The left IMA graft to the LAD showed a string sign with no antegrade flow in an asymptomatic 67-year-old man 3 years after the operation. The LAD lesion had regressed from 95% stenosis to less than 50% during this period. Exercise electrocardiographic and thallium 201 myocardial scintigraphic examinations revealed no ischemia in the LAD region. When the LAD was temporarily occluded by a PICA balloon, the anterograde flow from the IMA to the LAD could be demonstrated by angiography. The IMA graft in no flow situation has maintained anatomical patency for 3 years after the operation.

We report a case with successful surgical resection for a leiomyoma with an extension into the right atrium from the pelvic vein. The patient was a 54-year-old woman who presented with syncope in 1989. She had had a history of resection of a uterine leiomyoma 10 years previously. Preoperative angiograms showed a long tumor with an extension into the right atrium through the inferior vena cava originating from the right internal iliac vein. The diagnosis of intravenous leiomyomatosis was made. The operation was performed through a median sterno-laparotomy using cardiopulmonary bypass with successful results. Histologic sections showed a benign leiomyoma. To our knowledge, 20 cases of resection of intravenous leiomyomatosis with the use of extracorporeal circulation have been reported in the literature. This rare condition was discussed with the review of the literature.

Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.

Objective: Therapeutic antibodies have few varieties of side effects due to their high specificity; however, many therapeutic antibodies have serious side effects. A thorough understanding of the side effects is crucial for early recognition and optimal management. To facilitate the understanding of the side effects of therapeutic antibodies, this study attempted to classify therapeutic antibodies based on their side effects using principal component analysis (PCA) and cluster analysis. Method: We collected data on the serious side effects of therapeutic antibodies from package inserts and created a therapeutic antibody-side effect matrix, with therapeutic antibodies as indices and side effects as columns. PCA was performed on the therapeutic antibody-side effect matrix, and hierarchical cluster analysis was performed using principal components. Results: The therapeutic antibodies were classified into four clusters. Cluster 1 included immune checkpoint inhibitors, and featured type 1 diabetes, thyroid disorder, and myasthenia gravis. Cluster 2 included antibodies that inhibit the vascular endothelial growth factor pathway, and featured impaired wound healing, nephrotic syndrome, and thrombosis. Cluster 3 included anti-epidermal growth factor receptor antibodies, and featured diarrhea, hypomagnesemia, and skin disorders. Cluster 4 included other therapeutic antibodies, and featured infection, bone marrow suppression, and hypersensitivity. Conclusion: Therapeutic antibodies can be classified based on their side effects. The results of this study make it easier to understand the side effects of therapeutic antibodies with complex profiles. A better understanding facilitates early detection of side effects and enables high-quality management of side effects.