Kawasaki disease: State of the art

Kawasaki disease is an acute febrile arteritis of childhood that can result in coronary artery aneurysms if untreated in the first 10 and ideally 7 days of illness. Kawasaki disease begins as a necrotizing arteritis with neutrophilic infiltrate, followed by subacute/chronic changes and luminal myofibroblastic proliferation that can cause coronary artery stenosis. Manifestations include the presence of ≥5 days of fever, together with clinical criteria of extremity changes, rash, conjunctivitis, oral changes, and unilateral cervical lymphadenopathy. Echocardiography should be performed at the time of diagnosis, then 1–2 weeks and 4–6 weeks later, with more frequent studies in individuals with coronary artery dilation or persistent fever. Coronary artery dimensions are characterized both as z‐scores and absolute measurements, and coronary architecture evolves over time in children who have aneurysms in the first weeks of illness. Systematic follow‐up and therapies are tailored to the degree of coronary disease and to coronary ischemia.     

Sleep apnea: State of the art

Many patient with, or at risk of, cardiovascular disease have sleep disordered breathing (SDB), which can be either obstructive (with intermittent collapse of the upper airway) or central (episodic loss of respiratory drive). SDB is associated with sleep disturbance, hypoxemia, hemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalize the sleep and respiratory physiology, but recent randomized trials of cardiovascular outcomes in SDB have either been neutral (obstructive sleep apnea) or suggested the possibility of harm, likely from increased sudden death, in central sleep apnea. Alternative methods for the treatment of SDB are being explored, including implantable technologies, but these have not been studied in adequately powered randomized controlled studies. International guidelines recommend screening for SDB, which can be done easily in clinical practice, as there may be a role for the treatment of patients with obstructive sleep apnea and daytime sleepiness, or resistant hypertension, or atrial fibrillation. Further randomised outcome studies are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnea; for those with heart failure with preserved ejection fraction; and for those with decompensated heart failure. The case is made that no longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with sleep apnea and cardiovascular disease.     

Hepatocyte transplantation: State of the art

Advances in biotechnology have allowed hepatocyte transplantation as a relevant proposition to treat liver disease. This procedure may change the crescent mortality in liver transplantation waiting lists due global organ shortage. Recent clinical trials have described promising results of hepatocyte transplantation for acute, acute-on-chronic and metabolic liver disease. In this report, we discuss progresses regarding hepatocyte culture, cryopreservation systems, hepatocyte immortalization, suitable recipient site for hepatocyte engraftment, cell differentiation and fusion into hepatocytes, current clinical trials, and summarize the bioartificial liver systems. These progressions motivate expectation concerning hepatocyte transplantation as a consistent therapy for liver disease.     

State of the art: Cardiac transplantation

Recent advances in the management of heart transplant recipients have resulted in improved survival, particularly in the early post-transplant period. Although graft rejection, infection, malignancy, and allograft vasculopathy remain important challenges to the long-term management of heart transplant recipients, active research in these fields continues to advance our understanding and improve outcomes. This review will provide an overview of modern heart transplantation, summarize our current understanding of best practices for the management of heart transplant recipients, and describe recent advances in the field and areas of active research.     

State of the art: interventional pulmonology

Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.     

State of the art: sequelae of tuberculosis

Sequela of tuberculosis (TB sequela) is defined as the state with various secondary complications after healing of TB, such as chronic respiratory failure (CRF), cor pulmonale or chronic pulmonary inflammation. Pathophysiology of TB sequelae is consisted of disturbed pulmonary function, CRF, sleep disorder and pulmonary hypertension. In addition, secondary pulmonary infection with mycosis or nontuberculous mycobacteriosis (NTM) is difficult to be controlled.     

