Search PubMed⌕ Search

Biomedical subjects

Y Ikari

Publications and source records attributed to Y Ikari.

At least 55 records · Page 3Linked to original sources
PubMed1994

Angiographic follow-up after successful percutaneous coronary angioplasty for chronic total coronary occlusion: experience in 110 consecutive patients.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 110 consecutive patients (111 vessels) with chronically occluded coronary arteries and was successful in 69 patients (69 vessels). Successful initial PTCA was related to the extent of coronary artery disease, the morphology of the proximal surface of the occlusion site, and the clinical duration of occlusion. Repeat angiography was performed for 62 patients, with successful initial PTCA and demonstrated restenosis in 34 (55%) patients, of whom 11 had total occlusion. Repeat PTCA was performed in 30 patients and was successful in 80%. Follow-up angiography after repeat PTCA was carried out in all patients who underwent successful second PTCA, and, it demonstrated re-restenosis in 7 (29%) patients. In this study, among 111 total occlusions, 28 vessels undergoing successful initial PTCA and 17 undergoing successful repeat PTCA were free from restenosis or re-restenosis at the time of follow-up angiography.

Adult↗
PubMed1994

Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization.

Of 1,855 patients with angina pectoris who underwent percutaneous transluminal coronary angioplasty (PTCA) in our hospital, 21 experienced distal embolization. Five of the patients had slow washout of contrast medium distal to the dilated stenosis accompanied by S-T segment elevation (slow-flow pattern). In the other 16 cases, a dislodged embolus was found distal to the dilated stenosis (occlusive pattern) following balloon inflation. Of the 21 patients, 8 (38%) developed acute myocardial infarction (MI). All patients with acute MI were thought to have intraluminal thrombus on angiography performed before PTCA. Interestingly, patients with recent MI or worsening angina had a significantly higher rate of acute MI (p < 0.05).

Adult↗
PubMed1994

Risk factors for the development of post-lab acute coronary occlusion following successful percutaneous transluminal angioplasty.

Acute coronary occlusion can occur following percutaneous transluminal coronary angioplasty (PTCA) upon return to the coronary care unit (CCU), and is sometimes life-threatening. To identify high-risk patients for acute occlusion following PTCA, we analyzed 11 patients with post-lab acute occlusion. All of the patients had some evidence of intimal tear or dissection at the site of dilatation. During the study period, 1343 patients (1998 lesions) with angina pectoris underwent PTCA. Of these, 331 vessels (17%) had some degree of intimal tear or dissection at the site of dilatation. From these 331, 50 patients (50 vessels) without evidence of acute occlusion were randomly selected to serve as the control group. Patients in the acute occlusion group had more extensive dissection (p < 0.05) and less water balance (drip-infused water-urine, ml) during angioplasty (p < 0.1) than those in the control group. Furthermore, a significantly higher percentage of patients in the acute occlusion group complained of chest discomfort upon arrival at the CCU (72% vs 8%, p < 0.0001). These variables may be useful in identifying high-risk patients for post-lab acute occlusion, particularly in the presence of an intimal tear or dissection at the target site.

Acute Disease↗
PubMed1993

Transluminal extraction atherectomy and adjunctive balloon angioplasty for restenosis after Palmaz-Schatz coronary stent implantation.

Two patients who developed restenosis after implantation of Palmaz-Schatz coronary stents were successfully treated by transluminal extraction atherectomy and there has been no recurrence on follow-up angiograms. The optimum strategy for managing restenosis after coronary stenting remains unclear, but transluminal extraction atherectomy appears to be a safe and effective option.

Angioplasty, Balloon, Coronary↗
PubMed1993

A case of chronic pancreatitis complicated by massive pericardial and right pleural effusion.

A 42-year-old man was admitted complaining of dyspnea. Chest X-ray showed an increase in cardiac size, and echocardiography revealed a large volume of pericardial effusion. Pancreatic enzyme levels were elevated in both serum and pericardial effusion. Computed tomography and endoscopic retrograde pancreatography demonstrated a fistula connecting a pancreatic pseudocyst with the pericardium and the right pleural cavity. Massive pericardial and right pleural effusion is an extremely rare complication of chronic pancreatitis. In this case, computed tomography and endoscopic retrograde pancreatography were useful for diagnosing the fistula.

Adult↗
PubMed1993

Percutaneous angioplasty of stenosed gastroepiploic artery grafts.

