Kawasaki disease is a disease of unknown etiology that most frequently affects infants and children under 5 years of age. Inflammation occurs in medium-sized muscular arteries throughout the body including the coronary artery, being classified as a systemic vasculitis syndrome. Histopathological investigations of Kawasaki disease have mainly focused on the coronary artery because it is directly associated with the cause of death. However, to identify the cause and pathology of Kawasaki disease, it is necessary to investigate lesions of whole organs. Thus, we attempted to review lesions in organs other than the heart and hypotheses of pathogenesis recently attracting attention.
For diagnosis of pulmonary thromboembolism, multidetector-row computed tomography (CT) is a minimally invasive imaging technique that can be performed rapidly with high sensitivity and specificity, and has been increasingly employed as the imaging modality of first choice for this disease. Since deep vein thrombosis in the legs, which is important as a thrombus source, can be evaluated immediately after the diagnosis of pulmonary thromboembolism, this diagnostic method is considered to provide important information when deciding on a comprehensive therapeutic strategy for this disease.
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) play a critical role in diagnosing aortic disease such as aortic dissection and aneurysm. Additionally, the advent of contrast-enhanced MRA has allowed MRA to advance markedly and several new imaging techniques to emerge as well. While computed tomography (CT) angiography using multidetector-row CT is a significant innovation, MRA may generate more useful diagnostic information, such as on the artery of Adamkiewicz.
CT angiography (CTA) based on the data acquired by multidetector-row CT (MDCT) is an established, minimally invasive modality for imaging peripheral arteries. CTA has been used to assess peripheral arterial disease before treatment, and it has replaced conventional angiography for the diagnostic evaluation of peripheral arteries. MDCT can optimize both the long scan length and spatial resolution. CTA using MDCT depicts the fine structures of vessels. Recently, automated CTA analysis software has been developed for measurement of the vascular lumen. The software can automatically measure the diameters of short axial sections at the post-processing workstation. Measurement of the vascular lumen is useful in the planning of intravascular treatment for peripheral arterial disease. CTA is also utilized in assessing the intravascular lumen after metallic stent placement.
Objective: In Japan, there have been no reports on the time-trends of mortality rates from pulmonary heart disease without pulmonary embolism (PHD). Our aim was to examine the annual changes of mortality in Japan. Materials and Methods: Annual age-adjusted and age-specific PHD mortality for Japanese residents during 1979–2006 were calculated from “Vital statistics of Japan” and census data and population estimates for intercensal years. Results: The number of age-adjusted deaths from PHD continued to decrease throughout the study period. The age-specific mortality from PHD increased throughout the life span except below 1 year old and decreased in recent years. Male mortality was greater at most ages. In Poisson regression analysis, the relative risk of death from PHD was increased in males and the aged except below 1 year-age, and decreased in recent years. The annual number of deaths from idiopathic pulmonary arterial hypertension/heritable pulmonary arterial hypertension (IPAH/HPAH) continued to increase throughout the study period. The number of annual new cases with IPAH/HPAH was estimated to be about 400 in a recent period of 10 years. Conclusion: The annual number of deaths from PHD decreased, and those from IPAH/HPAH increased significantly during 1979–2006 in Japan.
Objective: Chronic type B dissection though optimal is still considered to be a controversial procedure, even in the advent of stent grafts. Recently, we used a novel surgical technique involving left axillary perfusion to analyze the results of our surgical strategy and compare them with those reported in the literature. Materials and Methods: Between August 2004 and July 2009, 39 patients underwent graft replacement for chronic type B aortic dissection. The left axillary artery was used for perfusion inflow. Perfusion was maintained at approximately 23°C during open proximal anastomosis. The graft was anastomosed to the distal true lumen whenever possible. Results: Open proximal anastomosis was performed in 22 patients (56%). In 24 cases (62%), grafts were anastomosed to the true lumen of the peripheral aorta. The early overall mortality rate was 3% (1 patient). Permanent cerebral infarction occurred in 2 patients (5%); and paraparesis, in 1 patient (3%). The Kaplan–Meier survival estimates were 91% at 2 years and 88% at 5 years. Conclusion: Our surgical strategy is associated with excellent short-term and midterm outcomes. Although further investigation is needed, this strategy may be useful for patients with chronic type B dissection.
