Toshitaka Kashima

Population differences in S‐warfarin metabolism between CYP2C9 genotype‐matched Caucasian and Japanese patients

Our objective was to investigate population differences in the metabolic activity of cytochrome P450 (CYP) 2C9 between genotypically matched Caucasian and Japanese patients by using the unbound oral clearance of S‐warfarin as an in vivo phenotypic trait measure.

Developmental changes in pharmacokinetics and pharmacodynamics of warfarin enantiomers in Japanese children

To clarify developmental changes in the pharmacokinetics and dynamics of warfarin enantiomers to establish rational pediatric dosage.

Mycotic Aneurysm of the Right Coronary Artery

Mycotic embolism in patients with infective endocarditis is not uncommon, however, mycotic aneurysm of a coronary artery is very rare. We report the case of a 62-year-old woman with mitral valve endocarditis complicated by mycotic aneurysm of the right coronary artery. Mitral valve replacement and resection of the mycotic aneurysm with coronary artery bypass were performed.

Gastric injury caused by low-dose aspirin therapy in consecutive Japanese patients: a prospective study

PurposeLow-dose aspirin (<325 mg/day), administered to those with several conditions involving ischemic disorders, can cause upper gastrointestinal (GI) complications. In this prospective study, we aimed to clarify the incidence of aspirin-induced gastric ulcers in consecu tive Japanese patients and identify suitable preventive measures.MethodsWe recruited 125 consecutive adult outpatients who received low-dose aspirin (enteric-coated tablets 100 mg) for >8 weeks. Endoscopy and blood tests were used to evaluate their gastric injury (which was scored using a modified Lanza scale) and anti-Helicobacter pylori antibody titer, respectively.ResultsWe found that 39.8% of patients received either no upper GI drug or only mucoprotective drugs, 39.8% received medium-dose histamine H2 blockers, and 20.4% received proton-pump inhibitors (PPIs). Anti-H. pylori antibody titers were positive in 43.7% of patients. The incidence of definitive gastric ulcers in this population was 0.97%. Ordered logistic regression analysis revealed that the odds ratio for the increase in the modified Lanza score was 0.20 for medium-dose histamine H2 blockers and 0.09 for PPIs.ConclusionThe incidence of postoperative definitive gastric ulcers in Japanese patients receiving ≤100 mg enteric-coated aspirin was 0.97%. The use of PPIs and histamine H2 blockers may prevent aspirin-induced gastric injury in such patients.

Nonocclusive mesenteric ischemia after cardiopulmonary bypass

Nonocclusive mesenteric ischemia (NOMI) is a rare abdominal pathology caused by mucosal hypoperfusion without actual obstruction to the mesenteric arteries. We present a case of NOMI after a cardiopulmonary bypass operation. The patient was a 79-year-old woman with a history of hypertension and diabetes mellitus. A coronary bypass operation was performed with stable hemodynamic conditions, and continuous venovenous hemodialysis was performed on the second postoperative day because of renal insufficiency. After 24 h of hemodialysis, the hematocrit level increased from 29.1% to 36.1%. The patient had some vague abdominal pain on the third postoperative day with abnormal laboratory values: leukocytes 17.10 × 103/µl, creatine kinase 1085 U/l, glutamic-oxyloacetic transaminase 6188 U/l, and lactate dehydrogenase 8695 U/l. Selective angiography showed diffuse stenosis of the superior mesenteric artery (SMA) without any occlusive findings on the major branches; the patient was therefore diagnosed with NOMI. An infusion of urokinase and prostaglandin E1 was started; however, disseminated intravascular coagulopathy had developed and the patient died on the 21st postoperative day as a result of multiple organ failure. The autopsy demonstrated extensive necrosis and hemorrhage in the small intestine without any occlusive findings on the major branches of the SMA.

Hemostatic effect of tranexamic acid (transamin) during coronary artery bypass grafting

The hemostatic effect of tranexamic acid (TA) was evaluated in patients undergoing coronary artery bypass grafting (CABG). The subjects were 33 serial patients who underwent elective CABG performed by the same team between January 1997 and April 2000. They were divided into a group that received TA (n=15) and a non-TA control group (n=18). The TA group received 50mg/kg of TA intravenously before starting cardiopulmonary bypass (CPB) and 25 mg/kg immediately after CPB. Blood loss from the end of CPB to completion of surgery (post-CPB), as well as during the first 6h (BL6), 6–12 h (BL6–12), 12–18h (BL12–18), and 18–24h after surgery (BL18–24), was compared between the two groups. The time of chest tube removal, the volume of blood transfused, and graft patency were also compared. The blood loss at BL6, BL6–12, BL12–18, and BL18–24, as well as the blood transfussion volume, were all significantly (P<0.05) lower in the TA group than in the control group. There was no significant difference in graft patency between the two groups. In CABG patients, TA reduced blood loss without affecting graft patency, suggesting that it is useful in this setting.

A Case of Impending Ruptured Aneurysm of the Common Iliac Artery; Regarded as Being Associated with Serous Leakage in Retroperitoneal Space.

後腹膜腔にゼラチン様物質の貯留を伴った, 動脈瘤切迫破裂の一例を経験した. 症例は69歳, 男性. 左下腹部の膨満感と軽い疼痛があり, CTにて左総腸骨動脈瘤を認めた. 5日後, 急激な疼痛の増強がみられたため再度CTを施行し, 左後腹膜腔の low density mass を認めた. 緊急手術によりY型人工血管移植術を施行した. 手術時, 左後腹膜腔に約600cm3の無色透明ゼラチン様物質の貯留を認めたが瘤破裂の所見はなかった. 術後42日目のCTでは low density mass は消失していた. ゼラチン様物質の電解質は, Na+ 115.8mEq/l, K+ 6.11mEq/l, Cl- 102.6mEq/lであり, 瘤壁を通じ血漿成分が後腹膜腔へ漏出貯留したものである, と推論した. きわめて特殊な症例であると判断したので, ここに報告する.

Congenital Bicuspid Aortic Stenosis in Siblings.

当施設では, これまで22例の先天性大動脈二尖弁の症例を経験しているが, 今回同胞に発生した大動脈二尖弁狭窄を経験し, 文献上検索したかぎり1例の報告も認められなかったので報告する. 症例は兄58歳, 妹56歳であり, 兄は51歳時, 妹は15歳時より心臓弁膜症を指摘されていた. 両者とも大動脈二尖弁狭窄の診断にて21mm Medtronic-Hall 弁にて大動脈弁置換術を施行し, さらに妹ではペースメーカー植込み術を追加した. 術後経過は両者とも良好である. 先天性大動脈二尖弁は遺伝的な関係が関与するため, 発見されたなら, 家族内および親族の精査が必要であろうと考えられる.