Background : Studies using cardiovascular magnetic resonance imaging have demonstrated subendocardial deposition of amyloid protein in patients with cardiac amyloidosis (CA). We examined whether subendocardial dysfunction due to amyloid deposition exists in patients with CA.
Methods : We examined 98 consecutive patients with CA and 20 control individuals. CA patients were divided into three groups. Group 1 had no evidence of cardiac involvement (n＝32), group 2 had heart involvement but no congestive heart failure (CHF) and/or serum brain natriuretic peptide (BNP) levels < 100 pg/mL (n＝23), and group 3 had heart involvement and CHF and/or serum BNP levels ≥ 100 pg/mL (n＝43). Circumferential, radial, and longitudinal strains of the inner half and outer half layers of the left ventricular (LV) wall were examined.
Results : There was no significant difference in strain parameters between those with AL and ATTRm amyloidosis. There were no significant differences in circumferential inner/outer strain among the 4 groups. Regarding radial strain, groups 2 and 3 had a depressed inner radial strain compared with group 1 in the entire basal and mid-LV wall (P < 0.001, one-way analysis of variance) and that in group 1 was smaller than that in controls. Longitudinal strains of the inner/outer layers in the basal and mid-LV wall were significantly depressed with apical sparing in groups 2 and 3 compared with those in group 1.
Conclusions : In patients with CA, complete endomyocardial radial systolic dysfunction and longitudinal transmural systolic dysfunction exist in the basal and mid-LV wall.

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Background : Laparoscopic surgery for early endometrial carcinoma (EC) has been covered by the national health insurance system of Japan since 2014. Our facility introduced this surgery in 2016, and 27 surgeries were performed as of December 2017. The outcomes and safety of laparoscopic surgery (TLH group) for early endometrial carcinoma were evaluated herein and compared with those of conventional laparotomy (TAH group).
Methods : The surgery-related data of 27 cases in the TLH group and 49 in the TAH group were extracted from medical records and the results obtained were compared.
Results : No significant differences were observed in patient backgrounds between the two groups, except for pelvic lymphadenectomy, which was performed on only 4 cases in the TLH group. Surgical time was longer in the TLH group than in the TAH group (201.1±44.8 vs. 176.8±29.3 min, P<0.001), whereas total blood loss was less (29.7±25.0 vs. 162.4±135.8 mL, P<0.001). The adverse events of ileus and hematoma/postoperative hemorrhage were only observed in the TAH group. The duration of the postoperative hospital stay was shorter in the TLH group (6.1±3.5 vs. 8.9±3.7 days, P<0.001). The mode of surgery did not affect the postoperative pathological diagnosis or recurrence/survival ; however, observation periods were inadequate.
Conclusions : Laparoscopic surgery appears to be safe for early EC in our facility without the loss of radicality or occurrence of adverse events, such as ileus and postoperative bleeding. The accumulation of more cases is needed to refine this procedure.

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