Chemodivergent Synthesis of Polycyclic Aromatic Diarylamines and Carbazoles by Thermal/Photochemical Process-Controlled Dephosphinylative Functionalizations of Amino(phosphinyl)arenes.

A chemodivergent synthesis of polycyclic aromatic diarylamines and carbazoles was established by employing thermally or photochemically controlled processes using KOtBu/1,10-phenanthroline. The synthetic processes involved the dephosphinylation of 9-amino-10-(phosphinyl)phenanthrenes, which were obtained through a regioselective palladium-catalyzed direct [4 + 2] benzannulation of phosphinyl ynamines with 2-iodobiphenyls. When the dephosphinylation was conducted under heating conditions (∼100 °C), it proceeded to yield 9-aminophenanthrene. However, when the reaction was performed under the illumination of purple light (LEDs, λmax = ca. 390 nm), KOtBu/1,10-phenanthroline promoted single-electron-transfer-triggered dephosphinylation followed by cyclization, producing the corresponding π-expanded carbazoles. We successfully synthesized a highly π-expanded dicarbazole through a dual dephosphinylative cyclization. Additionally, we present the optical properties of a series of amino compounds produced through the dephosphinylative processes.

Venous thromboembolism associated with hyperhomocysteinemia, homozygosity for the methylenetetrahydrofolate reductase 677C>T gene variant, and secondary polycythemia.

: The development of pulmonary embolism/deep vein thrombosis (DVT) in the extremities is influenced by various risk factors. Hyperhomocysteinemia is one such risk factor, which may be associated with vitamin B12/folate deficiency, or the methylenetetrahydrofolate reductase gene variant, 677C>T. Here, we report a 47-year-old male who developed pulmonary embolism/DVT, associated with hyperhomocysteinemia (plasma homocysteine: 71.9 nmol/ml; reference range: 6.3-18.9 nmol/ml) and was homozygous (T/T) for the methylenetetrahydrofolate reductase variant. Serum levels of vitamin B12 and folate were within the normal range, while secondary polycythemia (hemoglobin: 18.2 g/dl and hematocrit: 50.8%) may have acted as an additional trigger for the thromboembolism. The pulmonary embolism/DVT was successfully managed and the patient has been doing well for longer than 3 years.

A Case of Acute Myocardial Infarction due to Left Main Trunk Occlusion Complicated With Aortic Dissection as Diagnosed by Intravascular Ultrasound.

A 52-year-old man was transferred to our hospital with a sudden onset of severe chest pains. His electrocardiogram revealed ST-segment elevation suggestive of acute myocardial infarction. Emergency coronary angiography showed subtotal occlusion of left main trunk (LMT) with delayed coronary flow. Because intravascular ultrasound revealed a large intimal flap, we diagnosed aortic dissection involving the LMT. After stenting of the LMT, the patient underwent surgical repair of the aortic dissection. Although it is difficult to obtain a correct diagnosis of aortic dissection complicated with myocardial ischemia, we succeeded in diagnosing this rare condition by use of a intravascular ultrasound.

Development of a tennis ball-sized tumor at the site of an implanted pacemaker.

A 77-year-old woman who had undergone a pacemaker implantation 6 years previously developed a tumor on the left side of the chest. The mass gradually grew to the size of a tennis ball and was excised along with the pacemaker generator. Histopathological examination revealed that the mass was a chronic expanding hematoma. Although carcinogenesis occurring around a pacemaker has been reported previously, the development of a hematoma has not been reported. Thus, we suggest that when a patient has a mass in the proximity of a pacemaker, chronic expanding hematoma should be considered as one of the differential diagnoses.