Intraortic pulse pressure is correlated with coronary artery stenosis.

There is increasing evidence that peripheral pulse pressure measured at the brachial artery is a good predictor of coronary heart disease. However, the relation between pulse pressure and angiographically demonstrated coronary artery stenosis has not been fully elucidated. We designed the present study to investigate the association of the various components of blood pressure, such as systolic pressure, diastolic pressure, and pulse pressure of both peripheral and central arteries with angiographically determined coronary artery stenosis. Levels of aortic systolic pressure, aortic diastolic pressure, aortic pulse pressure, peripheral systolic pressure, peripheral diastolic pressure, and peripheral pulse pressure were determined in 323 patients who underwent diagnostic coronary angiography. Of these 323 patients, 215 patients had significant organic coronary artery stenosis. Aortic pulse pressure was significantly higher in patients with coronary artery stenosis (P = 0.0050). Aortic diastolic pressure was lower in patients with coronary artery stenosis (marginally significant, P = 0.0462). However, no statistically significant difference was observed between other blood pressure components and coronary artery stenosis. Multivariate analyses showed that aortic pulse pressure was associated with coronary artery stenosis independently of aortic diastolic pressure. Moreover, aortic pulse pressure was positively correlated with the number of vessels involved (P = 0.0024). The results of the present study indicate that aortic pulse pressure is significantly and independently correlated with angiographically determined coronary artery stenosis.

A case of primary cardiac lymphoma located in the pericardial effusion.

Primary cardiac lymphoma is a rare disorder with a poor prognosis. We present here a case of 77-year-old woman who was diagnosed as having cardiac lymphoma antemortem according to a cytologic examination of the pericardial effusion. Determination of the levels of serum-soluble interleukin-2 receptor and serum deoxythymidine kinase was useful for the diagnosis. Echocardiography, computed tomography, magnetic resonance imaging, and gallium scan revealed neither lymphadenopathy nor tumor in the heart, so she was diagnosed as having malignant lymphoma that probably originated from the pericardium. Systemic chemotherapy with CHOP (cyclophosphamide, farmorubicin, oncovin, and prednisolone) resulted in a complete resolution of the pericardial effusion. She has been in remission 48 months after discontinuation of the chemotherapy.

Cholesterol crystal embolization (CCE) after cardiac catheterization: a case report and a review of 36 cases in the Japanese literature.

Cholesterol crystal embolization (CCE) is a complication of atherosclerosis. A 67-year-old Japanese man underwent coronary artery bypass grafting. After the surgery, he underwent coronary angiography via the right femoral artery. Twelve days later, he suddenly developed acalculous cholecystitis and was treated with antibiotics. Gradual deterioration in renal function, purplish discoloration of the distal portion of his toes, and eosinophilia were noted. We performed a skin biopsy and made a diagnosis of CCE. Cilostazol and intravenous heparin improved the symptoms and decreased the creatinine level. We retrospectively studied the clinical features of 36 cases registered with a diagnosis of CCE in the Japanese literature.

Primary amyloidosis with pulmonary involvement which presented exudative pleural effusion and high fever.

We describe here an extremely rare case of primary amyloidosis which presented moderate pleural effusion and high fever. A 71-year-old man was admitted to our hospital because of exertional dyspnea, fatigue and fever. A chest X-ray showed right-sided moderate pleural effusion. A thoracocentesis revealed an exudative pleural effusion. Cytology and cultures of the effusion were negative. External drainage failed to control the effusion. To determine the etiology of the effusion and fever, bronchoscopy was performed. Biopsies of the tracheal wall showed amyloid deposition. The pleural effusion might have been due to the inflammation and the disturbed lymphatic drainage caused by the amyloid deposition. Treatment with melphalan (6 mg) and prednisolone (35 mg) for 4 days every 6 weeks decreased the fever and alleviated his symptoms.

Ruptured aneurysm of the sinus of valsalva coexisting with a ventricular septal defect and single coronary artery.

A 26-year-old man had been diagnosed with a cardiac murmur from birth. In 1998, he was admitted to hospital because of slight fatigue. A grade 5/6 continuous murmur was audible near the right sternal border at the second intercostal space. Doppler echocardiography detected an abnormal flow that suggested that an aneurysm of the right coronary sinus of Valsalva had ruptured into the right ventricular inflow tract. Blood tests showed a 19% step-up in oxygen saturation value between the right atrium and right ventricle, indicating a ventricular septal defect with left to right shunt. Coronary angiography revealed a single coronary artery. Surgical repair was carried out and the patient made an uneventful recovery. This rare combination of a ruptured aneurysm of the sinus of Valsalva coexisting with a ventricular septal defect and a single coronary artery has not been reported previously.