Buerger Disease: Pathological Changes in Elderly Patients.

Reports of vascular lesion changes in elderly Buerger disease patients are rare. Patients are expected to continue to have typical Buerger disease even after the age of 50. However, after 50, when patients suffer from atherosclerotic risk factors, such as hypertension, diabetes mellitus, or hyperlipidemia, what kind of changes will occur? We will report on 3 cases of hypertension, diabetes mellitus, or hyper lipidemia after or around 50 years of age. As a result, atherosclerosis was present in the iliac or aortic regions in the remaining thromboangiitis lesions below the groin area. (This is secondary publication from the J Jpn Coll Angiol 2021; 61: 107-113.).

Paravesical space arteriovenous malformation as a specific subgroup of pelvic vascular anomaly: a case series and review of literature.

Treatment of pelvic arteriovenous malformations (AVMs) is frequently challenging because of the complex structures and anatomical diversity among cases. We present a case series of six patients with pelvic AVMs. All patients had a similar anatomical structure consisting of multiple feeders from the unilateral internal iliac artery, collecting into a dilated venous sac in the unilateral paravesical space and draining into a single outflow, eventually joining the pre-prostatic vein or internal iliac vein. Five among these patients were successfully treated by catheter-directed embolo-sclerotherapy. In addition to our six cases, we identified six previous case reports of pelvic AVM with similar anatomical characteristics. Herein, we summarize the clinical and anatomical features of these 12 paravesical AVM cases. In all cases, the patients were men; the AVM was predominantly located at the right paravesical space and demonstrated good therapeutic effect of catheter-directed embolosclerotherapy. These paravesical AVMs may constitute a new subgroup of pelvic vascular anomalies with the same etiology that are treatable by adequate catheter intervention.

Skeletal muscle mass of old Japanese women suffering from walking difficulty in nursing home.

By using 24 hour urinary creatinine levels, skeletal muscle mass (kg), its rate (%) of body weight and creatinine height index (%) were determined in old Japanese women suffering from walking difficulty in nursing home and compare with those of young university students. Those of old subjects showed approximately 30-50%, 36-44% and 44-46% of young subjects, respectively. It is suggested that these values are important and useful biomarkers for the planning and the achievement of rehabilitation program for the maintaining and restoring skeletal muscle mass and for the careful support by registered care workers to aged persons. J. Med. Invest. 65:122-125, February, 2018.

Clinical Study of Phlebitis Migrans and Incompetence of the Leg's Superficial Vein in Buerger Disease.

Three of four (75%) vein biopsy samples from four patients (all male, mean onset: age 33.0, mean biopsy: age 59.7) of chronic phase phlebitis migrans showed positive periodontal bacteria DNA under the PCR (polymerase chain reaction) method. Of the 24 cases of Buerger disease (22 males, 2 females, mean onset: age 31.9, mean examination: age 62.6) that were investigated in our vascular laboratory, 65% of the patients suffered from moderate to severe varicose veins. Eight cases had a history of phlebitis migrans and three had an active ulcer or uncontrollable erosion in the foot. The rate of incidence was significantly higher than that of the well-matched control group. Other findings included one instance of deep vein thrombosis, and one instance of deep vein reflux. We could suggest that some intractable ulcer or erosion cases of Buerger disease may be complicated by superficial vein incompetence or other deep vein insufficiency. We also we need to check Buerger disease patients with duplex for vein reflux and other insufficiencies. Treatment of the varicose veins (including elastic stockings) was effective for all of the patients. (English Translation of Jpn J Phlebology 2011; 22: 25-31.).

Discrimination of types of venous emboli using Doppler ultrasound.

BACKGROUND: Many studies have identified features of the emboli traveling in the arterial system by Doppler ultrasound, and estimated their composition and size for anticipation of cerebral infarct. Another concern is features of the emboli in the venous system for anticipation of pulmonary embolism (PE). The objective is to prove that the emboli in the venous system can be discriminated by Doppler ultrasound in animal study and to assess whether PE can be predicted by using this technique in clinical case. METHODS: Animal study--lard oil, thrombus, or bone marrow was injected to the femoral veins in pigs. High intensity transient signals were transhepatically identified at the inferior vena cava using Doppler ultrasound. Intensity volume (dB) and frequency shift (Hz) of each signal were obtained. The cutoff values at which thrombi, fat emboli, and marrow emboli could be discriminated were calculated by receiver-operating characteristic curves analysis. Human study--Subjects were 47 patients who underwent total knee arthroplasty. On postoperative day 0 and 1, High intensity transient signals were identified at the affected common femoral vein using Doppler ultrasound. Contrast computed tomography was done, and the patients were divided into two groups according to the presence of PE. The two groups were distinguished by intensity volume (dB) and frequency shift (Hz) of each signal and calculated the sensitivity and specificity. The statistics analysis was done as in animal study. RESULTS: Animal study--Thrombus and bone marrow could be discriminated from lard oil well at frequency shift of 208 Hz and 196 Hz (with sensitivity of 86.9, 85.7%, and specificity of 82.3%, 91.8%, respectively). Human study--The sensitivity and specificity were 76.7 and 75.0% to discriminate patients with and without PE at frequency shift of 208 Hz. CONCLUSIONS: Our animal study results indicated that emboli could be identified and discriminated in the venous system. Clinical study informed that the frequency shift (208 Hz) of the Doppler signal was the best parameter to discriminate PE with and without PE in patients with total knee arthroplasty.

Aldehyde dehydrogenase inhibitors from the mushroom Clitocybe clavipes.

Five fatty acid derivatives including three novel compounds were isolated from the mushroom Clitocybe clavipe. Their structures were elucidated by spectral analyses. These compounds inhibited aldehyde dehydrogenase in vitro.