ABSTRACT
Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.
Subject(s)
Brain Abscess/diagnosis , Brain Abscess/etiology , Central Nervous System Fungal Infections/etiology , Delayed Diagnosis , Near Drowning/complications , Scedosporium , Survivors , Tsunamis , Aged , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Brain Abscess/drug therapy , Brain Abscess/therapy , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Female , Humans , Japan , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/etiology , Lung Diseases, Fungal/therapy , Magnetic Resonance Imaging , Pyrimidines/administration & dosage , Scedosporium/isolation & purification , Tomography, X-Ray Computed , Triazoles/administration & dosage , VoriconazoleSubject(s)
Angioplasty, Balloon, Coronary/instrumentation , Angioscopy , Coronary Artery Bypass/adverse effects , Coronary Restenosis/pathology , Coronary Restenosis/therapy , Drug-Eluting Stents , Saphenous Vein/transplantation , Tomography, Optical Coherence , Aged , Humans , Male , Recurrence , Saphenous Vein/pathology , Ultrasonography, InterventionalABSTRACT
BACKGROUND: The relationship between blood lipid profile and coronary plaque tissue characteristics, and differences in the tissue characteristics between acute coronary syndrome (ACS) and chronic coronary artery disease (CCAD) are unclear. The purpose of the present study was to compare the plaque tissue characteristics in patients with ACS and CCAD and to examine the relationship between the tissue characteristics and blood lipid profile. METHODS AND RESULTS: Integrated backscatter intravascular ultrasound (IVUS) and conventional IVUS were performed in patients with ACS (n=24) and CCAD (n=68) at the time of coronary intervention. Percent tissue volume and cross-section area of lipid pool, fibrous tissue, dense fibrous and calcification were defined in target lesions. The lipid pool area (LPA) in the ACS patients was significantly higher than in the CCAD patients (LPA, 7.0+/-3.4 vs 5.1+/-3.2 mm(2), P=0.01). In the CCAD group, LPA/non-LPA ratio tended to be higher in the ACS than in the CCAD patients (1.4+/-0.9 vs 1.1+/-0.8; P=0.08), and LDL/HDL ratio was an independent predictor for LPA/non-LPA ratio (P=0.002). In addition, LDL/HDL ratio was a useful index for the prediction of a high LPA/non-LPA ratio (area under the receiver operating characteristic curve = 0.79). CONCLUSIONS: Elevated LDL/HDL ratio may be a positive predictor for coronary lipid-rich plaque and plaque vulnerability in patients with CCAD.
Subject(s)
Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Artery Disease/diagnosis , Predictive Value of Tests , Ultrasonography, Interventional/methods , Acute Coronary Syndrome , Aged , Coronary Artery Disease/blood , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/pathology , Female , Humans , Lipids/blood , Male , Middle Aged , ROC CurveABSTRACT
We observed late stent thrombosis image by optical coherence tomography (OCT) in vessels with off-label paclitaxel-eluting stents (PES) implantation. A 59-year-old Japanese man was treated with a single on-label PES for chronic coronary artery disease in the left circumflex artery. After 9 months, he was implanted with two linked PESs in the left anterior descending artery (LAD) and a single PES in the right coronary artery (RCA). He was examined for suspicion of a colon tumor by fiberscope after discontinuation of dual anti-platelet therapy without consultation. He complained of chest pain and was transferred to our center. Emergency coronary angiography demonstrated thrombotic total occlusion of the proximal LAD in the two linked PESs. After thrombus aspiration therapy, OCT was performed to evaluate the stents in the 3 vessels. The off-label two linked PESs demonstrated the same average neo-intimal hyperplasia (NIH) thickness and percentage of uncovered stent struts compared with the on-label PES in the RCA by visualized OCT image. However, the heterogeneity of NIH in the LAD stent was significantly higher than the stents in the other two vessels. The implantation of the two linked off-label and the heterogeneity of NIH may increase hyperplatelet coagulability more than on-label single PES use.
