The role of plasma levels of oxidized low density lipoprotein (OxLDL) in the development of coronary heart disease (CHD) has not been fully elucidated. We examined the relationship among plasma levels of OxLDL, measured by an enzyme immunoassay using an antibody against OxLDL (FOH1a/DLH3) and apolipoprotein B, CHD, and modalities at the onset of acute coronary syndrome (ACS). A total of 115 individuals who underwent coronary angiography were studied. Of these, 21 patients complicated with extracoronary cardiovascular diseases were excluded. Consequently, 94 patients (63 men) (ACS: 23, stable angina pectoris (SAP): 46, and normal coronary artery (NCA):25) were eligible for inclusion in the study. Elevated plasma levels of OxLDL were associated with CHD, especially with ACS. In patients with NCA, hypertension was associated with plasma OxLDL. Plasma levels of OxLDL were significantly higher in patients with new-onset type ACS than in those with worsening type ACS (2.98 versus 1.53 mg/dL, P = 0.002). In conclusion, plasma levels of OxLDL are associated with CHD and significantly higher in patients with new-onset ACS. The findings of the present study suggest that plasma OxLDL can be a marker of the development of CHD and modalities of ACS.

Recently developed 16-detector row computed tomography (CT) has been introduced as a reliable noninvasive imaging modality for evaluating the coronary arteries. In most cases, with appropriate premedication that includes beta-blockers and nitroglycerin, ideal data sets can be acquired from which to obtain excellent-quality coronary CT angiograms, most often with multiplanar reformation, thin-slab maximum intensity projection, and volume rendering. However, various artifacts associated with data creation and reformation, postprocessing methods, and image interpretation can hamper accurate diagnosis. These artifacts can be related to pulsation (nonassessable segments, pseudostenosis) as well as rhythm disorders, respiratory issues, partial volume averaging effect, high-attenuation entities, inappropriate scan pitch, contrast material enhancement, and patient body habitus. Some artifacts have already been resolved with technical advances, whereas others represent partially inherent limitations of coronary CT angiography. Familiarity with the pitfalls of coronary angiography with 16 detector row CT, coupled with the knowledge of both the normal anatomy and anatomic variants of the coronary arteries, can almost always help radiologists avoid interpretive errors in the diagnosis of coronary artery stenosis. (c) RSNA, 2005.

A 38-year-old Japanese woman underwent cardiac evaluation to assess an arrhythmia detected after the delivery of her fourth baby. At the age of 22 years, she had undergone cardiac evaluation, including catheter examination, because of a heart murmur. Coronary angiography showed a huge right coronary artery (RCA) draining to the right atrium and a normal left coronary artery. Because the left to right shunt ratio was trivial and the patient was asymptomatic, conservative observation was undertaken. On the current admission to hospital, there was a grade III continuous murmur at the second left sternal border. The patient underwent right and left cardiac catheter examination in March 2000. Selective coronary angiography demonstrated an enlarged lumen of the RCA, an enlarged aneurysmal cavity in the terminal portion of the RCA, and the postero-descending artery being filled by collateral circulation from the left coronary artery. Moreover, 2 new fistulas had appeared from the left coronary system. An oxygen saturation study showed that the pulmonary to somatic flow ratio (Qp/Qs) was 2.2. The patient underwent surgical treatment in July 2000 and on coronary angiography 1 month later, there was no abnormal shunt flow from either coronary artery into the aneurysmal cavity, although the RCA was still enlarged.

Background Angiotensin-converting enzyme inhibitors have been shown experimentally to prevent restenosis after balloon injury. We previously reported that quinapril reduced the 6-month restenosis (percent diameter stenosis greater than or equal to50%) rate after percutoneous coronary intervention (PCI). However, it was not established whether this favorable outcome was maintained for longer periods.Methods This study was a prospective, randomized, open, and non-placebo controlled trial. Patients with coronary artery disease were enrolled after successful coronary balloon angioplasty or stenting. Two hundred and fifty-three patients were randomly assigned to the quinapril (10-20 mg per day) or control groups. The major clinical end points included death, myocardial infarction, cerebrovascular accident, or revascularization (either coronary artery bypass grafting or repeat PCI). These were tabulated according to the intention-to-treat principle.Results Long-term follow-up was available with a median of 4:8 (interquartile range 4.2-5. 1) years after the procedure. The incidence of combined end points of mortality and morbidity (myocardial infarction and cerebrovascular accident) in the quinapril group was lower than that in the control group (6.1 % vs 14.8%; relative risk [RR] 0.42, 95% Cl 0.18-0.96, P =.033). The overall incidence of end-point events in patients with quinapril also occurred less frequently (29.8% vs 46.7%; RR 0.58, 95% Cl 01.38-0.86, P =.007).Conclusions These clinical outcomes show that the benefit of quinapril in patients following PCI is maintained for 4 years.

