Coronary perforation during percutaneous coronary intervention

Coronary perforation is an undesirable complication during percutaneous coronary intervention (PCI). We reviewed the cases of overt coronary perforation in our institute and analyzed their clinical backgrounds, the characteristics of the target lesion, management, and clinical outcomes. Between 1991 and 2005, we experienced 12 cases (0.35%) of coronary perforation in a total of 3415 PCI procedures. The perforation occurred during the use of debulking devices in 3 cases, immediately after stenting in 2, immediately after postdilatation of the stent in 2, and during wiring in 3 cases. Restoration was attempted by long inflation of a balloon in 7 cases, implantation of a covered stent graft in 1, and emergency surgical repair in 1 case. Subsequent cardiac tamponade occurred in 3 patients who required pericardiocentesis, and 1 patient died due to congestive heart failure. Administration of protamine was effective in stopping the bleeding in 6 patients, whereas continuation of antiplatelet therapy resulted in no overt rebleeding. Coronary perforation during PCI is a rare complication but is associated with significant morbidity and mortality. Intravenous administration of protamine is effective when it is used in conjunction with nonsurgical devices for initial management of perforation.     

A Systematic Approach to Rhinoplasty of the Japanese Nose: A Thirty-Year Experience

The Japanese nose exhibits a combination of leptorrhine and mesorrhine features that mandates an innovative treatment strategy. Unlike elsewhere in Asia, the Japanese nose often has adequate dorsal height, and at times even dorsal convexity, but maintains a more retruded and amorphous tip configuration. The proposed systematic approach to Japanese rhinoplasty is divided into four categories: (1) dorsal augmentation with or without tip augmentation, (2) dorsal reduction with tip augmentation, (3) tip augmentation only, and (4) dorsal reduction only. The use of autologous and alloplastic materials to achieve the desired aesthetic objectives is described herein. A layered auricular graft technique is outlined for tip surgery, and a unique nasal implant design is discussed.     

Angiographic evaluation of the abnormal endoscopic pancreatogram

Out of 1,269 pancreatograms, 122 were abnormal. Angiography was performed in these patients. Fifty-five were found to have pancreatic carcinoma. In the remaining 67 patients a false positive angiographic diagnosis of either chronic pancreatitis or pancreatic cancer was made in 11%. In one patient a hemangioma was diagnosed as a pancreatic cyst. The remaining 58 patients all had normal pancreatic angiograms in spite of gross ductal abnormality on endoscopic retrograde cholangiopancreatography (ERCP). All these patients were followed for an average of 19 months and showed no clinical evidence of pancreatic disease. It is suggested that angiography should be considered a complementary examination to ERCP and is particularly useful to exclude carcinoma when the pancreatogram is abnormal.     

Adenocarcinomas of the stomach induced in beagle dogs by oral administration of N-ethyl-N'-nitro-N-nitrosoguanidine.

Two 8-month-old and two 4-month-old male beagle dogs received 250 ml of 150 microgram/ml solution of N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) and 2% Tween 60 mixed with a pellet diet twice a day for 8 months as the same methods used for mongrel dogs in our first report [Juntendo Medical Jouranl 19, 579-583 (1973)]. Gastric carcinomas with distant lymph nodes metastases occurred in three beagle dogs except for one died from anesthesia at the endoscopy. Metastases to the liver were observed in two beagles. In the most long-lived beagles, peritonitis carcinomatosa with ascites and metastases to the liver, lungs, bones, and skin were found. Main gastric tumors were located at the subcardia in two dogs (elevated tumor in dog No. 6, ulcerated tumor in dog No. 8), but in dog No 7 at the angulus (ulcerated tumor). Histologically, carcinomas were composed of poorly differentiated adenocarcinoma, signet-ring cell carcinoma, tubular adenocarcinoma, and undifferentiated adenocarcinoma. In all of three dogs which developed adenocarcinoma of the stomach, Stewart's criteria were completely satisifed. Using our methods the target organ is limited only to the stomach, without any sarcomatous lesion of the intestines.