停用辛伐他汀对健康男性肱动脉内皮功能的影响

目的 观察停用辛伐他汀对Tc水平正常健康男性肱动脉内皮功能的影响.方法 16例健康青年男性服用20mg辛伐他汀4周后停药,分别检测停药前后不同时间点肱动脉内皮依赖性舒张功能(FMD),并测定血管活性物质--NO、血浆内皮素和6-酮-前列腺素F1α(6-keto-PGF1α)以及血脂参数的变化.结果 健康男性服用辛伐他汀4周后,在停药第1天观察到FMD较停药前明显降低,甚至低于未服药时的基线水平(P＜0.05).停药后血清NO水平较停药前和基础值亦明显降低,其变化与FMD的变化一致.停药后血浆内皮素水平升高,6-keto-PGF1α水平降低.血清LDL-C在停药后最初2d内无明显改变,其变化与FMD无明显相关.结论 健康男性服用辛伐他汀后突然停药,不仅使该药对肱动脉内皮功能的改善作用迅速消失,而且还对血管内皮功能造成进一步损害,该不良影响可能与循环中NO水平降低有关,是非TC依赖性的.     

Spontaneous coronary artery dissection: Case series and review of literature

AimSpontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management.MethodsA retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed.ResultsAll patients were young (mean – 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy.ConclusionsClinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival.Implications and practiceThe awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.     

Case report of a rare spontaneous superficial temporal artery aneurysm

Unlike posttraumatic temporal artery aneurysm, spontaneous temporal artery aneurysm is an exceptional finding. We report the case of a 34-year-old woman with no history of previous trauma who presented a progressively enlarging right temporal lump. A CT scan revealed a 1.6 cm diameter aneurysm arising from the superficial temporal artery. The aneurysm was surgically resected. The postoperative course was uneventful. Histological examination revealed the presence of intima, media and adventitia.     

Case report: a very large dissection in the left anterior descending coronary artery of a 56-year-old man

Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intimal tears that initiate and propagate the dissection in the vessel wall. In rare cases, the SCAD occurs in male patients. We report the case of a 56-year-old man with acute myocardial infarction who was successfully treated via systemic thrombolysis in a peripheral hospital. Associated conditions were thrombosis of right femoral artery in the past and high platelet count (800,000/mm³). After 1 month, elective coronary angiography revealed a very diffuse spiral dissection of the left anterior descending artery; hence, our choice of medical treatment consisted of double oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg once daily). After a 2-year follow-up, there was absence of both angina and myocardial ischemia and there was a decrease in platelet count. Many strategies could be considered in patients with SCAD, such as PCI, bypass surgery, or conservative medical management. In general, the long-term prognosis of patients with SCAD is considered favorable if they survive the acute phase.     

Spontaneous coronary artery dissection: Case report and evidence for a defect in collagen metabolism

Spontaneous coronary artery dissection is a rare disease witha higher prevalence in women, especially in the post-partumstate. In one case, we attempted to relate this pathology toa disorder in collagen metabolism. A 32-year-old woman presentedtwo episodes ofmyocardial infarction, 2 and 4 months after deliverywhich were shown to be due to two consecutive coronary arterydissections on coronary angiogram. Collagen metabolism was investigated in skin fibroblast culturesderived from the patient, and in control fibroblast cultures.After protein labelling in culture, total protein and collagensynthesis were determined. Quantification of procollagen synthesizedin cell cultures and their rate of conversion into collagenwere determined both in the culture media and a cell layer extractby DEAE cellulose chromatography. The results showed a reduced total collagen synthesis in thecultures of the patient in comparison with control cultures.The ratio between type I and III procollagen was not altered.The rate of conversion of procollagen into collagen was higherin the pathological cultures than in control cultures. Impairedcollagen synthesis due perhaps to a change in hormonal equilibriumin the post-partum state might therefore have been responsiblefor coronary artery dissection.     

Spontaneous coronary artery dissection and associated CT coronary angiographic findings: a case report and review

We report a case of an acute coronary syndrome in a 21-year-old male with invasive coronary angiography and computed tomography (CT) coronary angiography showing a spontaneous dissection of the left anterior descending artery. To our knowledge the CT coronary angiographic appearance of spontaneous coronary artery dissection has been reported only once before. We describe the role CT coronary angiography may have in the evaluation of coronary dissection as well as potential treatment options.     

