Kei Yunoki

Osaka City General Hospital | OCGH · Department of Cardiology

Background Type I variant Kounis syndrome is characterized by coronary spasm following an allergic or anaphylactic reaction. Coronary spasm is also recognized as a contributing factor in spontaneous coronary artery dissection (SCAD). Case summary A 46-year-old woman presented to the emergency room with a chief complaint of chest discomfort followi...

Background Optical coherence tomography (OCT) can be used to characterize the details of calcified plaques because it allows high-resolution evaluation of coronary plaques, thrombi, and calcium. Case summary A 72-year-old man on haemodialysis who had stenosis with a severe calcified lesion at the left anterior descending artery underwent percutane...

Iatrogenic acute aortic regurgitation (AR) is an uncommon condition, and its presentation as severe AR following coronary angiography or percutaneous coronary intervention (PCI) is exceedingly rare. We report a case of iatrogenic severe AR resulting from aortic valve injury caused by manipulation of the guiding catheter during PCI.

Aims: Some reports have suggested that hypertensive acute heart failure (AHF) is caused by intravascular congestion, not interstitial congestion. We evaluated the differences in extracellular fluid volume assessed by bioelectrical impedance analysis (BIA) between AHF patients with and without high systolic blood pressure (sBP). Methods: This pro...

There has been no previous prospective study evaluating 3-month dual antiplatelet therapy (DAPT) after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation in patients with acute coronary syndrome (ACS). The STOPDAPT trial is a prospective multi-center single-arm study evaluating 3-month DAPT duration in all-comer population after CoCr-...

Vascular medial calcification is often observed in patients with arteriosclerosis. It is also associated with systolic hypertension, wide pulse pressure, and fluctuation of blood pressure, which results in cardiovascular events. Eicosapentaenoic acid (EPA) has been shown to suppress vascular calcification in previous animal experiments. We investig...

Background The klotho gene was identified as an “aging-suppressor” gene that accelerates arterial calcification when disrupted. Serum and vascular klotho levels are reduced in patients with chronic kidney disease, and the reduced levels are associated with arterial calcification. Intake of eicosapentaenoic acid (EPA), an n-3 fatty acid, reduces the...

CT images of thoracic and abdominal aortas in a klotho mutant (kl/kl) mouse after 4 weeks of EPA food. (MOV)

CT images of thoracic and abdominal aortas in a klotho mutant (kl/kl) mouse before control food. (MOV)

CT images of thoracic and abdominal aortas in a klotho mutant (kl/kl) mouse before EPA food. (MOV)

CT images of thoracic and abdominal aortas in a klotho mutant (kl/kl) mouse after 4 weeks of control food. (MOV)

A 72-year-old man underwent video-assisted thoracoscopic left upper lobectomy for small cell lung cancer. After 16 days, he experienced epigastric abdominal pain and vomiting, and was taken by ambulance to our hospital. Contrast-enhanced computed tomography (CT) showed a propagation of thrombus in the stump of the left superior pulmonary vein (LSPV...

We thank Dr Roik et al for their interest in our study regarding novel angiographic classification of chronic thromboembolic pulmonary hypertension lesions.1 They raise the issue about the usage of pressure wire, intravascular ultrasound, and optical coherence tomography in performing balloon pulmonary angioplasty (BPA). These modalities were not a...

A 54-year-old man was transferred to our hospital due to congestive heart failure and left ventricular thrombi. Transthoracic echocardiography (TTE) showed mobile “ball-like” not only left ventricular but also right ventricular thrombi associated with severe impaired left and right ventricular function. Contrast-enhanced computed tomography (CT) an...

Background— Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for standard therapy, pulmonary endarterectomy. Although there are several classifications of vascular lesions, these classifications are based on the features of the specimen removed during pu...

There has been no previous prospective study evaluating dual antiplatelet therapy (DAPT) duration shorter than 6 months after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation. STOPDAPT trial is a prospective multi-center single-arm study evaluating 3-month DAPT duration after CoCr-EES implantation. The primary endpoint was a composi...

Statin therapy targeting reduction of low-density lipoprotein cholesterol (LDL-C) decreases the risk of coronary heart disease (CHD) and all-cause mortality. However, a substantial number of cases of CHD are not prevented and residual risk factors remain unsettled. A high triglyceride (TG) level is considered to be an important and residual risk fa...

