Masahiko Matsumoto

Angiogenic strategy for human ischemic heart disease: Brief overview

In the Western World ischemic coronary disease is the leading cause of morbidity and mortality. Therapeutic approaches mostly aim to restore flow to a localized segment by angioplasty or bypass surgery. Therapeutic angiogenesis and or arteriogenesis describes a strategy where blood vessel formation is induced for the purposes of treating and/or preventing ischemic disease. At present, at least 17 clinical trials of myocardial angiogenesis have been presented involving over 900 patients. Therapeutic angiogenesis makes use of the administration of angiogenic growth factor protein or gene to promote the development of endogenous collateral vessels in ischemic myocardium. Most recently, interest has grown in the potential angiogenesis effects of cell therapy—such as autologous bone marrow cells or cultured stem cells—and there are now several groups initiating phase I/II trials in this area. (Mol Cell Biochem 264: 143–149, 2004)

Is the size of an abdominal aortic aneurysm associated with coagulopathy

Abdominal aortic aneurysm (AAA) volume and intraluminal thrombi were analyzed with respect to the number and function of platelets, blood cells, and coagulation factors. A group of 43 patients who underwent repair of an AAA were enrolled in this study. The maximum diameter and volume of the AAA, and the volume of intraluminal thrombi and lumen were measured by computed tomography with planimetry. The platelet count and platelet function, prothrombin time, activated partial thromboplastin time, fibrinogen, plasminogen, antithrombin 3, fibrin degradation products (FDP), D-dimer, and blood cell counts were measured. Spontaneous platelet aggregation and the FDP, and D-dimer levels were elevated; all other factors remained within the normal range. Intraluminal thrombus volume was strongly correlated with the volume and diameter of the AAA. However, no correlation was observed between the size of the AAA and coagulating factors, including the number and aggregation value of platelets. AAAs are frequently associated with a coagulating disorder. However, its size and thrombus volume are not correlated with coagulation changes. Although an intraluminal thrornbus increases along with fee enlargement of the AAA, the clinical manifestation of bleeding is rarely associated with an AAA. Therefore coagulopathy in patients with an AAA is not fully explained by its morphology.

Long-Term Survival of Uhl's Anomaly with Total Cavopulmonary Conversion

We report a long-term survivor with Uhls anomaly who underwent one and a half ventricle repair combined with a partial right ventriculectomy in infancy, followed by successful total cavopulmonary conversion with right ventricular exclusion 5 years later. The combination of total cavopulmonary connection and right ventricular exclusion could be the optimal surgical option for a critically ill infant with Uhls anomaly.

Coated prostheses are associated with prolonged inflammation in aortic surgery: a cost analysis.

This prospective study was conducted to compare inflammatory responses between patients receiving coated and uncoated vascular prostheses, and to examine their effect on length of stay and cost of patients undergoing abdominal aortic aneurysmectomy. Patients undergoing elective vascular reconstruction of an abdominal aortic aneurysm were assigned randomly to coated-graft or uncoated-graft groups (n = 20, for each group). Interleukin (IL)-6, granulocyte elastase, white blood cell count, C-reactive protein (CRP), and body temperature (BT) were prospectively recorded preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. In-hospital stay and hospitalized costs were also analyzed. IL-6 and CRP concentrations in the coated-graft group were higher than those in the uncoated-graft group (P = 0.01 and 0.05). BT was more frequently elevated >37 degrees C at POD 14 in the coated-graft group than in the uncoated-graft group (P =0.03). Discharge was delayed, and overall hospitalization cost was higher in the coated-graft group than in the uncoated group (17.6 vs. 13.5 days, and 2 010 000 vs. 1 780 000 yen, P = 0.006 and P = 0.002, respectively). Coated vascular prosthesis demonstrated more profound inflammatory reaction than noncoated prosthesis, postoperatively.

