Increased Incidence of Cancer in Japanese Patients with Critical Limb Ischemia.

Objective: This multicenter observational study was conducted in order to investigate the incidence of cancer in patients with critical limb ischemia. Materials and Methods: We prospectively investigated the incidence of cancer in 68 patients with critical limb ischemia over a two-year period. Patients underwent an intensive examination at enrollment, which included tumor marker levels and chest and abdominal computed tomography, as well as one- and two-year follow-up examinations. We compared the observed incidence of cancer with the expected incidence calculated from national cancer rates by the standardized incidence ratio (SIR). Results: The majority (83.6%) of the patients were men, and 92.5% of the patients had a peripheral arterial disease that was classified as Fontaine stage III or IV. During enrollment, newly diagnosed cancers were detected in seven patients. Four additional cancers were detected during the follow-up period. All of the detected cancers were asymptomatic. We observed an increased risk of cancer (SIR, 4.04; 95% confidence interval, 1.31-9.42) in patients with critical limb ischemia. Conclusion: This study suggests that critical limb ischemia is associated with an increased risk of cancer. Our findings should be taken into serious consideration by future investigators considering the use of therapeutic angiogenesis.

Correlation between the characteristics of acceleration and visco elasticity of artery wall under pulsatile flow conditions (physical meaning of I* as a parameter of progressive behaviors of atherosclerosis and arteriosclerosis).

Previously, I* parameter has been proposed to diagnose noninvasively the progressive degree of atherosclerosis which is considered to concern the discrimination of the progressive degree of visco elasticity of blood vessel wall. However, the detailed physical meaning of this parameter has not yet been clarified. In this paper, the theoretical analysis and experiments were conducted and the detailed physical meaning of I* parameter was clarified. The following results were obtained. I* parameter was found to well correlate with the progressive degree of visco elasticity of blood vessel wall characterized by the Ith* parameter derived based on the analysis of visco elasticity in this paper. That is, I* was found to have the physical meaning of representing the progressive degree of visco elasticity of blood vessel wall. On the basis of this results, using clinical data, two dimensional representation between the progressive degree of visco elasticity of blood vessel wall by I* and the decrease in the rigidity of blood vessel wall by PWV was found to be useful to conduct much more detailed diagnosis of atherosclerosis.

Frequency response of blood vessel wall with atherosclerosis and aneurysm.

This research was conducted to investigate frequency response of blood vessel wall. The principal frequency of blood vessel wall, f1 was found to decrease with progression of atherosclerosis and irregularity of the vibration trajectory of blood vessel wall was found to increase. When an aneurysm appeared, a new vibration wave was found to appear in the high frequency region, f2. When the aneurysm wall has enough strength, intensity of high frequency wave was found to increase. However, it decreases with decrease in the strength of aneurysm wall. The visco-elastic deterioration of blood vessel wall was found to well correlate with the changing characteristics of f1. A two-dimensional representation of f1 and f2 was conducted which tracks the progression of atherosclerosis and aneurysm. It will enable us to diagnose the introduction period of operation of blood vessel wall of atherosclerosis with an aneurysm.

Transient thrombocytosis after endovenous laser treatment for primary varicose vein of the lower extremity.

We presented a case of a completely occluded great saphenous vein and transient thrombocytosis following endovenous laser treatment (EVLT) for primary varicose veins of the lower extremity. A 54-year-old man with a left saphenous varicose vein underwent EVLT surgery. Twelve-watt laser irradiation was delivered over the length of 33 cm of the saphenous vein. The cumulative exposure was 1042 J. Nine days after treatment, the platelet count increased up to 610 ⋅ 10(3) /mm(3) and returned to normal after 2 months. A complete occlusion of the great saphenous vein commonly occurs after EVLT, but no case of transient thrombocytosis has been reported.

Relationship between peripheral arterial disease and incident disability among elderly Japanese: the Tsurugaya project.

AIM: The aim of this study was to investigate whether peripheral arterial disease (PAD) is predictive of disability and whether the relationship between PAD and disability can be fully explained by baseline physical functions. METHODS: We followed for five years 783 Japanese aged 70 years or older without a disability at baseline in 2003. We defined participants certificed as requiring long-term care as having incident disability. The hazard ratio (HR) and 95% confidence interval (95% CI) for incident disability were calculated using the Cox proportional hazards model. RESULTS: After adjusting for possible confounders other than physical function, the HR of incident disability among participants with PAD was 1.86 (95%CI: 1.06 to 3.26).Although the risk was attenuated (HR=1.63, 95%CI: 0.92 to 2.86) after adding baseline physical function as a covariate, the HR was still high. Furthermore, the relation was not statistically significant, but the group with higher physical function and PAD also had a higher HR of incident disability than those who had higher physical function without PAD. CONCLUSION: PAD is an important predictor of disability even if the level of baseline physical function is high.

[Noticeable clinical response to S-1/CDDP combination therapy for Virchow node recurrence after surgery for advanced gastric carcinoma with marked involvement of the esophagus - report of a case].

