The utility of intravascular ultrasound for the diagnosis and management of spontaneous coronary artery dissection in a middle-aged woman with acute inferior myocardial infarction

AbstractSpontaneous coronary artery dissection (SCAD) is an infrequent cause of acute myocardial ischemia and is associated with various pathophysiologies, such as pregnancy, postpartum, and collagen diseases. It is frequently fatal and most cases are diagnosed at autopsy. Therefore, the early diagnosis of SCAD and initiation of treatment may be life saving. In this report, we describe a case of SCAD of right coronary artery, possibly triggered by transient high blood pressure, with no apparent atherosclerotic involvement detected by intravascular ultrasound (IVUS) and successfully treated with stent implantation. The IVUS helped us to confirm the diagnosis, navigate the guidewire into the true lumen, and understand the mechanism for the appearance of a lotus root formation

Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival