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Ito S.,Nagoya City East Medical Center | Yoshida T.,Nagoya City East Medical Center | Suda H.,Nagoya City East Medical Center
Journal of Cardiology Cases | Year: 2013

We experienced a rare and serious case of fractured hydrophilic guide wire necessitating surgical intervention during percutaneous coronary intervention (PCI) for a tortuous and calcified stenosis in the proximal right coronary artery. An 85-year-old female presented to our hospital and was diagnosed as having unstable angina. A 0.014. in. hydrophilic guide wire (HI-TORQUE WHISPER MS Guide Wire™, Abbott Vascular, Abbott Park, IL, USA) was fractured during PCI trying to pass a microcatheter Corsair™ (ASAHI INTEC, Seto, Japan). During the procedure to retrieve the retained guide wire, the distal segment of the fractured guide wire penetrated the atherosclerotic coronary wall and ascending aorta unexpectedly. The surgical procedure could be performed successfully by extracting the fractured guide wire segments and stopping the bleeding. The edge of a hydrophilic guide wire that is fractured by friction between the microcatheter and guide wire is extremely sharp and can perforate both the atherosclerotic coronary vessel wall and aortic wall. Caution should be exercised when using such a device in combination with a polymer-jacketed wire at an acute angulated and calcified lesion.<. Learning objective: Guide wires are the most common devices for interventional cardiologists. Guide wire fracture is a rare complication, but cardiologists should be well informed about it. This case report presents a detailed situation of hydrophilic guide wire fracture and penetration of coronary artery and even the aorta and discusses the mechanism.>. © 2013 Japanese College of Cardiology.


Kimura M.,Nagoya City East Medical Center
Indian Journal of Surgery | Year: 2016

Patients with unresectable esophageal cancer suffer from dysphagia, causing severe malnutrition and reduced quality of life (QOL). We elect to perform bypass because patients can have greater long-term survival with chemoradiation following this operation. We sought to compare complications in cases of bypass without thoracotomy versus those with thoracotomy. Thirty-four locally advanced esophageal cancer patients between 2007 and 2014 were studied. Eighteen patients underwent thoracotomy, and 16 patients did not have a thoracotomy. CT was obtained to check the anastomosis and the oral stump of the esophagus and to measure the diameter of the intrathoracic esophagus. In the thoracotomy group, the rate of postoperative pulmonary complications was high. On the other hand, in the non-thoracotomy group, the rates of anastomotic leak and recurrent nerve paralysis were high. The stump of the esophagus was 2 cm lower in the T group than in the nT group. As the esophagus shortens after division, the final difference in esophageal height between the groups was only around 1 cm. We concluded that a viable gastric tube with a good blood supply as well as a careful cervical operation are the most important aspects of the esophageal bypass operation. © 2016 Association of Surgeons of India


In this case report, we describe the recovery of abnormal coronary pressure waveform using a PressureWire Certus during percutaneous coronary intervention in a patient with severe stenosis in the proximal segment of the left anterior descending coronary artery. Since the diastolic pressure in the distal left anterior descending coronary artery was lower than that in the aorta, the pressure waveform before percutaneous coronary intervention represented the left ventricular pressure through a fistula due to a "wedge effect" in the stenosis as if the pulmonary artery wedge pressure determined by a Swan-Ganz catheter reflected the pressure in the distal portion (left atrium). We diagnosed this case coronary artery-left ventricular fistula based on the above findings. PressureWire Certus may be a valuable tool with which to estimate the hemodynamics in a patient with a coronary anomaly. © Springer 2013.


Ito S.,Nagoya City East Medical Center | Saeki T.,Nagoya City East Medical Center
Journal of Cardiology Cases | Year: 2015

A 69-year-old man underwent repeat percutaneous coronary intervention for in-stent restenosis in the obtuse marginal artery 8 months after biolimus-eluting stent (2.5. ×. 28. mm Nobori stent, Terumo, Tokyo, Japan) implantation. Coronary angiography showed focal stenosis in the distal part of the stent. Intravascular ultrasound revealed low echoic heterogeneous intimal tissue. Optical coherence tomography also revealed a heterogeneous finding classified as a layered pattern. Coronary angioscopy detected a white mass with a paste-like appearance at the stenosis extending around the in-stent restenosis as a thin membrane where stent strut could be seen transparently. A small part of the mass was swinging in the blood stream. Coronary angioscopic imaging was beneficial for the understanding of the suspected mechanism and feature of the in-stent restenosis after second-generation stent implantation, which was apparently different from neointimal hyperplasia after bare-metal stent implantation.<. Learning objective: The learning objectives of this case report include understanding the mechanism of in-stent restenosis after second-generation drug-eluting stent implantation by showing the coronary angioscopic imaging beyond the other intravascular imaging. In particular, this case can make the general and interventional cardiologists learn that the mechanism of in-stent restenosis <1 year is different from that after bare-metal stent implantation.>. © 2015 Japanese College of Cardiology.


Ito S.,Nagoya City East Medical Center | Mizoguchi T.,Nagoya City East Medical Center | Saeki T.,Nagoya City East Medical Center
Internal Medicine | Year: 2016

For the secondary prevention of cardiovascular disease, comprehensive cardiac rehabilitation is required. This involves optimal medical therapy, education on nutrition and exercise therapy, and smoking cessation. Of these, efficient exercise therapy is a key factor. A highly effective training protocol is therefore warranted, which requires a high rate of compliance. Although moderate-intensity continuous training has been the main training regimen recommended in cardiac rehabilitation guidelines, high-intensity interval training has been reported to be more effective in the clinical and experimental setting from the standpoint of peak oxygen uptake and central and peripheral adaptations. In this review, we illustrate the scientific evidence for high-intensity interval training. We then verify this evidence and discuss its significance and the remaining issues. © 2016 The Japanese Society of Internal Medicine.


