Impact of severe coronary disease associated or not associated with diabetes mellitus on outcome of interventional treatment using stents: results from HERZ (Heart Research Group of Kanazawa) analyses.

Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) leads to less re-stenosis than PCI using a bare metal stent (BMS), however there is still controversy whether use of a DES for severe coronary disease leads to an acceptable outcome in patients with diabetes mellitus (DM). In this study 8159 lesions were treated in 6739 patients (mean age 68.9 years) with coronary artery disease. Use of a DES significantly decreased the re-stenosis rate compared with BMS in both DM (9.6% versus 21.3%) and non-DM (9.5% versus 17.1%) patients. The re-stenosis rate was significantly higher in DM than in non-DM patients in the BMS group but not in the DES group. There was no statistically significant difference in event-free survival after stenting of patients with left main coronary artery (LMCA) disease between the BMS and DES groups. It was concluded that, compared with BMS, DES reduced re-stenosis in patients with DM, however, we advise careful treatment after using DES for severe coronary disease, including LMCA lesions, in patients with DM.

Impact of long-acting calcium channel blockers on the prognosis of patients with coronary artery disease with and without chronic kidney disease: a comparison of three drugs.

Calcium channel blockers (CCBs) can prevent cardiovascular events in patients with coronary artery disease (CAD). This study looked retrospectively at the prognosis of CAD in hypertensive patients with CAD who had undergone a coronary angiograph, had been given a CCB (benidipine [n = 66], amlodipine [n = 45], or long-acting nifedipine [n = 31]) on hospital discharge and were then followed up for a mean +/- SD of 5.2 +/- 2.9 years. Systolic/diastolic blood pressure for all 142 patients decreased significantly from a mean +/- SD of 137 +/- 20/74 +/- 15 mmHg to 129 +/- 20/71 +/- 12 mmHg. Major adverse cardiovascular events (MACE) occurred in 15 patients. Chronic kidney disease (CKD) was a significant risk factor for MACE (hazard ratio 2.35, 95% confidence intervals 1.45, 3.80). Benidipine was superior to nifedipine in preventing MACE in patients both with and without CKD. In conclusion, benidipine and amlodipine reduced the frequency of MACE in hypertensive patients with CAD, particularly in those with complicating CKD.

[Intrapericardial lipoma with stenosis of the left bronchus and pulmonary artery].

In a 1-year-6 month-old girl with asthma, a chest magnetic resonance imaging revealed an intrapericardial lipoma at the site of the transverse sinus behind the great arteries. The tumor compressed the left bronchus and pulmonary artery resulting in the stenosis. Under cardiopulmonary bypass, the tumor was successfully removed. The stenosis of the left bronchus and pulmonary artery were released.

Systemic mastocytosis without cutaneous involvement.

An autopsy case of systemic mastocytosis without cutaneous involvement in a 76-year-old woman was described. The patient presented with general malaise, chest and epigastric discomfort, flushing of the face and progressive hepatosplenomegaly, and she terminated in hemorrhagic complications of DIC within 2 months. There was neither rash nor urticaria pigmentosa recognizable in the entire course. The diagnosis was made by the histologic identification of abnormal aggregates of mast cells in a bone marrow aspirate. These mast cell granules were chloroacetate esterase-positive, peroxidase-negative, and electronmicroscopically they were composed of fine granular materials containing variable numbers of lamellar structures. At autopsy, diffuse infiltration of the mast cells was found in the liver, spleen, bone marrow, lymph nodes, lungs, kidneys, stomach, and adrenal glands.

Mucoepidermoid carcinoma of the liver.

An autopsy case of mucoepidermoid carcinoma of the liver associated with congenital cysts in a 78-year-old man was reported. The liver weighed 1,900 g, and there was a massive tumor of 11 X 10 X 6.5 cm in the left lobe with multiple sero-mucinous cysts. Histologically, the tumor cells consisted of four types of cells: mucus-secreting cells, squamous cells, intermediate cells, and oxyphilic cells. The variety of tumor cells quite resembled that of mucoepidermoid carcinoma of the salivary gland. The sero-mucinous cysts were lined with a single layer of cuboidal or columnar cells and were not communicated with the biliary ducts. Part of the cysts with benign lining cells was in continuity with tumor cells of the intermediate type. Discussion was made on the histogenesis of hepatic mucoepidermoid carcinoma in particular emphasis on the association of the congenital cysts.

