Congenitally Corrected Transposition of the Great Arteries at Age 88 Years.

Most patients with congenital heart disease are diagnosed shortly after birth; however, some patients are overlooked and diagnosed in adulthood. We present the case of a man in whom congenitally corrected transposition of the great arteries (CCTGA) was first diagnosed at the age of 88 years. CCTGA is a rare disease; patients without frequently associated cardiac anomalies are considered to have long life expectancies; however, their prognosis remains unclear. This case is the oldest patient at the time of CCTGA diagnosis in the literature, which may provide new insights for CCTGA without frequently associated cardiac anomalies.

La plupart des cardiopathies congénitales sont diagnostiquées peu après la naissance; certains cas passent toutefois inaperçus et sont diagnostiqués une fois le patient arrivé à l'âge adulte. Nous présentons le cas d'un homme chez qui une transposition congénitalement corrigée des gros vaisseaux (TCCGV) a été diagnostiquée alors qu'il avait 88 ans. La TCCGV est une maladie rare; les patients qui ne présentent pas aussi l'une ou l'autre des anomalies cardiaques qui y sont fréquemment associées ont généralement une bonne espérance de vie, bien que le pronostic demeure obscur. De tous les cas rapportés dans la littérature médicale, le patient qui est présenté ici est le plus âgé qui ait jamais reçu un diagnostic de TCCGV, ce qui pourrait éclairer sous un jour nouveau la TCCGV non accompagnée des autres anomalies cardiaques qui y sont fréquemment associées.

Virus-like particles associated with mass mortalities of the pen shell Atrina pectinata in Japan.

Mass mortalities of the pen shell Atrina pectinata occurred in the fishing grounds of Ariake Bay, in southwestern Japan, during late spring and summer in 2003 and 2004. Histological examination revealed extensive necrosis in the epithelial cells of the kidney and gill, and impairment of the endothelial cells of the mantle arteria. Although cestode larvae belonging to the genus Tylocephalum were found in the mantle, adductor muscle, kidney, and digestive gland, their prevalence and the intensity of infection were low. Examinations of moribund pen shells for Haplosporidium spp. infection using PCR analysis and for Perkinsus spp. infection using Ray's fluid thioglycollate medium were negative. Unenveloped virus-like particles were detected by transmission electron microscopy in the cytoplasm of affected kidney and gill cells of moribund pen shells. They were icosahedral spherical and 50 to 55 nm in diameter. These virus-like particles found in moribund pen shells are different from those described in other marine mollusks, and may be the causative agent of the mass mortalities of pen shells.

[A case of recurrent lung cancer successfully treated with vinorelbine and cisplatin/carboplatin].

A 73-year-old male underwent lobectomy with ND2a lymph node dissection and resection of the superior vena cava for right lung cancer in December 1998 at Akita University Hospital. Histopathological examination demonstrated moderately differentiated adenocarcinoma (pT4 (SVC) N2M0, Stage IIIB). He received 1 course of a combination of cisplatin (CDDP) and etoposide (ETP) as postoperative adjuvant therapy. In March 2001, he again underwent partial resection of the right lung (S8) due to recurrence. In December 2001, a new left lung metastatic tumor was found. The patient was transferred to our hospital, where he was given 1 course of vinorelbine (NVB) 25 mg/m2 (day 1, 8) and CDDP 80 mg/m2 (day 1). Subsequently, he received 2 courses of vinorelbine (NVB) 25 mg/m2 (day 1, 8) and carboplatin (CBDCA) 430 mg/body (day 1). After the chemotherapy, a complete response (CR) of metastatic lesions was achieved. Adverse reactions were grade 3 neutropenia, grade 2 alopecia and grade 1 nausea/vomiting. The combination of vinorelbine and platinum agent (CDDP/CBDCA) is a useful regimen in treating recurrent non-small-cell lung cancer.

Contributors to newly developed coronary artery disease in patients with a previous history of percutaneous coronary intervention beyond the early phase of restenosis.

OBJECTIVE: The low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio is considered to be a sensitive marker of the risk of atherosclerotic cardiovascular disease; however, in patients with a previous history of percutaneous coronary intervention (PCI), there is little information regarding the predictive value of this parameter beyond the period of early restenosis. The aim of this study was to investigate contributing factors to newly developed coronary artery disease in patients with a previous history of PCI after stabilization. METHODS: The clinical characteristics of 238 patients with a previous history of PCI who underwent coronary angiography following recurrent cardiac ischemia beyond the period of early restenosis were examined. RESULTS: Overall, 64% of the patients underwent late revascularization, while 31% and 50% underwent late target lesion revascularization and new lesion revascularization, respectively. A multivariate analysis identified the LDL-C/HDL-C ratio to be an independent contributor to late revascularization (hazard ratio (HR), 1.37; p<0.001). Similarly, the independent contributors to late target lesion revascularization and new lesion revascularization were the non-HDL-C level and LDL-C/HDL-C ratio, respectively. Based on the median value of the LDL-C/HDL-C ratio, the patients were classified into high and low LDL-C/HDL-C ratio groups. The log-rank test revealed a significantly higher incidence of late revascularization in the high-LDL-C/HDL-C ratio group than in the low-LDL-C/HDL-C ratio group among the patients with an LDL-C level of ≥ 100 mg/dL (p=0.011). However, the difference between the two groups was diminished among the patients with an LDL-C level of <100 mg/dL (p=0.047), and only diabetes mellitus (HR, 2.239; p=0.009) was found to be an independent contributor to late coronary revascularization in these patients. CONCLUSION: The LDL-C/HDL-C ratio is an important contributor to the development of new coronary artery disease in patients with a previous history of PCI beyond the period of early restenosis, particularly among patients with an LDL-C level of ≥ 100 mg/dL.