Spontaneous regression of hepatic inflammatory pseudotumor with primary biliary cirrhosis： Case report and literature review

Hepatic inflammatory pseudotumor (IPT) is a rare benign non-neoplastic lesion characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the association of IPT with systemic inflammatory disorders has been well established, a specific relationship with cholangitis is distinctly rare. We report a case of spontaneous regression of hepatic IPT with primary biliary cirrhosis (PBC). To date, only two cases of IPT with PBC have been reported. In our case, however, IPT developed during the course of improvement of cholangitis of PBC induced by effective treatment, differing from two previously reported cases. Our case indicates that the development of IPT does not also relate to the activity of cholangitis and/or hyper gamma-globulinemia, since our case was confirmed radiologically to be free of IPT when biliary enzymes and immunoglobulins were much higher than the corresponding values on admission. Comparison of our case with the two previously reported cases suggests that IPT occurring with PBC does not represent the same disease entity or be a bystander for PBC.     

Bentall operation in a patient with an anomalous left circumflex artery: Case report and review

Anomalous origin of a left circumflex artery from the right coronary sinus represents a technical challenge in patients who require aortic valve/root procedures. This case report describes a patient who presented with bicuspid aortic valve, anomalous origin of the circumflex artery, severe aortic regurgitation, and aneurysm of the ascending aorta as well as aortic root that was safely managed following the Bentall procedure with the combined button technique.     

Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.     

Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion: Case report

Rationale:Central retinal artery occlusion and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; to date there is no effective therapy for central retinal artery occlusion and BRAO. Transluminal Nd:YAG laser embolysis (TYE) could represent a therapeutic approach for retinal vascular occlusive diseases.Patient concerns:We report 2 cases with BRAO, 1 with inferor-temporal and 1 with superor hemiretinal BRAO. All the patients complained of a history of sudden blurry vision and impaired visual field and had a visible embolus within the intravascular, all of them treated with TYE, the laser applications being delivered directly to the embolus.Diagnosis:The diagnosis was based on the results from color retinography, optical coherence tomography and visual field testing. Fundus fluorescein angiography clearly indicated the location of retinal artery occlusion.Interventions:The patients’ symptoms could not be relieved after dilating the blood vessels in the eye, lowering intraocular pressure, massaging the eyeball, and inhaling oxygen. Informed consent was obtained from the patient for TYE and the patients were referred for this procedure.Outcomes:Upon the successful competition of the TYE procedure the embolus was removed completely, restoring the blood flow in the intraocular vessels and improving significantly the patients’ visual acuity.Lessons:World-wide experience with TYE is still limited, but the technique seems feasible for the treatment of RAO caused by visible emboli on the optic disc surface and the posterior pole of the fundus oculi.     

Never too late: A commentary on “Impact of age, sex and exercise on brachial and popliteal artery remodelling in humans”

Lysyl oxidase (LOX) is an enzyme critical for the stability of extracellular matrix and also known to have diverse biological functions. Little is known, however, about the role of LOX in regulating inflammation. Here we demonstrate that LOX suppresses secretion of monocyte chemoattractant protein-1 (MCP-1) in cultured vascular smooth muscle cells. Furthermore, enhancement of LOX activity reduces MCP-1 in a mouse model of abdominal aortic aneurysm (AAA), thereby preventing macrophage infiltration and AAA progression. These findings suggest that LOX has a novel function in resolving inflammation by reducing MCP-1 in AAA.     

Spontaneous rupture of a renal artery pseudoaneurysm in a hemodialysis patient: A case report

Rationale:Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported.Patient concerns:A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior.Diagnosis:Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms.Interventions:On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed.Outcomes:Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization.Lessons:When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.     

Endovascular therapy for acute basilar artery occlusion caused by vertebral artery dissection: Case report

Rationale:The best endovascular therapy revascularization strategies for acute ischemic stroke caused by vertebral artery dissection (VAD) are unclear. We describes a case of basilar artery (BA) occlusion caused by extracranial VAD, in which we used a stent-retriever to achieve thrombectomy in the BA through the contralateral vertebral artery (VA).Patient concerns:A 32-year-old male presented with a sudden-onset headache accompanied by articulation disorder, left-sided weakness, and tinnitus in the left ear.Diagnosis:Digital subtraction angiography showed the V1 to V2 segment dissection of the left VA and occlusion of the BA.Interventions:Thrombectomy was performed through the thinner right VA with three passes of the Solitaire FR device 4 × 20 mm in the BA, and angiograms showed modified treatment in cerebral ischemia 3 reperfusion of BA and left VA V4 segment still occluded.Outcomes:The patient had a modified Rankin Scale of 2 at 90 days, and re-established blood flow of the left VA and BA.Lessons:When extracranial VAD complicated with BA occlusion, choosing the clean-road path to perform a BA thrombectomy may be a fast and effective treatment strategy.     

