RESUMO
PURPOSE: This study aimed to illustrate the utility of our original system to deliver vascular plugs into aortic side branches during endovascular aneurysm repair (EVAR). TECHNIQUE: Our device, which we named "System-F," consists of a 14 Fr sheath, a 12 Fr long sheath with a side hole, a stiff guidewire as a shaft, and a parallelly-inserted delivery catheter navigated through the side hole into the aneurysm sac. Vertical motion and horizontal rotation of the side hole allow multidimensional movement of the delivery catheter within the aneurysm. This system was applied in 7 cases undergoing EVAR; 4 inferior mesenteric arteries and 14 lumbar arteries were embolized using vascular plugs. Type II endoleak (T2EL) was not observed in the follow-up survey of any case. Conclusion: The applicability of System-F for vascular plug placement in the side branches of abdominal aortic aneurysms has the potential to achieve high delivery capability and be widely applied for the prevention of T2EL. CLINICAL IMPACT: System-F has potential to change the strategies of pre-EVAR embolization.
RESUMO
A 77-year-old male with many comorbidities underwent off pump coronary artery bypass grafting. A severely atherosclerotic ascending aorta was revealed by preoperative computed tomography(CT) and epiaortic echography during operation. Therefore, V-composite saphenous vein grafting was adopted for non left anterior descending artery (LAD) coronary lesions in addition to left internal thoracic artery-left anterior descending artery bypass grafting. He was discharged with no complications and all grafts were confirmed to be patent by postoperative CT. V-composite saphenous vein grafting for avoiding cerebrovascular complications might be one of the useful options in coronary artery revascularization for non-LAD lesions in elderly patients or those with many comorbidities, especially with a severely atherosclerotic ascending aorta.
Assuntos
Aorta/cirurgia , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Veia Safena/cirurgia , Idoso , Aorta/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Esaxerenone, a mineralocorticoid receptor blocker, attenuates global ischemia-induced myocardial damage and coronary endothelial dysfunction. This study aimed to determine whether esaxerenone exerted cardioprotective effects against cardioplegic arrest in Wistar rat hearts. METHODS: Isolated male Wistar rat hearts aerobically perfused via the Langendorff method for 20 min were randomly allocated to the Control (n = 6; perfused for an additional 10 min and subjected to no treatment) or Esax (n = 6; perfused with 0.1 µmol/L esaxerenone in perfusate for 10 min before ischemia) groups. Hearts in both groups were perfused with St. Thomas' Hospital No. 2 solution (STH2) for 2 min and subjected to 28 min of global ischemia. The recovery of left ventricular developed pressure (LVDP) and total troponin T leakage were measured after reperfusion. RESULTS: The final recovery of LVDP (expressed as a percentage of pre-ischemic value) in the Control and Esax groups was 50.8 ± 3.5% and 62.1 ± 5.6%, respectively (p <0.05, Esax vs. Control). The total troponin T leakage in the Control and Esax groups was 138.8 ± 18.5 ng/g heart wt and 74.3 ± 18.6 ng/g heart wt, respectively (p <0.05, Esax vs. Control). CONCLUSION: The administration of esaxerenone before cardioplegic arrest enhanced the cardioprotective effect exerted by STH2.
