Right-sided iliac vein compression syndrome: when the vein is compressed between the internal and external iliac arteries-a case report.

Background: In its normal anatomical relationship, the inferior vena cava is located on the right side of the abdominal aorta. Iliac vein compression syndrome (IVCS) is a pathological condition in which a blood clot is formed due to blood flow obstruction when the left common iliac vein is compressed between the right common iliac artery and the vertebral body. Therefore, right-sided IVCS (RIVCS) is rare. The effectiveness of treatment for RIVCS has not been sufficiently investigated. Case summary: A 51-year-old man developed deep vein thrombosis in the right lower extremity and non-massive pulmonary embolism during steroid treatment for IgA nephropathy. Magnetic resonance angiography (MRA) suggested iliac compression syndrome. Symptoms improved with the use of direct oral anticoagulants and compression stockings. At the 8-month follow-up, the clinical course was uneventful. Discussion: The causes of RIVCS in this case are believed to be the effects of steroids, prolonged sitting, and compression of the right external iliac vein. However, considering that deep vein thrombosis did not form in the left lower limb where there was no venous compression, it can be considered that the compression of the right external iliac vein had a significant impact. This case has been followed up for 8 months with anticoagulants and is progressing well. This is the first case to report the course of RIVCS treated conservatively with anticoagulant therapy for 8 months. This case suggested that conservative treatment is effective for RIVCS.

"Happy Heart Syndrome" Followed Up with Cardiac Magnetic Resonance Imaging.

We herein report a 49-year-old woman who developed "happy heart syndrome" while watching a family theater performance. She was followed up with cardiac magnetic resonance imaging (CMR). The time course of the CMR findings was similar to that previously reported for Takotsubo cardiomyopathy (TTC), including the form of "broken heart syndrome." CMR findings for "happy heart syndrome" have not been sufficiently investigated. However, the CMR findings in this case suggest that "happy heart syndrome" and other conventional TTC including "broken heart syndrome" are clinically a single disease, at least from an imaging aspect.

Capecitabine May Accelerate Atherosclerosis and Causes Acute Myocardial Infarction in the Left Main Trunk.

We report a case of a 59-year-old man who developed acute myocardial infarction which is supposed to be associated with capecitabine administration. At the age of 57 years, the patient underwent a laparoscopic colectomy for sigmoid colon cancer and subsequently received adjuvant chemotherapy with capecitabine. About one year later, he developed an acute myocardial infarction and was treated with percutaneous coronary intervention. He did not demonstrate any coronary risk factors except dyslipidemia, which itself was unlikely to be involved in prominent atherogenesis. Considering the reports so far, we presumed that capecitabine contributed to the progression of atherosclerosis in the present case.

The association of calcium channel blocker with risk of adverse limb events in patients with chronic limb-threatening ischemia after endovascular treatment.

Symptoms of lower-extremity artery disease (LEAD) emerge from impaired vascularization in distal circulation of the extremities. Calcium channel blockers (CCB) can improve distal circulation when used as adjunctive therapy with endovascular treatment (EVT), but few studies have evaluated that. We investigated the relationship between CCB therapy and post-EVT outcomes. Through a consecutive EVT registry, we evaluated those relationships in whole cohort and the following 2 subgroups; the patients suffered from intermittent claudication (IC) or chronic limb-threatening ischemia (CLTI), with adjusting baseline characteristics by propensity score matchings. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, a composite endpoint of all death, nonfatal myocardial infarction, and nonfatal stroke), and major adverse limb event (MALE, a composite of major amputation, acute limb ischemia, and surgical reintervention). The group that received CCB had less MALE in whole cohort (HR 0.31; 95% confidence interval (CI) 0.20-0.47), and less MACCE and MALE in CLTI cohort (HR 0.67; 0.50-0.89 and 0.32; 0.20-0.52 respectively) compared to the group that did not receive CCB. The relationships were common in the cohorts with baseline adjustment. MACCE and MALE in IC (HR 1.01; 0.57-1.80 and 0.60; 0.25-1.45, respectively) showed no significant differences both with and without baseline adjustment. CCB use was related to fewer MACCE and MALE events in adjusted patients who underwent EVT, and the trend was more evident, especially in the adjusted CLTI cohort. This study highlights the necessity of future studies regarding CCB. Clinical Trial Registration: URL: https://www.umin.ac.jp ; Unique identifiers: UMIN000015100.