Imaging of vasculitis: State of the art

The increasing availability and improvement of imaging techniques are making a profound impact in the evaluation and management of patients with vasculitis, particularly for those with large vessel vasculitis, and will most likely play an ever more important role in the future. Deep, large vessels can be examined by CT or MRI, while ultrasound is the method of choice for the evaluation of superficial vessels (such as temporal, carotid, and axillary arteries). PET is very sensitive in detecting large vessel inflammation, but it does not delineate the vessel wall. Imaging studies can also be used to monitor the disease course and the development of late vascular complication. This review will focus on the role of imaging studies in diagnosing and monitoring LVV, but will also mention their principal applications in medium and small-sized vessel vasculitis. Indications and limitations of the available imaging modalities will be discussed as well.     

State of the art: Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common of the autoimmune musculoskeletal conditions in children. As awareness of this condition increases, so too does the apparent prevalence reported from countries around the world, suggesting that significant numbers of children with JIA have previously gone undiagnosed. Prevalence varies with race and possibly geography. However, JIA should no longer be considered as a rare condition. In the past decade, there have been definite advances in understanding the pathogenesis of JIA, and there have been parallel advances in therapies. There have been fairly modest advances in the classification of JIA, but there is at least heightened international debate on the issue, which will lead to progress. It is estimated that nearly one‐third of children with this condition continue into adult life with inflammatory joint disease, and therefore the burden of disease remains significant.     

Coronary CT angiography:State of the art

Coronary computed tomography(CT)angiography has been recognized as the most rapidly developed imaging technique in the diagnosis of coronary artery disease due to the emergence and technological advances in multislice CT scanners.Coronary CT angiography has been confirmed to demonstrate high diagnostic and predictive value in coronary artery disease when compared to invasive coronary angiography.However,it suffers from high radiation dose which raises concerns in the medical field.Various dose-reduction strategies have been proposed with effective outcomes having been achieved to reduce radiation exposure to patients.This article provides an introduction and overview of the series of articles that will focus on each particular topic related to coronary CT angiography.     

Vulnerable plaque intervention: State of the art

Progressive atherosclerotic disease is responsible for many of the late adverse clinical events that detract from the high procedural and clinical success of percutaneous coronary intervention. Despite recent advances in catheter based technology for the treatment of obstructive coronary artery disease, the greater risk to the patient over time may in fact come from the significant rate of acute coronary events triggered by nonculprit and/or nonobstructive coronary artery lesions. These areas of vulnerability within the epicardial coronary tree have generated a great deal of interest surrounding the concepts of vulnerable plaque (VP), vulnerable blood and the vulnerable patient. This ‘state of the art’ review discusses the limitations of coronary angiography alone in providing risk assessment; reviews the underlying biological concepts of VP; discusses evolving noninvasive and invasive imaging technologies for the detection of VP; and finally provides a futuristic look at how the field of interventional cardiology may transcend the traditional angiogram and move toward a more comprehensive treatment approach that benefits the patients' overall coronary health. © 2008 Wiley‐Liss, Inc.     

Ileal pouch-anal anastomosis: State of the art

IPAA surgery has evolved to assume a major role in the operative management of CUC and FAP. In experienced centres, the safety of performing this somewhat complex procedure, often in gravely ill patients, has been confirmed. A significant decrease in morbidity has accompanied increased experience and simplification of the operative techniques. Two major issues await resolution. The first has to do with the less than totally predictable functional results of IPAA surgery. While many patients do well, others, for no apparent reason, do poorly with excess frequency, urgency and incontinence. Whether operative modifications or preoperative testing can alter this outcome is at this time unclear. The second issue has to do with the potential long-term sequelae of IPAA surgery. Pouchitis and nutritional and metabolic consequences, including the potential for malignant transformation of ileal mucosa or of retained rectal mucosa, cannot be ignored. At present, these risks seem remote but only long-term follow-up will determine whether IPAA surgery deserves its current enthusiasm.     

Liver magnetic resonance imaging: State of the art

Magnetic resonance imaging (MRI) has now been used for about three decades to characterize the human liver in a non-invasive way, that is without the need of using ionizing radiation or removing tissue samples. During the past few years, technical progress has been considerable and novel applications of MRI have been implemented in the clinic. The beginning of a new decade offers an excellent opportunity for having fi ve experts to present their view on the current status of MRI (and magnetic resonance spec...