A heparin calcium self-injection at home has been covered by insurance in Japan since January 2012. A big burden of going to the hospital of twice a day was reduced for pregnant women for whom warfarin could not be used for thromboprophylaxis or the patients for whom warfarin could not be used for other reasons. Patients with thrombotic disorders and those with venous thromboembolism are able to use self-injection therapy. I hope to carry out the right usage thoroughly and to try for safe management.
The aim of this study was to evaluate a strategy for diagnosis and treatment of endoleak, after endovascular aneurysm repair (EVAR), for abdominal aortic aneurysm at early and mid-term follow-up. One hundred eighty one patients receiving MD-CT imaging more than 6 months after EVAR were enrolled in this study. Endoleak after EVAR was evaluated by intraoperative angiography and postoperative MD-CT. Type I/V endoleak developed in 6 patients (3.3%). Four patients received graft limb extension to the external iliac artery, which resulted in good sealing without aneurysmal expansion (greater than 5 mm). Type II endoleak developed in 30 cases (16.6%), and 5 cases (16.7%) showed aneurysmal expansion. Four cases underwent coil embolization through the ilio-lumbar artery. One patients suffered open conversion, but there was no aneurysm rupture in mid-term follow-up. We concluded that type II EL with aneurysmal expansion is not benign and should be carefully followed-up with CT imaging, and be treated by endovascular re-intervention.
Evidence indicates that abnormalities in physical properties of cell membranes may be strongly linked to hypertension and other circulatory disorders. Recent studies have shown that chronic kidney disease (CKD) might be a risk factor for cardiovascular and cerebrovascular outcomes. The purpose of the present study is to examine possible relationships between kidney function and membrane fluidity (a reciprocal value of membrane microviscosity) of red blood cells (RBCs), in hypertensive and normotensive subjects, using an electron spin resonance (ESR) and spin-labeling method. The order parameter (S) for the ESR spin-label agents (5-nitroxide stearate) in RBC membranes was significantly higher in hypertensive subjects than in normotensive subjects, indicating that membrane fluidity was decreased in hypertension. The order parameter (S) of RBCs was inversely correlated with estimated glomerular filtration rate (eGFR), suggesting that decreased eGFR value might be associated with reduced membrane fluidity of RBCs. Multivariate regression analysis also demonstrated that, after adjustment for general risk factors, eGFR might be a significant predictor of membrane fluidity of RBCs. The reduced levels of both membrane fluidity of RBCs and eGFR were associated with increased plasma 8-iso-prostaglandin F2α (an index of oxidative stress) and decreased plasma nitric oxide (NO)-metabolites. This suggested that kidney function could be a determinant of membrane microviscosity of RBCs, at least in part, via the oxidative stress- and NO-dependent mechanisms. The ESR study suggests that CKD might have a close correlation with rheologic behavior of RBCs and microcirculatory disorders in hypertensive subjects. In addition, intervention with low-salt intake or aerobic physical exercise significantly restored membrane fluidity of RBCs in hypertensive subjects. We propose that impaired membrane microviscosity of RBCs might have a crucial role in the progression of circulatory dysfunction in hypertensive subjects with CKD.
To make a clear treatment strategy based on various treatment outcomes of previous care for critical limb ischemia in arteriosclerosis obliterans (ASO) with hemodialysis, 273 patients with critical limbs ischemia who were or were not receiving hemodialysis and who successfully underwent bypass grafting (bypass, n=197) or endovascular intervention (percutaneous angioplasty, n=76) were retrospectively compared at our hospital. The patency rate was higher for patients without hemodialysis than with hemodialysis in the endovascular intervention group, but there was no significant difference between the two groups in bypass grafting. The amputation-free survival rate was higher in patients without hemodialysis than with hemodialysis in bypass grafting and the endovascular intervention group. The P III risk score is useful in predicting limb salvage. The Goodney score is useful in predicting general condition. The infectious death rate was higher in patients with hemodialysis than without hemodialysis. We do not use a prosthetic graft for a bypass surgery when it is possible.
This study investigated the improvement and evaluation of a walking-breathing exercise for hemodialysis patients with peripheral arterial occlusive disease (HD-PAD). The subjects were 12 HD-PAD patients (6 patients each in the exercise group and the control group). For the patients, we designed a walking-breathing exercise to be carried out as follows: with each step forward, as the heel lands on the ground, two quick inhalations are done, followed by one exhalation as the foot’s plantar surface touches the ground. Seventy-five days after the exercise, there were significant improvements in the ankle blood pressure (p<0.05) and ankle brachial pressure index immediately post one minute walking (Ex-ABI, p<0.05), and their recovery time (p<0.05) in the exercise group. In addition, four PAD limbs showed negative Ex-ABI tests. However, there was no significant improvement in the control group. In conclusion, the walking-breathing exercise was effective in the treatment of HD-PAD.
During the CABG procedure, we have used Endoscopic Vein Harvest (EVH) to harvest great the saphenous vein of the thigh since January 2005. We began using EVH among Femoro-Popliteal bypass (FP bypass) surgical patients from August 2007 and have operated on 12 patients (12 limbs) until December 2012. FP bypass with EVH can make surgical wound healing time shorter, so this procedure is very useful for patients.
In a 68 year old male it was revealed he had an abdominal aortic aneurysm. His aorta suffered severe atherosclerosis and plaque. He complained of severe abdominal pain. Computed tomography and ultrasonography examination revealed no abnormal findings. We also suspected impending rupture of AAA, but the diagnosis is not confirmed. Later, he showed signs of livedo reticularis and acute renal failure. It was then revealed that ischemic enteritis due to cholesterol crystal embolism (CCE), of spontaneous onset, was the cause of his abdominal pain. Typically CCE is triggered by iatrogenic procedures, but some cases resolve spontaneously. At this initial stage, CCE displayed non- specific findings. Sometimes it is difficult to make an early accurate diagnosis.