There has been no previous prospective study evaluating dual antiplatelet therapy (DAPT) duration shorter than 6 months after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation. STOPDAPT trial is a prospective multi-center single-arm study evaluating 3-month DAPT duration after CoCr-EES implantation. The primary endpoint was a composi...

Background: We previously demonstrated that inflammatory biomarkers such as myeloperoxidase (MPO), a member of the heme peroxidase superfamily, and neopterin (produced by activated macrophages after interferon-γ stimulation by T-lymphocytes) are important in the pathogenesis of coronary plaque instability. Additional evidence supports high sensitiv...

Background: The development of aortic valve stenosis (AS) involves multiple events, including inflammation and lipid deposition and oxidation. Circulating levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) play an important role in the development and progression of atherosclerosis. The aims of this study were to inv...

Background Alpha glucosidase inhibitor (GI) attenuates postprandial hyperglycemia (PPH) and reduces the risk of cardiovascular events in patients with impaired glucose tolerance or type 2 diabetes. Dipeptidyl peptidase 4 (DPP-4) inhibitors also attenuate PPH. PPH is one of the factors leading to endothelial dysfunction which is an early event in th...

A high prevalence and a rapid progression of aortic valve stenosis (AS) in patients undergoing hemodialysis (HD) has been reported. In these circumstances, intraleaflet hemorrhage of aortic valve may be related to the development of AS in HD patients. We immunohistochemically examined the relationship among intraleaflet hemorrhage, neovascularizati...

Low high-density lipoprotein (HDL) cholesterol is well-established as a negative risk factor for coronary artery disease (CAD) and its anti-oxidant property has been attributed mainly to the HDL-bound enzyme paraoxonase-1 (PON-1). Recently, myeloperoxidase (MPO), a pro-oxidant enzyme released from activated neutrophils, has been shown to alter the...

Background: Vascular calcification is frequently found in patients with coronary artery disease, and is associated with the incidence of cardiovascular events. Several studies have indicated that intake of n-3 (omega-3) fatty acids from fish reduces the risk of fatal coronary artery disease. However, the effects of n-3 fatty acids on arterial calci...

Heme oxygenase-1 (HO-1) is a cytoprotective enzyme that is induced by intraplaque hemorrhage and degrades free heme and releases ferrous iron, which is rapidly sequestered by ferritin. In vitro studies have shown that binding of hemoglobin to hemoglobin scavenger receptor (CD163) induces HO-1 and the anti-inflammatory mediator interleukin (IL)-10....

Inflammation and oxidative stress play key roles in atherosclerotic plaque instability, and plaque rupture/erosion and subsequent thrombus formation constitute the principal mechanisms of total vessel occlusion and acute ST-elevation myocardial infarction (STEMI). Plaque disruption triggers the formation of initial platelet aggregates that grow in...

End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) have a high prevalence of cardiovascular events. Low-density lipoprotein (LDL) in dialysis patients has been shown to be susceptible to in vitro peroxidation; therefore, oxidized-LDL (ox-LDL) could be generated in these patients. Moreover, myeloperoxidase (MPO) released from activ...

Objectives: This study sought to investigate the association between pathological characteristics of aspirated intracoronary thrombi and the incidence of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) treated with thro...

Background: Aortic valve stenosis (AS) occurs with increased frequency in hemodialysis (HD) patients and could contribute to the excess cardiovascular mortality. However, little is known about differences in progression of the AS process between HD and non-HD patients. Neopterin, a by-product of the guanosine triphosphate pathway, is produced by ac...

Recent studies have demonstrated that erythrocytes are a potential component in atheromatous lesions and thrombus formation in patients with ST-elevation myocardial infarction (STEMI). The purpose of this study was to determine the associations of red blood cell (RBC) component of coronary thrombi with oxidative stress and myocardial reperfusion. A...

Oxidative stress has been implicated in the pathogenesis of heart failure. Reactive oxygen species (ROS) are produced in the failing myocardium, and ROS cause hypertrophy, apoptosis/cell death and intracellular Ca2+ overload in cardiac myocytes. ROS also cause damage to lipid cell membranes in the process of lipid peroxidation. In this process, sev...

