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PURPOSE A graph plot (GP) method using 123I-N-isopropyl-p-iodoamphetamine (123I-IMP) has been proposed as a simple and non-invasive estimation of quantitative cerebral bloodflow (CBF). A regression equation for the GP method was estimated by the data of resting state. Therefore, the accuracy of CBF values in high flow range may be an underestimated possibility in this method.The aim of this study was to formulate a new regression equation for the GP method by the data of resting state and acetazolamide (ACZ) challenge, and to clarify the accuracy of it. METHODS The images of 26 consecutive patients who underwent both 123I-IMP chest radioisotope-angiography (RIA) and single photon emission computed tomography (SPECT) examinations were used to construct the new regression equation. Examinations of the resting state and ACZ challenge were performed in different days. All patients were analyzed by both the GP method and autoradiography (ARG) method which is the conventional examination with the one-point arterial blood sampling. A linear regression equation between the index of the input function was obtained by the GP method and CBF value of ARG. The linear regression equation based on the resting data was compared with the equation based on the resting and ACZ challenge (rest+stress) data. RESULTS Goodliner correlation was obtained between the index of the input function obtained by the GP method and CBF value of the ARG method in the rest+stress state (y=2.75x+15.1, r=0.78). In contrast, correlation results between the index of the input function obtained by the GP method and CBF value of the ARG method in the resting state was expressed as y=2.28x+18.4, r=0.54 rCBF values based on the resting data was 20% underestimated in the high flow range compared with values based on the rest+stress data. CONCLUSION The new linear regression equation for the GP method is useful for clinical study. Key words: non-invasive cerebral blood flow measurement method, graph plot (GP), autoradiography (ARG), 123I-N-isopropyl-p-iodoamphetamine (123I-IMP).

A graph plot (GP) method using 123I-N-isopropyl-p-iodoamphetamine (123I-IMP) has been proposed as a simple and non-invasive estimation of quantitative cerebral bloodflow (CBF). A regression equation for the GP method was estimated by the data of resting state. Therefore, the accuracy of CBF values in high flow range may be an underestimated possibility in this method.The aim of this study was to formulate a new regression equation for the GP method by the data of resting state and acetazolamide (ACZ) challenge, and to clarify the accuracy of it.The images of 26 consecutive patients who underwent both 123I-IMP chest radioisotope-angiography (RIA) and single photon emission computed tomography (SPECT) examinations were used to construct the new regression equation. Examinations of the resting state and ACZ challenge were performed in different days. All patients were analyzed by both the GP method and autoradiography (ARG) method which is the conventional examination with the one-point arterial blood sampling. A linear regression equation between the index of the input function was obtained by the GP method and CBF value of ARG. The linear regression equation based on the resting data was compared with the equation based on the resting and ACZ challenge (rest+stress) data.Goodliner correlation was obtained between the index of the input function obtained by the GP method and CBF value of the ARG method in the rest+stress state (y=2.75x+15.1, r=0.78). In contrast, correlation results between the index of the input function obtained by the GP method and CBF value of the ARG method in the resting state was expressed as y=2.28x+18.4, r=0.54 rCBF values based on the resting data was 20% underestimated in the high flow range compared with values based on the rest+stress data.The new linear regression equation for the GP method is useful for clinical study. Key words: non-invasive cerebral blood flow measurement method, graph plot (GP), autoradiography (ARG), 123I-N-isopropyl-p-iodoamphetamine (123I-IMP).

Background: There is currently no established therapy for childhood IgA nephropathy (IgAN). Mizoribine, a newly developed immunosuppressive agent characterized as a safe and well-tolerated drug, has been widely used in diverse conditions. Our preliminary study demonstrated that mizoribine could reduce the amount of proteinuria in children with IgAN. The present study was conducted to confirm this finding. Methods: Ten children with IgAN (median age 13.5 years) of moderate histological severity were enrolled. None of them had been previously treated by immunosuppressants. Mizoribine was administered orally for a median period of 20.5 months. We compared the urinary protein excretion expressed as the ratio of urinary protein to urinary creatinine (UP/UC) and the hematuria evaluated as the level of occult blood by dip-stick (OB score). Renal histology was also examined in three patients using paired biopsy specimens obtained both before and after treatment. We performed blood examinations regularly to monitor the toxicity and plasma concentration of mizoribine. Results: The median observation period was 44.5 months, consisting of a median 13.0 months before therapy, 20.5 months during therapy and 12.0 months after therapy. Significant reductions in both UP/UC and OB score were induced by mizoribine (P

In order to clarify the mechanism of unusual renal tubular dysfunction seen in a child with Shiga toxin (Stx)-mediated hemolytic uremic syndrome (HUS), we studied the renal biopsy specimens for Stx binding and apoptosis of renal tubular cells. A 7-year-old boy with Stx-2-mediated HUS demonstrated extensive renal tubular damage characterized by nonoliguric acute renal failure, increased urinary tubular enzymes and defective urine-concentrating capacity. His renal biopsy specimens were analyzed for Stx binding and apoptotic cell death. Seven kidney tissue specimens obtained from patients without HUS served as controls. Detection of Stx binding to renal sections and apoptotic cells were performed using mouse monoclonal anti-Stx 2 antibody and the TUNEL method, respectively. Positive staining was observed predominantly in renal tubular cells, while the 7 kidney tissue specimens from control patients did not show positive staining. To the best of our knowledge, this is the first case to show Stx binding and apoptotic cell death in renal tubules on biopsy specimens obtained from a child with Stx-mediated HUS. In conclusion, this case suggests that vascular endothelial cells are not the sole nor the consistent target for Stx-mediated cell injury and that significant renal tubular damage other than glomerular damage might occur in some children with Stx-mediated HUS.

