Vaginal delivery after improvement in COVID-19 by monoclonal antibody treatment: A case report and literature review.

As the COVID-19 pandemic persists, pregnant women have been increasingly affected worldwide. Women during the last trimester of pregnancy are susceptible to severe COVID-19, and there are many challenges towards its treatment. Monoclonal antibody treatment (MAT) is approved for COVID-19 patients to reduce disease severity. However, there are few reports on the MAT in perinatal women. Herein, we report a 39-year-old pregnant female (36 weeks and 6 days of gestation) with improvement in COVID-19 pneumonia after treatment with casiribimab/imdevimab, resulting in successful vaginal delivery (a 2.868 kg male newborn), along with a literature review. Early diagnosis and treatment of pregnant women with COVID-19 are important. Infectious diseases doctors and/or obstetricians should be aware of the MAT option administered to perinatal COVID-19 women to reduce disease severity.

Coronary artery bypass grafting for acute myocardial infarction in stent ERA.

PURPOSE: We evaluated a treatment strategy for acute myocardial infarction (AMI) that percutaneous coronary intervention (PCI) is performed on a culprit lesion unless the culprit is an unprotected left main trunk. Emergent coronary artery bypass grafting (CABG) is done when the culprit is a left main trunk and a mechanical complication exists. METHODS: From 1997 to 2008, 22 and 232 patients underwent CABG for AMI and non-AMI, respectively. Of the 22 patients of AMI, PCI was performed in 12 patients and not performed in 10 patients before surgery. We investigated complication, intubation period, in-hospital mortality and hospitalization period. RESULTS: No in-hospital mortality was observed in all 22 AMI patients. There was no difference in in-hospital mortality and complication between the AMI and the non-AMI patients. No significant difference was found in hospital stay, complication, intubation period, in-hospital mortality and hospitalization period between patients who received preceding PCI and not. CONCLUSIONS: These results suggest that our treatment strategy is reasonable. Further studies will be warranted to clarify the role of preceding PCI.

Spontaneous rupture of a giant coronary artery aneurysm causing cardiac tamponade: A case report.

A 62-year-old woman with a history of dyslipidemia and hypothyroidism was referred to our institution with syncope. Cardiac tamponade due to spontaneous rupture of a 50-mm aneurysm of the coronary artery was diagnosed by transthoracic echocardiography, enhanced computed tomography, and coronary angiography. Emergency surgery was performed, and despite developing postoperative complications such as acute renal insufficiency, the patient was discharged from hospital without sequelae 89 days later. Histological findings revealed cystic media degeneration, but neither significant atherosclerotic changes nor inflammatory cell infiltration. Although coronary artery aneurysms are comparatively rare and generally asymptomatic, those over 30 mm in diameter are considered to be at increased risk of rupture. A coronary artery aneurysm of about 50 mm ruptured in our patient, supporting this view.

A case of iliac arteriovenous fistula presenting with iliac artery aneurysm preoperatively diagnosed by ultrasonography.

Iliac arteriovenous fistula is a rare but severe complication of iliac artery aneurysm. We present a case of iliac arteriovenous fistula concomitant with iliac artery aneurysm, which was preoperatively diagnosed by ultrasonography (USG) and successfully treated with emergent surgery. An 84-year-old female admitted to our hospital complaining of a sudden onset of right leg edema and dyspnea. Physical examination revealed pansystolic murmur at the right inguinal region. A chest X-ray showed enhanced pulmonary vascular shadow and bilateral pleural effusion with cardiomegaly. USG of the right lower abdomen revealed an arteriovenous fistula between the right iliac artery and vein concomitant with the iliac artery aneurysm. An emergent surgery was performed, and the fistula was directly closed within the aneurysm. To reduce bleeding through the fistula during surgery, we placed fingers inside the aneurysm and compressed the iliac vein just after the aneurysmal sac was opened. The postoperative course was satisfactory.

Comparison of biomechanical and histological properties in dog carotid arteries injured by neointima or intimal thickening.

A general formula (Oka and Azuma's equation) has been rigorously derived for the circumferential wall tension in a hollow cylindrical tube in equilibrium. To evaluate the validity and usefulness of Oka and Azuma's equation, T = P(1) x r(1) - P(2) x r(2) (T, circumferential wall tension; P(1) and P(2), internal and external pressures of the tube; r(1) and r(2), the corresponding internal and external radii), we experimentally investigated changes in circumferential wall tension of noninjured (control) and injured dog common carotid arteries by using a newly developed apparatus with a photo- and X-ray-sensitive image sensor. We also studied histological features of the control and injured arteries with special reference to the relation of biomechanical properties. Two types of animal models with injured arteries--balloon-induced neointima or external collar-induced intimal thickening--were adopted in the present study. In the control arteries, the circumferential wall tension was experimentally confirmed to change from negative to positive by an increase in intraluminal pressure ranging from 50 to 180 mmHg. The critical intraluminal pressure that produced 0 dyne/cm of the circumferential wall tension was around 135 mmHg. The activation of arterial smooth muscles caused a significant increase in the critical pressure in the control arteries. In the arteries injured by neointima, the critical intraluminal pressure was significantly lower than that in the control. The activation of smooth muscles also significantly increased the critical pressure in the injured arteries. Histological examination demonstrated the existence of a circumferential neointimal formation along with a shortening of the internal diameter. In other arteries injured by intimal thickening, the circumferential wall tension was always negative at intraluminal pressure ranging from 50 to 180 mmHg. Newly developed structures consisted of elastic and collagen fibers, smooth muscles, and extracellular matrix in the intima and media of the injured arteries. These experimental findings suggest that the circumferential wall tension of dog common carotid arteries has been confirmed experimentally to become negative. We have also concluded that circumferential wall tension calculated with Oka-Azuma's equation may be one of the best parameters for evaluating changes in the biomechanical and histological properties of pathologically injured arteries.