OBJECTIVES: This report describes our early experience and results with percutaneous transluminal coronary angioplasty of gastroepiploic artery grafts in 12 patients. BACKGROUND: Angioplasty has been successfully performed in saphenous vein and internal thoracic artery grafts; however, experience with angioplasty in gastroepiploic artery/coronary artery bypass grafts is limited. METHODS: Balloon angioplasty was performed in 12 patients (11 men, 1 woman; mean age 58 +/- 8 years) with either total occlusion (6 patients) or severe stenosis (6 patients) of a gastroepiploic artery/coronary artery anastomosis. In seven patients, a guide wire/balloon catheter system was used through a 7F sheath inserted into the celiac trunk. In seven patients, including two who had unsuccessful wire/balloon angioplasty, an over the wire system was used through a 6.5F Cobra or 7F JR4 guide catheter, selectively inserted into the gastroduodenal artery. RESULTS: Angioplasty was successful in five (83%) of six patients with stenosis and in one of six patients with total occlusion (p = 0.08, 1 - beta = 0.68). The guide wire could not be advanced through the lesion in five patients, and the balloon catheter did not cross the lesion in one patient whose gastroepiploic artery was tortuous. Catheters exhibited better trackability and pushability when the over the wire system was used, and five of the six successes were achieved using this approach. Follow-up arteriography was performed in five patients, and all of the gastroepiploic artery grafts were patent without stenosis. CONCLUSIONS: Angioplasty can be safely performed in stenosed gastroepiploic artery grafts. An over the wire system that uses a thin balloon catheter inserted through a guide catheter in the gastroduodenal artery seems optimal.

Aged↗
PubMed1992

Cutaneous leiomyosarcoma.

A child's head-sized tumor on the upper back developed in a 43-year-old man. In spite of an extensive operation for the tumor, he died of multiple metastasis 15 months after the operation. Histologically, tumor cells proliferated throughout the dermal and subcutaneous regions, and a boxed-in appearance was noted with silver staining. Because electron microscopic observations strongly suggested a smooth muscle origin, we diagnosed this case as cutaneous and subcutaneous leiomyosarcoma.

Adult↗
PubMed1992

Fabry's disease with complete atrioventricular block: histological evidence of involvement of the conduction system.

A 63 year old man with complete atrioventricular block was diagnosed as having Fabry's disease. A short PR interval is a common electrocardiographic finding in Fabry's disease, but complete atrioventricular block is a very rare complication. Necropsy indicated that lipid accumulation in the atrioventricular conduction system was the probable cause of this patient's atrioventricular block.

Electrocardiography↗
PubMed1992

Coronary angiographic findings and in-hospital outcome of aggressive treatment in impending myocardial infarction.

The influence of coronary angiographic findings and treatment on clinical outcome was determined in 104 patients with impending myocardial infarction (unstable angina with prolonged chest pain and persistent electrocardiographic changes on admission). Coronary arteriography was performed on day one (aggressive strategy) in 50 patients and following medical treatment (conservative strategy) in 48 patients, of whom 40 were unstable. Six elderly patients were treated medically without angiography. A complex eccentric morphology of the coronary vessels was the most common finding in both groups, but the incidence of intracoronary thrombus was significantly higher in the aggressive strategy group (78%) and in unstable patients (77%) compared with patients controlled medically (24%). Severe multivessel disease was also common in refractory patients without thrombus. Percutaneous transluminal coronary angioplasty was less successful and produced more distal emboli in patients with thrombus. Emergency intervention was applied to 90% of the aggressive strategy group-it failed to improve the in-hospital outcome, but shortened hospitalization significantly. Elderly patients treated medically without angiography had the highest mortality. We concluded that intracoronary thrombus plays a major role in the pathogenesis of impending infarction, and that the majority of such patients cannot be stabilized medically. An aggressive strategy can be applied safely to impending infarction and will shorten hospitalization.

Aged↗
PubMed1992

[Percutaneous transluminal coronary angioplasty and coronary bypass grafting for refractory angina in chronic dialysis patients].

Between June 1983 and July 1989, 25 consecutive chronic dialysis patients with medically refractory angina pectoris underwent revascularization, either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) (21 males and 4 females, mean age of 57 +/- 10 years, and mean duration of dialysis of 3.7 +/- 5.0 years). Patients with single-vessel disease and/or mildly calcified lesions received PTCA (n = 15), while those with multi-vessel disease and/or severely calcified lesions received CABG (n = 10). As controls for PTCA-treated dialysis patients, 208 non-dialysis patients who received initial PTCA in 1988 were used. The mean number of diseased vessels was 2.7 +/- 0.7 for CABG group, and 1.5 +/- 0.8 for PTCA group (p < 0.01). In both groups, 80% of patients were successfully revascularized. In CABG group, however, 7 of 10 patients had major complications including 2 hospital deaths, while no complications occurred in the PTCA group. During the follow-up period after CABG (35 +/- 30 months), recurrent angina developed in one patient, who was successfully treated with PTCA. In the PTCA group, angiographic success was initially obtained in 16 of 21 lesions (76%), which was significantly lower than that in the control group (92%, p < 0.05). Follow-up angiography revealed restenosis in 6 of 16 lesions with successful PTCA (38%), similar to that observed in the control group (32%, p = ns). A second PTCA was successful in 5 of 6 patients with restenosis, however, 4/5 patients developed recurrent angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Hypertrophic cardiomyopathy in late-onset variant of Fabry disease with high residual activity of alpha-galactosidase A.