We have recently experienced a case in which S-1/CDDP combination therapy proved remarkably efficacious for a rapid, extensive lymph node recurrence with metastasis into a Virchow node that had developed after resection of advanced gastric carcinoma accompanied with a marked invasion of the esophagus. The patient, a woman aged 73, underwent a total gastrectomy upon left thoracolaparotomy for a gastric carcinoma at the cardia with a 5-cm involvement of the esophagus. On day 65 post-operation, a diagnosis of Virchow node and para-aortic lymph node recurrence was made on the basis of CT scan findings. Of tumor markers checked, CEA and CA19-9 were noted to be increased to as high as 37.55 ng/mL and 3,235 U/mL, respectively. The patient received three courses of S-1/CDDP combination therapy, with a consequent noticeable contraction of the Virchow node and enlarged para-aortic lymph node. Further, she was given two courses of S-1 therapy, which resulted in normalization of tumor markers. The patient has since been on continued chemotherapy without any sign of recurrence.

Optimal region-of-interest settings for tissue characterization based on ultrasonic elasticity imaging.

Pathologic changes in arterial walls significantly influence their mechanical properties. We have developed a correlation-based method, the phased tracking method, for measurement of the regional elasticity of the arterial wall. Using this method, elasticity distributions of lipids, blood clots, fibrous tissue and calcified tissue were measured by in-vitro experiments of excised arteries (mean +/- SD: lipids, 89 +/- 47 kPa; blood clots, 131 +/- 56 kPa; fibrous tissue, 1022 +/- 1040 kPa; calcified tissue, 2267 +/- 1228 kPa). It was found that arterial tissues can be classified into soft tissues (lipids and blood clots) and hard tissues (fibrous tissue and calcified tissue) on the basis of their elasticity. However, there are large overlaps between elasticity distributions of lipids and blood clots and those of fibrous tissue and calcified tissue. Thus, it was difficult to differentiate lipids from blood clots and fibrous tissue from calcified tissue by setting a threshold for a single elasticity value. Therefore, we previously proposed a tissue classification method using the elasticity distribution in each small region. In this method, the elasticity distribution of each small region of interest (ROI) (not a single pixel) in an elasticity image is used to classify lipids, blood clots, fibrous tissue and calcified tissue by calculating the likelihood function for each tissue. In the present study, the optimum size of the ROI and threshold T(o) for the likelihood function were investigated to improve the tissue classification. The ratio of correctly classified pixels to the total number of classified pixels was 29.8% when the size of a small region was 75 microm x 300 microm (a single pixel). The ratio of correctly classified pixels became 35.1% when the size of a small region was 1,500 microm x 1,500 microm (100 pixels). Moreover, a region with an extremely low likelihood with respect to all tissue components was defined as an unclassified region by setting threshold T(o) for the likelihood function to 0.21. The tissue classification of the arterial wall was improved using the elasticity distribution of a small region whose size was larger than the spatial resolution (800 microm x 600 microm) of ultrasound. In this study, the arteries used in construction of the elasticity databases were classified into each tissue using the constructed elasticity databases. Other arteries, which are not used for constructing the elasticity databases, should be classified in future work to thoroughly show the effectiveness of the proposed method.

[Ultrasonic measurement of arterial wall for quantitative diagnosis of atherosclerosis--elasticity imaging of arterial wall and atherosclerotic plaque].

To provide useful information for the diagnosis of atherosclerosis in addition to the imaging of morphology using B-mode ultrasonography, we have developed a method, namely, the phased-tracking method, to measure the small change in the thickness of the arterial wall due to the heartbeat. This change in thickness corresponds to strain due to the change in internal pressure, and the elasticity of the arterial wall is obtained by the simultaneous measurement of the change in thickness and pulse pressure. Furthermore, an elasticity image can be classified into tissue components using the reference data obtained by in vitro experiments because the elastic properties are different among the tissue components in the arterial wall. We have measured the elasticity distributions of lipids, blood clots, fibrous tissue, and calcified tissue in vitro. From these results, it was found that arterial tissues can be classified into soft tissues (lipids, blood clots) and hard tissues (fibrous tissue, calcified tissue) on the basis of their elasticity. However, it is difficult to differentiate lipids from blood clots and fibrous tissue from calcified tissue because the elasticity distributions of these components overlap each other. To overcome this problem, we proposed a tissue classification method in which, the elasticity distribution of each small region of interest (not a single pixel) in an elasticity image was used in the classification of lipids, blood clots, fibrous tissue, and calcified tissue, respectively. Tissue classification results obtained by this method showed good agreement with the pathological image of the corresponding section.

The analysis and diagnosis of unstable behavior of the blood vessel wall with an aneurysm based on noise science.