Experimental studies have demonstrated that vascular injury resulted in an induction of vascular angiotensin-converting enzyme (ACE), and have suggested that inhibition of vascular ACE might be important in the prevention of restenosis. The present study aimed to determine the effect of quinapril, an ACE inhibitor with high affinity to tissue ACE, on restenosis following coronary intervention. The design of this study was a prospective, randomized, open, and non-placebo controlled trial. Patients with ischemic heart disease were enrolled after successful percutaneous transluminal coronary angioplasty or stent implantation at 7 participating institutions. Two hundred and fifty-three patients with 294 lesions were randomly assigned to the quinapril (10–20 mg per day) group or control group. Administration of quinapril was continued for 3–6 months of the follow-up. Quantitative coronary angiography was performed before and after angioplasty and at follow-up. Core laboratory measurements were performed independently and blinded. Follow-up angiography was performed in 108 patients with 124 lesions in the quinapril group and in 107 patients with 130 lesions in the control group. The baseline characteristics and findings of angioplasty showed no significant differences between the two groups. However, in the quinapril group, restenosis per patient and per lesion was significantly lower (34.3% vs. 47.7%, p < 0.05 and 30.6% vs. 43.8%, p < 0.05). Multivariable analysis revealed that administration of quinapril independently contributed to reducing the restenosis per patient and per lesion (odds ratio, 0.73; 95% confidence interval, 0.54–0.99 and odds ratio, 0.75; 95% confidence interval, 0.57–0.99). In conclusion, quinapril significantly reduces restenosis following coronary intervention.

The present study evaluated whether hyperinsulinemia is a predictor of restenosis after coronary balloon angioplasty in 69 patients who underwent elective coronary balloon angioplasty; patients were excluded if they were known diabetics being treated with insulin. Quantitative coronary angiography was performed before and after angioplasty and at follow-up. Restenosis was defined as the presence of greater than or equal to 50% stenosis at follow-up. Plasma insulin responses before, 30, 60, and 120 min after 75 g glucose load (OGTF) were measured. Plasma insulin levels were higher in patients with restenosis than in patients without restenosis. Minimal lumen diameter at follow-up was smaller, and percent diameter stenosis at follow-up was higher and late loss was greater in the highest sum of insulin levels during OGTT (Sigma insulin) quartile (0.95 +/-0.15 vs 1.47 +/-0.09 mm, p=0.005; 66.3 +/-5.8 vs 40.5 +/-3.3%, p=0.0003; 0.90 +/-0.15 vs 0.49 +/-0.08 mm, p=0.02). Even after adjustment for coronary risk factors and administration of angiotensin converting enzyme inhibitors, the association of hyperinsulinemia with restenosis leads to the conclusion that hyperinsulinemia is a strong risk factor for restenosis.

We experienced a case of primary sclerosing cholangitis (PSC) which was very much localized in the cholodochus and very difficult to differentiate from choledochal cancer. Therefore, a report of 10 cases of localized PSC found in Japan is made with a discussion on the literature. The patient was a 48-year-old woman who visited this hospital with the chief complaint of jaundice. An-timitochondrial antibodies were normal, and squeezed-type complete obstruction was found in the central part of the choledochus on PTCD. By choledochography just before surgery, localized stenosis 5mm long was seen in the central part of the choledochus. In the belief that she had choledochal cancer, laparotomy was performed, but no mass was palpable in the choledochus, and the stenotic site presented no neoplastic finding macroscopically. Judging the con-dition to be PSC, cholecystectomy, removal of the stenotic choledochus, choledochojejeunostomy in Roux-en-Y fashion were performed. At present, two years and a month after the operation, the patient is in good health. PSC is a rare disease, and only 77 cases were collected by Yoshikawa et al in 1984 in Japan. It is of two types, localized and diffuse, and only 10 cases of the localized type have been found in this country including the present patient. The localized type of PSC is very difficult to differentiate from choledochal cancer preoperatively, and ex-cision should be performed when choledochal cancer cannot be conclusively ruled out. Rewiew of long-term prognosis following localized excision of localized PSC is to be desired.

広島湾内の「カキ」養殖従事者の健康状態を調査し, 労働条件・生活・行動・食事などと健康状態の関連について検討した。「カキ」養殖従事者の生活労働条件はかなり過酷であり、とくに男性において目立った。摂取食品は労働に応じ, 摂取量は多く, 動物性食品も多いようであった。このような条件下にある「カキ」養殖従事者の健康状態で問題になるのは男性では肥満傾向, 高血圧, 高脂血症であり, 女性では肥満傾向のみであった。しかし男女とも動脈硬化性血管障害危険因子を有するものは50%以上みられ, これらに対する対策を今より実施しないと将来問題が起こらないとは断言できないと考えられた。その対策としては, 健康教育の徹底, 個人指導の強化などが必要であり, 決して楽観すべきではないと考えられる。このような健康管理が実施されてはじめて「カキ」養殖従事者の健康状態は, 現在以上に良好な状態に保つことが可能となり, その生産性の向上も期待できるものと思われる。