[Visualization of peripheral left coronary aneurysms in Kawasaki disease by subcostal two-dimensional echocardiography].

Our previous study provided a new two-dimensional echocardiographic technique for detecting peripheral "right" coronary artery aneurysms in Kawasaki disease using a subcostal approach. In the present paper, we presented an additional study for detecting peripheral "left" coronary artery aneurysms. Because the left anterior descending artery runs along the anterior interventricular sulcus and the left circumflex artery around the mitral valve ring, both coronary regions are difficult to search by a conventional method. Then coronary aneurysms of these regions were searched using the subcostal approach in this study. First, the sector beam was directed toward the heart on a plane parallel to a line between the patient's shoulders which allowed simultaneous visualization of four chambers (P1). The area around the mitral valve ring in this plane was examined for coronary aneurysms of the peripheral left circumflex artery. Secondary, the beam section was positioned parallel to the line cutting both the long axes of the sternum and spinal column which allowed visualization of the right ventricular outflow tract, pulmonary valves, interventricular septum, mitral valves and left atrium (P2). Thirdly, the sector plane was angled to the left (P3), and still more to the left (P4) until the left atrium just disappeared. By scanning from P2 to P4, the area around the mitral valve ring was examined for coronary aneurysms of the peripheral left circumflex artery. By scanning from P4 to the cardiac apex (P5), the anterior interventricular sulcus was searched for coronary aneurysms of the peripheral left anterior descending artery. Of 143 patients with Kawasaki disease, aged two months to 8 years, 7 peripheral left coronary aneurysms were visualized in five patients. These were three aneurysms in the left circumflex artery at the origin of the obtuse marginal artery, two aneurysms in segment 13, and two aneurysms in the left anterior descending artery at the origin of the second diagonal branch. These echocardiographic features coincided well in size, shape and anatomic location with angiographic appearances. In one patient whose echocardiogram in sector P2 showed a small echo-free space (2 X 2 mm) at the area around the mitral valve ring, the angiographic study showed the intact left circumflex artery, suggesting that there was a limitation to distinguish a very small coronary aneurysm from a normal one. There was no false negative diagnosis. These results showed that this new echocardiographic technique is useful for detecting peripheral left coronary aneurysms in patients with Kawasaki disease.

Subcostal 2-dimensional echocardiographic imaging of peripheral left coronary artery aneurysms in Kawasaki disease.

Our previous study provided a new 2-dimensional echocardiographic technique to detect peripheral right coronary artery aneurysms in Kawasaki disease, with use of the subcostal approach. An additional study was performed to detect peripheral left coronary artery aneurysms. Because the left anterior descending artery runs along the anterior interventricular sulcus and the left circumflex artery along the mitral valve ring, these regions were searched for coronary aneurysms by use of the subcostal imaging approach. Among 143 patients with Kawasaki disease, 44 left coronary aneurysms were visualized in 22 patients. Three aneurysms at the origin of the obtuse marginal artery and 1 in the further peripheral site of the left circumflex artery were observed in 3 patients. Two aneurysms at the origin of the second diagonal branch of the peripheral left anterior descending artery were detected. These echocardiographic studies were done prospectively, and their features coincided well in size, shape, and anatomic location with confirmatory angiographic appearances.

Subcostal two-dimensional echocardiographic imaging of peripheral right coronary artery in Kawasaki disease.

A new two-dimensional echocardiographic technique was developed to detect peripheral right coronary aneurysms in Kawasaki disease. Because the main stem of the right coronary artery runs along the tricuspid valve ring and the posterior interventricular groove, these regions were examined for coronary aneurysms using the subcostal approach. Of 52 patients with Kawasaki disease, 14 right coronary aneurysms were visualized in eight patients. Most of the coronary aneurysms were elicited as circular or oval echo-free spaces on the right side of the right ventricle or at the area around the tricuspid valve ring. These echocardiographic features coincided well in size, shape and anatomic position with angiographic appearances. The subcostal approach could not image the normal coronary artery. In three patients whose echocardiograms showed no abnormal echo-free space, the angiographic studies proved that the right coronary arteries were intact. These results suggest that this echocardiographic technique is useful for detecting peripheral right coronary aneurysms in patients with Kawasaki disease.