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The pulmonary artery pressure (PAP) response to hypoxia is characterized by an initial vasoconstriction followed by vasodilation. Pulmonary vessels can release endothelium-derived relaxing factor (EDRF), which is considered to be nitric oxide (NO), but the role of EDRF in the regulation of normal and hypoxic pulmonary vascular tone is still uncertain. We designed this study to address the in vivo role of EDRF in vasodilation during sustained hypoxia. We studied the effects of an EDRF-synthesis inhibitor, Nomega-nitro-L-arginine methyl ester (L-NAME), on the pulmonary vascular response to sustained hypoxia (10% O2, 20 min) in normoxic (N) and chronically hypoxic (CH) rats. Biphasic PAP response was observed in N rats, whereas PAP was unchanged in CH rats during sustained hypoxic exposure. The L-NAME-induced PAP increase during normoxia was greater in CH than in N rats, suggesting that basal EDRF plays an important role in attenuating the severity of pulmonary hypertension in CH rats. Administration of L-NAME increased the initial increment in PAP by acute hypoxia and shifted the PAP response upward throughout sustained hypoxia, while still showing the biphasic pattern, in N rats. In contrast, PAP increased acutely and remained elevated with little recovery in the late phase in CH rats. The inducible NO synthase messenger RNA (mRNA) expression and protein showed greater increases in the lungs of CH than in N rats. These results suggest that EDRF release during sustained hypoxia may partly contribute to the roll-off in PAP response during sustained hypoxia in N rats, and that augmented EDRF may prevent a further increase in PAP during chronic hypoxia.

症例は68歳, 女性で, 咳嗽を訴え, 当科に入院となった. 胸部エックス線写真で前縦隔に腫瘍を認めた. CT写真上, 前縦隔腫瘍の他に, 後胸膜面に一カ所と, 他に肋骨転移を疑わせる腫瘍を認めた. 経皮生検で胸腺腫と診断した. 臨床病期はIVb期であった. 抗癌剤を投与したが腫瘍は縮小しなかった. 3カ月後, 息切れ, 呼吸困難を訴え, 緊急入院となった. 血液データから赤芽球癆と診断し, 輸血, 副腎皮質ステロイド剤によるパルス療法を施行したが, 改善せず, 心不全で死亡した.

症例は72歳女性.胸部X線写真上両側肺炎様陰影を示し気管支漏を呈した.TBLBで腺細胞の気管支肺胞型増殖の所見を認め, 臨床的に肺胞上皮癌と診断された.本症の気管支漏はステロイド抵抗性で, 呼吸不全で死亡した.剖検で膵尾部に腫瘤を認め膵尾部腺癌の肺転移と診断された.光顕所見で腫瘍細胞に粘液形成が認められたこと, 及び喀痰の生化学的分析結果から考察すると, 気管支漏の原因は, 気道の炎症性変化による血清成分の滲出よりも腫瘍細胞からの能動分泌の可能性が考えられた.

We report three dengue fever cases, infected during a group tour to the Philippines. A 58-year old male experienced sudden onset of high fever 5 days after returning to Japan, followed by rash and thrombocytopenia. The other 2 cases experienced similar symptoms. Clinically suspected from the travel history, incubation time and the state of dengue fever epidemic in the Philippines, dengue virus infection was confirmed by the laboratory tests. The incidence and geographical distribution of dengue virus infection have greatly increased in recent years. There have been reports of Japanese travelers who visited dengue endemic countries, infected and developed symptoms after returning home. Dengue virus infection should be included in the differential diagnosis of the patients who develop high fever and rash after returning from tropical areas.

Chronic hypoxemia has been suggested as the cause of weight loss in malnourished patients with chronic obstructive pulmonary disease. Insulin-like growth factor 1 (IGF-I) is believed to improve nitrogen balance and have anabolic effects, and it has been proposed as one of the mediators of vascular smooth muscle proliferation. The aim of this study was to assess the effects of IGF-I administration on the nutritional status and pulmonary vasculature in normoxic and chronic hypoxic rats. Twenty rats were randomly assigned to the normoxic (n = 10) and chronic hypoxic groups (n = 10). They received daily subcutaneous injections of either 3.2 mg/kg of recombinant human IGF-I (rhIGF-I) or isotonic saline (control group) for 3 weeks. Body weight was greater in IGF-I-treated rats compared with vehicle-treated rats, especially during the early and late stages of chronic hypoxic exposure, whereas similar weight gain was observed between IGF-I- and vehicle-treated normoxic rats. In addition, IGF-I treatment increased serum total protein and albumin at the end of hypoxic exposure. However, IGF-I had no additive effects on the degree of pulmonary hypertension. These results indicated that IGF-I promoted anabolism under chronic exposure to hypoxia, whereas no adverse effect was observed in the development of pulmonary hypertension.

Monocrotaline (MCT) is bioactivated in liver cytochrome P-450s to MCT pyrrole (MCTP), which primarily injures the lung endothelium to result in the development of pulmonary hypertension (PH) in rats. However, whether there is a relation between the degree of PH and the activity of liver cytochrome P-450 to convert MCT to MCTP remains unclear. To examine the relation between these physiological and biochemical changes, we first measured the severity of MCT-induced (20 mg/kg) PH in male, female, castrated male, and phenobarbital (PB, liver P-450s inducer)-pretreated male rats. The degree of right ventricular hypertrophy was more severe in PB-pretreated male than in control male rats. It was also more severe in male than in either female or castrated male rats, suggesting that sex-specific P-450s could be involved in the metabolic pathways of MCT in the liver. Further to explore which of the isozymes (2A2, 2C11, and 3A) of P-450s in the liver is responsible for the bioactivation of MCT, we measured the rate of MCTP production in hepatic microsomes by a modified Mattock's method. Treatment of male rats with PB and pregnenolone 16alpha-carbonitrile (PCN), which is the specific inducer of P-450 3A, increased the rate of MCTP production, suggesting that P-450 3A may contribute to the conversion to pyrrole. Therefore we measured the amount of P-450 3A protein by immunoblotting and attempted to inhibit MCT metabolism by using antibodies to P-450 3A. P-450 3A was significantly induced by PCN (6.5-fold) and PB (4.6-fold) treatment and reduced by castration (0.38-fold). The amount of P-450 3A was closely correlated with the production of MCTP, and the conversion of MCT to MCTP was strongly inhibited by antibodies against P-450 3A. These results indicated that P-450 3A was predominantly responsible for the metabolism of MCT to MCTP in rat liver and suggested a tight linkage between the degree of PH and the activity of liver P-450 3A.