Start and initial results of the Fukushima Prefecture acute myocardial infarction registration survey.

Acute myocardial infarction (AMI) remains one of the most serious heart diseases and elucidation of its pathogenesis and advances in treatment strategies have been desired. In 2009, to understand the status of AMI in Fukushima Prefecture for improving treatment outcomes, a new AMI registration survey system was conducted throughout the prefecture. A total of 1,556 cases were registered in the initial 2 years from 2009 to 2010. The hospital-based overall incidence of AMI in Fukushima Prefecture was 37.9 people per population of 100,000 per year. Mortality from AMI within 30 days of onset was 10.2%. We report herein the actual situation of AMI onset and treatment in Fukushima Prefecture based on the initial results of the survey.

Modified reduction aortoplasty with external reinforcement of the ascending aortic aneurysm caused by giant cell arteritis treated as polymyalgia rheumatica.

A 74-year-old Japanese woman was referred to our hospital for surgical repair of an ascending aortic aneurysm and severe aortic valve regurgitation. She had received low dose steroid treatment for 6 years due to a diagnosis of the polymyalgia rheumatica (PMR), and no signs of inflammation were detected serologically. Modified reduction aortoplasty with external prosthetic support of the ascending aorta was performed following uneventful aortic valve replacement under cardiopulmonary bypass. The macroscopic view of the ascending aortic wall showed the diffuse spotty medial defects. The pathological interpretation of the aneurysmal wall was giant cell arteritis (GCA). Because PMR is intimately associated with GCA, physicians should be aware of the development of thoracic aortic aneurysm even in the course of PMR. Reduction aortoplasty is simple and may not be precluded from the treatment option for the aortic dilatation associated with giant cell arteritis.

Embolic attack in patients with atrial fibrillation and atrial thrombus depends on the character of the thrombus.

It is very important to prevent embolisms from left atrial thrombi (LAT). The present study was a trial for the management of patients with AT using 122 patients with atrial fibrillation and LAT who were followed for 1 year after transesophageal echocardiography. LAT were classified by their shape and mobility into the mobile ball type (MB, n=28), fixed ball type (FB, n=32) and mountain type (MO, n=42). The patients were given warfarin (INR: 1.5-2.0, n=43), aspirin 81 mg (n=74) and/or ticlopidine 200 mg/day (n=31). The embolic rate (ER) in the MB group was significantly higher than in the other groups [ie, MB 39.3% vs FB 15.6% (p<0.05), vs MO 2.4% (p<0.05)]. The ER in the FB group was significantly higher than in the MO group (p<0.05). Therapy with a combination of ticlopidine and aspirin reduced the ER in the patients with ball thrombi. The ER of the ball thrombus type group, especially the MB group, was very high in spite of therapy with anti-coagulants and/or anti-platelet agents, and such patients should be treated by early surgical intervention. However, the combination of ticlopidine and aspirin may be useful for preventing embolism.