Lambda-like J wave due to acute myocardial infarction of the diagonal branch

The culprit lesion of acute myocardial infarction could be predicted by electrocardiogram findings. However, we experienced some cases with coronary angiographic finding in the area of ST-T elevation that was different from that predicted. The lambda-like J wave could be caused by ischemia although the mechanism has not been fully elucidated. We report a case of acute myocardial infarction that showed discrepancy between ST-T elevation with lambda-like ischemic J wave in a broad area and coronary angiographical finding of diagonal branch occlusion. J. Med. Invest. 66 : 185-187, February, 2019.

Association of Decreased Docosahexaenoic Acid Level After Statin Therapy and Low Eicosapentaenoic Acid Level with In-Stent Restenosis in Patients with Acute Coronary Syndrome

Aim: It is speculated that statin therapy modulates the synthesis of polyunsaturated fatty acids (PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, the data available on the effects of statin therapy on the serum levels of PUFA and the subsequent impact on in-stent restenosis (ISR) in patients with acute coronary syndrome (ACS) are limited.

Methods: A total of 120 ACS patients who received emergent coronary stent implantation, follow-up coronary angiography to evaluate ISR, and new statin therapy were enrolled. We measured the serum levels of the PUFA and lipids at the onset of ACS and at the follow-up coronary angiography.

Results: The follow-up coronary angiography revealed 38 ISR cases. New statin therapy significantly reduced the serum levels of DHA and low-density lipoprotein cholesterol (LDL-C), while it did not affect EPA level. Single regression analysis revealed that a decreased serum level of LDL-C was associated with decreased DHA level. The multiple logistic regression analysis revealed that the decreased DHA level after statin therapy and low serum level of EPA on admission were determinants of prevalence of ISR.

Conclusion: Statin therapy decreased the serum level of DHA with a parallel reduction in LDL-C level in patients with ACS. Decreased DHA level after statin therapy and low EPA level on admission are risk factors for ISR, indicating that in patients with ACS, decreased serum levels of DHA may be a residual target for the prevention of ISR.

A case of successful pregnancy and delivery after brain metastasis of choriocarcinoma

This is report regarding a 28-year-old woman who conceived and delivered a healthy child following treatment for brain metastasis of choriocarcinoma in 1980 and a prolonged postoperative disease-free period. The patient had delivered a hydatidiform mole. Eight months afterwards she was admitted to our hospital with occipital pain, vomiting and stupor, and upon CT examination was found to have a brain tumor. The surgically removed tumor was pathologically diagnosed as choriocarcinoma. Postoperative methotrexate chemotherapy rapidly lowered the preoperative urinary human chorionic gonadotrophin (19 IU/ml), and allowed restoration of the preoperative LH level, consciousness, ambulation, and manifest ovulation. Occasional mild cramps were received by continuous use of anticonvulsants which did not affect her daily life. Four and one-half years postoperatively she conceived, and had a healthy boy weighing 2,294 g at the 39th week of gestation in June 1985. Both mother and baby have been doing well for 7 postpartum years.