Directional Coronary Atherectomy in Takayasu's Disease

A 44-year-old woman with a history of coronary aorta bypass grafting (CABG)for stenosis of the left main trunk (LMT) due to Takayasu's disease underwent directional coronary atherectomy (DCA) to the LMT lesion under percutaneous cardiopulmonary support because she had angina pectoris and heart failure due to occlusion of the grafts. Three and a half years after the catheter intervention, her clinical condition remains good. DCA may be an alternative to CABG in limited cases with LMT disease.     

Atrial natriuretic peptides predict mortality in the elderly

Objectives. To ascertain whether atrial natriuretic peptides could be used as prospective and independent predictors of total mortality in an elderly population.
Design. Atrial natriuretic peptides, ANP(1–98) and ANP(99–126), were measured in 541 subjects from the 85-year-old population of Gothenburg, Sweden. Before the study cardiovascular disorders such as congestive heart failure, ischaemic heart disease, hypertension and atrial fibrillation were defined. Total mortality was recorded during the prospective 60-month follow-up period.
Setting. Individuals aged 85 years from the population of Gothenburg, Sweden, were visited once at home and made one visit to Vasa Hospital.
Main outcome measures. Sixty-month mortality in relation to circulating concentrations of atrial natriuretic peptides.
Results. Circulating concentrations of ANP(1–98) and ANP(99–126) were significantly correlated with 60-month mortality in the total study population (ANP(1–98), P <0.001; ANP(99–126), P <0.01). In subjects with cardiovascular disorders, 60-month mortality was significantly correlated with increased concentrations of ANP(1–98) ( P <0.01) and ANP(99–126) ( P <0.05). In subjects with no defined cardiovascular disorder, 60-month mortality was significantly correlated with increased ANP(1–98) concentrations ( P <0.01).
Conclusions. In the elderly population, atrial peptides predict mortality in subjects with defined cardiovascular disorders as well as in the total population and may predict future cardiovascular disorder.     

Exercise Induced Atrioventricular Block with Gap Phenomenon in Atrioventricular Conduction

A 54-year-old man with normal atrioventricuiar (AV) conduction at rest gave a 4-year history of presyncope during exercise. Treadmill testing showed exercise induced AV block. Electrophysiological study demonstrated rate dependent infranodal AV block and abnormal refractory period of the His-Purkinje system. The gap phenomenon in AV conduction occurred during the programmed stimulation. Supernormal conduction could be considered as the mechanism of the gap phenomenon in this patient.     

Urinary schistosomiasis in a Japanese man

A 29-year-old Japanese man with a history of travel to Africa visited the Department of Urology, Nara Medical University complaining of intermittent asymptomatic gross hematuria over a period of 30 months. As he was suspected of being infested with schistosomal parasites based on his past history of swimming in Malawi Lake during his stay in Egypt two years previously, we examined his urine microscopically for the presence of Schistosoma haematobium eggs and diagnosed him as having urinary schistosomiasis. Endoscopic examination revealed multiple small erythematous torose lesions on the right posterior wall of the urinary bladder. Since he was treated by oral administration of praziquantel every 6 h for 2 days (total daily dose of 2400 mg), a specific anthelmintic drug for schistosomiasis, the disease has been successfully kept under control without significant lesions in the bladder mucosa after the immediate disappearance of the eggs in his urine.     

Alpha-blocker test: Alternative to pressure–flow study of bladder outlet obstruction and detrusor contractility in patients without an enlarged prostate

OBJECTIVES: We investigated whether the cause of urinary disturbance in men with a prostate volume < or =20 mL can be determined by analyzing the efficacy of alpha1-adrenoceptor antagonist (alpha-blocker) treatment. METHODS: Thirty-five men who were >50 years of age, with an International Prostate Symptom Score (IPSS) > or =8 points, a quality of life (QOL) index > or =2 points and a prostate volume 20 mL served as controls. The alpha1-adrenoceptor antagonist tamsulosin was administered at a dose of 0.2 mg/day for 4 weeks. Results for the IPSS, QOL index, free flowmetry and pressure-flow studies were obtained before and after tamsulosin administration. RESULTS: In both groups, tamsulosin improved the IPSS and QOL index and the bladder outlet obstruction index (BOOI) was lowered without reducing the bladder contractility index (BCI). No parameter showed a significant difference in treatment efficacy between the two groups. In the non-enlarged prostate group, both the pretreatment BOOI and BCI correlated with the efficacy of treatment in improving maximum flow rate (Qmax). In the enlarged prostate group, BOOI and BCI did not correlate with Qmax. When Qmax was improved by > or =3.5 mL/s, the positive predictive value for both pretreatment BOOI >40 and BCI >100 was 100% in the non-enlarged prostate group. CONCLUSIONS: The alpha-blocker test is one method to assess the presence of bladder outlet obstruction and the state of detrusor contractility in men without an enlarged prostate.     

"Fork" Stenting for Bifurcational Lesion

Based on the experience of our in vitro examination to assess the stents for a safe and effective angioplasty through the struts, a Palmaz-Schatz stent was implanted easily and completely from the left main trunk to the left anterior descending coronary artery through the struts of a Wiktor stent implanted from the left main trunk to the circumflex artery in two cases .     

Diffuse xanthogranulomatous pyelonephritis in a patient with myotonic dystrophy and cerebral palsy

Xanthogranulomatous pyelonephritis (XGP), a morphological and clinical variant of chronic pyelonephritis, is an uncommon disease in children. It is characterized by the destruction of the renal parenchyma and replacement by granulomatous tissue containing foamy lipid-laden macrophages and is classified into diffuse and focal XGP. We present a case of diffuse XGP in a child with myotonic dystrophy complicated by cerebral palsy and discuss the importance of correct diagnosis and preoperative management to reduce inflammation and improve malnutrition associated with the disease.