Restless Legs Syndrome with Severe Limb Pain during Pregnancy / General Medicine

Herein we report a case of restless legs syndrome (RLS) during pregnancy in a 32-year-old woman who began feeling pain in her feet at night at 30 weeks of gestation. She could relieve the pain by moving her legs, but her symptoms worsened, preventing sleep. She was diagnosed with pregnancy-related RLS. Neither carbamazepine nor gabapentin alleviated her symptoms effectively, but the discomfort spontaneously improved two months after delivery. RLS during pregnancy leads to sleep disorders, which are associated with adverse pregnancy outcomes. More attention should be given to RLS during pregnancy.

Surgical Management for Arteriosclerosis Obliterans Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 110 consecutive patients (males 99, females 11, mean age 66.0±8.8 years) operated upon for arteriosclerosis obliterans (ASO). The screening of IHD was routinely conducted by using dipyridamole thallium scintigraphy, and when results were positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged as positive for IHD. Forty-eight patients (44%) of ASO were simultaneously afflicted with IHD. Ten patients were operated on for ASO after coronary artery bypass grafting (CABG), five for ASO and IHD (CABG) simultaneously, eight for ASO after PTCA. Twenty-five patients underwent surgery for ASO only with infusion of nitroglycerin, with or without diltiazem. We also compared 15 patients with thrombotic obliteration at the end of the abdominal aorta o: Leriche's syndrome with the remaining 95 patients in this series. The patients with Leriche's syndrome were younger and had higher incidences of hyperlipidemia (<i>p</i>=0.0254) and IHD (<i>p</i>=0.0225) than those without Leriche's syndrome. In surgical treatment for ASO, particularly for Leriche's syndrome, meticulous attention to complications is needed due to the frequent association of IHD. When both ASO and IHD are severe enough to warrant surgical treatment at the earliest opportunity, we recommend concomitant operations for ASO and IHD (CABG).

Multivessel Coronary Artery Bypass Surgery with Internal Thoracic Artery Grafts: Early and Late Besults / 日本心臓血管外科学会雑誌

Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.