An unusual cause of ischemia after coronary bypass grafting!!

Coronary subclavian steal syndrome is an uncommon cause of ischemia recurrence after coronary artery bypass grafting. Endovascular treatment of subclavian artery stenosis or occlusion is increasingly common and appears to offer a safe and effective alternative to surgical revascularization. We report a case of recurrent angina after coronary artery bypass grafting for critical subclavian artery stenosis. The anomalous origin of the vertebral artery from the aortic arch was an indication for endovascular treatment. We discuss the diagnostic difficulties and the management pitfalls of subclavian artery angioplasty in this syndrome.     

Deploying bioresorbable vascular scaffolds—tardus,altius, amplius!!

• Current generation bioresorbable vascular scaffolds (BVS) have thick struts and relatively low radial strength; meticulous deployment is required to prevent underexpansion while avoiding stent fracture.
• The current study suggests safety of very high‐pressure (mean 28 atm) post‐dilation of BVS with a noncompliant balloon.
• Duration of inflation and inflation pressure stabilization are important factors that influence the extent of optimal stent expansion and should be studied in future attempts to optimize BVS deployment.

     

潘托拉唑三联疗法与奥美拉唑三联疗法治疗幽门螺杆菌相关性消化性溃疡的对比研究

目的:研究潘托拉唑治疗消化性溃疡及根除幽门螺杆菌(HP)的疗效和安全性.方法:将经过胃镜和病理学检查证实了的消化性溃疡患者随机分成潘托拉唑组(治疗组)和奥美拉唑组(对照组).其中治疗组60例,应用潘托拉唑、羟氨苄青霉素和甲硝唑治疗;对照组57例,应用奥美拉唑、羟氨苄青霉素和甲硝唑治疗.停药后均复查胃镜观察溃疡愈合情况以及HP根除情况.结果:两组胃溃疡的愈合率分别为92.3%和95.4%,HP根除率分别为92.3%和90.9%;十二指肠溃疡的愈合率分别为97.1%和94.3%,Hp根除率分别为91.2%和94.3%,两组比较差异无显著性(P>0.1).各项症状的改善情况两组相似(P>0.1).治疗期间两组均有良好的耐受性.结论:潘托拉唑对消化性溃疡有很高的治愈率,以它为主的三联疗法可达到很高的HP根除率,对消化性溃疡的疗效与奥美拉唑相当,不良反应极少,患者耐受性、依从性好,是一种有广泛应用前景的新型质子泵抑制剂.     

肠道克隆病的X线诊断

目的:探讨X线对克隆病的诊断要点,并分析其误诊原因.方法:26例患者进行结肠和小肠双对比造影,男性14例,女性12例,平均年龄42岁.病理诊断为克隆病17例.X线表现包括:(1)纵行龛影,(2)卵石征,(3)偏心性狭窄,(4)病变节段性分布,这四种表现为克隆病的主要征象,(5)其他不典型表现.结果:根据X线表现将克隆病分为:(1)典型表现:具有三种主要征象,有5例(29.41%);(2)较典型表现:具有两种主要征象,有3例(17.56%);(3)不典型表现:只有一种主要征象,有9例(52.90%).X线将其他病变误诊为克隆病的9例患者中,8例(88.89%)为不典型表现,误诊的主要原因有肠结核病变的节段性分布,淋巴瘤和缺血性肠病的纵行龛影,溃疡性结肠炎的卵石征等.结论:出现三种主要征象,应首先考虑克隆病的诊断,出现两种主要征象,应疑诊克隆病.     

The Glomerulus: The Sphere of Influence

The glomerulus, the filtering unit of the kidney, is a unique bundle of capillaries lined by delicate fenestrated endothelia, a complex mesh of proteins that serve as the glomerular basement membrane and specialized visceral epithelial cells that form the slit diaphragms between interdigitating foot processes. Taken together, this arrangement allows continuous filtration of the plasma volume. The dynamic physical forces that determine the single nephron glomerular filtration are considered. In addition, new insights into the cellular and molecular components of the glomerular tuft and their contribution to glomerular disorders are explored.