Coronary hemodynamics in vasospastic angina: quantitative analysis by digital subtraction angiography

To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77 +/- 0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65 +/- 0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca(++)-antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion.     

Left ventricular pressure-volume diagram determined by forward and backward formatting of radionuclide ventriculography and analog pressure data

Pressure-volume (PV) loop is of great value for the assessment of left ventricular (LV) function, but its clinical application has been limited by methodological complexity. A new system was developed to make accurate loop with simplified procedure, and was applied to clinical and interventional study. The system constitutes of a mobile gamma camera, a poly-amplifier and a data processor (GMS-550U, Toshiba Medical) installed in cardiac catheterization labo for simultaneous raw data handling and successive analysis. Since LV time activity curve (TAC) obtained by usual ECG gating is not fully reliable for a entire cardiac cycle, radionuclide data acquired in list mode was formatted forward and backward from ECG trigger together with analog data of LV pressure, ECG and PCG. PV loops were drawn in 10 patients (OMI, AP, MR, HCM) and 5 normals before and after infusion of angiotensin-II (AII), and Emax and LV work (systolic; SW, diastolic; DW, net; NW = SW - DW) were measured. Radionuclide ventriculography was safely performed with cardiac catheterization even in patients with congestive heart failure. Satisfactory PV loops were obtained by the advantage of simultaneous acquisition of RNV and analog data. Changes of ECG, PCG, volume, pressure and derived indices through one cardiac cycle were readily comparable each other. Peak LV pressure (mmHg) increased from 134 to 159 and then 182 by infusion of AII, but no change in heart rate was observed Emax was higher in normals and AP (mean 1.96 mmHg/ml/m2) than in OMI and MR (range of 0.85-1.36). SW increased in response to rise of LV pressure in all subjects. NW increased in normals and AP, but decreased in OMI and MR with relative increase in DW. In conclusion, this new system is feasible for repetitive studies under drug intervention, since it makes accurate PV loop under physiologic state, i.e. without pacing and volume overloading. Variable changes of SW, DW, and NW in response to afterloading were clarified, which may be useful for the evaluation of cardiac reserve in normal and diseased heart.     

Clinical analysis of high grade bladder cancer

The prognosis and other clinical manifestation of 128 patients with high grade bladder tumor were analyzed. Thirty two percent of the total cases of bladder cancer were high grade bladder cancer and 83% of their tumors were invasive tumor at stage T2 and worse. Urinary cytologies were positive in 88% of these patients. The 5-year survival rate in these patients was 32% and those in T1, T2 T3 and T4 cases were 64.2%, 55.6%, 22.7% and 8.0% respectively. The patients treated with radical (total) cystectomy showed a much better survival rate than the cases treated with TUR or partial cystectomy. These results suggest that high grade bladder cancers tend to be invasive and the patients with high grade bladder cancer would have a poorer prognosis than the patients with other histological grade tumors. Thus, these patients should be treated more aggressively including radical cystectomy than the other cases of bladder cancers.     

Effect of isepamicin (HAPA-B) on reproduction. IV. Peri- and post-natal study in rats (intramuscular administration)

Peri- and post-natal effect of HAPA-B, a new aminoglycoside antibiotic, was studied in Jcl: Wistar rats. The antibiotic was given intramuscularly to dams at doses of 25, 100 and 200 mg/kg from day 17 of gestation to 21 days after delivery and throughout lactation. Influences of the drug on dams and their offspring were studied. A decrease in food intake and an increase in water intake were observed in the 200 mg/kg treated group. At autopsy of dams after weaning, pale discoloration and hypertrophy of the kidney were observed in 100 and 200 mg/kg groups. All other observations including delivery and nursing performance of dams, postnatal development of offspring, behavior and reproduction performance of the offspring were normal. The no effect dose level of HAPA-B found in this study was 25 mg/kg on rat dams and 100 mg/kg on the offspring.     

Metal allergy to implanted orthopedic prosthesis of the knee from which suppurative drainage persisted]

A 63-year-old Japanese woman who had been taking 5 mg of prednisolone per day for rheumatic arthritis from the age of 23 years underwent surgery on the right knee, during which an orthopedic prosthesis made of an alloy of cobalt (Co) and chromium (Cr) was implanted, in November 2000. Two years and 7 months later, a painful edema developed over the right knee. Although repeated aspiration of the joint yielded a yellow-green fluid, the culture of which was negative, she was given antibacterial drugs. The orthopedic prosthesis of her right knee broke in November 2003, and she underwent a 2nd operation to replace the Co and Cr alloy prosthesis in January 2004. One week after the 2nd operation, redness and swelling of her right knee developed, and suppurative drainage continued from the pin-hall of the wound. Although repeated bacterial and fungal cultures of pus were negative, she was given antibiotics. A 2-day closed patch test with a metal allergen from Torii Pharmaceutical Co. Ltd (Tokyo Japan) showed positive reactions to only Co and Cr in December 2004. She underwent a 3rd operation to remove the Co and Cr alloy prosthesis of her right knee in February 2005, and suppuration improved 2 months later. A diagnosis of Co-Cr alloy allergy mimicking suppurative arthritis was made. Patch testing is indispensable for patients with persistent inflammation after implantation of a prosthesis made of an alloy of Co and Cr and for preoperative patients for whom implantation of a prosthesis made of metals is planned.     

COVERED WALLSTENT FOR PALLIATION OF MALIGNANT COMMON BILE DUCT STRICTURE: PROSPECTIVE MULTICENTER EVALUATION

Background: Occlusion due to tumor ingrowth is a major drawback in self‐expandable metallic stents. Covering the stent is a probable solution to prevent tumor ingrowth. A manufactured covered self‐expandable metallic stent, Covered Wallstent, has become commercially available. We evaluated the Covered Wallstent in a prospective uncontrolled multicenter setting. Methods: Between October 2001 and October 2003, 97 patients with common bile duct strictures deemed unfit for surgical resection underwent placement of a single Covered Wallstent, and were followed prospectively until April 2004. Results: Placement of the stent was successful in all the patients attempted. As a procedure‐related complication, acute pancreatitis developed in four patients, in one of whom obstruction of the pancreatic duct orifice with the stent body seemed to be a major cause. The 30‐day mortality was 9.3% (nine patients). Stent occlusion occurred in 22 patients as a late (greater than 30 days) complication, due to either tumor overgrowth (14 patients) or encrustation (eight patients). Distal migration of the stent was demonstrated in two other patients. No stent occlusions due to tumor ingrowth were observed. Patency rates of the stent for 3‐, 6‐, and 12‐month periods were, respectively, 90.7, 82.5, and 45.9%. Conclusions: The present results in a large series suggest that placement of the Covered Wallstent is feasible and effective in the palliation of patients with malignant common bile duct strictures. The Covered Wallstent seems to be reliable in eliminating tumor ingrowth. The role of stent covering in promoting stent function should be examined in a prospective comparative study between covered‐ and uncovered Wallstents.     

Small-dose cytosine arabinoside in the treatment of elderly patients with acute leukemia and refractory anemia with excess of blast

Five elderly patients with acute nonlymphocytic leukemia (ANLL) and four patients with refractory anemia with excess of blast (RAEB) were treated with small doses of Ara-C (5-30 mg/day, subcutaneous injection) for 10-28 days. Three patients achieved complete remission and four patients partial remission. Side effects were severe bone marrow suppression in eight patients and gastrointestinal symptoms in three patients. From these results it was indicated that a small-dose Ara-C regimen provides alternative therapy in selected elderly patients with ANLL and RAEB.