Assuntos
Modelos Animais de Doenças , Parada Cardíaca Induzida , Preparação de Coração Isolado , Antagonistas de Receptores de Mineralocorticoides , Traumatismo por Reperfusão Miocárdica , Ratos Wistar , Sulfonas , Troponina T , Função Ventricular Esquerda , Pressão Ventricular , Animais , Masculino , Função Ventricular Esquerda/efeitos dos fármacos , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Troponina T/sangue , Fatores de Tempo , Sulfonas/farmacologia , Pressão Ventricular/efeitos dos fármacos , Recuperação de Função Fisiológica , Miocárdio/metabolismo , Miocárdio/patologia , Soluções Cardioplégicas/farmacologia , PirróisRESUMO
INTRODUCTION AND IMPORTANCE: The incidence of acquired Gerbode defect has been increasing due to advances in cardiac imaging technology, and some closure methods have been introduced. PRESENTATION OF CASE: A 58-year-old man developed cardiogenic shock due to acute severe aortic valve regurgitation with an acquired Gerbode defect caused by infective endocarditis. Emergency surgery was performed. A large patch with a 0.4 mm extended-polytetrafluoroethylene (e-PTFE) sheet covered with autologous pericardium was used to close the Gerbode defect, and a bioprosthetic valve was used for aortic valve replacement. CLINICAL DISCUSSION: Large patch closure with 0.4 mm e-PTFE sheet and autologous pericardium for fragile Gerbode defect caused by infective endocarditis might be effective with regard to sturdiness, good fitting to the tissue, and excellent resistance to bacteria. CONCLUSION: We encountered a rare case of cardiogenic shock due to acute severe aortic valve regurgitation and acquired Gerbode defect caused by infective endocarditis. In our case, large-patch closure for perforation in a fragile membranous septum was effective.
RESUMO
Giant cell arteritis is reportedly associated with thoracic aortic aneurysm and acute aortic dissection. We encountered a patient with giant cell arteritis who suffered acute aortic dissection three times within a short period. A pathological specimen of the ascending aorta taken at surgery for type A acute aortic dissection revealed the typical features of giant cell arteritis. Giant cell arteritis patients might be at greater risk of acute aortic dissection than healthy individuals.
Assuntos
Aneurisma da Aorta Torácica/etiologia , Dissecção Aórtica/etiologia , Arterite de Células Gigantes/complicações , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Recidiva , Resultado do TratamentoRESUMO
Background: Although the causative pathogens in cardiac implantable electronic device (CIED) infections are well known, the relationship between time after implantation and infection patterns has not been sufficiently investigated. This study investigated the microbiology and onset of CIED infections according to infection patterns. MethodsâandâResults: This retrospective study included 97 patients who underwent CIED removal due to device-related infections between April 2009 and December 2018. After device implantation, infections peaked in the first year and declined gradually over 10 years. Most infections (>60%) occurred within 5 years. Staphylococcal infections, the predominant form of CIED infections, occurred throughout the study period. CIED infections were categorized as systemic (SI; n=26) or local (LI; n=71) infections according to clinical presentation, and as CIED pocket-related (PR; n=85) and non-pocket-related (non-PR; n=12) infections according to the pathogenic pathway. The main causative pathogen in SI was Staphylococcus aureus, whereas coagulase-negative staphylococci were mainly related to LI. Both SI and LI peaked in the first year after implantation and then decreased gradually. There was no significant microbiological difference between PR and non-PR infections. PR infections showed the same temporal distribution as the overall cohort. However, non-PR infections exhibited a uniform temporal distribution after the first year. Conclusions: The severity of CIED infections depends on the causative pathogen, whereas their temporal distribution is affected by the microbiological intrusion pathway.
RESUMO
BACKGROUND: Spatial dispersion of atrial activation is a cause of postoperative atrial fibrillation (PoAF) after cardiac surgery. This study evaluated whether temporal dispersion of atrial activation causes PoAF after surgery in a clinical setting. METHODS: Nineteen patients were enrolled. Postoperative atrial activation was evaluated by 24-hour Holter electrocardiography, with atrial pacing wires on the right atrium, for 5 days after cardiac surgery. No patient received antiarrhythmic drugs, including beta-blockers. The cycle length of 15 continuous atrial beats was measured at 4 time points: (i) earlier than 12 hours before PoAF, as a control, (ii) just before PoAF onset, (iii) during PoAF, and (iv) just before cessation of PoAF. Inhomogeneity of atrial activation was quantified by using the variation coefficient for a cycle length of 15 atrial beats during each phase. RESULTS: The median inhomogeneity index of atrial activation (interquartile range) was 0.102 (0.046-0.136) in controls, 0.943 (0.582-1.610) just before PoAF onset (vs. control; p=0.009), 0.966 (0.631-1.117) during PoAF, and 0.471 (0.138-0.645) just before cessation of PoAF. CONCLUSIONS: Dispersion of atrial activation significantly increased just before PoAF onset. Temporal dispersion of atrial activation is a precursory variation of PoAF.
