Successful coronary stenting of the left anterior descending artery at the branching site of the targeted septal perforator immediately after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy

We report a case of simultaneous percutaneous treatment of hypertrophic obstructive cardiomyopathy (HOCM) and coronary artery disease. Cardiac catheterization revealed a left ventricular outflow tract pressure gradient (LVOTPG) of 130 mmHg and a significant left anterior descending artery (LAD) stenosis at the site of the 1st major septal branch. The LVOTPG was eliminated by injection of ethanol into the branch. Subsequently, a coronary stent was implanted in the LAD. A coil stent was selected due to possibility of repeat septal ablation in the future. Simultaneous treatment of HOCM and LAD stenosis is considered safe and effective using a coil stent.     

Successful engraftment of allogeneic peripheral blood stem cell transplant after nonmyeloablative preparative regimen with cytarabine and cyclophosphamide: report of 2 cases

We report our experience with allogeneic peripheral blood stem cell transplantation (allo-PBSCT) following a nonmyeloablative conditioning regimen consisting of cytarabine (8 g/m2) and cyclophosphamide (120 mg/kg) in the treatment of 2 patients aged 50 and 55 years with refractory chronic myelomonocytic leukemia and chronic myeloid leukemia in accelerated phase, respectively. Our nonmyeloablative regimen was well tolerated by older patients at high risk of regimen-related toxicity by the conventional conditioning regimen but was immunosuppressive enough to achieve mixed chimerism. After allo-PBSCT, we monitored chimerism in these patients by fluorescence in situ hybridization using X- and Y-specific probes and polymerase chain reaction-based analysis of a variable number of tandem repeats. We found that full chimerism and graft-versus-leukemia (GVL) effects could be induced in these patients by donor lymphocyte infusions and withdrawal of posttransplantation immunosuppressive therapy. Our observations suggest that a nonmyeloablative conditioning regimen can establish mixed chimerism and that donor lymphocyte infusion may induce GVL effects in older patients at high risk of regimen-related toxicity.     

Long-term follow-up of thyroid function in patients who received bone marrow transplantation during childhood and adolescence

An increasing number of long-term surviving bone marrow transplant (BMT) recipients have recovered from their primary disease but are at risk of developing failure of endocrine organs. We investigated 147 patients who underwent allogeneic BMT. Thyroid function was evaluated by serial measurement of basal TSH and free T4 levels as well as by TRH provocative test. Thyroid ultrasound examination was performed for evaluation of thyroid tumor after BMT. Five patients were found to have overt thyroid dysfunction (hypothyroidism in four patients and hyperthyroidism in one patient). Twenty-three patients in the under 9-yr-old group at BMT and 16 patients in the over 10-yr-old group at BMT had subclinical compensated hypothyroidism. Younger age at BMT was the strongest factor for developing thyroid dysfunction, compared with older age (P < 0.001). Only in patients with subclinical compensated hypothyroidism did median basal and peak TSH increase to the upper half of the normal range by 8 yr after BMT and then returned slightly to the middle of the normal range spontaneously. These results suggest that thyroid dysfunction in long-term BMT survivors depends on age at BMT, with a greater risk among younger patients, indicating the need for life-long surveillance.     

Clinicopathological features and outcome of hepatic resection for liver metastasis from gastric cancer

BACKGROUND/AIMS: The efficacy of operative resection of lesions metastatic to the liver from colorectal or neuroendocrine tumor is well established. However, the appropriate management of liver metastasis from gastric cancer is controversial. We analyzed the prognostic factors in patients who underwent hepatectomy for metastasis from gastric cancer. METHODOLOGY: Retrospective clinical and pathological study in Tokyo Metropolitan Bokutoh Hospital. Ten patients underwent hepatectomy for metastases from gastric cancer out of 1807 patients with gastric cancer between 1981 and 1998. INTERVENTIONS: Clinical investigation and histopathological examination of resected specimen. MAIN OUTCOME MEASURES: Survival, recurrence, liver metastases and lymph node metastases. RESULTS: The 1-, 3-, and 5-year survival rates of these ten patients were 50%, 30%, 20%, respectively. The median survival time was 25 months, and two patients survived longer than five years. The survival time tended to be longer, but not to a significant extent, in patients with no lymph nodal involvement at the primary site (P = 0.067). CONCLUSIONS: Even though it is rare, a survival time of 5-years can be achieved by resection of gastric cancer metastatic to the liver. These results suggest that a patient with liver metastasis from gastric cancer has a greater chance of surviving long-term if there is no lymph node metastasis at the primary site.     

Isolation and Characterization of an Actin-like Protein from Membranes of Human Red Cells

The existence of an actin-like protein in human red-cell membranes has been confirmed. The protein was extracted from acetone-treated ghosts and purified by (NH₄)₂SO₄ fractionation. The protein undergoes G-F transformation and forms filaments in the presence of O.I. M KCl. The filaments can be 'decorated'by muscle heavy meromyosin. The protein has the same molecular weight as muscle actin and interacts with muscle myosin. All these properties show that the protein closely resembles muscle actin.     

Myositis as a manifestation of chronic graft-versus-host disease

We report a 22-year-old man who had myositis in the course of chronic graft-versus-host disease after bone marrow transplantation for acute monocytic leukemia. The distribution of muscular involvement was different from idiopathic polymyositis. Muscular atrophy and weakness were noted in the distal muscles as well as in the proximal muscles of the upper extremities but there was little weakness in the proximal muscles of the lower extremities. However, histological and immunohistochemical study of the biceps brachii muscle showed findings similar to those of idiopathic polymyositis. It was suggested that myositis can be a manifestation of chronic GVHD caused by a cellular immune reaction by donor T cells.     

