[Open heart surgery in a patient with a history of Takotsubo cardiomyopathy].

An 81-year-old man had a history of Takotsubo cardiomyopathy induced by general fatigue after travel and acute gastritis 2 years previously. Recently, dyspnea on effort had been worsening. Since preoperative echocardiography showed severe aortic valve regurgitation (AR) with left ventricular (LV) dilatation, aortic valve replacement (AVR) by the standard procedure was indicated.

Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease.

Background: Epicardial fat (EF) is the visceral fat of the heart deposited under the visceral layer of the pericardium and has the same origin as abdominal visceral fat, which is shown to be strongly related to the development of coronary artery disease (CAD). We measured the volume of EF (EFV) by 64-multidetector computed tomography (MDCT) and studied the relationship between EFV and the severity of CAD.

Hypothesis: Epicardial fat volume increases steeply in patients with significant coronary artery stenosis and in those with severe coronary artery calcification.

Prevalence of subclinical atherosclerosis in asymptomatic patients with low-to-intermediate risk by 64-slice computed tomography.

Background: Recent research has shown that cardiovascular risk scoring significantly underestimates or misclassifies risk in key subsets of the population. There is a growing need for a noninvasive imaging to detect a subclinical atherosclerosis. Thus we hypothesized that 64-slice computed tomography (CT) could effectively detect subclinical atherosclerosis in asymptomatic patients with low-to-intermediate risk.

[Impact of preoperative 64-row multislice computed tomography for congenital aortic stenosis; report of a case].

A 63-year-old woman was diagnosed as having severe aortic stenosis (AS) with 98 mmHg peak pressure gradient detected by echocardiography. Since, preoperative enhanced 64-row multislice computed tomography (MSCT) showed bicuspid aortic valve with only 2 sinuses of Valsalva, congenital aortic stenosis was suspected. The left and right coronary arteries originated from respective sinus of Valsalva, and severely thickened cusps of aortic valve were detected clearly by preoperative 64-row MSCT.

Coronary pressure measurement based decision making for percutaneous coronary intervention.

The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR≥0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR≥0.

[Clinical experience with intravenous administration of nifekalant hydrochloride for ventricular tachycardia in a hemodialysis patient after open heart surgery].

A 78-year-old man with chronic renal failure (CRF) on hemodialysis (HD) was diagnosed as having severe aortic regurgitation with left ventricular dysfunction. Aortic valve replacement with a 21 mm ATS mechanical bileaflet prosthesis was performed without intraoperative complications. Sustained ventricular tachycardia suddenly occurred 1 day after surgery, then intravenous administration of nifekalant hydrochloride (NIF) was started at a dose of 0.

Prevalence of non-calcified coronary plaque on 64-slice computed tomography in asymptomatic patients with zero and low coronary artery calcium.

Objectives: To study the prevalence of noncalcified plaque in asymptomatic low-risk patients with no or mild coronary artery calcium (CAC).

Methods: From 502 patients with coronary risk factors who underwent 64-slice computed tomography, 224 asymptomatic patients were identified with no CAC (n=117) or mild CAC (n=107; defined as patients with Agatston scores from 1 to 100).

Results: Patients with no CAC were younger and had diabetes less often.

Distribution of coronary atherosclerosis in patients with coronary artery disease.

The distribution of coronary atherosclerosis has not been fully clarified. We measured coronary artery calcium score (CACS) in 624 consecutive patients for the right coronary artery (RCA), left main trunk (LMT), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCx), then calculated total CACS. Coronary artery calcium score was measured using the Agatston method.

Prevention of coronary slow flow/no reflow during percutaneous coronary intervention by the use of embolic protection device, 'Filtrap'.

A 68 year-old man underwent percutaneous coronary intervention (PCI). A 64 multi-slice computed tomography (MSCT) demonstrated a non-calcified plaque with positive remodeling. Intravascular ultrasound showed severe attenuation which suggested high risk of coronary no reflow during PCI.

Prevalence of subclinical atherosclerosis in asymptomatic diabetic patients by 64-slice computed tomography.

Objectives: Patients with diabetes have a 2-fold to 4-fold higher risk of a cardiovascular event than nondiabetic patients. Thus there is a need to identify patients with diabetes who are at risk of cardiovascular events before the onset of symptoms. We studied the prevalence of coronary artery disease in asymptomatic diabetic patients compared with asymptomatic nondiabetic patients by 64-slice computed tomography (CT).