Assuntos
Arritmias Cardíacas/diagnóstico , Fibrilação Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Átrios do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Idoso , Arritmias Cardíacas/epidemiologia , Fibrilação Atrial/epidemiologia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND: There have been a few cases of echogenic cardiac implantable electric device (CIED) lead-associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients. METHODS: Preoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open-heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed. RESULTS: A total of 106 patients underwent lead removal in our institute (April 2009-March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead-related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). CONCLUSIONS: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead-associated intracardiac masses.
RESUMO
BACKGROUND: Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomic mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in nonresectable cardiac tumors. OBJECTIVE: The purpose of this study was to evaluate the surgical procedures and late outcomes of the treatment of VT associated with cardiac tumors. METHODS: We examined six patients (age 1-65 years) who had undergone surgical treatment of VT associated with cardiac tumors between 2010 and 2016. The 4 pathologies of the cardiac tumors were lipoma 2, fibroma 2, hemangioma 1, and lymphoma 1. Intraoperative epicardial mapping using CARTO was performed in 5 patients(80%). Surgical procedures and long-term outcomes were evaluated. RESULTS: Arrhythmogenic substrates with abnormal electrograms, such as fractionated or late potential, were identified locally or circumferentially beside the tumor in every patient. Complete tumor resection with cryoablation was performed in 3 patients. Two patients underwent partial tumor resection with cryoablation. Cryoablation without tumor resection was performed in 1 patient. No mortality and morbidity occurred. Additional catheter ablation was required in 2 patients to treat occurrence of nonclinical VT and induction of clinical VT during hospital stay. Mean follow-up time was 90 ± 52.5 months. There was no recurrence of clinical VT. CONCLUSION: The outcomes of surgical treatment of VT associated with cardiac tumors were excellent. Intraoperative CARTO mapping was beneficial to eliminate the VT substrates associated with nonresectable cardiac tumors.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Criocirurgia/métodos , Neoplasias Cardíacas/complicações , Taquicardia Ventricular/terapia , Adolescente , Adulto , Idoso , Mapeamento Potencial de Superfície Corporal/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
Patients with genetic Creutzfeldt-Jakob disease in which arginine is substituted for methionine at codon 232 (M232R) of the prion protein gene (CJD232) have been described in Japan, and a recent study has revealed the presence of two clinical phenotypes: a rapidly progressive type (rapid-type) and a slowly progressive type (slow-type). Although the former is known to show pathologic features similar to those of classical CJD, the neuropathology of the latter still remains unclear. We report the autopsy findings of slow-type CJD232 of 37 months' duration in a 73-year-old man who had methionine homozygosity at codon 129 of the prion protein gene (129MM). His initial symptoms included agraphia and memory disturbance, followed by relatively slowly progressive dementia. Myoclonus and akinetic mutism became evident 5 and 23 months after disease onset, respectively. The electroencephalogram revealed periodic sharp wave complexes at 7 months before death. The neuropathologic features were partly reminiscent of those of MM2-cortical-type sporadic CJD, showing spongiform change of the large confluent vacuole type, neuronal loss with gliosis, and coarse, perivacuolar prion protein deposits, which were later shown to consist of protease-resistant type 2 prion protein, in the cerebral cortex and striatum. It was of considerable interest that not only was the medial thalamus severely involved, but also that the cerebellar cortex showed loss of Purkinje cells and abundant plaque-like prion protein deposits. These findings are not a feature of MM2-cortical-type sporadic CJD. Whether or not the M232R substitution, in combination with the genetic polymorphism and the molecular type of pathological prion protein, really participates in the development of CJD232 and its different phenotypes awaits further studies.