Atorvastatin increases plasma soluble Fms-like tyrosine kinase-1 and decreases vascular endothelial growth factor and placental growth factor in association with improvement of ventricular function in acute myocardial infarction.

OBJECTIVES: This study examined whether atorvastatin increases plasma levels of soluble Fms-like tyrosine kinase 1 (sFlt-1) and reciprocally decreases vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) levels in patients with acute myocardial infarction (AMI). BACKGROUND: Statins exert cardioprotective actions partly through anti-inflammatory actions. By capturing VEGF and PlGF in plasma, sFlt-1 acts as a natural inhibitor of VEGF and PlGF, which have proinflammatory properties. METHODS: Left ventriculography and enzyme-linked immunosorbent assay of plasma levels of sFlt-1, VEGF, and PlGF were repeated after AMI in 50 consecutive patients with a first AMI. Patients were randomized to treatment with atorvastatin (10 mg/day; n=25) or placebo (n=25) within 3 days after AMI, and therapy was continued for 6 months. RESULTS: The sFlt-1 levels were low in the acute phase, followed by an increase at 2 weeks after AMI, whereas free VEGF and PlGF levels were high in the acute phase, followed by a decrease at 2 weeks. Atorvastatin increased sFlt-1 levels and reciprocally decreased VEGF and PlGF levels at 6 months compared with placebo. The increase in sFlt-1 levels and the decrease in VEGF and PlGF levels were correlated with improvement of left ventricular ejection fraction during the follow-up period. CONCLUSIONS: There was a reciprocal relationship between changes in sFlt-1 levels and changes in VEGF and PlGF levels after AMI; and atorvastatin increased sFlt-1 levels while decreasing VEGF and PlGF levels. These changes were associated with late improvement of post-MI ventricular function, and may represent an additional benefit of statin therapy.     

Regional vascular occlusion of the liver by radiological intervention for the treatment of hepatocellular carcinoma

We believe that regional vascular occlusion of the liver is more effective for the treatment of hepatocellular carcinoma (HCC) than transcatheter arterial embolization or percutaneous ethanol injection. We report a patient with HCC in whom regional vascular occlusion by means of radiological intervention was successfully performed. A 68-year-old man was admitted to our hospital because of a HCC measuring 2 cm in diameter in segment VIII (S8). For treatment, we initially performed subsegmental vascular occlusion by simultaneous transcatheter arterial embolization and percutaneous transhepatic portal-venous embolization. Both the arterio-and the portograms taken immediately after the procedure demonstrated the lack of arterial and portal blood supply to S8. Subsequent evaluation of the liver by computed tomography and magnetic resonance imaging suggested that S8 had become completely infarcted and the segment appeared wedge-shaped. This finding was histologically confirmed when hepatic subsegmentectomy was performed 5 weeks later. The results in this patients confirmed the results reported by Nakao et al. in 1986 (Hepatocellular carcinoma: Combined hepatic arterial and portal venous embolizationRadiology 161:303–307) suggesting that regional vascular occlusion of the liver was safe and that the effectiveness was comparable to that of hepatic resection.     

Evaluation of heart-rate turbulence as a new prognostic marker in patients with chronic heart failure.

The significance of heart-rate turbulence (HRT) in patients with chronic heart failure (CHF) was evaluated to examine whether it is sensitive to the risk of ventricular tachycardia (VT). HRT is reported to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with CHF remains unknown. HRT was measured in 50 CHF patients (left ventricular ejection fraction <50% and/or left ventricular end-diastolic diameter >55 mm, 34 cardiomyopathy, 16 post-MI) and 21 patients without obvious heart diseases (control). HRT slope and HRT onset were measured by the original definitions using digitized Holter ECG recordings. Cardiac pump function was assessed by echocardiography. The value of the HRT slope was significantly lower in CHF than in control (3.7 +/- 1.7 vs 16.4 +/- 5.3, mean +/- SD, p < 0.01). The value of the HRT onset in patients with CHF was significantly higher than that in control patients (-1.1 +/- 1.9 vs -3.6 +/- 1.7, mean +/- SD, p < 0.05). The HRT slope and onset in CHF patients with VT were nearly identical to those without VT. The HRT slope appears to be a powerful prognostic marker that shows significant differences between CHF subgroups when divided by clinical events; that is, CHF death and CHF hospitalization. However, it has limited value for predicting fatal ventricular arrhythmias.     

New thrombolytic modality — regional administration of tissue plasminogen activator for hepatic artery and portal vein thromboses after liver transplantation: Case report

A 2 1/2-year-old boy with biliary atresia underwent orthotopic living-related liver transplantation. On the 7th postoperative day, he had an episode of hepatic arterial thrombosis following disseminated intravascular coagulation (DIC) due to severe intraabdominal sepsis. Tissue plasminogen activator was administered regionally and the hepatic arterial flow recovered promptly. On postoperative day 33, portal vein thrombosis occurred and direct tissue plasminogen activator injections into the portal vein improved portal blood flow. However, the patient eventually died of poorly controlled DIC. Throughout the course, color Doppler ultrasonogram and arterial ketone body ratio were good indicators of hepatic arterial and portal blood flow. When hepatic arterial thrombosis and portal vein thrombosis occur, retransplantation is often inevitable. Thus, while the patient is awaiting a suitable donor, it could be possible to maintain blood flow to the graft with this new thrombolytic therapy.