if the aromatic ring "petals" caught the Ag(+) ions in the way an insectivorous plant (Venus flytrap) catches insects. The ligands are called "argentivorous molecules". Evidence of intramolecular Ag(+)-π interactions in solution and in the solid state is reported.

The impact of adenosine pharmacologic stress combined with low-level exercise in patients undergoing myocardial perfusion imaging (BIWAKO adenosine-Ex trial).

BACKGROUND: The combination of adenosine infusion with low-level exercise has become a common approach for inducing stress during stress myocardial perfusion imaging (MPI). We investigated stress MPI performed by combined low-level exercise and adenosine infusion. This combined protocol can decrease adverse reactions and reduce the effect of scattered rays from the liver. METHODS AND RESULTS: Subjects were clinically referred for a 53-min rest-stress Tc-99m Sestamibi MPI procedure using BIWAKO PROTOCOL. Ninety-eight patients (44.5%) underwent adenosine infusion with ergometer exercise testing and 122 patients (55.5%) underwent adenosine infusion without exercise testing. We evaluated the liver/heart (L/H) uptake ratio, background activity in the upper mediastinum, and adverse reactions. RESULTS: The L/H ratio and background activity were lower in the adenosine-exercise group than in the adenosine-non-exercise group (1.8 ± 0.54 vs. 2.1 ± 0.62, P < 0.0056; 43.1 ± 12.2 vs. 61.5 ± 15.4, P < 0.0001). The adenosine-exercise group had fewer adverse reactions than the adenosine-non-exercise group (11.2 vs. 19.7%). All of the adverse reactions were minor, with the exception of severe back pain in one case. The incidence of adverse reactions in our study was lower than that in previous studies for unknown reason. CONCLUSION: Adenosine infusion in combination with low-level exercise seems to result in higher-quality images and fewer adverse reactions than adenosine infusion without exercise. The combined protocol decreases adverse reactions and improves the quality of myocardial perfusion images by decreasing background activity.

Countermeasures against physical motion in schoolchildren requiring no sedation during rest and stress myocardial perfusion imaging with technetium-99m-tetrofosmin.

For children, cardiac nuclear medicine imaging has not been widely used because of problems of physical motion, even in schoolchildren who require no sedation. In this study, rest-stress myocardial perfusion imaging (MPI) with technetium-99m-tetrofosmin (Tc-99m TF) was performed with the use of a Vac-Loc cushion, a patient immobilizer commonly used for radiotherapy, for immobilizing school-age patients. The immobilizer attenuated the gamma radiation by 6%. By visual assessment, physical motion-related artifacts were markedly improved in images acquired with the immobilizer, compared to those without. In the assessment of image reproducibility with the immobilizer, taking the reproducibility as 2.5Σ + 0.7σ, there were deviations of 4.45, 5.28, and 3.28 mm along the X-, Y-, and Z-axes, respectively, demonstrating a high reproducibility and a negligible rest-stress position error. It is suggested that for radiotherapy, the immobilizer could expand the versatility of MPI while allowing only minimal physical motion in children.

The optimal cardiac phase for detecting the thrombi of the left atrial appendage on multi-slice computed tomography in patients with atrial fibrillation.

We evaluated patients with atrial fibrillation (Af) to define the optimal phase for ECG-gated image reconstruction for multi-slice CT (MSCT) of the left atrial appendage (LAA). We performed MSCT scans in 37 patients with Af, and we reconstructed multi-planar reformation images of the LAA, defined by the absolute delay (ms) immediately after the T wave, and by the relative delay (%). For visual analysis of the image quality for each image, a four-grade scoring system (poor to excellent) was used by two blinded, independent reviewers. Images obtained by absolute delay and by relative delay were classified as being of poor, fair, good, or excellent quality in 2, 2, 8, and 25 cases, and in 18, 11, 8, and 0 cases, respectively. This phase-definition strategy in Af patients is more effective by absolute delay than by relative delay, and MSCT could provide an alternative diagnostic assessment of LAA thrombi.

New protocol of myocardial SPECT imaging with technetium-99m sestamibi for reducing the time interval between rest and adenosine stress phases.

We have developed a new protocol of myocardial perfusion-gated single-photon emission computed tomography (SPECT), by use of technetium-99m sestamibi (MIBI), in which SPECT imaging at rest followed by SPECT imaging after adenosine with low level ergometer stress can be conducted by use of the Monzen position within a shortened total testing time of 1 h or less. The study group consisted of 137 patients who underwent this new imaging protocol. The diagnostic quality of the images was as good as that of images obtained with the conventional method (30-60 min after the injection of MIBI). The SPECT image quality for the 137 patients was evaluated, and the percentages of images rated as excellent, good, fair, and poor were 65.3, 27.4, 5.8, and 1.5% for the rest image, and 68.2, 21.9, 8.4, and 1.5% for the stress image, respectively. The shortened total testing time reduced the physical and mental burden on the patient compared with that of conventional myocardial perfusion imaging. Because this technique allows us to perform rest and stress myocardial imaging within a short period, it is expected to be very useful in the clinical setting.

[Evaluation of a New Protocol for Two-isotope (123)I-BMIPP/(99m)Tc-TF Single Photon Emission Computed Tomography (SPECT) to Detect Myocardial Damage within One Hour].

Objective The present study aimed at establishing a new protocol using both (99m)Tc-Tetrofosmin (TF) and (123)I-BMIPP SPECT to detect myocardial damage within one hour. Methods Initial (123)I-BMIPP SPECT was immediately followed by (99m)Tc-TF SPECT. The influence of (123)I scattered rays on (99m)Tc energy windows set at 15% and 10% were measured using an RH-2 phantom. Participants in the study were patients with heart diseases who had provided written informed consent to undergo the new protocol. The patients maintained the MONZEN position throughout the procedure and an injection syringe was attached to the left arm for (99m)Tc-TF injection during (123)I-BMIPP SPECT. Results & Discussion The phantom study showed only slight (123)I contamination of (99m)Tc at the 10% window setting. The new method separated the (123)I and (99m)Tc energy windows well and neither crosstalk nor scatter correction were needed. Images obtained from dual (simultaneous) acquisition were contaminated, whereas contamination and influence of scattered rays were absent in images obtained by use of the new protocol. These images were thus useful for clinical diagnosis. Conclusion The new protocol is more convenient for patients and might improve the efficiency of detecting myocardial damage.

Exploring a technique for reducing the influence of scattered rays from surrounding organs to the heart during myocardial perfusion scintigraphy with technetium-99m sestamibi and technetium-99m tetrofosmin.

We have devised a new position (Monzen position) which can suppress the influence of scattered rays from surrounding organs (liver, etc.) when conducting myocardial imaging. Unlike the conventional techniques, which require a waiting period of 30-60 minutes before imaging can be started after the infusion of technetium-99m sestamibi or technetium-99m tetrofosmin, this position allows single-photon emission tomography to be started about 5-10 minutes after the infusion of the tracer. Therefore, with this technique the total time required for imaging is reduced and consequently the physical and mental burden of the patient is also reduced. Furthermore, the number of patients who can receive this test at any facility can be increased. This position may also be applicable in myocardial scintigraphy using some other tracers.