Masao Chino

Coronary Disease Morphology and Distribution Determined by Quantitative Angiography and Intravascular Ultrasound

Although previous studies have demonstrated that even quantitative coronary angiography (QCA) can not provide accurate disease morphology, there has not been a systematic comparison of disease morphology determined by QCA and intravascular ultrasound (IVUS), particularly in Japanese patients. Therefore, the present study prospectively examined patients in a multicenter cooperative study. A total of 491 coronary sites from 562 patients (446 men, 116 women; mean age, 64+/-11 years) who underwent coronary interventions were enrolled. The target lesions (>50% diameter stenosis) were evaluated pre-operatively by both QCA and IVUS operating at 30-40 MHz and the percent area stenosis, eccentricity index (EI) and lesion length were determined. The minimal (min) and maximal (max) distances from the center of the stenotic lesion to the outline of the vessel wall were measured, and the EI was calculated by the formula: [(max - min)/max]. By QCA, lesion length was determined by measuring the distance between the proximal and distal shoulders of the lesion. When the lesions were observed by IVUS with a motorized pull-back system, the length was calculated by multiplying the time for observation of the disease and 0.5 or 1 mm/s. Although the severity of the stenosis determined by QCA (86+/-10%, mean +/- SD) did not differ from that by IVUS (83+/-13%), there was no correlation between them (r=0.32, y=0.25x+65) and the correlation did not improve when lesions with remodeling, enlargement (n=176) or shrinkage (n=79) were omitted from the calculation. The EIs by QCA and IVUS were 0.51+/-0.26 and 0.52+/-0.22, respectively (NS), and there was no correlation between them (r=0.30, y=0.36x+33). However, when the lesions with remodeling were excluded, the correlation greatly improved (r=0.80, y=0.84x+10.6, p<0.05). Lesion length determined by QCA (12.4+/-6.1 mm) was significantly shorter than that by IVUS (16.3+/-8.9 mm, p<0.01). These results demonstrate that coronary angiography significantly misinterprets disease morphology in terms of severity, eccentricity and length, in part because of vessel remodeling that can be accurately determined only by IVUS.

Trousseau's syndrome with brachiocephalic vein thrombosis in a patient with uterine carcinosarcoma. A case report.

The authors treated a patient with the previously unreported occurrence of brachio cephalic vein and superior vena cava thrombosis in association with a distantly located cancer. A 71-year-old woman presented with swelling over the right side of the neck and abdominal distension. Physical examination revealed a huge mass, and computed tomog raphy demonstrated thrombosis of the brachiocephalic vein and superior vena cava accompanied by jugular vein dilatation. No coagulation disorder was demonstrable. After anticoagulation and thrombolysis, hysterectomy was performed; microscopic examination of the specimen revealed uterine carcinosarcoma. Even though local tumor obstruction is a much more common cause of neck vein thrombosis, a distant occult cancer can present as this form of Trousseaus syndrome. In patients with otherwise unexplained neck vein thrombosis, examination not only of the head and neck but also of the abdomen and pelvis should be pursued.

Intercostal-to-pulmonary arterial anastomosis, complicated by high-output heart failure: case report.

A patient who had high-output heart failure resulting from anastomosis of the intercostal and bronchial arteries to the right pulmonary artery is reported. The patient was a fifty-one year-old man who was admitted to our hospital with left heart failure. A radionuclide angiocardiogram revealed blood flow from the aorta to the right pulmonary artery. A descending aortogram revealed abnormally dilated right intercostal and bronchial arteries, which formed the anastomosis. The right pulmonary artery was visualized via that anastomosis. Tuberculous pleurisy in the patients history was considered to be the cause of the aanastomosis. The therapeutic procedure used was embolization via a catheter for the anastomosis, but most anatomoses could not be embolized. The present report is considered the first on anastomosis of the intercostal artery to the pulmonary artery to the extent that high-output heart failure occurs.

Advanced Atrioventricular Block and Complete Left Bundle Branch Block in a Case of Takayasu’s Aortitis

A 56-year-old woman, who had received an aortic valve replacement suffered from complete left bundle branch block and advanced atrioventricular block. On the basis of marked systemic inflammatory findings on admission and histopathological findings on previous cardiac surgery, this patient was considered to have conduction disturbances that were a consequence of myocardial involvement of Takayasus aortitis. The conduction disturbances improved rapidly after treatment with steroids.

Synthetic studies on naphthopyrans from a polyketide lactone

Abstract Naphthopyrans, one of which is a synthetic precursor of antifungal semivioxanthin, have been synthesized from a 14-membered polyketide lactose by the intramolecular aldolization.

