Background Dialysis is an independent risk factor for in‐stent restenosis (ISR) after stent implantation in coronary arteries. However, the characteristics of ISR in patients undergoing dialysis remain unclear, as there are no histological studies evaluating the causes of this condition. The aim of the present study was to investigate the causes of ISR between patients who are undergoing dialysis and those who are not by evaluating tissues obtained from ISR lesions using directional coronary atherectomy. Methods and Results A total of 29 ISR lesions from 29 patients included in a multicenter directional coronary atherectomy registry of 128 patients were selected for analysis and divided into a dialysis group (n=8) and a nondialysis group (n=21). Histopathological evaluation demonstrated that an in‐stent calcified nodule was a major histological characteristic of ISR lesions in the dialysis group and the prevalence of an in‐stent calcified nodule was significantly higher in the dialysis group compared with the nondialysis group (75% versus 5%, respectively; P <0.01). On the other hand, the prevalence of an in‐stent lipid‐rich plaque was significantly lower in the dialysis group compared with the nondialysis group (0% versus 43%, respectively; P =0.03). In all cases with an in‐stent calcified nodule, the underlying calcification before stent implantation was moderate to severe. When tissue characteristics were stratified according to duration post–stent implantation, an in‐stent calcified nodule in the dialysis group was mainly observed within 1 year after stent implantation. Conclusions In‐stent calcified nodules are a common cause of ISR in patients undergoing dialysis and are observed within 1 year after stent implantation, suggesting different causes of ISR between patients undergoing dialysis and those who are not.

Objective:To evaluate the TRUCLEAR™ system (Smith and Nephew Inc., London, UK), a hysteroscopic system that morcellates and aspirates masses, in terms of the operating time, surgeon's convenience, and effect on patients compared with conventional electrosurgical resection.Methods:Patients undergoing hysteroscopic resection of endometrial polyps were randomly allocated to undergo hysteroscopic morcellation or electrosurgical resection (UMIN-CTR identifier: UMIN000019649). The primary outcome was the operating time. Secondary outcomes were the removal success, fluid deficit, convenience with the technique, insertion time, number of insertions during the operation, visibility of the operative field, recurrence of the patient's chief complaint, and adverse events.Results:Sixty-seven women were randomly allocated to the morcellation arm (n = 34) or electrosurgical resection arm (n = 33) from November 2015 to November 2016. The polyps were completely removed, and no adverse events were observed in all 67 patients. The average operating time (8.3 min vs. 12.0 min, P = 0.014), insertion time (5.0 min vs. 9.0 min, P < 0.001), and number of insertions (1.0 vs. 8.2, P < 0.001) were significantly lower in the morcellation arm than in the electrosurgical resection arm. Surgeons' subjective evaluation measured on a 10-cm visual analog scale was higher in the morcellation arm than in the electrosurgical resection arm in terms of easiness of removal (8.4 vs. 6.5, P < 0.001) and visibility of the operative field (7.8 vs. 6.4, P < 0.001).Conclusion:Surgeons gave the hysteroscopic morcellator system a better evaluation compared than electrosurgical resection, and the system shortened the operating time.

The ion-exchange property of sodium difluorotetrasilicate, Na-TSM, with potassium, rubidium and cesium ions was investigated in addition to two other typical layered inorganic materials. The selectivity sequence of Na-TSM was Cs+ &gt; Rb+ &gt; K+ and the selectivity difference of Na-TSM was highest among the examined layered materials. It was found from a chemical analysis that cesium ion-exchange participated in magnesium ions, which is a lattice component of Na-TSM, in addition to an ordinary ion-exchange reaction with the interlayer sodium ions. The exchange of cesium ions with magnesium ions was found to be stoichiometric, and was expected to be an ideal ion-exchange reaction. It was a peculiar phenomenon only on Na-TSM. Once cesium ions were exchanged in a Na-TSM lattice, they were hardly released, due to a reverse ion-exchange with sodium ions. The highest selectivity difference and tight binding of cesium ions were interpreted by an ion-exchange with lattice magnesium ion as well as decreased dehydration, which resulted in the interlayer gallery height.

To assess the role of hypertension in asymptomatic cerebral lacunae, we evaluated cranial computed tomography in 76 untreated hypertensive patients, 173 hypertensive patients treated with antihypertensive drugs, and 69 agematched normotensive control subjects who were more than 60 years of age and without a history of stroke. Cerebral lacunae were diagnosed by computed tomography as a hypodense lesion less than 15 mm in diameter seen on a single 10-mm scan section. The factors contributing to lacunae were determined by stepwise discriminant analysis. Single or multiple cerebral lacunae were revealed in 27.6% (21 of 76) of untreated hypertensive patients, 17.3% (30 of 173) of treated hypertensive patients, and 7.2% (5 of 69) of normotensive control subjects. Incidence of lacunae was significantly higher in hypertensive patients than normotensive control subjects.Stepwise discriminant analysis showed that the most strongly contributing factor for lacunae was the grade of hypertensive retinopathy in untreated hypertensive patients and mean blood pressure in treated hypertensive patients. Asymptomatic cerebral lacunae were frequently detected by computed tomography in elderly patients with essential hypertension. The severity and duration of hypertension correlate positively with this type of vascular complication in hypertension. widely available, it is quite common to find evidence of previous cerebral infarction verified by CT in the absence of a history of prior stroke. The incidence of asymptomatic or silent stroke was reported as 11% by diagnostic investigation of 1203 cases of acute stroke cases registered in the Stroke Data Bank by the National Institute of Neurological and Communicative Disorders and Stroke.1 The same incidence was reported by Kase et al 2 in the Framingham study. Lacunar infarcts have been defined pathologically by Fisher 3 as small infarcts that lie in the deeper noncortical parts of the cerebrum and brain stem as a result of occlusions of the penetrating branches of the large cerebral arteries. Larger lacunae (>1.5 cm) tend to be symptomatic, whereas smaller ones are liable to be asymptomatic unless located in a sensory or motor tract. 34 Many authors emphasize the prevailing role of hypertension in the pathogenesis of lacunae, 35 but the contribution of hypertension in the development of lacunae has been questioned recently.The aim of the present study was to evaluate whether asymptomatic cerebral lacunae verified by CT occurred more frequently in patients with essential hypertension compared with normotensive control subjects. In addition, contributing factors for cerebral lacunae are identified in hypertensive patients by stepwise discriminant analysis. MethodsA total of 318 elderly outpatients (129 men and 189 women; mean age, 69.9 years; range, 60 to 91 years) were studied at the Department of Internal Medicine in NTT Izu-Teishin Hospital From the Department of Internal Medicine, NTT Izu-Teishin Hospital, Shizuoka, Japan.Correspondence to Toshio Ikeda, MD, Department of In...

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.