Previously, one of the authors developed a noninvasive measurement method of acceleration and deceleration during the expansion process of the blood vessel wall under pulsatile pressure flow by measuring the strain rate of the blood vessel wall using a supersonic Doppler effect sensor aided by computer analysis (DPC method). In this paper, on the basis of the analysis of chaos theory, that is, the complexity of science, the unstable behavior of the blood vessel wall with an aneurysm was investigated by identifying the characteristic DPC wave forms induced by the onset and progression of aneurysm. These results showed that unstable dynamic behavior of the blood vessel wall occurs due to the progression of the aneurysm. Furthermore, using the theoretical analysis of chaos, this unstable behavior of the blood vessel wall was quantified and the fundamental principle of a noninvasive diagnostic method of the progressive degree of aneurysm was proposed.

C-reactive protein and peripheral artery disease among Japanese elderly: the Tsurugaya Project.

We investigated the cross-sectional relationship between ankle brachial index and cardiovascular disease risk factors, including C-reactive protein (CRP), among Japanese elderly, a topic which has had little prior epidemiologic study. Our study population comprised 946 subjects aged at least 70 years in whom both CRP and ankle brachial index were measured. The participants were classified into a low (ankle brachial index<0.9) and normal ankle brachial index group. We found that current smoking, high-density lipoprotein cholesterol <40 mg/dl, a low body mass index (continuous variable), hypertension, diabetes and statin use were all significantly related to a lower ankle brachial index. Higher log-transformed CRP level was significantly related to a lower ankle brachial index after adjustment for the cardiovascular risk factors mentioned above (p <0.01). The odds ratios for low ankle brachial index compared to 0-1 risk factors were 5.79 (95% confidence interval [CI]: 2.99-11.20) for 2 risk factors and 17.45 (95% CI: 6.78-49.91) for 3 or more risk factors; independently of other risk factors, the odds ratio for CRP>1.0 mg/l was 2.10 (95% CI: 1.13-3.88) compared to lower CRP values. Thus, a high level of CRP is related to a low ankle brachial index among Japanese elderly as well as Western subjects. This is the first study to report the relationship between CRP and low ankle brachial index among Japanese elderly.

[Efficacy of TS-1 in patients with peritonitis carcinomatosa from gastric cancer].

Medical treatment with TS-1 was performed in patients with gastric cancer with peritonitis carcinomatosa. The median survival time for the patients who underwent distal or total gastrectomy was 14.0 months, and that for the patients who underwent exploratory laparotomy was 9.3 months. Compared with other medical care, the anti-cancer drug TS-1 enabled prolonged survival time and shortened hospitalization. Since TS-1 had few side effects, it was useful to patients suffering from gastric cancer with peritonitis carcinomatosa.

[Imaging of elasticity distribution in arterial wall by transcutaneous ultrasound and electronic staining].

Knowledge of the physical properties of atherosclerotic plaque is essential when evaluating its vulnerability in a clinical setting. Such knowledge, however, is still difficult to obtain with the various approaches developed to date. This paper describes a novel noninvasive method (phased tracking method) for measuring minute change in thickness of each of the multiple layers of the arterial wall during one cardiac cycle. Such minute change in thickness less than 100 microns of the arterial wall cannot be measured by conventional ultrasound B-mode or M-mode images. A method for evaluation of the regional elastic modulus in the circumference direction, E theta, from the resultant change in wall thickness is also described. This method was applied to in vivo experiments in subjects with hyperlipemia and normal subjects. The spatial distribution of the regional elastic moduli, E theta, was evaluated for the carotid atherosclerotic plaques. By comparing the pathological findings with the distribution of elasticity, average elasticity of lipid and that of a mixture of smooth muscle and collagen fiber could be determined. Based on these reference parameters, each point was statistically categorized as lipid, mixture, or other. Thus, the plaque was electronically stained using transcutaneous ultrasound. By applying this method to the common carotid arteries, the presence of thin collagen fiber was clarified along the arterial axis for normal subjects, while soft inclusion of lipid was found for every plaque in subjects with hyperlipidemia. This novel method offers potential as a diagnostic technique for detection of plaque vulnerability with high spatial resolution.

Elasticity imaging of atheroma with transcutaneous ultrasound: preliminary study.

BACKGROUND: Knowledge of the physical properties of atherosclerotic plaque is essential when evaluating its vulnerability in a clinical setting. Such knowledge, however, is still difficult to obtain with the various approaches developed to date. METHODS AND RESULTS: This article describes a noninvasive method for evaluating the regional elasticity (the elastic modulus in the circumferential direction) of tissue surrounding atherosclerotic plaque in which a novel phased tracking method is applied to measure minute changes in thickness of each of the multiple layers of the arterial wall during one heartbeat. By comparing the pathological findings with the distribution of elasticity, average elasticity of lipid and that of a mixture of smooth muscle and collagen fiber can be determined. On the basis of these reference parameters, each point is statistically categorized as lipid, mixture, or other. Thus, the plaque is electronically stained using transcutaneous ultrasound. By applying the method to the common carotid arteries, the presence of thin collagen fiber was clarified along the arterial axis for normal subjects, whereas soft inclusion of lipid was found for every plaque in subjects with hyperlipidemia. CONCLUSIONS: This novel method offers potential as a diagnostic technique for detection of plaque vulnerability with high spatial resolution.