Shiaki Kawada

Evaluation of intracardiac thrombus with computed tomography

Left atrial (LA) and left ventricular (LV) thrombus was evaluated by computed tomography in 56 patients. The patients were divided into 2 groups: Group I, 28 patients with mitral valve disease, and Group II, 28 patients with myocardial infarction. Computed tomography and 2-dimensional echocardiography were performed in all the patients studied. Cineangiocardiography was performed in all Group I and in 13 Group II patients. Open heart surgery or autopsy was performed in all Group I and 4 Group II patients. The sensitivity in detecting LA thrombus was 100% with computed tomography, 70% with angiocardiography, and 60% with 2-dimensional echocardiography. The specificity in detecting LA thrombus was 91% with computed tomography, 86% with 2-dimensional echocardiography, and 88% with angiocardiography. Thrombi located at the LA appendage were associated with great difficulties in detection by other methods, but were well delineated with computed tomography. LV thrombus was also visualized by computed tomography with similar or greater accuracy than other diagnostic methods, although the sensitivity and specificity were not ascertained because surgery or autopsy was performed in only a minority of Group II patients. Therefore, as far as the detection of intracardiac thrombus is concerned, computed tomography has the advantage of offering uniform slices of the heart in an attempt to detect thrombi in unknown areas of cardiac chambers, including the LA appendage or LV apex, without being disturbed by the surrounding cardiac and noncardiac structures. Thus, computed tomography has excellent accuracy in the detection of intracardiac thrombus.

Endotracheal Tube with Movable Blocker to Prevent Aspiration of Intratracheal Bleeding

A newly developed endotracheal tube with a movable blocker was found to be lifesaving in patients with copious and persistent intratracheal bleeding. The cases of 4 patients are presented. In 3 patients, severe intratracheal bleeding was attributed to the extensive bronchopulmonary laceration caused by blunt chest trauma. In the remaining patient, the bleeding was due to rupture of the sutured site in the right pulmonary artery; the rupture was caused by a postoperative bronchopleural fistula. In these patients, spread of blood was completely prevented and pulmonary resection was performed safely by using the blocker in this new device.

Evaluation of left atrial thrombus with computed tomography

Left atrial thrombi were evaluated with computed tomography in 23 patients with mitral valvular diseases. In three of the patients, left atrial thrombi were delineated with computed tomography and were confirmed by cardiac surgery or autopsy. The minimum size of the thrombi detected tomographically was 3.5 gm. There were no false-positive or false-negative results with computed tomography in 13 patients who subsequently underwent cardiac surgery. Computed tomography is essentially noninvasive and appears to be one of the best methods to evaluate left atrial thrombus.

Functioning Paraganglioma in the Posterior Mediastinum

An unusual case of a functioning paraganglioma originating from the posterior mediastinum is reported. The main indications in the 21-year-old patient were hypertension and an abnormal roentgenogram of the chest. Blood and urine catecholamine assay confirmed the diagnosis of norepinephrine-secreting tumor, which was covered by the parietal pleura and attached to the sympathetic trunk. In the literature we could find reports of 25 patients with paraganglioma arising from the sympathetic trunk in the posterior mediastinum, 8 of whom had some symptoms and only 3 of whom were assayed for catecholamines. We diagnosed the present tumor as functioning aorticosympathetic paraganglioma according to the new classification and terminology suggested by Glenner and Grimley [1].

The role of high-sensitivity C-reactive protein in asymptomatic intra- and extracranial large artery diseases.

Background: It remains unclear whether high-sensitivity CRP (hs-CRP) is predictive of atherosclerosis in the intracranial artery. The aim of this study is to assess the role of hs-CRP in asymptomatic intracranial artery occlusive diseases. Methods: Of the 3,366 apparently healthy subjects who received a brain checkup, 138 with ≧25% intracranial artery stenosis on magnetic resonance angiography, 267 with ≧25% extracranial carotid artery stenosis on B-mode ultrasonography and 435 without intracranial artery or extracranial carotid artery stenosis (age-matched controls) were selected for this study. Results: The mean CRP concentration in the subjects with intracranial artery stenosis was not significantly different from that in the control subjects, and the differences of mean CRP concentrations among the subgroups with 25–49, 50–74 and 75% or greater stenosis in the intracranial artery were not significant. The odds ratios of hs-CRP for extracranial carotid artery stenosis tended to increase with increasing CRP concentrations, but those of hs-CRP for intracranial artery stenosis showed no significant difference. Conclusion: The degree of atherogenic inflammation in asymptomatic intracranial artery stenosis may be less than that in extracranial carotid artery stenosis.

A tuberculous pseudoaneurysm of the thoracic aorta presenting as massive hemotpsis— A case of successful surgical treatment

Tuberculous aneurysms of the aorta need early diagnosis and prompt surgical intervention because if untreated, they lead to severe consequences. We report herein, a case of a 63 year old woman who underwent successful resection of a tuberculous pseudoaneurysm which had ruptured into the left upper lobe of the lung after a punch biopsy, performed under bronchoscopy, had caused severe bleeding. Subsequent CT and MRI examinations suggested a fistula between the mass and the aorta and proved useful in establishing the diagnosis of a pseudoaneurysm. We wish to emphasize the need for bronchoscopy to be done carefully because of the risk of inducing massive hemoptysis.

Interactions between UFT and Anticoagulants in Lung Cancer Patients

In order to study the interactions between UFT and anticoagulants, the plasma and tissue concentrations of 5-FU, uracil and FT-207 were examined in patients with lung cancer. Higher plasma concentrations of 5-FU and uracil were observed in the patients who were given warfarin and ticlopidine beforehand, whereas the concentrations of FT-207 were almost the same in the patients who were given anticoagulants as in those who were not. This may be interpreted as an inhibition of dihydrouracil dehydrogenase, the common metabolizing enzyme of 5-FU and uracil, by anticoagulants. With regard to the tissue concentrations, higher levels of 5-FU and uracil in the tumor and lymph nodes were obtained after anticoagulants were given beforehand. Concentrations of FT-207 in these tissues, however, were almost the same in the patients who were given anticoagulants as in those who were not. We thus concluded that an increase of 5-FU in tumor cells and lymph nodes can be achieved after elevating the plasma concentrations of ordinary oral doses of UFT by using anticoagulation therapy beforehand.

Nonsurgical retrieval of an accidentally dislodged vent catheter retention ring

During open mitral commissurotomy in a patient with mitral stenosis, a vent catheter retention ring was accidentally slipped off into the left atrium and lodged near the orifice of the right renal artery. Nonsurgical retrieval of this intraarterial foreign body was performed successfully under fluoroscopic guidance in the operating room using a combined approach of angiographic catheters and guidewire, these being inserted via the arteriotomy site of the right femoral artery created for cardiopulmonary bypass.