Comparison of the effects of nicorandil versus verapamil on the incidence of slow flow/no reflow during rotational atherectomy.

In rotational atherectomy, the slow-flow/no-reflow phenomenon is a common complication, which usually results in myocardial injury. We prospectively randomized 111 patients with successful rotational atherectomy into a verapamil group (group V, n = 56) and a nicorandil group (group N, n = 55). We compared final burr size, total ablation time, maximum decrease in revolutions per minute, incidence of slow flow/no reflow, creatine kinase-MB increase, and cardiac troponin T increase between the 2 groups.

Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection.

Purpose: Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate.

Materials And Methods: We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.

[A clinical study of renal pelvic and ureteral cancer: prognosis and frequency of subsequent bladder cancer following surgical treatment].

Purpose: A retrospective investigation of patients presenting with renal pelvic and ureteral cancer was performed. This study focused on the prognostic factors and frequency of subsequent bladder cancer following surgical treatment.

Materials And Methods: Forty-five patients presenting with transitional cell carcinoma, who had undergone nephroureterectomy at the Department of Urology, Okayama Central Hospital, from March 1990 to November 2000, were reviewed.

A case of rectal Dieulafoy's ulcer and successful endoscopic sclerotherapy.

A 54-year-old woman presented a massive hematochezia 7 days after sigmoidectomy. Repeated colonoscopy and angiography failed to locate the site of bleeding and Hartman's operation was performed. Rebleeding from the rectum on the day of operation occurred and pulsate arterial bleeding with minimal surrounding ulcer 1 cm above the pectinate line was observed.

Endoscopic submucosal tumor biopsy using Stiegmann-Goff endoscopic ligator.

Endoscopic biopsy is an important tool for histological diagnosis of lesions residing in gastrointestinal tracts. However, it is less useful in submucosal lesions due to the existence of normal overlying mucosa. We developed a new and safe technique for the diagnosis of submucosal tumor using Stiegmann-Goff endoscopic ligator.

Endoscopic sphincterotomy assisted by percutaneous transhepatic choledochal tube: a preliminary report.

We report a method of endoscopic retrograde sphincterotomy in patients in whom the optimal viewing of the papilla of Vater is hardly obtained. Percutaneous transhepatic cholangiodrainage (PTCD)-tube is placed under ultrasonographic guidance. PTCD-tube coming out of the papilla of Vater is observed by the endoscope and the guide wire inside the shpincterotome is inserted into the PTCD-tube.

A case of traumatic neuroma of the gallbladder in the absence of previous surgery and cholelithiasis.

We experienced a patient with traumatic neuroma of the gallbladder with no history of gallbladder surgery or cholelithiasis. A 74-year-old man was referred to our department after a gallbladder tumor was incidentally discovered during a preoperative screening examination for prostate hypertrophy. Ultrasonography, MRI, CT and endoscopic retrograde cholangiography revealed a protuberant lesion of the gallbladder.

Common bile duct injury during laparoscopic cholecystectomy.

Bile duct injury can occur more frequently during laparoscopic cholecystectomy than in open cholecystectomy. Three cases of common bile or hepatic duct injuries occurred in a series of eighty laparoscopic cholecystectomies; In case 1, the common bile duct was misidentified as the cystic duct. In case 2, bile peritonitis occurred on the fourth postoperative day caused by necrosis of the common hepatic duct involving the cautery surrounding it.

Immunotherapy by a slow delivery system of interleukin-2 in mice models.

A sustained release system for interleukin-2 (IL-2), and IL-2 mini-pellet (IL-2 mp), was developed by fusing IL-2 into a needle shaped collagen. Serum concentration of IL-2 after a single subcutaneous injection of the IL-2 mp into C57BL/6 mice remained elevated longer than after an injection of aqueous IL-2. IL-2 in the serum became undetectable by 6h after a subcutaneous injection of 1 x 10(6) unit of IL-2 in phosphate-buffered saline (PBS).

Laparoscopic cholecystectomy report of 30 cases.

Laparoscopic cholecystectomy (LSC) was attempted in 30 patients and was accomplished in 29 during the nine months between March and November 1991. Twenty eight patients had cholelithiasis with or without adenomyosis, and two had adenomyosis of the gall-bladder. Mean operative time was 219 min and postoperative pain was slight.