Yuji Ozaki

High-sensitivity C-reactive protein and left ventricular remodeling in patients with acute myocardial infarction

Abstract Inflammatory cytokines are suspected to play an important role in the pathophysiology of left ventricular (LV) remodeling. We investigated whether high-sensitivity C-reactive protein (CRP) (hs-CRP) is a predictor for LV remodeling in patients with acute myocardial infarction (AMI) with successful reperfusion, and also whether such a situation can be avoided by the administration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The subjects were 139 patients with an initial attack of anterior myocardial infarction successfully treated by reperfusion therapy. They were randomly divided into the following two groups: an angiotensin (AG) group (91 patients treated with ACEI/ARB) and a NON-AG group (48 patients not treated with ACEI/ARB). Levels of hs-CRP, creatine kinase, human atrial natriuretic polypeptide, brain natriuretic peptide (BNP), fasting blood glucose, serum lipids, fibrinogen, fibrin degradation product, prothromloin time, and activated partial thromboplastin time were measured immediately after 1, 2, 3, and 7 days, and 1 months after the onset of AMI. ACEI or ARB administration lowered hs-CRP levels and prevented the development of LV remodeling. Peak CRP levels significantly correlated with BNP levels during the acute stage (r = +0.54, P < 0.0001), end-diastolic volume index (r = +0.78, P < 0.0001), end-systolic volume index (r = +0.36, P = 0.0405), ejection fraction (r = −0.45, P = 0.0052), left ventricular end-diastolic diameter (r = +0.61, P < 0.0001), cardiac output (r = −0.52, P = 0.0005), cardiac index (r = −0.41, P = 0.0099), and systolic pulmonary arterial pressure (r = +0.48, P = 0.0017) 1 month after the onset of AMI in the NON-AG group but not in the AG group. Logistic multivariate analysis revealed that peak CRP alone was an independent risk factor for the development of LV remodeling in the NON-AG group (odds ratio = 1.79, P = 0.002). These results suggest that hs-CRP is a useful factor for predicting LV remodeling. Furthermore, ACEI or ARB administration to AMI patients showing increased hs-CRP levels during the early stage of the disease could prevent LV remodeling.

A Case of Penetration of the Large Intestinal Wall by a Toothpick

A 66‐year‐old man was admitted to hospital with symptoms of acute abdomen. Based on colonoscopic findings, localized peritonitis due to penetration of the sigmoid colon by a toothpick was diagnosed. During colonoscopy, the toothpick was removed using a grasping forceps, meaning that surgery was avoided. In cases where abdominal pain of unknown origin is observed, physicians should proceed with routine medical care while considering the possibility of foreign body ingestion, and work toward an early diagnosis.

Colonoscopic extiripation of whipworms in patient with acute abdomen-like symptoms

A 25‐year‐old Indonesian male who had been living in Japan for the previous 2 years was hospitalized with sudden severe pain throughout his entire abdomen, but without abdominal guarding. Colonoscopy revealed 15 Trichuris trichiura whipworms in the cecum. These worms were extirpated using biopsy forceps. Immediately after extirpation, the abdominal pain disappeared. In Japan, whipworm infection with acute abdomen‐like symptoms at onset is extremely rare. In the present case, whipworm infection was diagnosed during colonoscopy, and the patient was simultaneously treated by extirpation of worms, thus indicating the utility of colonoscopy.

A Case of a Giant Lipoma of the Duodenal Bulb

We describe a 58‐year‐old male whose major complaint was epigastric pain. A pediculate mass located in the anterior wall of the duodenal bulb and extending into the descending portion of the duodenum was noted on endoscopy of the upper digestive tract. The mass nearly completely occupied the duodenal lumen and was covered by normal mucosa with a tiny ulcer. Ultrasound endoscopy showed a nearly homogeneous hyperechoic pattern localized in the submucosa, and abdominal CT showed fatty density, suggesting a lipoma. The mass was resected by laparotomy, because it was large and extended to near the duodenal papillae. The tumor measured 55X35X30 mm and was histologically confirmed to be a lipoma which had originated in the submucosa. Giant duodenal lipomas more than 50 mm in maximum diameter have only been reported in 5 cases in Japan including our present case and 9 cases abroad, but some differences were observed in the description of the Japanese cases versus the non‐Japanese cases, such as the fact that the non‐Japanses cases often presented with severe symptoms such as bloody stools and intussusception.