Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography

Background: Fluoroscopy and intravascular ultrasound (IVUS) lack sufficient resolution for assessing the results of complex stenting in true bifurcation lesions.
Objectives: After diverse bifurcation stenting at the left main coronary artery (LM) bifurcation model, the results were examined using microfocus computed tomography (MFCT).
Methods: The strut distribution of three kinds of stents deployed on a straight vessel segment was investigated. Classical crush, double kissing (DK)–double crush, and culotte stenting were performed on a three-dimensional (3D) LM model. The results were assessed using cross-sectional, longitudinal, and 3D reconstruction views of MFCT.
Results: Nonuniform strut distribution was observed in a corrugated stent design deployed on a straight vessel segment. Following classical crush stenting, a relatively large gap at the nonmyocardial site was observed in the corrugated stents. When the guidewire recrossed outside the ostium of the crushed side branch stent, kissing balloon inflation caused further crushing of the stent at the more distal segment. The dilated strut rose up from the main vessel bed after the first kissing balloon inflation in DK crush stenting; the advantage of DK would be cancelled after main vessel stenting due to recrushing the raised strut. The culotte stenting with closed-cell stents showed the restriction of the expansion at the branch ostium when it was dilated with a 3.5-mm balloon. The culotte stenting with open-cell-based stents showed a good stent apposition except for a tiny gap and small metallic carina at the distal bifurcation.
Conclusion: MFCT analysis in the 3D phantom model is useful to assess the structural deformation of the stents and gap on vessel wall coverage after complex stenting at the LM bifurcation.     

Guidelines for the treatment of Crohn''s disease in children

This paper shows guidelines for the treatment of Crohn's disease in children by the Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in the form of an elemental formula is indicated as primary therapy for children with Crohn's disease at onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN) with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective, additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought to be before epiphyseal plates have been closed.     

PET-CT诊断胃癌腹膜转移的临床价值

目的 评价正电子发射体层摄影-CT(PET-CT)诊断胃癌腹膜转移的价值.方法 2002年11月至2006年1月,141例胃癌患者在日本静冈县立癌症中心接受了PET-CT检查,其中114例同时接受了多层螺旋CT检查,并与细胞学检查、病理活检和临床表现作了比较.结果 PET-CT诊断胃癌腹膜转移的准确率为87.9%,灵敏度74.4%,特异度93.1%,阳性预测值80.6%,阴性预测值90.5%,显著优于多层螺旋CT的78.1%、39.4%、93.8%、72.2%和79.2%(P＜0.01).15例Cy1P0病例,PET-CT与多层螺旋CT检测的灵敏度分别为53.3%和13.3%,无统计学差异(P=0.053);19例P1病例,PET-CT与多层螺旋CT检测的灵敏度分别为84.2%和63.2%,也无统计学差异(P=0.141).结论 PET-CT对于诊断胃癌腹膜转移有一定的临床价值.     

Bone marrow transplantation for late infantile metachromatic leukodystrophy: Pathogenic investigation for graft rejection

A Japanese boy aged 2 years 11 months with late infantile metachromatic leukodystrophy underwent bone marrow transplantation (BMT) from his human leukocyte antigen (HLA) identical but mixed lymphocyte culture reactive father. Chimerism and increased arylsulfatase A activities of leukocytes had been observed with retarded progression of neurological deterioration during the first 3 months post-BMT. Graft rejection gradually occurred and donor cells were almost completely eliminated from the patient at 1 year after BMT. The process of neurodegeneration progressed clinically and neuroradiologically. Three possible reasons for the pathogenesis of graft rejection are: (i) T cell depletion of donor marrow cells as graft-versus-host disease (GVHD) prophylaxis; (ii) a slightly weak conditioning regimen; and (iii) a small number of marrow cells transplanted. It is stressed that as BMT is still a preliminary therapy for metachromatic leukodystrophy indications, conditioning, and GVHD prophylaxis for BMT should be considered individually.     

Assessment of autonomic nervous activity during gastrointestinal endoscopy: Analysis of blood pressure variability by tonometry

We continuously measured blood pressure by tonometry in 30 patients during endoscopy to determine the influence of upper gastrointestinal endoscopy on cardiac events. Patients were divided into two groups: one group treated with scopolamine butylbromide as premedication (SB group) and another group without premedication (C group). Time- and frequency domain analyses of beat-to-beat systolic blood pressure variability were performed for 128 consecutive beats. For time-domain analysis, we calculated the coefficient of variation of systolic blood pressure (CV_BP). For the frequency domain analysis, we determined the low-frequency (LF_BP; 0.04–0.15 Hz) and high-frequency (HF_BP; 0.15–0.40 Hz) powers of the variation in systolic blood pressure and the ratio of LF_BP to HF_BP (LF_BP/HF_BP) during endoscopy. The CV_BP and HF_BP, indicators of parasympathetic tone, increased in the early phase of endoscopy but decreased significantly in the middle and late phases compared with the pre-endoscopy value. The ratio of LF_BP/HF_BP, an indicator of indirect sympathetic tone, increased throughout the endoscopic procedure. Moreover, premedication with scopolamine butylbromide prevents the excessive parasympathetic nervous reflex when an endoscope passes through the upper digestive tract and also brings both decreased parasympathetic tone and increased sympathetic tone at the late phase of endoscopic procedure. Our results indicate that gastrointestinal endoscopy induced an autonomic nervous abnormality, which may contribute to the occurrence of cardiac events during endoscopic procedures.     

Effects of Long-term Oral Administration of NZ-105, a Novel Calcium Antagonist,With or Without Propranolol in Spontaneously Hypertensive Rats

Abstract— A new calcium antagonist, NZ-105 ((±)-2-[benzyl(phenyl)amino]ethyl 1,4-dihydro-2,6-dimethyl-5- (5,5-dimethyl-2-oxo-1,3,2-dioxaphosphorinan-2-yl)-4-(3-nitrophenyl)-3-pyridinecarboxylate hydrochloride ethanol) (10 mg kg^?1, p.o.), showed slow-onset hypotensive effect in spontaneously hypertensive rats (SHRs). The tachycardia evoked by NZ-105 was completely prevented when combined with a β-adrenoceptor blocker, propranolol (20 mg kg^?1), which did not affect the hypotensive response to NZ-105. In long-term administration experiments for 12 weeks with SHRs, the systolic blood pressure in the control group increased with age and the heart rate was stable throughout the period. NZ-105 (10 mg kg^?1 day^?1) alone and its combined treatment with propranolol (20 mg kg^?1 day^?1) maintained the systolic blood pressure and heart rate at a low level compared with the control group. The hypotensive action of NZ-105 was reproducible after repeated dosing for 12 weeks. Long-term administration of propranolol affected neither the elevation of the systolic blood pressure nor the heart rate substantially. The heart weight per body weight was significantly reduced after the chronic combination of both drugs, suggesting that the cardiac hypertrophy accompanying hypertension was prevented.     

Tubulovillous adenoma developing after urinary reconstruction using ileal segments

A case of tubulovillous adenoma arising in an augmented bladder is described. Ureteroileal substitution and ileocystoplasty was performed when the patient was 18 years old. She noticed gross hematuria 44 years after the surgery. Cystoscopy revealed a non-papillary multiple tumor at the site of ileovesical anastomosis and transurethral resection biopsy was performed. Histopathological examination revealed a tubulovillous adenoma. A tubulovillous adenoma developing at the augmented bladder is rare. To our knowledge, this is the second case in which a tubulovillous adenoma developed in an augmented bladder.     

Influences of Immobilization and Footshock Stress on Pharmacokinetics of Theophylline and Caffeine in Rats

The influences of immobilization and footshock stress on pharmacokinetics of theophylline (20 mg kg^?1) and caffeine (30 mg kg^?1) administered orally were examined in rats. The immobilization stress for 30 min or 1 h immediately after oral administration caused marked immobilization period-related decreases in plasma theophylline concentrations during the absorption phase, but did not affect plasma caffeine concentrations. The k_a and C_max values for theophylline were significantly decreased, and the t_max was significantly increased. On the other hand, when the immobilization stress was loaded for 1 or 3 h before the oral administration, the plasma theophylline or caffeine concentrations were not affected. The footshock stress for 30 min immediately after oral administration did not significantly decrease plasma theophylline concentrations during the absorption phase. These results suggest that the pharmacokinetics of theophylline are influenced by strong stress, possibly due to the inhibition of its absorption from the gastrointestinal tract, but the pharmacokinetics of caffeine are not influenced by stress, probably due to its central action.     

Primary testicular leiomyosarcoma

We report a case of primary testicular leiomyosarcoma. A 76-year-old man, who complained of left scrotal swelling for 6 months, underwent radical orchiectomy. Microscopic examination revealed intratesticular leiomyosarcoma. The patient received no adjuvant therapy and at 12 months after surgery, there had been no recurrence. Primary leiomyosarcoma of the testis is extremely rare; this is the 9th case recorded worldwide.