A case of biopsy-proven cardiac sarcoidosis without any other extracardiac manifestations

SummaryA 49-year-old woman was referred to our hospital for uncontrollable heart failure. She had never been diagnosed as having sarcoidosis. Chest X-ray showed cardiomegaly without bilateral hilar lymphadenopathy. Echocardiography showed diffuse hypokinesis of the left ventricle mimicking idiopathic dilated cardiomyopathy. No specific manifestations implying sarcoidosis were observed. On cardiac catheterization, coronary angiograms were normal, whereas concurrent routine endomyocardial biopsy showed foci of non-caseating granuloma, indicating sarcoidosis. Pathological finding was the only clue to diagnose cardiac sarcoidosis among our standard examinations for heart failure. No other additional investigations found any extracardiac features of sarcoidosis. All serological and immunological examinations were within normal range. This is a challenging case of biopsy-proven cardiac sarcoidosis without any other extracardiac involvement

Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality

Background. Optimal treatment practices and factors associated with in-hospital mortality in spontaneous pneumothorax (SP) are not fully understood. We evaluated prevalence, clinical characteristics, and in-hospital mortality among Japanese patients with primary or secondary SP (PSP/SSP). Methods. We retrospectively reviewed and stratified 938 instances of pneumothorax in 751 consecutive patients diagnosed with SP into the PSP and SSP groups. Factors associated with in-hospital mortality in SSP were identified by multiple logistic regression analysis. Results. In the SSP group (n=327; 34.9%), patient age, requirement for emergency transport, and length of stay were greater (all, p<0.001), while the prevalence of smoking (p=0.023) and number of surgical interventions (p<0.001) were lower compared to those in the PSP group (n=611; 65.1%). Among the 16 in-hospital deceased patients, 12 (75.0%) received emergency transportation and 10 (62.5%) exhibited performance status (PS) of 3-4. In the SSP group, emergency transportation was an independent factor for in-hospital mortality (odds ratio 16.37; 95% confidence interval, 4.85–55.20; p<0.001). Conclusions. The prevalence and clinical characteristics of PSP and SSP differ considerably. Patients with SSP receiving emergency transportation should receive careful attention

経皮的冠動脈形成術後患者におけるスタチンの再狭窄予防効果の検討

Background : As statins have the anti-atherosclerotic pleiotropic effects, we retrospectively examined the effects of statins on restenosis after percutaneous coronary intervention (PCI). Methods: We reviewed consecutive 341 patients who underwent successful PCI and follow-up angiography six months after the procedure between January 2002 and December 2004. Statins were initiated in 207 patients (statin group), but not in the other 134 (control group). We compared the angiographic findings,low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) between the two groups. Results: LDL-C level in statin group was significantly higher than those in control group at baseline (116.0 ± 35.8 vs 103.1 ± 24.5 mg/dL, p ＜ 0.01); however, the values were inverted between the two groups at follow-up (99.9 ± 29.5 vs 107.6 ± 26.0 mg/dL, p＝ 0.015). CRP levels were comparable between these two groups. Statin group showed significantly lower angiographic restenosis (defined as .. 50% stenosis at the target site) rate (35.3 vs 46.3 %, p ＝ 0.042)and target lesion revascularization (TLR)rate (14.5 vs 23.9 %,p ＝ 0.018)than control group. Multivariate analysis indicated that the prescription of statin, but not LDL-C level at follow-up and % reduction of LDL-C during the follow-up period, predict the restenosis prevention. Conclusions: Statins can decrease restenosis and TLR rate after PCI, independent of lipid-lowering effect and CRP level in this study.背景：スタチンには様々な抗動脈硬化作用があることが知られているが，我々は経皮的冠動脈形成術の再狭窄にスタチンが影響を与えるか，後ろ向きに検討を行った．方法：当院で2002年１月から2004年12月までの期間で経皮的冠動脈形成術を施行し，約６ケ月後に経過観察のための冠動脈造影を施行された341例を対象とした．207例がスタチン投与を受け(スタチン群），それ以外の134例は投与を受けていなかった（コントロール群）．両群間で冠動脈造影所見とLDL コレステロール，CRP について比較検討を行った．結果：ベースラインではLDL コレステロール値はスタチン群で有意に高かった（116.0± 35.8 vs103.1 ± 24.5 mg/dL，p ＜ 0.01）．しかし６ケ月後の経過観察の時点では逆転していた（99.9 ±29.5 vs 107.6 ± 26.0 mg/dL，p＝0.015）．CRP は両群間で差はなかった．スタチン群ではコントロール群に比べて再狭窄率は有意に低下していた．（35.3 vs 46.3 %，p ＝ 0.042）．また再治療率も同様であった．（14.5 vs 23.9 %，p ＝ 0.018）．多変量解析では経過観察時のLDL コレステロール値やLDL コレステロール低下率は再狭窄率とは相関を認めなかった．結論：本研究ではスタチンがコレステロール低下効果やCRP とは関係なく経皮的冠動脈形成術後の再狭窄率や再治療率を減少させうることを示した