Assuntos
Cerebelo/patologia , Cérebro/patologia , Síndrome de Creutzfeldt-Jakob/genética , Príons/genética , Idoso , Atrofia/genética , Atrofia/metabolismo , Atrofia/patologia , Western Blotting , Cerebelo/metabolismo , Cérebro/metabolismo , Síndrome de Creutzfeldt-Jakob/patologia , Progressão da Doença , Gliose/genética , Gliose/patologia , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Mutação , Fenótipo , Polimorfismo de Nucleotídeo Único , Príons/metabolismoRESUMO
We investigated time-related predictors of death or neurological sequelae in extremely preterm infants (EPI) born at 22 to 24 weeks' gestation by categorizing clinical patterns according to their survival time and morbidity. Data on 113 infants born at 22 to 24 weeks' gestation from January 1991 through April 2006 were analyzed by a case-control approach. Cesarean section, Apgar score
Assuntos
Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/mortalidade , Recém-Nascido Prematuro , Índice de Apgar , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Seguimentos , Hemorragia/epidemiologia , Humanos , Recém-Nascido , Japão/epidemiologia , Modelos Logísticos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Análise Multivariada , Oligo-Hidrâmnio/epidemiologia , Gravidez , Prognóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoAssuntos
Demência/terapia , Equipe de Assistência ao Paciente , Idoso , Idoso de 80 Anos ou mais , Família , HumanosRESUMO
To understand the molecular features underlying stem cell aging, we established intestinal epithelial organoids derived from both young and aged mice and investigated alterations in their senescence and epigenetic status. Senescence-related changes including accumulation of senescence-associated ß-galactosidase and up-regulation of Cdkn1a (p21) by DNA demethylation were observed in intestinal epithelial organoids derived from aged mice. We also demonstrated that the important stem cell marker Lgr5 was epigenetically silenced by trimethylation of histone H3 lysine 27, inducing suppression of Wnt signaling and a decrease of cell proliferation in organoids from aged mice. We further treated intestinal epithelial organoids from aged mice with nicotinamide mononucleotide (NMN), a key NAD+ intermediate. As a result, the organoids showed a higher NAD+ level, increased cell proliferative ability, activation of Lgr5 and suppression of senescence-associated genes, indicating that treatment with NMN could ameliorate senescence-related changes in intestinal epithelia. These findings suggest that organoids derived from aged animals could be a powerful research tool for investigating the molecular mechanisms underlying stem cell aging and for development of some form of anti-aging intervention, thus contributing to prolongation of healthy life expectancy.
RESUMO
[This corrects the article DOI: 10.1038/s41514-018-0031-5.].
RESUMO
The purpose of this study was to determine the 22-year experience of the relationship between preoperative left atrial diameter (LAD) and atrial fibrillation (AF) recurrence after AF surgery. Between November 1993 and April 2015, 244 patients underwent AF surgery concomitant with mitral valve surgery, and were completely followed up in our institute. The full-maze procedure was performed in 231 patients and pulmonary vein isolation in 13. Three quartiles divided the list of sorted LAD data into 4 groups: group Q1: LAD = 40.5 ± 4.3 (n = 55), group Q2: LAD = 47.9 ± 2.0 (n = 61), group Q3: LAD = 54.2 ± 1.6 (n = 66), and group Q4: LAD = 64.2 ± 5.6 (n = 62). The AF cure rates for 22 years were verified between the groups. Although the AF cure rate of the full-maze procedure was 94%, 80%, 63%, and 51% at 1, 5, 10, and 20 years after AF surgery, respectively, it was 100% at 5 and 10 years after the pulmonary vein isolation (P = 0.088). Although there were no significant differences in the AF cure rate between groups Q1-Q3, the AF cure rate was significantly lower in group Q4 than the other groups (P < 0.001). A multivariate Cox proportional hazard model revealed that the preoperative LAD and cardiothoracic ratio were significant risk factors of AF recurrence (hazard ratio 1.063 per 1-mm increase, P = 0.003, and hazard ratio 1.064 per 1% increase, P = 0.043, respectively). AF surgery was effective for 22 years after surgery for AF concomitant with mitral valve disease. A preoperative LAD of ≥58.0 mm and the cardiothoracic ratio were risk factors of AF recurrence after AF surgery.
