Osamu Morizuki

Diagnosis of cardiac allograft rejection by the detection of circulating plasma cardiac myosin light chains

Twenty adult male Japanese monkeys of the species Macaca fuscata were randomly paired and subjected to heterotopic cardiac transplantation performed by the Ono-Lyndsey method. Without immunosuppression, graft survival ranged between 8 and 27 days, with a mean survival of 14 days. Plasma cardiac myosin light chains were measured by radio-immunoassay, which showed transient increases in myosin levels just following transplantation. Three hearts showed high values at this period and stopped beating when the myosin levels decreased (type 1). The other 7 hearts showed low myosin values after transient increases and 5 of them were rejected with a preceding reincrease in the myosin levels (type 2). Pathological study revealed myocardial necrosis, perivascular cuffing of mononuclear cells and/or neutrophils and/or plasma cells in the type 1 hearts. Measurement of the plasma myosin light chain level was therefore revealed to be of great value in the monitoring of cardiac allograft rejection.

Diagnosis of cardiovascular lesions by percutaneous angioscopy and intravascular ultrasound

We performed simultaneous angioscopy and intravascular ultrasound imaging (IVUS) to evaluate the luminal changes of cardiac chambers, valves and vessels in patients with various categories of cardiovascular disease. We observed cardiac chambers in 7, coronary arteries in 3, aortic valve in 6, aorta in 10, vena cava in 2, pulmonary arteries in 3 and femoral arteries in 5 pts. The angioscopy was suitable for detection of the changes in color and for 3D evaluation of small changes. The IVUS was suitable for detection of calcified tissues and for evaluation of cardiac and vessel wall structures. Furthermore, we could observe dynamic motion of the cardiac valves by the IVUS. The results indicate that simultaneous observation by IVUS and angioscopy gives us much more information on the cardiovascular changes.

Spontaneous Massive Hemothorax in a Patient with von Recklinghausen's Disease.

症例は55歳の女性で全身皮膚にカフェオレスポット, 神経線維腫を認めるレックリングハウゼン病の患者である. 突然の左胸痛で発症し, 左血胸, ショック状態となり, 緊急手術を施行した. 左開胸にて下行大動脈両側の胸膜下に血腫があり, 血腫からの動脈性出血を認めた. 大動脈裏面の肋間動脈からの出血が疑われたが同定できず, アンスロンチューブでバイパス下に大動脈を遮断し, 下行大動脈人工血管置換を行った. 術前のショック状態, 大量輸血に起因すると思われる肝不全, 呼吸不全のため, 長期のICU管理を要したが, 術後5か月目, 元気に退院した. 切除した大動脈の病理学的検索では, 大動脈外膜への神経線維腫の侵潤および中膜弾性線維の走行の乱れが認められた. この血管病変により肋間動脈の自然破裂をきたしたものと推察された. レックリングハウゼン病に合併した自然動脈破裂例は自験例を含め19例であり, これらを集計して報告する.