Temporal sinus node modification by high-dose continuous intravenous administration of landiolol in a patient with persistent inappropriate sinus tachycardia

AbstractA 20-year-old woman underwent an electrophysiological study for drug-resistant persistent inappropriate sinus tachycardia (IST). Use of a high-dose continuous intravenous administration of landiolol, a short-acting beta-adrenoreceptor blocker, made the patient׳s heart rate suddenly drop with a slight change in the P-wave morphology. Three-dimensional right atrial (RA) activation mapping revealed that the earliest activation site moved 8mm to a lower anterior site around the high lateral RA. Radiofrequency energy applied to the earliest activation site during tachycardia was successful. A temporal sinus node modification with landiolol administration was useful for mapping and for safe catheter ablation of IST

Abscess Formation of the Round Ligament of the Liver: Report of a Case

Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.</p

Impact of Insulin Resistance on Neointimal Tissue Proliferation after 2nd-Generation Drug-Eluting Stent Implantation

Percutaneous coronary intervention is established as an effective treatment for patients with ischemic heart disease; in particular, drug-eluting stent implantation is known to suppress in-stent restenosis. Diabetes mellitus is an independent risk factor for restenosis, so reducing insulin resistance is being studied as a new treatment approach. In this prospective study, we sought to clarify the factors associated with in-stent restenosis after percutaneous coronary intervention, and we evaluated the homeostasis model assessment of insulin resistance (HOMA-IR) index as a predictor of restenosis. We enrolled 136 consecutive patients who underwent elective percutaneous coronary intervention at our hospital from February 2010 through April 2013. All were implanted with a 2nd-generation drug-eluting stent. We distributed the patients in accordance with their HOMA-IR index values into insulin-resistant Group P (HOMA-IR, ≥2.5; n=77) and noninsulin-resistant Group N (HOMA-IR, \u3c2.5; n=59). Before and immediately after stenting, we measured reference diameter, minimal lumen diameter, and percentage of stenosis, and after 8 months we measured the last 2 factors and late lumen loss, all by means of quantitative coronary angiography. After 8 months, the mean minimal lumen diameter was smaller in Group P than that in Group N (1.85 ± 1.02 vs 2.37 ± 0.66 mm; P=0.037), and the mean late lumen loss was larger (0.4 ± 0.48 vs 0.16 ± 0.21 mm; P=0.025). These results suggest that insulin resistance affects neointimal tissue proliferation after 2nd-generation drug-eluting stent implantation

Usefulness of a Perfusion Balloon for Intraprocedural Stent Thrombosis in a Patient With ST-Segment Elevated Myocardial Infarction Complicated With Cardiogenic Shock

Intraprocedural stent thrombosis is a rare but serious complication of reperfusion therapy for acute coronary syndrome. There is currently no consensus on the intraprocedural management of intraprocedural stent thrombosis. It is difficult to attain thrombolysis in myocardial infarction flow grade 3, particularly in cases of cardiogenic shock. A 49-year-old man who presented with anterior ST-segment elevated acute myocardial infarction with cardiogenic shock underwent emergency percutaneous coronary intervention to diffuse proximal lesions in the left anterior descending artery under the support of intra-aortic balloon pumping. Intraprocedural stent thrombosis occurred following the postdilations with a 3.5- × 38-mm everolimus-eluting stent. Despite administration of argatroban and nitroprusside, and after frequent balloon inflations using 3.5-mm noncompliant balloons and thrombectomy, the no-reflow phenomenon was repetitively established. However, after brief and prolonged balloon inflations using 3.5- and 3-mm Ryusei perfusion balloon catheters (Kaneka Medix), the diffusely protruded thrombus inside the stent regressed, and thrombolysis in myocardial infarction flow grade 3 was obtained. The final intravascular ultrasound image showed a well-suppressed, in-stent thrombus and 24% gain of stent area (from 7.5 to 9.3 mm2). A Ryusei perfusion balloon enabled frequent, long inflation times without deteriorating hemodynamics during reperfusion in ST-segment elevated acute myocardial infarction complicated with cardiogenic shock. Thus, extended balloon inflation using a perfusion balloon is deemed a viable option not only for intraprocedural stent thrombosis but also for cases with a high burden of thrombi during the primary stenting procedure for patients with acute coronary syndrome

Perinatal Asphyxia Reduces Dentate Granule Cells and Exacerbates Methamphetamine-Induced Hyperlocomotion in Adulthood