Assuntos
Técnicas de Ablação/efeitos adversos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Veias Pulmonares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
This report describes a case of surgical treatment for a coronary artery saccular aneurysm of the left main bifurcation. A coronary artery saccular aneurysm (7 mm × 10 mm) and three vessel disease, including the left main trunk, were diagnosed by coronary angiography. A surgical resection and saphenous vein patch repair of the left main coronary artery aneurysm was performed concomitantly with coronary artery bypass grafting. The pathological findings of the aneurysm clarified that the aneurysm wall was atrophic and extremely thin because of a collapsed trilaminar arterial structure due to atherosclerosis. A coronary computed tomographic scan revealed no aneurysmal formation in the patent left main trunk and patent grafts 3 years after surgery.
Assuntos
Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária , Vasos Coronários/cirurgia , Veia Safena/transplante , Idoso , Angiografia por Tomografia Computadorizada , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a common etiological agent of a life-threatening infection in neonatal intensive care units (NICUs). Neonates with very low birth weight and patients with serious diseases are more likely to be exposed to invasive procedures which make them at a high risk of MRSA colonization and infection. Since MRSA colonization is a risk factor for MRSA infection, prevention of MRSA transmission is an important issue in NICUs. NICUs in Japan practice standard contact precautions and active surveillance cultures (ASC) to prevent MRSA transmission. In this report, we analyzed the clinical characteristics of MRSA colonization and infection between January 2010 and December 2015 in our perinatal care center. METHODS: We conducted retrospective analysis of 1716 neonates hospitalized in our perinatal care center. RESULTS: 120 cases had MRSA colonization (6.99%) and among them 33 neonates were infected. The duration of stay (P≤0.001) and the birth weight (P≤0.001) showed statistically significant differences between MRSA-colonized neonates and non-MRSA-colonized neonates. The number of central venous catheterization showed statistically significant differences (Pâ=â0.001) and the number of digestive system diseases showed marginally significant differences (Pâ=â0.072) between MRSA-colonized non-infected neonates and MRSA-infected neonates. CONCLUSIONS: As previous reports have shown, we present that the neonates with central venous catheterization were more likely to be infected with MRSA. We also need to pay attention to neonates with digestive system diseases, showing signs of infection, because they may be potentially infected with MRSA.
Assuntos
Peso ao Nascer , Portador Sadio/epidemiologia , Doenças do Sistema Digestório/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Portador Sadio/microbiologia , Cateterismo Venoso Central , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Japão/epidemiologia , Tempo de Internação , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologiaRESUMO
We studied the objective diagnosis of Alzheimer-type dementia based on changes in the corpus callosum. We examined midsagittal head MR images of 40 Alzheimer-type dementia patients (15 men and 25 women; mean age, 75.4+/-5.5 years) and 31 healthy elderly persons (10 men and 21 women; mean age, 73.4+/-7.5 years), 71 subjects altogether. First, the corpus callosum was automatically extracted from midsagittal head MR images. Next, Alzheimer-type dementia was compared with the healthy elderly individuals using the features of shape factor and six features of Co-occurrence Matrix from the corpus callosum. Automatic extraction of the corpus callosum succeeded in 64 of 71 individuals, for an extraction rate of 90.1%. A statistically significant difference was found in 7 of the 9 features between Alzheimer-type dementia patients and the healthy elderly adults. Discriminant analysis using the 7 features demonstrated a sensitivity rate of 82.4%, specificity of 89.3%, and overall accuracy of 85.5%. These results indicated the possibility of an objective diagnostic system for Alzheimer-type dementia using feature analysis based on change in the corpus callosum.