One-year limb outcome and mortality in patients undergoing revascularization therapy for acute limb ischemia: short-term results of the Edo registry.

The present study aimed to clarify the current status, therapeutic strategy, and 1-year outcome in acute limb ischemia (ALI) patients in Japan. The EnDOvascular treatment (Edo) registry database includes 324 patients from 10 institutes who were registered between November 2011 and October 2013. A total of 70 ALI patients (mean age 74.0 years) from the Edo registry database were enrolled in this study. Of the 70 included patients, 72.9% were male and 35.7% had embolism. Of patients, 38.6%, 42.9%, and 18.6% underwent EVT, surgery, and hybrid thrombectomy, respectively, in primary revascularization strategy. Limb ischemia was categorized into four classes at initial evaluation: SVS/ISCVS class I (n = 13, 18.6%), SVS/ISCVS class IIa (n = 36, 51.4%), SVS/ISCVS class IIb (n = 21, 30%), and SVS/ISCVS class III (n = 0, 0%). Three patients with SVS/ISCVS class IIb limb ischemia developed myonephropathic metabolic syndrome. No catheter-directed thrombolysis was employed as a primary revascularization strategy. The 1-year rates of all-cause death, major amputation, and a composite of perioperative death or major adverse limb event were 28.6%, 5.7%, and 40.0%, respectively. Lower age, male sex, dyslipidemia, high estimated glomerular filtration rate, high albumin level, and low C-reactive protein level were independent positive predictors of all-cause death. In this registry, SVS/ISCVS class IIa ALI was predominant. Approximately 40% of primary revascularization strategy was surgery and EVT, followed by hybrid therapy. All-cause death and major amputation rates at 1 year were less than 30% and 6%, respectively.

Cardiac calcified amorphous tumour associated with multiple myeloma.

We report an 86-year-old woman who was diagnosed with multiple myeloma (MM) and was receiving chemotherapy since the age of 82. A high echoic mass attached to the mitral valve was observed on transthoracic echocardiography 4 years after the treatment. The possibility of malignancy could not be ruled out, and hence, the mass was excised surgically. Pathologically, most of the mass consisted of calcified lesion without tumour tissue, and these findings were not inconsistent with calcified amorphous tumour (CAT). This case suggests that CAT may be associated with MM and has been reported after a thorough literature review.

Pericarditis caused by herpes zoster.

A 53-year-old immunocompetent male visited our hospital complaining of chest pain which persisted for 6 h. After detailed examination, the patient was diagnosed with viral pericarditis and treated with aspirin. On day 3 after admission, rash with blisters appeared on the right side of chest. Paired serum evaluation on the day of admission and 3 weeks later revealed that varicella zoster virus(VZV)titer had significantly increased, and the patient was diagnosed with pericarditis caused by herpes zoster. Although VZV is known to cause various complications, there are few reports of pericarditis associated with VZV. We should consider the possibility of concomitant pericarditis with herpes zoster. .

Spontaneous closure of ventricular septal perforation following percutaneous coronary intervention for acute myocardial infarction.

We report on an 84-year-old woman with anteroseptal acute myocardial infarction. Emergency coronary angiography revealed the occlusion of proximal left anterior descending artery without collateral circulation, and percutaneous coronary intervention was performed. Two drug eluting stents were implanted, and the procedure was concluded with thrombolysis in myocardial infarction grade 3 without complications. Postoperatively, no murmur was audible on auscultation and no shunt flow was observed on transthoracic echocardiography (TTE), and normal blood pressure was maintained. On day 2, however, the patient's vital signs deteriorated to a state of shock and systolic murmur appeared at the apical region. TTE showed a left-to-right shunt in the apical septal region, and ventricular septal perforation was diagnosed. Although emergency surgery was considered, the patient's vital signs improved the following day. The disappearance of the cardiac murmur and the shunt was confirmed. The clinical course was uneventful thereafter, and the patient was discharged.