Objective: To verify the diagnostic efficiency of venous duplex ultrasound and lymphangioscintigraphy (LAS) in establishing the cause of leg edema and to clarify the pathology of these leg edemas. Materials and Methods: Between April 2009, and March 2010, 62 patients with leg edema of unknown origin were referred to the Edema Clinic of the Yamaguchi University Graduate School of Medicine. All patients underwent a venous duplex ultrasound scan and LAS. Results: Of 62 patients, lymphatic insufficiency, venous insufficiency or both was diagnosed in 42 (68%), and lymphedema, in 29 (47%). Venous duplex ultrasound detected obvious venous disorders in only 13 (21%), and for 20 patients, the ultrasound and LAS did not reveal any abnormalities; however, for 15 of the 20 (24% of all patients), venous edema was attributed to functional causes. Conclusion: Venous duplex ultrasound and LAS assisted in the diagnosis of leg edema of unknown origin and also proved useful in establishing treatment strategies.
Endovascular stent grafting is a novel therapeutic technique for repairing aortic aneurysms, and is especially useful for descending aortic aneurysm and aneurysm at the distal arch. However, no effective endovascular approach for the ascending aorta has been reported a remaining site for endovascular repair because of the anatomical restrictions and the presence of vital branches to the head and arms that are present in this region. This report describes an endovascular stent graft repair of a pseudoaneurysm at the ascending aorta using a fenestrated stent graft. The fenestrated stent graft is easy to use and less invasive for the endovascular repair of the ascending aorta.
Mycobacterium abscessus is an acid-fast nontuberculous mycobacterium that grows rapidly in culture. The organism is found in dust, soil, and water and after trauma, it may infect skin and soft tissue. The organism is rarely found in humans, and infections occurring after cardiovascular surgery are rare clinical events. To our knowledge, only a few cases of hemodialysis arteriovenous graft infection and endocarditis caused by M. abscessus have been described. We reported a first case of patient with M. abscessus graft infection after a stripping operation and skin grafting to a left lower leg ulcer.
An inflammatory aneurysm localized in the iliac artery is very rare. Aneurysms of the common iliac artery have been reported sporadically, but there has been no report of internal iliac artery aneurysm. The patient was a 64-year-old male presenting with left lower abdominal pain and fever. Abdominal computed tomography (CT) revealed an aneurysm of 42 × 52 mm in the left internal iliac artery. The aneurysmal wall had thickened and mantle sign was positive. Since the aneurysm was expected to adhere tightly to surrounding tissues, the risk of open surgery was judged to be high, and coil embolization of the aneurysm and the peripheral branches of the internal iliac artery was performed. Postoperatively, the left lower abdominal pain disappeared, and signs of inflammation were mitigated. The endovascular procedure was extremely effective for the treatment of this inflammatory iliac artery aneurysm.
A 67-year-old woman with peripheral arterial occlusive disease in both lower extremities, secondary to an abdominal aortic aneurysm, developed chronic total occlusion of the abdominal aortic aneurysm during the 3-year follow-up period. She suffered from sudden onset of paraplegia 3 months after palliative axillobifemoral bypass grafting and died of pneumonia. The paraplegia was considered to have been caused by thrombosis of lumbar arteries that might have served as an important collateral pathway in the distal spinal cord, due to proximally propagated infrarenal aortic thrombosis. It is necessary to recognize that chronically thrombosed abdominal aortic aneurysm (AAA) still has a risk of causing serious complications with a high mortality rate, especially in cases treated medically or with palliative operations.
We present a case of superficial thrombophlebitis of the arm, known as a variant of Mondor’s disease. A 71-year-old woman who underwent a left simple mastectomy with axillary dissection for breast cancer had a cord-like vein structure in the right antecubital fossa following postoperative intravenous chemotherapy, and complained of limited elbow extension due to the firm and inflexible structure. She successfully underwent surgical resection of the vein cord to relieve the elbow motion limitation.
Elastic stockings (ES) are widely used for the prevention of venous thromboembolism. Here we report a case of foot ulcers induced by ES in patients with pneumonia and hypoxia. A 94-year-old woman was admitted for the treatment of pneumonia. The patient had been wearing an ES because of a history of deep vein thrombosis of the leg. Multiple foot ulcers occurred within 24 hours after the admission despite the absence of peripheral arterial occlusive disease. The ulcers took almost 5 months to heal. For patients with hypoxia, ES may further deteriorate local tissue hypoxia and thus should be used carefully.