Background: Obstetric complications have been regarded as a risk factor for schizophrenia later in life. One of the mechanisms underlying the association is postulated to be a hypoxic process in the brain in the offspring around the time of birth. Hippocampus is one of the brain regions implicated in the late-onset dopaminergic dysfunction associated with hypoxic obstetric complications. Methodology/Principal Findings: We used an animal model of perinatal asphyxia, in which rat pups were exposed to 15 min of intrauterine anoxia during Cesarean section birth. At 6 and 12 weeks after birth, the behavior of the pups was assessed using a methamphetamine-induced locomotion test. In addition, the histopathology of the hippocampus was examined by means of stereology. At 6 weeks, there was no change in the methamphetamine-induced locomotion. However, at 12 weeks of age, we found an elevation in methamphetamine-induced locomotor activity, which was associated with an increase of dopamine release in the nucleus accumbens. At the same age, we also found a reduction of the dentate granule cells of the hippocampus. Conclusions/Significance: These results suggest that the dopaminergic dysregulation after perinatal asphyxia is associated with a reduction in hippocampal dentate granule cells, and this may partly contribute to the pathogenesis of schizophrenia.浜松医科大学学位論文　医博第548号(平成２１年３月１８日

A Single Amino Acid Mutation in SNAP-25 Induces Anxiety-Related Behavior in Mouse

Synaptosomal-associated protein of 25 kDa (SNAP-25) is a presynaptic protein essential for neurotransmitter release. Previously, we demonstrate that protein kinase C (PKC) phosphorylates Ser187 of SNAP-25, and enhances neurotransmitter release by recruiting secretory vesicles near to the plasma membrane. As PKC is abundant in the brain and SNAP-25 is essential for synaptic transmission, SNAP-25 phosphorylation is likely to play a crucial role in the central nervous system. We therefore generated a mutant mouse, substituting Ser187 of SNAP-25 with Ala using “knock-in” technology. The most striking effect of the mutation was observed in their behavior. The homozygous mutant mice froze readily in response to environmental change, and showed strong anxiety-related behavior in general activity and light and dark preference tests. In addition, the mutant mice sometimes exhibited spontaneously occurring convulsive seizures. Microdialysis measurements revealed that serotonin and dopamine release were markedly reduced in amygdala. These results clearly indicate that PKC-dependent SNAP-25 phosphorylation plays a critical role in the regulation of emotional behavior as well as the suppression of epileptic seizures, and the lack of enhancement of monoamine release is one of the possible mechanisms underlying these defects

ジゾク セイ シンボウサイドウ アブレーション ゴ ノ サイハツ ヨソク インシ ノ ケントウ : サボウ ケイタイ ・ サ シンジ キノウ ノ ユウヨウ セイ

持続性心房細動に対するカテーテルアブレーション(CA)治療後の再発予測を,術前の心エコー図検査から行い,その有用性について検討した.対象は2011 年1 月からの1 年間,心房細動(AF)に対し,初回CA を施行したAF 連続80 例のうち持続性AF32 例である.CA 前に経胸壁心エコー図検査(TTE)および経食道心エコー図検査(TEE)を施行し,各指標を計測し,術後再発予測因子を検討した.CA 後1 年で14 例(44%)にAF の再発を認めた.再発群は非再発群に比し,左房長径が有意に大きく,左心耳壁運動速度は先端と外側の陰性波計測値が有意に低下していた.多変量解析では左房長径および左心耳先端壁運動速度陰性波(LAAWV apex-d)がCA 後AF 再発の予測因子であった.ROC 曲線にて,左房長径はカットオフ値を58 mmとすると感度92.3%,特異度66.7%,LAAWV apex-d はカットオフ値を9.4 cm/s とすると感度78.6%,特異度83.3%で,両者共CA 後AF の再発を予測し得た.TTE およびTEE からCA 後の再発予測が可能であった.Background:Catheter ablation( CA) of persistent atrial fibrillation (PsAF) has been widely performed. However, echocardiographic predictions for the AF recurrence are not completely understood.Objective:The purpose of this study was to evaluate the value of both the left atrial( LA) longitudinal diameter and left atrial appendage wall velocity (LAAWV) for predicting AF recurrences after CA of PsAF.Methods: We retrospectively analyzed 32 patients with PsAF who had undergone CA. Both the transthoracic and transesophageal echocardiographic parameters, and clinical parameters were assessed.Results:During a one-year follow-up period, 14 patients (44 %) had AF recurrences after a single CA procedure. There was a significant difference in the LA longitudinal diameter (63±3.3 mm vs. 58±5.4 mm;p=0.0029) and LAAWV apex-d (7.9±2.1 cm/s vs. 11.7±3.0 cm/s;p= 0.0003) in the patients with and without AF recurrences. A multivariate analysis revealed that the LA longitudinal diameter (p=0.0247) and LAAWV apex-d (p=0.047) were significant predictors of arrhythmia recurrences. In the receiver operator curve analysis, a longitudinal diameter> 58 mm demonstrated a sensitivity of 92.3 % and specificity of 66.7%, and a LAATDI apex-d of 9.4 cm/s demonstrated a sensitivity of 78.6 % and specificity of 83.3%, in predicting an arrhythmia recurrence.Conclusion:The LA longitudinal diameter and LAAWV could be used as non-invasive pre-procedural predictors of arrhythmia recurrences after single CA procedures in patients with PsAF