Entrapment of diagnostic catheter within Advisor HD grid mapping catheter

The potential for catheter entanglement with the HD Grid mapping catheter is explicitly stated in the manufacturer's product manual. A case of an entrapped 6 French quadripolar diagnostic catheter within an HD Grid mapping catheter is presented. We discuss the diagnosis, management, and resolution of this complication in our patient. The patient's arrhythmia was successfully eliminated, and no vascular complication in the postprocedural setting nor arrhythmia recurrence at follow-up were observed. Strategies to prevent and safely manage this complication, while salvaging access, are also discussed.     

Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

This study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 18% and 29% respectively. On the other hand, 20% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma ( p  = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury ( p  = 0.001). The MESS has a significant correlation to both age groups I and II ( p  = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.     

Surgical anatomy of hepatoduodenal ligament and hepatic hilus

The anatomical situation and variations of structures in the hepatoduodenal ligament and hepatic hilus are a legacy of their embryological development. The vascular, biliary, and lymphatic structures contribute to the functioning of blood and bile flow as well as lymph drainage of the liver. Connective tissue, fatty tissue, and the peritoneal sheet are enveloping underlying structures. Their position, shape, and relation to neighboring structures influence the situation during operative procedures. The cystic artery origin is variable, as is the number; and its recognition is important for safe cholecystectomy. Venous drainage of the gallbladder goes into the portal system of adjacent segments 4 and 5 and influences the spread of gallbladder pathology. There are some surgically important variations in the course and distribution of bile ducts and arteries in the hepatoduodenal ligament. The biliary anatomical variations significantly influence the incidence of bile ducts injuries during laparoscopic cholecystectomy. The arterial supply of extrahepatic bile ducts is delicate and variable and should be considered when trying to prevent ischemic injuries to the bile ducts. Inflammation and the combination of inflammation and anatomical variation are thought to contribute to a dangerous situation in regard to eventual injury to the bile ducts and vascular structures during operative procedures. This paper explores these questions.     

Effects of arginine-vasopression on regional blood volume distribution in supine humans

Summary In healthy humans, the increase in arterial blood pressure seen in patients with autonomic dysfunction in response to exogenous vasopressin (AVP) is abolished. We tested the hypothesis that redistribution of blood from the intra- to the extrathoracic vascular compartment might contribute to this buffer response. Regional distribution of^99mTc labeled autologous red cells was assessed in healthy supine volunteers (n=7) during arginine-vasopressin administration (1 ng·kg^–1 bolus i.v. followed by a 14-min infusion of 3 ng·kg^–1·min^–1), along with arterial and central venous pressures, and heart rate. Exogenous vasopressin increased plasma vasopressin concentration from 4.0±1.4 SEM to 91 pg·ml^–1±12. Thoracic counts increased slightly but significantly by 2.2%±0.9, while global abdominal counts remained unchanged. Most surprisingly, counts in the liver markedly increased (+8.1%±1.8, p=0.02), but significantly decreased in the spleen (–3.1%±1.4). Intestinal (–2.5%±2.4) and limb counts did not change significantly. Consistent with the increase in thoracic counts centralvenous pressure increased from 3.6 mm Hg±1 to 4.7±1 (p=0.02), while arterial pressure and heart rate did not change. All changes reversed towards baseline when vasopressin administration ceased. Thus, in humans with an intact autonomic system, vasopressin, at concentrations observed during hypotension, increases liver and, albeit to a small extent, also thoracic blood volume, but decreases splenic blood content. These results 1) are incompatible with the hypothesis that AVP induces a shift of blood from intra- to extrathoracic capacitance vessels, and 2) show that AVP increases rather than decreases central blood volume.     

甲氨蝶呤抑制兔颈动脉球囊损伤后新生内膜形成

目的　探讨不同剂量甲氨蝶呤 (MTX)对血管损伤后新生内膜形成的影响。方法　制备兔颈动脉球囊损伤模型 ,动物随机分为对照组、MTX 0 5mg/kg、MTX 1 5mg/kg及MTX 5mg/kg组 ,每组 5～ 8只 ,采用肌肉注射方式给药 ,于术后 2周和 4周取材 ,分别进行伊文思染色观察内皮覆盖情况、增殖细胞核抗原 (PCNA)免疫组化染色和定量组织形态学分析。结果　MTX治疗组血管内膜面积、内膜 /中膜面积比值均显著低于对照组 ,内膜面积抑制率达 4 6 %～ 5 6 %,不同剂量MTX之间差异无显著性。内膜及中膜PCNA阳性细胞数目较对照组减少。伊文思蓝染色显示各组间内皮修复程度差异无显著性。结论　MTX能够有效地抑制球囊损伤后血管平滑肌细胞的增殖和新生内膜形成 ,在一定剂量范围内 ,MTX的作用无明显差异。     

