Large anomalous systemic arterial supply to basal segments of the left lung

A 29-year-old man with a large anomalous systemic arterial supply to basal segments of the lower lobe was reported here. Pulmonary arteriography showed the absence of blood flow to basal segments. Aortography verified the anomalous artery from the descending thoracic aorta. Lobectomy was performed because the anastomosis between the anomalous and pulmonary arteries was anatomically difficult and segment 6 was small. The resected specimen showed that the anomalous artery had findings of pulmonary hypertension equivalent to grade V in the classification of Heath and Edwards. If the anastomosis between the anomalous and pulmonary arteries is anatomically feasible, pathological examination of open lung biopsy specimen is necessary to determine the operative procedures in this disease and two-staged operation is desirable.     

Continuous Blood Pressure Monitoring During Hernodialysis

As the number of patients suffering from circulatory problems increases, continuous blood pressure monitoring during hemodialysis is desirable. Monitoring of the fistulated venous pressure was proven to be a satisfactory substitute for that of the systemic arterial pressure, after fistulated venous pressure had been ascertained to correlate strictly with systemic arterial pressure. Utilization of a double-lumened cannula, one lumen for blood outflow and another for monitoring of fistulated venous pressure, was established and showed clinical applicability. This principle is considered to be useful not only for blood pressure monitoring, but also for activation of a dialysis machine control system.     

Preoperative glucocorticoids decrease pulmonary hypertension in piglets after cardiopulmonary bypass and circulatory arrest

BACKGROUND: Glucocorticoids during cardiopulmonary bypass benefit pediatric patients undergoing repair of congenital heart defects and are routine therapy, but underlying mechanisms have not been fully examined. The hypothesis was that glucocorticoids could improve cardiopulmonary recovery after cardiopulmonary bypass and deep hypothermic circulatory arrest. METHODS: Crossbred piglets (5 to 7 kg) were cooled with cardiopulmonary bypass, followed by 120-min deep hypothermic circulatory arrest. Animals were then warmed to 38 degrees C, removed from bypass, and maintained for 120 min. Methylprednisolone (60 mg/kg) was administered in the cardiopulmonary bypass pump prime (intraoperative glucocorticoids) or 6 hours before bypass (30 mg/kg) in addition to the intraoperative dose (30 mg/kg; preoperative and intraoperative glucocorticoids). Controls (no glucocorticoids) received saline. RESULTS: Pulmonary vascular resistance in controls increased from a baseline of 152 +/- 40 to 364 +/- 29 dynes. s/cm(5) at 2 hours of recovery (p < 0.001). Intraoperative glucocorticoids did not alleviate the increase in pulmonary vascular resistance (301 +/- 55 dynes. s/cm(5) at 2 hours of recovery, p < 0.001). However, animals receiving pre and intraoperative glucocorticoids had no increase in pulmonary vascular resistance (155 +/- 54 dynes. s/cm(5)). Plasma endothelin-1 in controls increased from 1.3 +/- 0.2 at baseline to 9.9 +/- 2.0 pg/mL at 2 hours recovery (p < 0.01), whereas glucocorticoid-treated animals had lower endothelin-1 levels (4.5 +/- 2.1 pg/ml, preoperative and intraoperative glucocorticoids; 4.9 +/- 1.7 pg/mL, intraoperative glucocorticoids) at the end of recovery (p < 0.05). Intracellular adhesion molecule-1 in lung tissue was lower in animals receiving pre and intraoperative glucocorticoids (p < 0.05). Myeloperoxidase activity was elevated in control lungs at 2 hours of recovery compared with glucocorticoid-treated groups (p < 0.05). Inhibitor kappaBalpha, the inhibitor of nuclear factor-kappaB, was higher in lungs of animals receiving glucocorticoids compared with controls (p < 0.05). CONCLUSIONS: Glucocorticoids prevented pulmonary hypertension after cardiopulmonary bypass and deep hypothermic circulatory arrest, which was associated with reduced plasma endothelin-1. Glucocorticoids also reduced pulmonary intercellular adhesion molecule-1 and myeloperoxidase activity. Inhibition of nuclear factor-kappaB, along with reduced neutrophil activation, contributed to glucocorticoid alleviation of pulmonary hypertension after cardiopulmonary bypass and deep hypothermic circulatory arrest.     