A new variant form of Fabry disease with hypertrophic cardiomyopathy of late onset is reported. Two unrelated male hemizygotes of this disease first presented with signs and symptoms of cardiomyopathy after 50 years of age. Cultured lymphoblastoid cells showed significantly higher residual alpha-galactosidase A activities than in the patients with classical phenotypic expressions.

Cardiomyopathy, Hypertrophic↗
PubMed1991

[Long-term prognosis in patients with echocardiographic left ventricular dysfunction masquerading as dilated cardiomyopathy].

The long-term prognosis and prognostic factors were assessed in patients with left ventricular dilatation with impaired function secondary to idiopathic dilated cardiomyopathy (DCM) or to heart diseases of various pathogeneses masquerading as DCM (DCM-like). The echocardiographic criteria for DCM-like disease were 1) left ventricular end-diastolic dimension exceeding 60 mm and 2) fractional shortening less than 15%. Those who showed improvement in either of these 2 parameters within 3 months were excluded from this study. One hundred and fifty-eight of 35,250 serially examined patients fulfilled the definitions. The pathogeneses of diseases were valvular heart disease (VHD) in 30 patients, ischemic heart disease (IHD) in 37, alcoholic cardiomyopathy (AC) in 12, hypertensive heart disease (HHD) in 31 and DCM in 48. All of the survivors were followed for more than 24 months; an average of 40 months. During this period, there were a total of 75 deaths, 18 (27%) of whom were judged as sudden death. Five-year survival rates calculated using the Kaplan-Meier method in AC and HHD were 86% and 77%, respectively, which were significantly higher than those in DCM (48%; p < 0.05); whereas, patients with VHD and IHD had lower values (60% and 46%, respectively) which were nearly equal to those in DCM. Factors that contributed to the increase in total cardiac mortality were advanced age, higher NYHA functional class, larger cardiac size on chest radiograph and history of heavy alcohol intake. Each of these factors were closely related to the specific pathogeneses as follows: age to IHD, cardiac size to VHD, and NYHA functional class to DCM. Long-term prognosis of DCM-like heart diseases, especially those of IHD and VHD, seemed to be as bad as those of DCM.

Adult↗
PubMed1990

Postoperative angiographic evaluation of gastroepiploic artery grafts: technical considerations and short-term patency.

Follow-up angiography was performed in 37 patients with right gastroepiploic artery (GEA) grafts at 27 +/- 32 days postoperatively. By the femoral approach, a 5F cobra or twist catheter was advanced selectively into the gastroduodenal artery (GDA) over a plastic-coated guidewire. In 29 patients, the GDA was successfully catheterized, and the GEA grafts were clearly visualized by the injection of 3-7 ml of contrast medium. GDA catheterization was unsuccessful in 8 patients, but in 4 of them the grafts were well visualized when 15-20 ml of contrast was injected. In the other 4 patients, visualization of the GEA grafts was poor, but the distal portions were outlined by retrograde perfusion from the native right coronary arteries. A total of 34 GEA grafts were patent (92%), and the diameters of these grafts were adequate when compared with respective recipient coronary arteries (2.8 +/- 0.9 and 2.3 +/- 0.6 mm, respectively; P less than .05). No complications were noted except for transient vasospasm (3 patients) in the GEA, hepatic artery, or both, which was relieved by the intra-arterial injection of isosorbide dinitrate (2.5 mg). Thus, the over-the-wire technique allows simple and safe GDA catheterization, which is essential for obtaining good visualization of GEA grafts.

Adult↗
PubMed1990

A case of Sweet's syndrome with early gastric cancer.

The case of a 49-year-old man with Sweet's syndrome (acute febrile neutrophilic dermatosis) is described, who had coincidently gastric cancer. The therapeutic effectiveness of colchicine is also presented as one treatment for Sweet's syndrome, because rapid regression of the lesions was noticed.

Adenocarcinoma, Mucinous↗
PubMed1990

[Radiation-induced malignant skin tumors in the hands of five doctors].

Radiation-induced malignant skin tumors in the hands in 3 surgeons, one physician, and one dentist are reported. The latent period of the irradiation ranged between 16 years and 34 years. Clinically, small keratotic lesions were seen in 4 doctors and a large tumor the remaining doctor. On histological examination, one of the tumors was a squamous cell carcinoma, 3 were carcinomas in situ, and the fifth was a basal cell carcinoma with a squamous cell carcinoma. While the occupational hazard of developing malignant skin tumors following irradiation have decreased recently, this paper emphasizes precautions should be taken when diagnosing and caring for cancer patients.

Adult↗