We evaluated the initial and long-term outcomes of elective unprotected left main coronary artery (UPLMCA) stenting and compared sirolimus-eluting stent (SES) implantation with bare metal stent (BMS) . From April 2001 to March 2006, elective percutaneous coronary intervention (PCI) for de novo UPLMCA stenosis was performed in 45 consecutive patients (21 patients were treated with SES and 24 patients with BMS) . The procedural success rate was 100% in both groups. There was no in-hospital complication such as death, Q-wave myocardial infarction, emergent repeated PCI and coronary artery bypass grafting (CABG) in either group. From 6 to 12 months after the procedure. CABG rate was significantly lower in the SES group than in the BMS group (0% vs. 16.7%, p=0.05) . There was no significant difference in angiographic restenosis rate (9.5% vs. 20.8%, p=0.29) and target lesion revascularization (TLR) (4.7% vs. 20.8%, p=0.11) between the two groups. Quantitative coronary angiography showed a shorter reference vessel diameter (3.47±0.38 vs. 3.98±p=0.01), shorter post procedural minimal lumen diameter (3.53mm vs. 4.13mm, p<0.01), and longer lesion length (18.7mm vs. 14.0mm, p=0.02) in the SES group. Our PCI for UPLMCA stenosis can be performed with good initial and long-term outcomes. SES stenting resulted in a lower CABG rate and smaller and longer treatable lesions. Our results indicate that the use of UPLMCA stenosis PCI could be expanded in the SES area.
A 26-year-old woman with a history of allergy to mangos and several kinds of spices developed anaphylactic shock after eating lychee. Oral tickling and itching of the throat preceded anaphylactic shock. Prick tests showed a positive reaction to lychee. Using patient's serum FEIA was positive to lychee and some kinds of pollen including mugwort pollen. Our diagnosis indicated that this patient suffered from oral allergy syndrome with anaphylactic shock due to lychee. This patient had a history of nasal allergy, anaphylactic shock due to mangos and skin symptoms such as itching and a rash after eating foods including hot spices. Some allergens of lychee are known to have a common epitope of the IgE and show cross-reactivity to allergens of other foods such as fruit, vegetables and spices. We speculated that the allergic symptoms of this case were caused by pathogenesis of pollen fruit syndrome due to profilin, which was a common allergen among foods which had made this patient ill in the past.
This is a report of a case in which a patient underwent rehabilitation for dual disabilities, hemiplegia and bilateral osteonecrosis of the femoral head. The patient had received oral steroid therapy for dermatomyositis 20 years prior, and after developing osteonecrosis of the femoral head, underwent osteotomy and was able to walk unassisted. The patient was later diagnosed with right hemiplegia and rehabilitation was started. Before the onset of the manifestations of stroke, the patient experienced right hip pain and limping was noted; however after the stroke, the pain diminished as a result of impaired sensation, and weight-bearing on the right lower limb became possible. Worsening of the pain was feared, but because of rest and impaired sensation, pain never inveased, and the patient was discharged to home inth no complications. The patient subsequently developed bilateral coxalgia, and hip replacement arthroplasty was performed. Long-term follow up with attention to complications appears to be important when treating hip disease and hemiplegia.
A 76 years-old single female with a history of lumbar spinal canal stenosis followed by right hip arthrodesis was diagnosed with herpes zoster in the derematomes L2-4 in the lower left extremity on 6 September 2004. On 20 September the patient was diagnosed with Segmental Zoster Paresis (following SZP) due to muscle weakness. A manual muscle test indicated a decrease of left leg muscular strength (level 2) mainly on the iliopsoas muscle and the quadriceps femoris muscle, and the right hip joint showed flexural difficulty. Life at home required that the patient go up and down stairs, and the prediction of a prognosis was difficult. Muscular strength and daily life activity improved approximately 3 months after hospitalization. SZP is rare disease, and prognosis is unknown frequently. We report a case of SZP that is a good prognosis, but has difficulty with the rehabilitation management.
Studies concerning the fitting of prostheses on patients with dual disabilities of amputation and hemiplegia are few. We report the fitting of a prosthesis of a patient with right below-elbow amputation in combination with left-side hemiplegia and higher brain function disabilities. As a result of rehabilitation, independence in feeding brushing teeth and writing was acquired. The patient, a 60-year-old male with a right below-elbow amputation from 50 years prior, suffered from a cerebrovascular accident on 14 January 2007 resulting in left-side hemiplegia. After conservative therapy, the patient was transferred to the rehabilitation department where he started active prosthesis-fitting rehabilitation from March 1. The rehabilitations objectives were independence in feeding and brushing teeth. After considering cosmetic, active and myoelectric prostheses, an active prosthesis was chosen for itsreliable performance. Feeding, brushing teeth and writing skills were finally acquired. The success of this case suggests that the fitting of a suitable prosthesis helps promote motivation towards patient rehabilitation and improved ADL skills.