A 68-year-old man was scheduled to undergo percutaneous coronary intervention for in-stent total occlusion of the severely tortuous right coronary artery. Intravascular ultrasound revealed heavy ...in-stent calcification. Lesion atherectomy was required; however, severe proximal vessel tortuosity was detected. We introduced a 7-Fr guide-extension catheter beyond the severely tortuous part and performed rotational atherectomy with a 1.5 mm burr. However, the balloon could not expand; therefore, we changed to an orbital atherectomy system. Subsequently, the balloon successfully expanded, and intravascular ultrasound revealed an enlarged lumen. Severe proximal vessel tortuosity limits the use of atherectomy devices; however, a guide-extension catheter delivers the atherectomy device beyond the tortuosity. The delivery of the orbital atherectomy system inside the guide-extension catheter is easy due to its low profile; the debulking effect increases with the number of passes and rotational speed. This strategy is a useful option for treating severe calcified lesions with proximal vessel tortuosity.
A 63 year-old woman with claudication underwent endovascular therapy for diffuse stenosis of the right superficial femoral artery in our hospital. We performed paclitaxel-coated balloon angioplasty ...using the IN.PACT™ Admiral™ and achieved acceptable results. After 42 days, we performed follow-up optical frequency domain imaging for the right superficial femoral artery lesion treated with paclitaxel-coated balloon and observed several high-intensity regions with attenuation on the lumen surface. Sustained drug availability is a notable characteristic of paclitaxel-coated balloon. To the best of our knowledge, this is the first report on the visualization of sustained drug retention on the lumen surface using follow-up optical frequency domain imaging after paclitaxel-coated balloon angioplasty in a human patient with superficial femoral artery disease.
Background: Little is known about the superiority of balloon angioplasty vs. stent implantation for femoropopliteal (FP) lesions according to subgroup. Methods and Results: This study involved 1,018 ...de novo (balloon angioplasty, n=462; stent implantation, n=556) and 114 in-stent restenosis (ISR) FP lesions (balloon angioplasty, n=69; stent implantation, n=45) treated with endovascular therapy. For de novo FP lesions, the 3-year primary patency rate was significantly better with stent implantation than with balloon angioplasty (61% vs. 69%, log-rank P=0.001), but it was similar for ISR FP lesions (40% vs. 43%, log-rank P=0.83). For de novo FP lesions, stent implantation was favorable in all subgroups except for female sex (hazard ratio HR, 0.92; 95% CI: 0.65–1.31, P=0.66), critical limb ischemia (CLI; HR, 0.70; 95% CI: 0.46–1.06, P=0.10), calcified lesion (HR, 0.81; 95% CI: 0.46–1.39, P=0.44), and poor tibial run-off (HR, 0.86; 95% CI: 0.59–1.25, P=0.42) subgroups. No difference was found between the 2 treatment strategies for ISR FP lesions in the majority of subgroups. Stent implantation, however, was favorable in totally occluded ISR FP lesions (HR, 0.45; 95% CI: 0.21–1.01, P=0.05). Conclusions: The primary patency rate in de novo FP lesions for the 2 treatment strategies was similar in the female, calcified lesion, CLI, and poor tibial run-off subgroups. Stent implantation was superior to balloon angioplasty for totally occluded ISR FP lesions.
We report a case of triple cancer of the pancreas, colon, and peripheral nerve sheath. A 68-year-old woman diagnosed with type 2 diabetes at age 63 had been administered antidiabetic oral medications ...since then. Her HbA1c had been 6.0-7.0 % in NGSP. We found that, in the last 5 months, her HbA1c had increased by 3.5 % and she had lost 9 kg, suggesting the need to check for possibly malignant disease. Contrast-enhanced computed tomography showed 1 tumor each of the pancreas, chest wall. Preoperative colonoscopy showed a tumor of the colon. The first two tumors, diagnosed pathologically as cancer of the pancreas and of the peripheral nerve sheath, were completely resected with no significant metastasis. The third tumor, diagnosed as cancer of the colon, was removed by endoscopic mucosal resection. Symptoms in those with diabetes that include progressive weight loss and deteriorating glycemic control should thus suggest the need to check for possibly malignant disease.
Design requirements for the next-generation LWR have been investigated by many organization. In summary, these investigations suggest that improvement in plant safety is required through the ...evaluation of system simplification, reliability enhancement and preclusion of human factors. Hybrid safety systems, which are combinations of passive safety systems and active safety systems, have the possibility to satisfy the design requirements for next-generation LWR. This article shows the configuration of hybrid safety systems by describing the system selection process and then shows the results of system simplification.
Development of Hybrid Safety Systems for Next-Generation PWR Makihara, Yoshiaki; Sugizaki, Takayoshi; Okabe, Kazuharu ...
Transactions of the Japan Society of Mechanical Engineers Series B,
1993/09/25, Letnik:
59, Številka:
565
Journal Article
Odprti dostop
Design requirements for the next-generation LWR have been investigated by many organization. In summary, these investigations suggest that improvement in plant safety is required through the ...evaluation of system simplification, reliability enhancement and preclusion of human factors. Hybrid safety systems, which are combinations of passive safety systems and active safety systems, have the possibility to satisfy the design requirements for next-generation LWR. This article shows the configuration of hybrid safety systems by describing the system selection process and then shows the results of system simplification.
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