[The significance of cancer screening by immunological parameters].

Provided by the evidences that, in cancer patients, the production of Th 1 cytokines including IL-12, IFN-gamma, and TNF-alpha, is impaired, we asked whether these cytokines can be useful parameters for cancer detection. To the aim 174 patients diagnosed cancer of various organs, and 100 control individuals without cancer were enrolled to the study. We evaluated mitogen-stimulated production of cytokines and induction of Th 1 subset using peripheral blood mononuclear cells in vitro. Th 2 population was measured as the counterpart of Th 1 subset. NK cell activity was also measured. As acquired values did not show the normal distribution we employed a non-parametric test to compare the values between cancer and control. PHA-induced production of IL-12, IFN-gamma and TNF-alpha, in cancer was lower than that in control. Th 1 subset induced in cancer was lower than that in control. We found no difference in Th 2 subset induction between cancer and control. On the other hand, NK cell activity was augmented in cancer patients. When patients were grouped to early stage and advanced stage, both groups showed suppressed production of all three cytokines and suppressed induction of Th 1 cells. Interestingly, none of cytokines nor Th 1 subset differed between the two stages, suggesting that the impaired cytokine production may be a common feature of cancer condition and participate in the etiology of cancer. In contrast, enhanced induction of Th 2 subset was seen in advanced stage compared to early stage, indicating that Th cells might be biased to differentiate to Th 2 cells in advanced stage. From the results IL-12, IFN-gamma, TNF-alpha and Th 1 subset as well as NK activity appear to be promising parameters for cancer detection. Above all, IL-12 and IFN-gamma seem to be the best parameters due to high sensitivity and specificity, and independence from the stage of cancer.

Trapped Rotablator: kokesi phenomenon.

We experienced a rare complication of rotational atherectomy. The burr was trapped at the angled, calcified narrowing in the left anterior descending coronary artery. The burr was retrieved after the resection of the pulmonary artery and the left coronary artery. We will discuss the cause and prevention of this complication. Cathet. Cardiovasc. Intervent. 49:82-84, 2000.

Primary stent implantation is superior to balloon angioplasty in acute myocardial infarction: final results of the primary angioplasty versus stent implantation in acute myocardial infarction (PASTA) trial. PASTA Trial Investigators.

Several studies have shown that stent implantations in acute myocardial infarction (AMI) result in better short- and long-term outcomes than primary balloon angioplasty. These results, however, have not been ascertained in randomized trials. We randomized 136 patients out of 208 patients with AMI within 12 hr from onset into two groups: 69 patients with primary balloon angioplasty (POBA group) and 67 patients with primary stent implantation (STENT group). We compared the incidences of major cardiac events (repeat MI, target lesion revascularization, and cardiac death) and angiographic parameters during hospitalization and follow-up periods up to 12 months in these two groups. There was no significant difference in the reperfusion success rates. The incidences of major cardiac events were lower in the STENT group than in the POBA group during hospitalization, the first 6 months and 12 months (6% vs. 19%, P = 0.023; 21% vs. 46%, P < 0.0001; 22% vs. 49%, P = 0.0011). Minimum lumen diameters were significantly bigger in the STENT group than the POBA group at predischarge angiogram and 6-month follow-up (2.85 +/- 0.62 vs. 2.08 +/- 0.82 mm, P < 0.0001; 2.24 +/- 0.64 vs. 1.72 +/- 0.76, P = 0.002). Restenosis rates at 6-month follow-up were significantly lower in the STENT group than in the POBA group (17% vs. 37.5%, P = 0.02). In selected patients with AMI, primary stent implantation results in a lower incidence of major cardiac events during the first 12 months, postprocedure, and less frequent 6-month restenosis than primary balloon angioplasty.

Isolated effect of partial left ventriculectomy for dilated cardiomyopathy: a case report.

A 38-year-old man underwent the Batista operation to treat end-stage dilated cardiomyopathy. There was no associated mitral regurgitation, so only partial left ventriculectomy was performed. The patient recovered successfully. His New York Heart Association (NYHA) class improved from IV to I, ejection fraction increased from 8% to 37% and left ventricular diastolic dimension decreased from 89 to 68 mm. Cardiac output and stroke volume increased from 3.8 to 6.7 l/min and from 52 to 85 ml/min, respectively. This case shows the isolated positive effect of partial left ventriculectomy without mitral valve reconstruction.

Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention.

To test the feasibility of using guiding catheters equal to or greater than 7 Fr in transradial coronary intervention (TRI), we measured the inner diameter of the radial artery (RA) and its flow using two-dimensional ultrasound and Doppler examinations before and after TRI in 250 Japanese patients. The incidence of severe flow reduction of the RA after TRI was 6.8% on average (7.2%, 4.7%, and 8.3% in patients with 6, 7, and 8 Fr sheaths used, respectively), which increased from 4.0% to 13.0% (P=0.0113) if the ratio of the RA inner diameter/sheath outer diameter was less than 1.0. The frequency of this ratio (> or = 1.0) for 7 and 8 Fr sheaths was 71.5% and 44.9% in male patients and 40.3 and 24.0% in female patients, respectively. We conclude that the use of guiding catheters equal to or greater than 7 Fr in the radial artery is feasible in selected patients.

Transradial coronary intervention in Japanese patients.

The objectives of this study was to test the feasibility and safety of transradial coronary intervention (TRI) in Japanese patients. We compared the results of TRI in 1,791 lesions (1,360 patients) between November 1995 and December 1997 with those of transfemoral coronary intervention (TFI) in 966 lesions (793 patients) between April and October 1995. We also examined the radial artery pulse in 294 patients 1-2 weeks after TRI by palpation and Doppler examination. Arterial puncture, coronary artery cannulation, lesion, and patient success rates were similar in both groups. No significant difference was noted in the major complication rate. Local complications were significantly lower in the TRI group (0.3% vs. 3.3%, P < 0.001). Doppler studies of the radial artery were performed in 294 patients chosen at random. In the first 234 patients, the sheath was pulled out 3 hr after the procedure, and in the last 60 patients, immediately after the procedure; radial artery occlusion rates were 5% and 0%, respectively. In conclusion, TRI seems safe and feasible in Japanese patients.

Short- and long-term clinical effects of primary directional coronary atherectomy for acute myocardial infarction.

We performed primary directional coronary atherectomy (DCA) without antecedent thrombolytic therapy in 21 of 67 patients with acute myocardial infarction within 24 hr of onset between June 1993-March 1994. Reperfusion with primary DCA was successful in 18 patients (85.7%, group D). Results were compared with those of primary balloon angioplasty patients treated between June 1992-May 1993 (group P). Minimum lumen diameter (MLD) values both immediately after reperfusion and in predischarge angiograms were significantly larger in group D than in group P, but were similar in late follow-up angiograms. Although a larger MLD in group D than in group P contributed to the prevention of reocclusion of the coronary artery before discharge in DCA patients, a high rate of restenosis at late follow-up canceled the beneficial effects of primary DCA.