Synthesis and characterization of a 14-membered polyketide lactone

Abstract A stable 14-membered polyketide lactone having a C-methyl group at C-13 has been synthesized and elucidated to have the bis-enol structure by X-ray crystallographic analysis, and its hydride reduction to the tetraols has also been described.

Aortitis Syndrome with Fatal Acute Aortic Regurgitation Due to Aortic Dilatation and Aortic Valve Perforation — A Case Report

This is a case report of a fifteen-year-old female with aortitis syndrome com plicated by acute fatal aortic regurgitation due to the aortic valve perforation, as well as to aortic dilatation, which was confirmed by the autopsy. Aortic valve perforation was first recognized as the important cause of acute aortic regurgi tation in the aortitis syndrome in this report.

Actual State of Radiation Exposure During Coronary Angioplasty

Percutaneous coronary intervention (PCI) has been associated with excessive radiation exposure, so the present study was designed to investigate the determinants of fluoroscopic time during PCI among characteristics inherent to the patient, procedure and hospital in 388 consecutive patients between November 1996 and March 1999 in 11 hospitals included in the Nationwide Database for Cost Analysis of percutaneous transluminal coronary angioplasty in Japan. Fluoroscopic time, which reflects radiation exposure, was used as the dependent variable in a multiple linear regression analysis. The mean fluoroscopic time was 27+/-15 min. The negative value of partial correlation of the hospital code (r=-0.374) and acute myocardial infarction (-0.163) indicated that these were explanatory variables that decreased fluoroscopic time. The positive value of the number of intraaortic balloon pump catheters (r=0.144), the number of balloons (r=0.304) and hospital stay (r=0.147) indicated these were explanatory variables that increased fluoroscopic time. The absolute value of r, (r=0.374), of the hospital code was the highest. In the final R(2) (=0.304) of the model, which is the partial R-square that determined the dependent variable, the hospital code showed the highest value. In conclusion, there was an inter-hospital difference in fluoroscopic time. Although the hospital code was found to be the most powerful determinant of fluoroscopic time, the R(2) (=0.304) of the model showed so lower value that other hospital characteristics that were not included in the model may influence the fluoroscopic time.

Familial hypertrophic cardiomyopathy with left ventricular dilatation and conduction disturbances.

Recent reports indicate the existence of a subgroup of hypertrophic cardiomyopathy (HC) in which patients develop left ventricular (LV) dilatation and die.1–4 Some investigators have proposed that the coexistence of HC with changes resembling dilated cardiomyopathy in a family belongs to the same HC subgroup.2,5–7 To our knowledge, however, only 1 report describing the association of that subgroup with intraventricular conduction disturbances and pacemaker insertion has been published.8 Our study describes a family affected by a combination of HC with LV dilatation and conduction disturbances.

INDICATION FOR CORONARY ARTERIOGRAPHY IN POSTINFARCTION PATIENTS

心筋硬塞を経過した130例の患者の冠状動脈造影(CAG),左室造影を検討し,どのような非観血的指標をもつ例にCAGを施行すれば,重症病変が効率的に発見し得るかを調べた.まず内科治療101例の平均21カ月の追跡調査(心臓死7例)より, 3枝狭窄,左室駆出率(EF)24%以下,左室拡張末期容積指数(EDVI)191ml/m2以上を重症指標とした・硬塞発作よりCAGまでの期間, 61例が狭心症,左心不全等の症状を有し,残り69例が無症状であつた. CAG所見として,有症状例の51%が3枝狭窄であつたのに対し,無症状例のそれは10%にすぎなかつた.硬塞後左心不全例の50%がEF24%以下, EDVI 191ml/m2以上であつた.しかし, EF 25～40%の22例中13例が無症状であり, EDVI 131～190ml/m2の35例中21例もが無症状であつた.心電図上広範囲(前下壁または前側壁)硬塞例の30%はEF 24%以下で, EDVI 191ml/m2以上であつた.心内膜下硬塞例の57%が3枝狭窄であつた.動脈硬化の危険因子数が増えるに従い冠状動脈有意狭窄数は増加し, 3個以上の危険因子をもつ例の49%は3枝狭窄であつた.硬塞前に労作性狭心症をもつ例の41%が3枝狭窄であつた.結論:硬塞後労作性狭心症または左心不全,心電図上広範囲または心内膜下硬塞例, 3個以上の危険因子,硬塞前労作性狭心症を有する例において, CAGを施行することは意義深いと思われる.