Search

This report summarizes our experience with the use of epidural cooling for protecting spinal cord ischemic injury in patients receiving thoracoabdominal aortic surgery. Of 8 cases with thoracoabdominal aortic surgery, we used epidural cooling in 5 cases. Epidural cooling was performed through an epidural catheter placed at Th 11 x 12 using chilled saline. Spinal cord temperature was maintained at approximately 28 degrees C. None of the 5 cases had paraplegia or paraparesis whereas two of 3 cases without epidural cooling had permanent paraplegia. In one case with paraplegia, we could not detect any changes in spinal evoked potential until the end of graft anastomosis. We monitored motor evoked potential in the recent 2 cases. We believe that epidural cooling combined with motor evoked potential monitoring appears to be a satisfactory strategy for preventing ischemic spinal cord injury in thoracoabdominal aortic surgery.

The time from admission to reperfusion in patients with acute myocardial infarction (AMI) was compared according to the type of hospital and treatment strategy. A total of 164 patients with a first AMI within 12h of onset were enrolled at one tertiary emergency center (TEC) and 6 community hospitals (CHs). The subjects were randomly assigned to receive either primary percutaneous transluminal coronary angioplasty (PTCA) (TEC-primary PTCA and CHs-primary PTCA groups) or 800,000 units of intravenous monteplase, half the standard dose of a mutant tissue plasminogen activator (t-PA), followed by rescue PTCA if the Thrombolysis in Myocardial Infarction (TIMI) flow grade was 2 or less (TEC-monteplase and CHs-monteplase groups) on the first coronary angiogram. Sixty minutes after admission, TIMI flow grade 3 rates of the study groups were as follows, in descending order: TEC-monteplase group, CHs-monteplase group, TEC-primary PTCA group, and CHs-primary PTCA group (56%, 41%, 36%, and 8%, respectively; p<0.01). However, there was no significant difference in the final TIMI flow grade 3 rate among the 4 groups. In the CHs, the peak creatine kinase tended to be lower in the monteplase group than in the primary PTCA group. The results suggest that low-dose monteplase followed by rescue PTCA is an effective strategy for promoting early reperfusion in patients with AMI, especially those who are treated at CHs.

Tissue-engineered vascular autografts (TEVAs) were made by seeding 4-6 x 10(6) of mixed cells obtained from femoral veins of mongrel dogs onto tube-shaped biodegradable polymer scaffolds composed of a polyglycolid acid (PGA) nonwoven fabric sheet and a copolymer of L-lactide and caprolactone (n = 4). After 7 days, the inferior vena cavas (IVCs) of the same dogs were replaced with TEVAs. After 3, 4, 5, and 6 months, angiographies were performed, and the dogs were sacrificed. The implanted TEVAs were examined both grossly and immunohistologically. The implanted TEVAs showed no evidence of stenosis or dilatation. No thrombus was found inside the TEVAs, even without any anticoagulation therapy. Remnants of the polymer scaffolds were not observed in all specimens, and the overall gross appearance similar to that of native IVCs. Immunohistological staining revealed the presence of factor VIII positive nucleated cells at the luminal surface of the TEVAs. In addition, lesions were observed where alpha-smooth muscle actin and desmin positive cells existed. Implanted TEVAs contained a sufficient amount of extracellular matrix, and showed neither occlusion nor aneurysmal formation. In addition, endothelial cells were found to line the luminal surface of each TEVA. These results strongly suggest that "ideal" venous grafts with antithrombogenicity can be produced.

Objectives: The efficacy of injection of a low-dose mutant tissue-type plasminogen activator (mt-PA), monteplase, followed by planned rescue percutaneous transluminal coronary angioplasty (PTCA) was compared with that of primary PTCA., Methods: A total of 164 patients with acute myocardial infarction within 12 hr from onset were randomly assigned to a treatment with 80 x 10(4) U bolus of monteplase (Group M) or no administration (Group P) by the envelope method, followed by immediate angiography with angioplasty in patients with Thombolysis in Myocardial Infarction (TIMI) flow grade 0, 1 or 2., Results: There were no differences in baseline characteristics between the two groups. Initial angiography showed a higher reperfusion rate (TIMI 2 + 3: 21% + 38% vs 13% + 9%, p < 0.001) and the median time to TIMI 3 was shorter (63 vs 78 min, p < 0.005) in Group M than in Group P, but the final TIMI 3 rate was similar (93% vs 96%). Peak creatine kinase was lower, and predischarge left ventricular ejection fraction measured in 70% of all patients was higher (59 +/- 9% vs 54 +/- 14%, p = 0.02) in Group M than in Group P. Recurrent ischemia with ST elevation occurred in three patients in Group M, but death, re-acute myocardial infarction or stroke did not occur in either group and the rate of bleeding complication was similar (4.9% vs 3.7%). PTCA was performed less frequently in Group M, but medical expenses were comparable in both groups., Conclusions: Low-dose mt-PA followed by rescue PTCA is effective for early recanalization and preservation of left ventricular function without increases in bleeding complications or medical expenses. These results suggest that low-dose mt-PA should be given to all patients with acute myocardial infarction who are scheduled to undergo primary PTCA.

The immediate and long-term patency of lesion-associated side branches after Palmaz-Schatz stent implantation was assessed by coronary angiography in 78 patients (83 lesions) at baseline, before and immediately after Palmaz-Schatz stent placement, and at 6 months. The patency of side branches was then analyzed. Of 83 lesions stented, 48 stent placements spanned 53 side branches with a diameter > or = 0.5 mm. Ten (19%) side branches were occluded before and 14 (26%) after stenting, and 4 (8%) at 6 months. Side branch ostial stenosis (> or = 50%) was present in 17 side branches; 5 (29%) with ostial stenosis became occluded before and 12 (71%) after stenting. Four of nine (44%) side branches arising from stenosis became occluded after predilatation and five (56%) after stenting. These findings demonstrate that both ostial stenosis and the location of side branches are associated with side branch occlusion.

A 50-year-old man was admitted to our hospital because of shortness of breath and an oppressive feeling in his chest on exertion. As a result of examinations including pulmonary-angiography, pulmonary perfusion scan and phlebogram, we diagnosed the case as chronic recurrent pulmonary embolism due to deep vein thrombosis. Later on, the patient showed an abnormal reaction on treadmill exercise test, and revealed redistribution at the anteroseptal and the inferior wall on thallium exercise test. We performed coronary angiography and diagnosed the case as angina pectoris (seg. 1 was total occlusion, segs. 2 and 3 were filled with bridge collateral, seg. 7 was 75% stenotic lesion). We evaluated the acute effect of vasodilators on pulmonary and systemic hemodynamics. The effect was beneficial in that it improved the hemodynamics. On account of this we thought a reversible condition was presented, and we administered these drugs to this patient.