Intermittent arm ischemia before percutaneous coronary intervention induces remote ischemic preconditioning (RIPC) and attenuates myocardial injury in patients with myocardial infarction. Several studies have shown that intermittent arm ischemia increases coronary flow and is related to autonomic nerve system. The aim of this study was to determine...

Despite the use of statin therapy and achieving the target for low-density lipoprotein cholesterol, a substantial number of coronary events are not prevented, and residual risk factors remain unsettled. Recently, ezetimibe has been shown to reduce not only low-density lipoprotein cholesterol but also triglyceride (TG) levels. The aim of this study...

Postprandial hyperlipemia has been shown to impair endothelial function and contribute to the development of atherosclerosis. We investigated the association between postprandial lipid profiles and endothelial function, and we examined the effects of ezetimibe on postprandial hyperlipemia and lipemia-induced endothelial dysfunction. A randomized pr...

It has been reported that idiopathic focal ventricular arrhythmias can originate from the papillary muscles in the left ventricle (LV), but the clinical features remains unclear and the treatment has not been established. We report on a 75-year-old male patient presenting with a dilated cardiomyopathy and frequent ventricular premature complexes (V...

A 45-year-old man with dilated cardiomyopathy was admitted to our hospital due to congestive heart failure (CHF). Despite the optimal medical treatment, his condition had not improved because of severe left ventricular dysfunction. Because he experienced non-sustained ventricular tachycardia (VT), a biventricular implantable cardioverter-defibrilla...

Myeloperoxidase (MPO) is a leucocyte enzyme that catalyses the formation of a number of reactive oxidant species. The purpose of this study is to evaluate the relationship between angiographic coronary plaque morphology in patients with unstable angina pectoris (UAP) or stable angina pectoris (SAP) and MPO levels. Plasma MPO levels on admission wer...

A 52-year-old man experienced acute chest pain and was transferred to our hospital. An electrocardiogram showed ST-segment elevation in leads II, III, aVf, and V1 through V3. The diagnosis at the emergency room was inferior acute myocardial infarction (AMI), and emergent coronary angiography (CAG) was performed. While CAG showed subtotal occlusion...

Previous studies have shown that oxidative stress and endothelial dysfunction are related to impaired myocardial microcirculation after reperfusion. Moreover, elevated myeloperoxidase (MPO) levels are associated with endothelial dysfunction. Plasma MPO levels were measured in patients with ST-segment elevation acute myocardial infarction (n = 160)...

The purpose of this study was to explore the possibility of using our novel echocardiographic index of inefficient left ventricular (LV) contraction in patient selection for cardiac resynchronization therapy (CRT). Forty consecutive patients with LV ejection fraction < or = 35% were divided into 2 groups, 9 CRT candidates and 31 non-CRT candidates...

Background: Oxidative stress and inflammatory processes are of major importance in plaque instability. We demonstrated previously that elevated plasma oxidized low-density lipoprotein (ox-LDL) levels are related to plaque instability. In this study, we investigated whether plasma ox-LDL levels were related to the types of intracoronary thrombi (ICT...

Effective clearance of extracellular haemoglobin (Hb) is thought to limit systemic oxidative heme toxicity, which is presumed to contribute to the pathogenesis of plaque instability. We immunohistochemically examined the relationship between intraplaque haemorrhage, 4-HNE (4-hydroxy-2-nonenal), an index of lipid peroxidation, and the Hb scavenger r...

Percutaneous balloon pericardiotomy and intrapericardial instillation seemed to be less invasive and effective treatments for refractory pericardial effusion. A 65-year-old man who suffered from refractory pericardial effusion associated with gastric cancer and had been hospitalized three times for pericardiocentesis, complained of dyspnea at rest...

A 60-year-old female had sudden onset of syncope. The emergency service noticed that she suffered cardiopulmonary arrest (ventricular fibrillation: VF). After defibrillation in the ambulance, she was transported to our emergency department. Electrocardiography monitoring showed QT prolongation. Serum potassium level was extremely low at 1.8 mEq/l....