肝动脉栓塞治疗晚期原发性肝癌破裂大出血的临床应用（附45例分析）

目的探讨肝动脉栓塞（TAE）治疗晚期原发性肝癌破裂大出血临床应用的价值和疗效。方法回顾性分析45例失去手术指征的晚期原发性肝癌破裂大出血患者急诊TAE治疗。其中8例在行TAE治疗的同时行肝动脉化疗栓塞术治疗。结果45例肝癌破裂出血患者全部止血成功,无复发性出血及急性肝功能衰竭发生。结论TAE是治疗晚期原发性肝癌破裂大出血安全、有效和首选的方法。     

Endovascular stenting for treatment of an adult patient with pulmonary artery stenosis with 1-year follow-up

This report describes the occurrence of symptomatic proximal left main pulmonary artery stenosis in a 58-yr-old man that was successfully treated with endovascular stenting with 1-yr follow-up. The technique and pitfalls of this procedure are described. Endovascular stenting provided a well-tolerated, nonsurgical approach to alleviating isolated pulmonary artery stenosis in this patient. © 1996 Wiley-Liss, Inc.     

Spontaneous bacterial empyema in a cirrhotic patient due to Clostridium perfringens: Case report and review of the literature

We report a case of a cirrhotic patient who developed a spontaneous bacterial empyema due to Clostridium perfringens. To our knowledge, only two cases of spontaneous bacterial empyema due to C. perfringens in cirrhotic patients were previously reported in literature. It should be suspected in a Child C cirrhotic patient, with a previous history of pleural effusion, fever and dyspnea. It has a fatal outcome as far as it has been described.     

缬沙坦对高血压患者动态的动脉硬化指数及脉搏波传导速度的影响

目的 研究缬沙坦对高血压患者动态的动脉硬化指数(AASI)及肱踝脉搏波传导速度(baPWV)的影响.方法 选择18例原发性高血压患者(1、2级),入选患者早晨7～9点一次服用缬沙坦80 mg/d进行降压,治疗2周后,不论血压高低,只要患者能耐受均将缬沙坦增至160 mg/d继续治疗8周.所有入选患者,治疗前后均进行门诊血压及24 h动态血压测量,进行空腹血糖和血脂检查及baPWV测定.并根据24 h动态血压计算AASI.结果 与治疗前比较,缬沙坦可降低高血压患者的收缩压[(133±9)mm Hg比(146±10) mm Hg,P＜0.01]、舒张压[(84±8)mm Hg比(93±8)mm Hg,P＜0.01)]及脉压,并降低高血压患者baPWV水平[(1385±132)cm/s比(1450±142) cm/s,P=0.014],AASI较治疗前也有所降低(0.31±0.14比0.34±0.14,P=0.330).结论 缬沙坦160mg/d在降低血压同时,可减慢baPWV,轻度改善动脉弹性功能.     

特发性大脑中动脉夹层三例报告

目的通过对大脑中动脉夹层发病机制及影像学的研究，可进一步了解其发病规律和影像学特点。方法比较3例大脑中动脉夹层患者的MRI、脑血管造影结果及1例尸体解剖资料。结果3例患者均以频繁脑缺血起病，其中1例患者的病情进行性加重，最后死亡。另外2例患者经脑血管造影，1例尸体解剖证实为大脑中动脉夹层，2例患者经动脉支架治疗后效果较好。结论大脑中动脉夹层发病较少见，对于原因不明的大脑中动脉狭窄患者，应首先想到此病，并给予积极治疗。     

High origin of radial artery from the axillary artery: Case report

The axillary artery is the main artery supplying the shoulder region and is clinically important. In the present case we report an arterial variation of the left upper extremity of a 65 year-old female cadaver. The radial artery arose from the axillary artery 2.5 cm below the anterior humeral circumflex artery and above the teres major muscle. It first coursed along the medial aspect of the arm, then it passed laterally between the biceps brachii and the brachialis muscle. Reaching the upper part of the elbow, it coursed medial to the brachioradialis muscle. It did not give off any branches in either the arm or in the forearm regions. It contributed to the formation of the superficial palmar arch in the palm of the hand. Further, the brachial artery entered the cubital fossa and divided into ulnar and common interosseous arteries. The right upper extremity had a normal arterial branching pattern.Being aware of the variations of the axillary artery may help to prevent diagnostic errors and avoid complications during the surgery of the region.