我々の施設にて経皮的腎血管形成術 (percutaneous transluminal renal angioplasty: PTRA) を施行した小児の腎血管性高血圧症4例の臨床的検討を行った。このうち2例 (2歳男児および10歳女児) は血管病変を来たしうる基礎疾患はなくPTRA施行後は服薬の必要なく正常血圧が維持されている。高安病による13歳女児では，PTRAの効果は一時的で，現在，降圧剤投与や基礎疾患の治療で血圧をコントロールされている。モヤモヤ病に合併した5歳男児では，PTRA施行中，病変血管の攣縮により有意な拡張は得られなかったが，いずれの症例においても重篤な合併症はなかった。 以上よりPTRAは小児に対しても安全で，繰り返し施行でき，侵襲性が低いといった長所を考慮すれば，基礎疾患の有無に関わらず，積極的に試みる価値があると思われた。

Non-invasive quantitative measurements are useful for clinical study as these are simple and pain-free procedures. A new non-invasive semi-automatic quantitative measurement method, the improved brain uptake ratio (IBUR) method using 99m Tc-ECD SPECT, has recently been reported. If an automatic ROI setting algorithm could be developed to determine the input function for the IBUR method, analysis of regional cerebral blood flow (rCBF) can be completed within a few min without recourse to complex techniques, through a fully automatic rCBF analysis program. The purpose of this study was to develop an automatic input function determination program for 99m Tc-ECD non-invasive cerebral blood flow quantification and to confirm the feasibility of use of this program. The images of 15 consecutive patients who underwent both 99m Tc-ECD chest RI angiography and SPECT examinations were used for development of the automatic arterial input function program. The images of 69 consecutive patients were used for validation of the program. The coincidence ratio between the ROI automatic method and the manual setting method was 98%. The mean difference in the ROI location was ±6.4 mm in the X direction and ±8.6 mm in the Y direction. Individual rCBF values obtained using these independent techniques were also reasonably well correlated ( r = 0.95). The total time for the IBUR analysis using the automatic method is 2–3 min as compared to 20–30 min for the current analysis method. This technique improves the throughput of nuclear medical examinations.

Background/Aim: A novel immunosuppressant, mizoribine (MZB), has recently been reported to be effective in the treatment of IgA nephropathy (IgAN), although its mechanism of action remains unknown. This study was conducted to investigate whether the efficacy of MZB on IgAN is exerted by suppression of interleukin-6 (IL-6) release. Methods: Peripheral blood mononuclear cells (PBMC) were collected from 4 children with IgAN (median age 13.0 years) and 4 control children (median age 5.2 years). PBMC were cultured with medium alone or medium with lipopolysaccharide (LPS), and then incubated with LPS and MZB. Culture supernatants were assayed for lL-6. Results: IL-6 release was increased by LPS in all subjects. Although the median value was higher in IgAN patients (median increase in IL-6 release 1,298.1%) than in controls (median 489.2%), statistical significance was not reached (p > 0.05). 10 mg/ml of MZB suppressed the release of IL-6 in both IgAN patients (median decrease in IL-6 release 39.3%) and controls (median 43.2%), with statistical significance (p < 0.05 and p < 0.01, respectively). Conclusion: This study suggests that MZB could suppress IL-6 release in vitro and thus may exert its efficacy on IgAN.

We studied the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene in 78 patients with primary vesicoureteral reflux (VUR), and examined renal function by dimercaptosuccinate (DMSA) renoscintigraphy and diethylenetriamine-penta-acetic acid (DTPA) renogram in each genotype. Patients were classified into three genotypes according to the ACE gene I/D polymorphisms: 32 in II genotype, 36 in ID, and 10 in DD. The incidence of presumably congenital unilateral small kidneys was high in DD patients (70%). Glomerular filtration rate obtained from DTPA renogram was 120.7+/-35.7 ml/min (expressed as mean+/-SD) in II genotype, 111.7+/-33.3 in ID, and 88.0+/-18.0 in DD. The total quantitative DMSA tracer uptake of both kidneys was also low in patients with the D allele. This study shows that the D allele of ACE gene is closely related to small congenital kidneys with refluxing ureters in patients with primary VUR, and in accordance with previous reports, this allele is also related to the progression of reflux nephropathy.

Renal biopsy was performed in a 12-year-old girl with hematuria and proteinuria which was first detected at the age of 7, and the findings were the mesangial proliferative glomerulonephritis with IgG and C3 deposits. The routine blood examination for the biopsy disclosed the presence of the prolonged activated partial thromboplastin time and the biological false positive reaction in the syphilis test. These results led us to the further investigation, which revealed the presence of high titers of anticardiolipin antibodies. Since this girl presented no extra-renal symptoms of systemic lupus erythematosus (SLE) and had negative serologic tests for SLE, we hypothesize that her nephritis is closely related to antiphospholipid antibodies.