Ito S.,Nagoya City East Medical Center
Prevention and Management of Stent Thrombosis after Complex Coronary Stenting in Patients with Risk of Gastrointestinal Bleeding | Year: 2012

Complex cases with gastrointestinal bleeding (GIB) risk are very challenging in terms of balancing the risk of ischemia and bleeding after coronary stent deployment, and concerns have been raised about the optimal anti-platelet therapy in such cases. An interventional strategy is also very important to prevent stent thrombosis with short term anti-platelet therapy. However, a dilemma is present with respect to these cases because complex cases always have a higher incidence of restenosis and/or late stent thrombosis without drug-eluting stents which need long-term dual anti-platelet therapy (DAPT). This book discusses the management of patients undergoing complex percutaneous coronary interventions (PCI) who may be at risk of gastrointestinal bleeding. © 2012 by Nova Science Publishers, Inc. All rights reserved.


Suzuki S.,Nagoya City University | Suzuki S.,Nagoya City East Medical Center | Pitchakarn P.,Nagoya City University | Pitchakarn P.,Chiang Mai University | And 3 more authors.
Experimental and Toxicologic Pathology | Year: 2013

Recently, considerable evidence has been generated that oxidative stress contributes to the etiology and pathogenesis of prostate cancer. The present study focused on the effects of apocynin, an inhibitor of the NADPH oxidase which generates intracellular superoxide, on a rat androgen-independent prostate cancer cell line (PLS10) in vitro and in vivo. Apocynin significantly inhibited cell proliferation of PLS10 cells via G1 arrest of the cell cycle in vitro. Surprisingly, it did not affect reactive oxygen species (ROS) but inhibited phosphorylation of Rac1, one component of the NADPH oxidase complex. A Rac1 inhibitor, NSC23766, also inhibited cell proliferation, and both apocynin and NSC23766 reduced phosphorylation of Rac1 and NF-κB, as well as cyclin D1. Furthermore, in a xenograft model of prostate cancer with PLS10, apocynin suppressed tumor growth and metastasis in a dose dependent manner in vivo, with reduction of cell proliferation and vessel number in the tumors. Expression and secretion of vascular endothelial growth factor (VEGF) were reduced by apocynin treatment in vivo and in vitro, respectively. In conclusion, despite no apparent direct relationship with oxidative stress, apocynin inhibited growth of androgen-independent prostate cancer in vitro and in vivo. Apocynin thus warrants further attention as a potential anti-tumor drug. © 2013 Elsevier GmbH.


Miyata Y.,Nagoya City East Medical Center
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2014

Quardicupid aortic valve( QAV) is a comparatively rare congenital anomaly, which presents with frequent aortic regurgitaion ( AR) due to sclerotic changes. We report 2 cases (a 67-year-old woman and a 53-year-old man) of QAV associated with AR. We made an definite diagnosis by preoperative transthoracic and intraoperative transesophageal echocardiography. Intraoperative findings showed type C QAV in case 1 and type B QAV in case 2 according to the Hurwitz classification. The left coronary ostia was slightly shifted to the aortic root in case 1. There were no other congenital anomalies, therefore only aortic valve replacement with mechanical prosthesis was performed in both cases. The postoperative courses were uneventful.


PubMed | Nagoya City East Medical Center
Type: Journal Article | Journal: Rinsho shinkeigaku = Clinical neurology | Year: 2016

A 74-year-old man lost consciousness immediately after defecation. The loss of consciousness lasted for several minutes, and he experienced difficulty in walking when he regained consciousness. He was transferred to our hospital via an ambulance. Upon neurological examination, nystagmus and ataxia in the left arm and leg were noted. An MRI of the brain revealed multiple acute infarcts mainly in the bilateral cerebellum. Intravenous thrombolytic therapy with alteplase was initiated 3h and 20min after the onset of symptoms, and an improvement in neurological symptoms was observed. Echocardiography displayed a mobile mass in the left atrium, suggesting myxoma. After 14 days from the onset of symptoms, the tumor was surgically resected, and a pathological diagnosis of myxoma was established. Because of the unique event surrounding the onset in this case, we considered that there was a potential detachment of myxoma and/or thrombi fragments triggered by an increase in intrathoracic pressure induced by the action of defecation. This present case suggests that clinicians should consider cardiac myxoma in patients with cerebral infarction if the stroke is preceded by a Valsalva maneuver-like action and accompanied by the loss of consciousness.


PubMed | Nagoya City East Medical Center
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2016

Patients with unresectable esophageal cancer suffer from dysphagia, causing severe malnutrition and reduced quality of life (QOL). We elect to perform bypass because patients can have greater long-term survival with chemoradiation following this operation. We sought to compare complications in cases of bypass without thoracotomy versus those with thoracotomy. Thirty-four locally advanced esophageal cancer patients between 2007 and 2014 were studied. Eighteen patients underwent thoracotomy, and 16 patients did not have a thoracotomy. CT was obtained to check the anastomosis and the oral stump of the esophagus and to measure the diameter of the intrathoracic esophagus. In the thoracotomy group, the rate of postoperative pulmonary complications was high. On the other hand, in the non-thoracotomy group, the rates of anastomotic leak and recurrent nerve paralysis were high. The stump of the esophagus was 2cm lower in the T group than in the nT group. As the esophagus shortens after division, the final difference in esophageal height between the groups was only around 1cm. We concluded that a viable gastric tube with a good blood supply as well as a careful cervical operation are the most important aspects of the esophageal bypass operation.

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