Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report

<p>Abstract</p> <p>Background</p> <p>Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure.</p> <p>Case presentation</p> <p>A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block.</p> <p>Conclusion</p> <p>This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.</p

1006-44 A Prognostic Factor in Coronary Artery Disease (CAD): Platelet-Dependent Thrombin Generation in Patients with CAD

We examined platelet-dependent thrombin generation in patients with coronary artery disease (CAD). Thrombin generation was measured according to the method of Aronson et al (Circulation, 1992). 0.5ml of platelet rich plasma (PRP, 15×104/ml) was prepared, and 40mM of CaCl, was added to start clotting. 0.5mM of S-2238 was added to each sample in a microtiter plate every 10min, and the plate was read kinetically at a wavelength of 405nm on a microtiter plate reader. The patients with CAD devided into 3 groups.Thrombin generation 20 min after CaCI2, additon is:Control (n=12)48±10(mOD)Stable angina (SAP) (n=15)79±27Unstable angina (UAP) (n=15)**562±155Acute myocardial infarct (AMI) (n=43)**440±269**p&lt;0.01 compared to SAPThe patients with UAP and AMI showed marked increase in thrombin generation compared to SAP and control subjects. AMI patients with severe coronary artery disease (Group B) showed higher levels of thrombin generation (Group A, Gensini score&lt;32: 382±248 mOD vs Group B, Gensini score&gt; 31: 578±238, P&lt;0.05). LVEF of group A is significantly higher than that of group B (P &lt; 0.05). These findings indicate that patients with UAP and AMI have an evidence of hypercoagulable states and that platelet-dependent thrombin generation may play an important role in pathophysiology of UAP or AMI, and may be a prognostic factor in CAD

HOW TREATMENT CHANGES SLEEP APNEA SYNDROME IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION

Digitalitzat per Artypla

Pressure-Wire-Guided Percutaneous Transluminal Pulmonary Angioplasty A Breakthrough in Catheter-Interventional Therapy for Chronic Thromboembolic Pulmonary Hypertension

AbstractObjectivesThis study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA).BackgroundPTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel.MethodsWe included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance.ResultsThe occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed.ConclusionsThe combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension

Impact of noncontrast PCI for ACS

Purpose : Contrast-induced acute kidney injury (CI-AKI) is one of the common serious complications of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to assess the significance of noncontrast strategy in the setting of ACS. Methods : CI-AKI was defined as an increase in serum creatinine of ≥ 0.5 mg / dL or ≥ 1.25 times from the baseline. One-year worsening renal function (WRF) was defined as an increase of ≥ 0.3 mg / dL in serum creatinine from the baseline after PCI. Results : Of 250 ACS patients, 81 were treated with noncontrast PCI. The average doses of contrast medium in the noncontrast and conventional groups were 17 (9–22) ml and 150 (120–200) ml, respectively. CI-AKI was observed in 4 patients (5%) in the noncontrast group and 29 patients (17%) in the conventional group. Noncontrast PCI was associated with a lower incidence of CI-AKI (adjusted odds ratio, 0.26 ; 95% confidence interval [CI], 0.08–0.82). The bootstrap method and inverse probability weighting led to similar results. CI-AKI was associated with a higher incidence of 1-year WRF (adjusted hazard ratio, 2.30 ; 95% CI, 1.12–4.69), while noncontrast PCI was not. Conclusions : Noncontrast PCI was associated with the lower incidence of CI-AKI in ACS patients

Total aortic arch replacement under intermittent pressure-augmented retrograde cerebral perfusion

Kitahori, Kawata, Takamoto et al. described the effectiveness of a novel protocol for retrograde cerebral perfusion that included intermittent pressure augmentation for brain protection in a canine model. Based on their report, we applied this novel technique clinically. Although the duration of circulatory arrest with retrograde cerebral perfusion was long, the patient recovered consciousness soon after the operation and had no neurological deficit. Near-infrared oximetry showed recovery of intracranial blood oxygen saturation every time the pressure was augmented

Ontogeny of S-100 protein-positive histiocytes and lymphocytes in the human fetal lymphoreticular system.

In the human lymphoreticular system, the alpha and beta subunits of S-100 protein are found in ordinary monocyte-macrophages and non-phagocytic histiocytes such as Langerhans cells and interdigitating reticulum cells, respectively. The beta subunit is also present in some CD8+ T cells. In the present study, we investigated the ontogeny of these histiocytes and lymphocytes in humans. Yolk sacs and 4 to 21-week fetuses were examined immunohistochemically for the presence of S-100 protein subunits using antisera monospecific to each subunit. S-100 alpha + macrophages were present in the yolk sacs and the hepatic sinusoids of the 4th week embryos prior to bone marrow hematopoiesis. These macrophages later appeared in other lymphoid organs when anlagen of these organs were formed. No S-100 beta + cells were found in the yolk sacs. S-100 beta+ histiocytes were first detected in the hepatic sinusoids of the 5th week embryo, and after the 8th week of gestation, they were distributed in other lymphoid organs. S-100 beta+ lymphocytes were not found in the liver. They were first detected in the thymus at the 12th week of gestation, and were subsequently distributed in other lymphoid organs. These results suggest that S-100 beta+ lymphocytes and histiocytes may belong to different cell lineages, and the former may not be the precursor of the latter.</p

Transformed diffuse large B-cell lymphoma from marginal zone lymphoma in the anterior mediastinum: A case report and review of the literature

Marginal zone lymphoma (MZL) arising from the anterior mediastinum is rare. In the majority of reported cases, the tumor was incidentally discovered, reflecting its indolent clinical features. We present a 38-year-old woman who had no medical history, and presented with a bulky anterior mediastinal tumor complicated by life-threatening compression of the vasculature and bronchi. Biopsy specimens of the neoplasm suggested transformed diffuse large B-cell lymphoma (DLBCL) from MZL. To our best knowledge, this is the first case report of anterior mediastinum MZL associated with an aggressive clinical course and life-threatening complications likely due to transformation to DLBCL