Effects of Rikkunshi-to on infantile hypertrophic pyloric stenosis, refractory to atropine

© 2008 Japan Pediatric Society Recently, atropine therapy for infantile hypertrophic pyloric stenosis (IHPS) has been developed as an alternative to pyloromyotomy, and a high success rate for this therapy has been reported. 1,2 We report here a case of IHPS treated with i.v. atropine therapy. Although projectile vomiting ceased in a week, vomiting recurred after hospital discharge despite the patient being treated with oral atropine. An upper gastrointestinal series indicated gastric hypomotility and uncoordinated hyperactive gastric peristalsis. Oral administration of Rikkunshi-to (TJ-43) or Liu-Jun-Zi-Tang, a Kampo medicine or a traditional herbal medicine, was initiated in the expectation that it would improve gastric motility and restore normal gastric myoelectric activity. This was based on the fact that this herbal medicine functions as a potent stimulator of gastric myoelectric activity in pediatric gastroesophageal refl ux patients. 3 We noted cessation of vomiting 1 week after initiation of treatment and this improvement confi rms that Rikkunshi-to could be used as a prokinetic agent.

Haemoglobin A1c cut-off point to identify a high risk group of future diabetes: results from the Omiya MA Cohort Study

Diabet. Med. 29, 905–910 (2012)

In Vivo Canine Model Comparison of Cardiovascular Effects of Antidepressants Milnacipran and Imipramine

Milnacipran is a specific serotonin and norepinephrine reuptake inhibitor, which has been widely used against major depressive episodes. In this study, cardiovascular effects of milnacipran were assessed in comparison with those of a typical tricyclic antidepressant imipramine using the halothane-anesthetized dogs. Milnacipran (nxa0=xa06) or imipramine (nxa0=xa06) was intravenously administrated in three escalating doses of 0.1, 1 and 10xa0mg/kg over 10xa0min with a pause of 20xa0min between the doses. Clinically relevant plasma concentrations were obtained after 0.1–1xa0mg/kg of milnacipran in this study, whereas therapeutic dose and plasma concentration of imipramine were reported to be similar to those of milnacipran. The low and middle doses of milnacipran hardly affected cardiohemodynamic or electrophysiological variables except that they slightly increased vascular tone and ventricular contraction, whereas same doses of imipramine delayed repolarization process without affecting the other variables. The high dose of both milnacipran and imipramine induced similar extent of negative chronotropic, inotropic and dromotropic effects together with vasoconstriction and repolarization delay. Thus, the effects of milnacipran may be more selective for cardiohemodynamics than for repolarization delay, whereas reverse will be true for imipramine, supporting lack of clinical report of patients with milnacipran-induced long QT syndrome unlike imipramine.

Hybrid procedures for an infant with hypoplastic left heart syndrome with intact atrial septum

A boy, prenatally diagnosed as hypoplastic left heart syndrome (HLHS) with intact atrial septum (IAS) was successfully treated by hybrid procedures. He underwent emergent catheter atrial septostomy and stent insertion in the atrial septum on Day 1 and then underwent bilateral pulmonary artery banding, ductal stent insertion, modified Norwood operation, bidirectional Glenn’s operation and finally Fontan type operation at 2xa0years of age. Considering the presence of decompression pathway from the left atrium in HLHS with IAS, we should organize a treatment team for collaborative work and plan an appropriate treatment strategy before delivery. Although his clinical course has been uneventful until now, closer medical observation is warranted because he may have coexisting pulmonary disease.

Varix of the heart.

A mass in the right atria was detected by computed tomography (CT) 2 years ago in a 61-year-old man with a medical history of hypertension and surgery for gall bladder carcinoma. The latest CT imaging indicated enlargement of the mass. Transthoracic echocardiography showed that a mobile mass in contact with the septum was present in the right atria, and a very bright region suggesting partial calcification was noted (Figure 1A and online-only Data Supplement). On nongated chest contrast CT, a low-intensity 26×20-mm region without enhancement and with partial calcification was present in the right atrium (Figure 1B and online-only Data Supplement); noncontrast MRI of the chest showed a round lesion with a diameter of approximately 26 mm and a clear boundary in contact with the septum. The inner region of the mass showed a slight high intensity on T1-weighted imaging (Figure 2A and online-only Data Supplement) and a low intensity …

Treatment of Abdominal Malignancy Invading the Vena Cava: A Report of Seven Cases

Retroperitoneal tumors and other abdominal malignancies invading the inferior vena cava can be treated surgically when no metastases are present. We resected four retroperitoneal tumors, two renal cell carcinomas, and one gastrointestinal stromal tumor with a concomitant caval resection. Although meticulous care is required when manipulating the major vessels, long-term survival with an improvement in the quality of life was achieved. These cases are described, with particular focus on the management of the major vessels.