细胞间粘附分子-1的反义寡核苷酸在小鼠心脏移植中的作用

目的 探讨细胞间粘附分子-1(ICAM-1)的反义寡核苷酸(ICAM-1-ASO)在小鼠心脏移植中对ICAM-1表达以及在排斥反应中的作用.方法 以BALB/c小鼠为供者,C57小鼠为受者,建立颈部异位心脏移植模型,移植后将受者随机分为3组,每组10只.分别为单纯移植组、对照寡核苷酸组(对照ODN)和ICAM-1-ASO组.各组移植后24 h开始经受者静脉分别注射双蒸水0.3 ml、对照ODN 10 mg/kg和ICAM-1-ASO 10 mg/kg,每天1次,连续5 d.移植后第8天各组随机取5只受者切取移植心,进行病理学检查;采用免疫组织化学方法对移植心组织中ICAM-1的表达进行观察;采用半定量逆转录聚合酶链反应(RT-PCR)对ICAM-1mRNA表达进行定量分析.每组中余下的小鼠继续观察直至移植心停跳,记录各组移植心的存活时间.结果 单纯移植组心脏移植后第8天可观察到明显的排斥反应,移植心心跳减慢、心律不齐、心律紊乱、搏动无力;病理学检查可见大量的淋巴细胞浸润,心肌间质水肿及大片心肌坏死;与移植前对比,内皮细胞和心肌细胞ICAM-1表达明显增强;ICAM-1mRNA表达也明显增加;移植心存活时间平均为(9.8±1.48)d.对照ODN组与单纯移植组差异无统计学意义.而ICAM-1-ASO组与单纯移植组相比,移植心ICAM-1的表达明显减弱,淋巴细胞浸润明显减少,排斥反应程度减轻;移植后第9天心律基本规整,偶有心律不齐,心跳力度较单纯移植组增强;移植心存活时间明显延长至(14.6±1.14)d.结论 ICAM-1-ASO抑制移植心组织中ICAM-1的表达和淋巴细胞的浸润,抑制移植后排斥反应的发生和发展,改善移植物的功能,延长移植物的存活时间,其作用具有序列特异性.     

Pulmonary oxygen transfer deficits of diabetic origin in patients undergoing coronary artery bypass grafting

The objective of this study was to determine the effects of a diabetic disposition on pulmonary gas exchange by examining 72 patients who underwent coronary artery bypass grafting (CABG), using the arterial/alveolar oxygen tension ratio [(a/a)Po ₂] as a criterion. Patients were divided into a diabetic (DM) group and a nondiabetic (non-DM) group. The postoperative blood gases and hemodynamic data measured when the blood glucose level was at a maximum on the day of CABG were used as the postoperative pulmonary gas exchange indices, and the physicians who managed these patients were unaware of this study. The preoperative (a/a)Po ₂ ratio was 0.66±0.03 (SE) in the DM group and 0.78±0.02 in the non-DM group (P<0.01), while the postoperative ratios were 0.42±0.03 and 0.52±0.03, respectively (P=0.01). The correlation coefficient (r) for regression analysis of the relation between the postoperative Pao ₂/Fio ₂ ratio and the postoperative (a/a)Po ₂ ratio was 0.99 in the DM group (P<0.01) and 0.88 in the non-DM group (P<0.01). The r values of the relation between (a/a)Po ₂ and (a-a)Po ₂ were –0.68 (P<0.00) and –0.84 (P<0.01), while those for the respiratory index were –0.87 (P<0.01), and –0.93 (P<0.01), respectively. Thus, pulmonary oxygen transfer was compromised before and after CABG in the DM group compared to the non-DM group. Moreover, the Pao ₂/Fio ₂, being the simplest pulmonary gas exchange index to calculate, was a reliable substitute for the (a/a)Po ₂ ratio during the early postoperative management of CABG patients.     