A 76-year-old woman was admitted to our hospital because of exertional dyspnea and leg edema during the previous month. Her systolic blood pressure on admission was 80 mmHg with 12 mmHg of pulsus paradoxous, and her pulse rate was 110 beats/min. Chest radiography revealed marked cardiomegaly and echocardiography showed massive pericardial effusion...

A 59-year-old woman was admitted to our hospital because of exertional dyspnea, abdominal distension, and leg edema over the past 2 weeks. She had a history of rheumatic fever at the age of 12 years. In 1983, at the age of 37, she had undergone tricuspid valve replacement with a Carpentier-Edwards bioprosthesis for tricuspid stenosis and mitral val...

A 65-year-old woman presented with exertional dyspnea and general fatigue that began 1 week ago. She had a family history of hereditary hemorrhagic telangiectasia manifesting as telangiectasia of gastrointestinal (GI) tract and nasal mucosa and of pulmonary arteriovenous fistulas (PAVFs). Her first PAVF was diagnosed in 1999 but was untreated at th...

Four cases of metastatic carcinoma of long bone were treated surgically.All lesions were replaced by bone cement and fixed by internal fixation (three Küntcher intramedullary nails and one plate). All patients were given reief of pain and got improvement of A. D. L..

Three rare traumatic epiphysial separation were presented. Two of them were the first metacarpal bone, the other was distal tibia. These cases were treated conservatively except one.

The higher level of zinc concentration in tumorous bone tissue of osteosarcoma have been reported in previous paper.The present study was performed in order to clarify the effect of zinc concentration on bone growth in rat.The increasing rate of body weight for 6 weeks, longitudinal length and zinc concentration of femur in rat were compared among...

A 19 year old man came to our clinic in June 1977, complaining of a lmup in the left back. At the time of operation it was noted that the growth involved the M. longissimus. The tumor was excised wildely and proved to be a desmoid on pathologic examination. No recurrence was found 1 year after surgery.

Benign chondroblastoma involving the patella is a rare condition, being reported only 10 cases in Japanese literature. Benign chondroblastoma associated with cystic change is called as cystic chondroblastoma (Schajowicz) and one of the extremely rare conditions, which is sometimes difficult to be distinguished from aneurysmal bone cyst.In Japanese...

A 40 year-old male complaining severe pain on his left acromioclavicular joint was admitted in our clinic.X-ray examination revealed osteolytic change of the left acromion.The excised tissue was diagnosed histologically as chronic osteomyelitis. No response was obtained on chemotherapy against the supposed osteomyelitis. On bone marrow puncture, at...

A ten years old boy had complained of swelling of the lateral aspect of the left knee for about one month. Roentgenograms revealed an enlarged cystic lesion in the proximal metaphysis of the left fibula. At surgery, the cortex of the cystic legion was egg-shell thin and the cyst contained bloody fluid and a scanty amount of lining tissue around the...

A boy aged 9 admitted to our clinic on July 1975, complaining of pain and swelling in the right scapular region. Roentgenograms showed a round osteolytic defect, about two centimeters in diameter in the right scapula. The area of bone destruction was filled with yellowish tissue, which was easily curetted from the bone. The histological picture rev...

An analysis of clinicopathological features of sixty-six patients with osteosarcoma examined at Kagoshima University between October 1956 and March 1975 has been presented.Twenty-seven, who have been observed since April 1970, and three unoperated cases were excluded, because of too short duration of the observation and lack of histological evidenc...

Case I: A woman of 37 years old, complained pain and swelling in the lesion of the left hip during five months. Roentgenogram revealed diffuse osteolytic lesion with pathological fracture in the upper end of the left femur. En bloc total excision of the tumor was performed and a specially designed prosthesis was inserted. Microscopic diagnosis was...

A case of eosinophilic granuloma in the left clavicula is reported.A boy aged 4. was admitted to our clinic on August 1972, complaining of pain and swelling in the left clavicular region. The rentogenographic examination revealed a round lytic lesion of the cortex in the proximal end of clavicula with excessive periosteal reaction. At operation the...

The giant cell tumor of short tubular bone is very rare. We have recently experienced the gaint cell tumor which occurred in the fifth metacarpal bone.A man, aged sixty-two years, had been suffering from pain and swelling in the right fifth metacarpal portion for about last five months. Roentgenograms revealed the significant osteolytic lesion. Aft...