Impact of glucose fluctuation and monocyte subsets on coronary plaque rupture.

BACKGROUND AND AIMS: It remains unclear whether glycemic fluctuation can affect plaque rupture in acute myocardial infarction (AMI). Here we investigate the impact of glucose fluctuation on plaque rupture, as observed by optical coherence tomography (OCT), and monocyte subsets in patients with AMI. METHODS AND RESULTS: We studied 37 consecutive patients with AMI. All patients underwent OCT examination, which revealed 24 patients with plaque rupture and 13 patients without plaque rupture at the culprit site. Peripheral blood sampling was performed on admission. Three monocyte subsets (CD14(+)CD16(-), CD14(bright)CD16(+), and CD14(dim)CD16(+)) were assessed by flow cytometry. Glycemic variability, expressed as the mean amplitude of glycemic excursion (MAGE), was determined by a continuous glucose monitoring system 7 days after the onset of AMI. MAGE was significantly higher in the rupture patients than in the non-rupture patients (P=0.036). Levels of CD14(bright)CD16(+) monocytes from the rupture patients were significantly higher than those from the non-rupture patients (P=0.042). Of interest, levels of CD14(bright)CD16(+) monocytes correlated positively and significantly with MAGE (r=0.39, P=0.02). CONCLUSION: Dynamic glucose fluctuation may be associated with coronary plaque rupture, possibly through the preferential increase in CD14(bright)CD16(+) monocyte levels.

Magnetic resonance venography of the lower limb.

Prior to surgery or endovascular therapy for the lower extremity varicose veins or deep venous thrombosis (DVT), ultrasonography provides useful information. But it depends on the operator's technique, each image is limited to a small field of view and interpretation may be subjective. On the other hand, magnetic resonance (MR) imaging is now available with several postprocessing techniques using workstations to demonstrate the gross and objective morphology of these lesions less invasively than the conventional ascending venography. As non-contrast MR venography, fat suppressed three-dimensional (3D) coronal balanced turbo field echo (bTFE) is mainly applied in the semisupine position. The varicose veins on the muscle fascia are easily recognized on volume rendering and the perforating veins can be identified on maximum intensity projection (MIP) and axial multiplanar reconstructions. Gadolinium-enhanced fluid attenuated inversion recovery-bTFE is added when coexisting joint effusion or edema masks the veins. For DVT, direct thrombus imaging (DTI) using fat suppressed 3D coronal inversion recovery-prepared blood suppressed gradient echo sequence is applied. However, the signal intensity of DVT depends on the clot's age on DTI and is sometimes confusing on bTFE. After gadolinium administration, blood shows higher signal intensity than clots regardless of the age and DVT can be easily depicted as filling defects on the axial reformations and summarized on the soap bubble-MIP.

The effect of allopurinol on interstitial purine metabolism and tissue damage in skeletal muscle I-R injury.

OBJECTIVE: Many studies show that allopurinol can reduce skeletal muscle I-R (ischemia-reperfusion) injury, but the mechanism of the effect is still unclear and some studies suspect the effect. In this study, we determined whether allopurinol really reaches to reperfused muscle and reduces tissue injury by inhibiting xanthine oxidase or not. EXPERIMENTAL DESIGN: In this study, microdialysis method combined with HPLC (high performance liquid chromatography) were employed and purines, MDA (malondialdehyde), allopurinol in gracilis muscle were measured continuously in I-R injury model of canine gracilis muscle. The effect was compared between Group N (no treatment: n=8), Group P (pre-ischemic treatment: n=8) and Group R (pre-reperfusion treatment: n=8). RESULTS: Allopurinol reduced the increase of xanthine, uric acid, MDA in the muscle and CPK in blood effluent from gracilis muscle after reperfusion. Tissue protecting effect of allopurinol was more effective in group R than in group P. CONCLUSIONS: By continuous measurement of purines, allopurinol and MDA in canine gracilis muscle during 5 hr ischemia and 2 hr reperfusion, it was proved that allopurinol was delivered to reperfused skeletal muscle and reduced I-R injury by inhibiting xanthine oxidase.

Pseudoaneurysm caused by disruption of an externally supported knitted Dacron graft for femoropopliteal bypass.

Technological advances in artificial blood vessels used in arterial reconstructive surgery have contributed significantly to the development of this field. The 5-year cumulative patency rate of femoropopliteal bypass using knitted Dacron grafts at Keio University Hospital is over 80% (1). This rate is comparable with the results of femoropopliteal bypass surgery using autovein grafts (2, 3, 4). Therefore, we usually perform femoropopliteal bypass using a knitted Dacron graft. However, pseudoaneurysm formation remains one of the major complications of arterial reconstructive surgery. In most cases, a pseudoaneurysm is caused by infection or external injury, and is detected at the anastomotic site. This paper deals with an extremely rare, non-anastomotic aneurysm caused by total disruption in the middle of an externally supported knitted Dacron graft used for femoropopliteal bypass.

[A case report of left limb compartment syndrome associated with laparoscopic surgery].

A 63-year-old male patient with early gastric cancer was attempted for laparoscopic wedge resection of the stomach. After the introduction of anesthesia, bandage of bilateral leg was carried out to prevent deep venous thrombosis during laparoscopic surgery. Although the procedure was converted to open surgery, the bandage has been continued throughout the surgery for 6 hours. After the operation, the swelling and severe tenderness at his left leg was observed. MRI revealed remarkable edema in left deep posterior compartment. Under diagnosis of left limb compartment syndrome, fasciotomy was carried out. Postoperatively the patient did well without any functional disturbance.

Two cases of rectal carcinoma associating aorto-iliac occlusive disease.

Two cases of rectal carcinoma associating aorto-iliac occlusive disease are presented. These two cases had complete obstruction of the affected vessels, but many collateral pathways from the aorta to the legs had developed, mainly through the superior rectal artery or parietal vessels. Changes in blood flow to the legs, following the radical operation for rectal carcinoma, were examined by both preoperative angiography and perioperative Doppler flow meter. Vascular reconstruction was carried out in one case prior to resection of the rectum, in order to prevent the ischemic legs from becoming worse, or necrotic. The indications for supportive vascular surgery in the case of rectal carcinoma with aorto-iliac occlusive disease are discussed herein.

[Double primary malignant neoplasm of renal cell carcinoma and stomach cancer: report of two cases].

Two cases of double primary malignant neoplasm of renal cell carcinoma and gastric cancer are presented. Case 1 was a 59-year-old woman with right renal cell carcinoma (granular cell subtype) and gastric cancer (poorly differentiated adenocarcinoma). Case 2 was a 72-year-old man with left renal cell carcinoma (clear cell carcinoma) and gastric cancer (tubular adenocarcinoma). In both cases, the occult blood reactions of stool was strong and clear gastrointestinal symptoms developed. In these 2 cases of synchronous double cancer, gastrectomy following nephrectomy was performed in the same operation.