Purpose: The aim of this study was to determine the influence of lesion preparation using the dual wire scoring balloon on stent expansion and long-term outcomes. Methods: Forty-six consecutive de novo lesions treated with a single >2.5 mm drug-eluting stent under intravascular ultrasound guidance, using two implantation strategies, were randomly assigned to: 1) pre-dilation with a non-compliant balloon (NC group; n = 23) or 2) pre-dilation with a dual wire scoring balloon (DS group; n = 23). Results: Although the balloon size and the maximal dilation pressure for pre-dilatation was larger (3.33 ± 0.28 vs 3.09 ± 0.33 mm, p = 0.01) and higher (11.6 ± 3.2 vs 8.6 ± 2.7 atm, p < 0.01) in the NC group than the DS group, there were no significant differences in the stent expansion. Quantitative coronary angiography at the follow-up demonstrated a smaller in-stent late loss (0.71 ± 0.63 mm vs 0.23 ± 0.52 mm, p = 0.03) in the DS group. During the long-term follow-up, there were no significant differences in the major adverse cardiac event rates. Conclusions: Lesion preparation with a dual wire scoring balloon prior to drug-eluting stent implantation might therefore be a more feasible strategy than that using a non-compliant balloon.
Patient: Female, 79Final Diagnosis: Cardiac recurrence of DLBCLSymptoms: Cardiogenic shockMedication: —Clinical Procedure: Biopsy specimenSpecialty: Cardiology/HematologyObjective:Unusual clinical courseBackground:Although diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in adults, isolated cardiac recurrence of DLBCL which can cause fatal heart failure via various mechanisms is extremely rare. Furthermore, the frequency of recurrence of DLBCL more than 5 years after attaining complete remission is as low as 3.6%. The rate of complete remission and partial remission of DLBCL that have recurred 5 or more years after attaining the initial remission are reported to be 61% and 29%, respectively.Case Report:A 79-year-old female with a history of DLBCL at the age of 63 years was transferred to our hospital because of cardiogenic shock. Although cardiac tamponade was suspected, her hemodynamics did not improve with pericardiocentesis. Thoracotomy showed an elastic to hard tumor occupying most of the right ventricular wall. Cytological examination of the pericardial effusion and histological examination of a biopsy of the tumor yielded a diagnosis of DLBCL; this information was available only post mortem. Immunostaining of a biopsy specimen suggested that her cardiac tumor was a recurrence of her lymphoma diagnosed 16 years previously. Bone marrow aspiration was not performed; no recurrences were detected in any other site. This patient thus appeared to have an isolated cardiac recurrence of DLBCL.Conclusions:When managing a patient with a cardiac tumor and a past history of DLBCL, albeit more than a decade previously, establishing a histological diagnosis as early as possible would facilitate possible successful treatment and a good prognosis.
We herein report three cases of group A Streptococcus (GAS) infection in a family. Patient 1, a 50-year-old woman, was transferred to our hospital in shock with acute respiratory distress syndrome, swelling in the right neck and erythemata on both lower extremities. She required intubation because of laryngeal oedema. At the same time, patient 2, a 48-year-old man, was admitted because of septic shock, pneumonia and a pulmonary abscess. Five days later, patient 3, a 91-year-old woman, visited our clinic with bloody stool. All three patients were cured by antibiotics, and GAS was detected by specimen cultures. During these patients’ clinical course, an 84-year-old woman was found dead at home after having been diagnosed with type A influenza. All four patients lived in the same apartment. The GAS genotypes detected in the first three patients were identical. When treating patients with GAS, appropriate management of close contacts is mandatory.
Objective Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall's diagnostic algorithm. Methods We conducted a retrospective medical chart review from January 2015 to December 2016. Patients Patients ! 50 years old who presented to the ED within 7 days of the onset of AAP who were evaluated by residents at the ED of an acute care hospital were enrolled in this study. Patients transported by ambulance and referred from other hospitals and classified as level 1 or 2 according to the Japanese version of the Canadian Triage and Acuity Scale were excluded. Data, including the clinical history, location and character of pain, and age and gender of patients as well as the level of experience of residents, were abstracted from charts. We evaluated the concordance rate between the actual diagnostic process followed by residents and Kendall's diagnostic algorithm for AAP. Results We analyzed 466 patients (mean age 67.6 years) in the study who were evaluated and diagnosed by 123 residents. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall's diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper-or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lowerquadrant pain, and left upper-or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians.
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