高晶体-高胶体渗透压混合液对脂多糖刺激的人血管内皮细胞ICAM-1 mRNA表达的影响

目的：探讨脂多糖（LPS）刺激的人血管内皮细胞（HUVECs)表面ICAM－1 mRNA表达的规律以及高晶体－高胶体渗透压混合液（HHS）对此过程的影响，方法：分离健康产妇脐静脉内皮细胞，进行原代培养，细胞长至单层时用逆转录酶－聚合酶链反应法分析其ICAM－1 mRNA的表达，结果：正常情况下HUVECs表面ICAM－1 mRNA表达微弱，LPS刺激1h后表达开始增加，至4h处达到峰值，0．25％，0．5％高晶体－高胶体渗透压混合液均可明显抑制LPS刺激的ICAM－1 mRNA表达（P＜0．05），但两者之间并无明显差异，且其作用时间对ICAM－1 mRNA表达也无明显影响，结论：LPS刺激的ICAM－1 mRNA表达是一个缓慢而持续的过程，HHS可明显抑制脂多糖诱导的ICAM－1 mRNA表达，且这种作用不受HHS浓度及作用时间的影响。     

Markers of inflammation and atherosclerosis in Egyptian patients with systemic lupus erythematosus

BACKGROUND: Cardiovascular events are markedly increased in systemic lupus erythematosus (SLE) and the mechanism of atherogenesis remains poorly understood. Low-grade inflammation and endothelial dysfunction play pivotal roles in the initiation, progression and propagation of the atherosclerotic process. Several methods have been employed to assess endothelial function, among them the measurement of biomarkers of endothelial activation and dysfunction (intercellular adhesion molecule (ICAM)-1). Since then, it has been reported that such biomarkers play a more important role than traditional risk factors in cardiovascular disease. OBJECTIVE: To measure (tumour necrosis factor (TNF)-alpha, interleukin (IL)-6 and ICAM-1) levels as markers of inflammation and atherosclerosis in 40 Egyptian patients with SLE with various degrees of activity in comparison with 20 healthy volunteers, and to investigate their relationship to disease activity and hypertension. METHODS: Sixty subject (40 with SLE and 20 healthy controls) were the subject of this study, their clinical disease activity was scored according to the SLE Disease Activity Index (SLEDAI), and serum sampling was obtained for TNF-alpha, IL-6 and ICAM-1 level assay. Renal biopsy was carried out and examined by light microscopy. The mean level of TNF-alpha, IL-6 and ICAM-1 were significantly higher in SLE patients with active disease (766.95 +/- 357.82 Pg/mL, 135.4 +/- 54.23 Pg/mL, 826.05 +/- 367.1 Pg/mL) when compared with those with inactive disease (314.01 +/- 100.87 Pg/mL, 47.33 +/- 18.61 pg/mL, 441.33 +/- 225.19 Pg/mL) and healthy control volunteers (172.7 +/- 39.19 Pg/mL, 21.15 +/- 10.99 Pg/mL, 111.5 +/- 17.36 Pg/mL), respectively. Furthermore, these levels were significantly higher in hypertensive (614.08 +/- 333.05 Pg/mL, 107.86 +/- 54.96 Pg/mL and 862.13 +/- 333.29 Pg/mL) compared to normotensive patients (267.5 +/- 112.72 Pg/mL, P = 0.008, 35.75 +/- 20.26 Pg/mL, P = 0.02I, and 337.25 +/- 235.62 Pg/mL, P = 0.02) for TNF-alpha, IL-6 and ICAM, respectively. There were no statistically significant difference regarding age, sex, smoking, cholesterol and high-density lipoprotein (HDL) levels between hypertensive and normotensive patients. CONCLUSION: A high concentration of soluble ICAM-1 in Egyptian patients with SLE and nephritis is reported here for the first time. Our finding of increased concentrations of TNF-alpha, IL-6 and ICAM-1 in Egyptian patients with SLE and lupus nephritis underlines the importance of inflammation and endothelial involvement in this disorder, but their predictive value in the disease monitoring needs to be further studied.