高血压病患者脉压与靶器官损害的关系

目的　探讨脉压与高血压病靶器官损害的关系。方法　回顾性调查近 5年住我院未治疗高血压病患者 696例(男 3 87例 ,女 3 0 9例 ) ,按平均压 <10 7mmHg和≥ 10 7mmHg分为二组 ,再分别以脉压≤ 60mmHg ,60 10 0mmHg分为 4个亚组。分析各亚组的脉压与体重指数 (BMI)、血糖、血脂、BUN、Cr、UA、CCr、LVMI、EF、FS及心脑并发症发生率的相关性。结果　 ( 1)各亚组的高血压病史、吸烟者、饮酒者、BMI、血糖、甘油三酯 (TG)、胆固醇 (TC)、高密度脂蛋白 (HDL)及低密度脂蛋白 (LDL)无明显差别 (P >0 0 5) ;( 2 )脉压与BUN、Cr、UA、年龄、SBP、LVMI呈正相关 (r分别为 0 75,0 60 ,0 70 ,0 48,0 59,0 56,P均 <0 0 5) ,而与CCr、DBP、FS、EF呈负相关 (r分别为 -0 68,-0 52 ,-0 49,-0 51,P均 <0 0 5)。 ( 3 )左室肥厚、冠心病、心功能不全及脑并发症的发生率与患者年龄、收缩压、舒张压和脉压有关 (P均 <0 0 5) ,统计学分析脉压起着更重要的作用。结论　高血压病患者的靶器官损害与年龄、收缩压、舒张压和脉压等因素有关 ,但脉压起着更重要的作用     

Early time course of neointima formation and vascular remodelling following percutaneous coronary intervention and vascular brachytherapy of in-stent restenotic lesions as assessed by intravascular ultrasound analysis

Summary In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up.By QCA the acute lumen gain measured 2.2±0.8 mm, the late lumen loss at 3 months was 0.1±0.5 mm and at 6 months 0.4±0.7 mm. By IVUS luminal cross-sectional area increased from 1.5±1.2 mm² to 7.9±1.9 mm² (p<0.001). The intima hyperplasia cross-sectional area at 3 months was only 0.2±1.0 mm² (p=0.191), but increased to 0.7±0.6 mm² (p<0.001) at 6 months resulting in a lumen cross-sectional area of 7.1±1.7 mm². Stent dimensions did not show any significant changes over time. The external elastic membrane cross-sectional area at 3 months increased by 1.3±1.9 mm² (p<0.001), and showed a further increase by 0.7±2.9 mm² at 6 months. Positive remodelling could be demonstrated also at the reference segment.In conclusion the absolute amount of intima hyperplasia during a 6-month follow-up period after VBT of ISR is low and most pronounced between the third and sixth month. Besides this, predominantly within the first 3 months of follow-up, significant positive remodelling could be demonstrated at the target lesion and at the reference site. Both observed effects may contribute to the preservation of the vessel lumen.Diese Publikation enthält die Ergebnisse der Promotionsarbeit von Frau Andrea Zimmermann     

The future of saphenous vein as a coronary artery bypass conduit

Continuing widespread use of autologous saphenous vein for coronary artery bypass grafting seems unavoidable despite its poor-term patency. We review here the evidence that platelet activation is responsible for early and late vein graft occlusion and conclude that other mechanisms probably contribute to late occlusions. We suggest that a rational strategy to improve vein graft patency should include: improved endothelial preservation during surgical implantation; use of better antiplatelet agents, in particular those which prevent platelet adhesion as well as aggregation; reduction of risk factors including serum cholesterol; and application of agents (e.g. heparin) which inhibit smooth muscle cell proliferation directly. We draw parallels between the pathogenesis of vein graft occlusion and coronary atherosclerosis and suggest that testing strategies for improving vein graft patency may also shed light on atherogenesis.     

CD34和VEGF在肝癌组织中的表达及与肿瘤血管生成的相关性

目的探讨CD34和血管内皮生长因子（VEGF）在肝细胞肝癌（HCC）组织中的表达及微血管密度（MVD）的临床病理意义。方法应用链霉素扰生物素蛋白-过氧化物酶法（S—P法）对50例HCC患者进行肿瘤血管生成免疫组织化学检测。对CD34阳性血管进行MVD计数．对VEGF进行半定量计数，并分析与HCC的临床病理特征的关系及意义。结果CD34在HCC组织中呈广泛、窦隙状表达，MVD值在有汇管区癌栓和肝内转移者高于无汇管区癌栓和无肝内转移者（P〈0．05），VEGF表达的阳性率在有汇管区癌栓和肝内转移者明显高于元汇管区癌栓及无肝内转移者（P〈0．05）。MVD值在VEGF阳性组和阴性组之间差异有显著性（P〈0．05）。结论HCC中MVD值和VEGF阳性表达率明显增高，由自分泌和旁分泌产生的VEGF通过促进HCC肿瘤血管生成而促进HCC的生长和转移。