Antimitochondrial antibodies-positive myositis accompanied by cardiac involvement.

We report a 55-year-old man who experienced proximal muscle weakness accompanied by the atrial flutter (AFL) with 1:1 conduction. Detailed examination revealed elevated antimitochondrial antibodies (AMA) and creatine kinase (CK). AFL was converted to sinus rhythm by cardioversion. He was diagnosed as AMA-positive myositis-associated AFL and was treated by prednisolone. Although his muscle weakness and CK level improved, AFL with 1:1 conduction reappeared. Therefore, radiofrequency catheter ablation (RFCA) was needed to treat the AFL, resulting in maintenance of sinus rhythm. This case report describes cardiac involvement in a patient with AMA-positive myositis.

Delayed cardiac tamponade 8 months after pulmonary vein isolation.

We herein report the case of a 55 year-old male who underwent pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. From 8 months after PVI, exertional dyspnea rapidly appeared. When he was referred to our hospital, massive pericardial effusion was observed by transthoracic echography. The pericardiocentesis revealed bloody pericardial effusion, and improved symptoms. Although aortic dissection, autoimmune disease, infection, metastatic pericardial tumor, primary pericardial tumor, and malignant neoplasm were considered as differential diagnosis, the cause of pericardial effusion failed to be found. From these findings, the cause of hemorrhagic pericardial effusion was considered delayed cardiac tamponade induced by PVI performed 8 months earlier. .

An Adult Case of Unicommissural Unicuspid Aortic Valve Diagnosed Based on the Intraoperative Findings.

We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings. UAV is very rare congenital aortic valve disease which is rarely diagnosed preoperatively.

A case of radiation-induced subclavian artery stenosis treated with percutaneous transluminal angioplasty.

We report on a female patient who underwent a standard radical mastectomy and radiation therapy for right breast cancer at the age of 50 years without recurrence. At the age of 76 years, she started to experience fatigue in the right upper limb. The symptom gradually worsened and she was admitted to our hospital for further investigation. With computed tomography scan and angiography, we observed a high degree of subclavian artery (SCA) stenosis and asymptomatic right common carotid artery (CCA) stenosis. After undergoing carotid artery stenting to the right CCA stenosis at another hospital, we performed percutaneous transluminal angioplasty to SCA. Although we chose to treat the highly calcified lesion only with a balloon and slightly decreased the degree of stenosis, her symptoms clearly improved. Since arterial severely stenotic lesions were limited in the area of radiation exposure while other part of the arteries looked smooth and relatively free of sclerosis, it was highly suspected that arterial injury was induced by radiation. There are few reports of radiation-induced injury of upper limbs. However, this case suggests that we need to consider the possibility of radiation-induced arterial injury in patients with a history of radiation therapy. .

Occlusion training increases muscular strength in division IA football players.

The purpose of this study was to investigate the effectiveness of 4 weeks of low-intensity resistance training with blood-flow occlusion on upper and lower body muscular hypertrophy and muscular strength in National Collegiate Athletic Association Division IA football players. There were 32 subjects (average age 19.2 ± 1.8 years) who were randomized to an occlusion group or control group. The athletes performed 4 sets of bench press and squat in the following manner with or without occlusion: 30 repetitions of 20% predetermined 1 repetition maximum (1RM), followed by 3 sets of 20 repetitions at 20% 1RM. Each set was separated by 45 seconds. The training duration was 3 times per week, after the completion of regular off-season strength training. Data collected included health history, resting blood pressure, pretraining and posttraining bench press and squat 1RM, upper and lower chest girths, upper and lower arm girths, thigh girth, height, and body mass. The increases in bench press and squat 1RM (7.0 and 8.0%, respectively), upper and lower chest girths (3 and 3%, respectively), and left upper arm girth were significantly greater in the experiment group (p < 0.05). Occlusion training could provide additional benefits to traditional strength training to improve muscular hypertrophy and muscular strength in collegiate athletes.