A 69-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was on amblatory oxygen inhalation therapy (3 L/min) and scheduled for percutaneous transluminal pulmonary angioplasty (PTPA). The patient's New York Heart Association functional status was class III with recent worsening of dyspnea and apparent leg edema. Transthoracic echocardiography revealed right ventricular enlargement with mean pulmonary artery pressure of 42 mmHg. After PTPA, he was complicated with postoperative reperfusion pulmonary edema, and noninvasive positive pressure ventilation (NPPV) was applied immediately. Hypoxemia was successfully treated with 15 days of NPPV. Although mean pulmonary artery pressure was unchanged, his brain natriuretic peptide level decreased from preoperative 390.3 to postoperative 44.3 pg/dL. In addition, total pulmonary resistance decreased from preoperative 18 to postoperative 9.6 wood unit·m2. The patient was discharged on day 25 with SpO2 of 95% on 5 L/min of oxygen inhalation. Because pulmonary edema is a postsurgical life-threatening complication following PTPA, application of NPPV should be considered.

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Adult T-cell leukemia /lymphoma (ATL) caused by human retrovirus, HTLV-1, is a neoplasm of mature T-cell. ATL is still an incurable disease with approximately 1,000 annual deaths in Japan. The useful biomarkers are required to achieve the success of treatment. In order to test whether or not two soluble cytokine receptors (sCD25 and sCD30) are useful biomarkers of the development of ATL, we investigated changes in the concentration of the two markers in 11 HTLV-1 carriers (pre/post ATL progression) and six patients with chronic ATL (pre/post acute crisis). Serum (or plasma) samples of newly diagnosed or referred ATL patients and HTLV-1 carriers were preserved in freezer to measure the level of soluble proteins, sCD25 and sCD30, using ELISA. The sCD25 concentration was measured by Cell freeN IL-2R (Kyowa Medex, Japan) and Determiner CL IL-2R (Kyowa Medex, Japan). The sCD30 concentration was measured by Human sCD30 Platinum ELISA (eBioscience). The probability of ATL development from HTLV-1 carrier state was analysed by Kaplan-Meier method. We found that the elevation of soluble cytokine receptors was one of the earlier events of ATL development. In addition, chronic type patients followed in our hospital showed sCD30 as well as sCD25 elevation prior to the diagnosis of acute crisis. Our findings suggest that a combination of sCD25 and sCD30 facilitates accurate diagnosis and intervention of ATL as useful biological markers. Further careful follow-up should be required for HTLV-1 carriers with elevated level of cytokine receptors, sCD25 and sCD30 to diagnose the early phase of ATL.

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