Tsuneyuki Nagae

A Case of Pyoderma Gangrenosum on the Stump of an Amputated Right Leg

We present here a case of pyoderma gangrenosum (PG) on the stump of an amputated leg. The patient was a 69‐year‐old woman who had both of her legs amputated due to acute arterial occlusion. An ulcer first appeared nine years later, after which point it continued to fluctuate in size. Complications included regional blood flow disorder at the amputated stump, diabetes, and secondary infection. Despite various therapies, the ulcer exacerbated, and hypoproteinemia, increased CRP, and fever were confirmed. The patient was diagnosed as having PG based on her clinical symptoms and because the ulcer did not respond to various therapies. The ulcer improved significantly in response to administration of 40 mg/day of prednisolone, and complete epithelialization was later achieved. Given the presence of multiple complications, it was extremely difficult to confirm PG. Therefore, it is important for physicians to consider PG as one of the causes of intractable ulcers.

Application of Infrared Attenuated Total Reflection Spectroscopy to In Situ Analysis of Atheromatous Plaques in Aorta

Ex vivo infrared attenuated total reflection (ATR) spectroscopic studies have been carried out to observe the accumulation of cholesterol ester in atheromatous plaques. It has been found that ATR spectra can be successfully obtained from the intima side of aorta and give the same information as the transmission spectra. This means, the ATR spectra include information about the chemical composition of atheromatous plaques together with the degree of eventual lesions. We have demonstrated that ATR microspectroscopic measurements can give images of atheromatous plaques distribution and enable in situ observation of the relative amount of accumulated cholesterol ester. The results clearly indicate that the ATR spectroscopy enables spectroscopic diagnoses in vivo as well as in vitro.

Effect of photodynamic therapy in intimal hyperplasia by phthalocyanine conjugated to the scavenger-receptor ligand, maleylated bovine serum albumin

Initial hyperplasia is major cause of restenosis after vascular interventions for arterial occlusive disease. We reported that a fluorescent probe, Texas Red, conjugated to the scavenger-receptor ligand, maleylated bovine serum albumin accumulated almost exclusively in the injured, hyperplastic sites. The purpose of this study is to test the feasibility of enhanced drug delivery to the hyperplastic lesion by targeting the scavenger-receptors.

Evaluation of intra-Aortic-aneurysmal thrombotic-activity by 111In-labeled-platelet scintigraphy.

大動脈瘤内に形成される血栓は,ときに血栓塞栓症や消費性凝固障害などの原因となり,その器質化は患者の予防を左右する重要な因子であることが知られている.したがって,瘤内血栓の動態を知ることは,手術適応や手術術式の検討,さらに術後経過観察にあたって有力な臨床情報となる.そこで真性大動脈瘤13例,解離性大動脈瘤14例,解離性大動脈瘤術後解離腔遺残13例に対し,in vivoにおける血栓活性の指標として,111In標識血小板による血栓シンチグラフィー(以下血小板シンチと略)を施行し,同時に施行した造影CTとの所見の相違から瘤内血栓の活性の評価を試みた.血小板シンチのRI集積は,真性大動脈瘤では腹部が胸部に比して強い傾向を示した.また,解離性大動脈瘤では病期の進行に伴いRI集積は減弱していく傾向を示し,解離腔の血栓性閉塞の完成をみた症例が存在した.術後解離腔遺残で抗凝固療法施行中の症例ではRI集積は認めなかったが,末梢側に血栓塞栓症を併発した症例では遺残解離腔に強いRI集積を認めた.これらのことから血小板シンチ像は臨床で予測される血栓活性と一致するものであった.血小板シンチはin vivoにおける血栓活性の指標として大動脈瘤の予後や合併症の予測,手術適応や手術術式の検討,さらに,術後経過観察にあたって有力な臨床情報となる.