Blood Pressure Variability, Cardiovascular Risk, and Risk for Renal Disease Progression

The adverse cardiovascular consequences of high blood pressure (BP) not only depend on absolute BP values, but also on BP variability (BPV). Evidence has been provided that independently of mean BP levels, BP variations in the short- and long-term are associated with the development, progression and severity of cardiac, vascular and renal organ damage, and with an increased risk of CV events and mortality. Alterations in BPV have also been shown to be predictive of the development and progression of renal damage, which is of relevance if considering that impaired renal function in a hypertensive patient constitutes a very potent predictor of future CV events and mortality even in treated subjects. This review will address whether antihypertensive treatment should target alterations in BPV, in addition to reducing absolute BP levels, in order to achieve the highest CV and renal protection in hypertensive and renal patients.     

Traumatic detachment of the inferior angle of the scapula in a 5-year-old boy—a sonographic diagnosis

A complete slip of the cartilage of the inferior angle of the scapula was diagnosed in a 5-year-old boy who fell inside a wooden construction at a kindergarten playground. Radiographs of the scapula were normal, and ultrasound demonstrated complete cartilage detachment, which was displaced deep and laterally. Computed tomography (CT) additionally demonstrated a thin rim of bone displaced along with the detached cartilage. Radiologic findings were confirmed during surgery. We report what we believe to be the first published case of traumatic detachment of the cartilaginous lower angle of the scapula in a child demonstrated by ultrasound.     

Improvement of multislice oxygen-enhanced MRI of the lung by fully automatic non-rigid image registration

Purpose

In oxygen-enhanced magnetic resonance imaging of the lung (O2-MRI), motion artifacts related to breathing hamper the quality of the parametric O2-maps. In this study, fully automatic non-rigid image registration was assessed as a post-processing method to improve the quality of O2-MRI.

Materials and methods

Twenty healthy volunteers were investigated on a 1.5 T MR system. O2-MRI was obtained in four coronal sections using an IR-HASTE sequence with TE/TI of 12/1200 ms. Each section was repeatedly imaged during oxygen and room-air ventilation. Spatial differences among the images were corrected by fully automatic non-rigid registration. Signal variability, relative enhancement ratio between oxygen and room air images, and spatial heterogeneity of lung enhancement were assessed before and after image registration.

Results

Motion artifacts were corrected in 5–10 s. Non-rigid registration reduced signal variability of the source images and heterogeneity of the O2-maps by 1.1 ± 0.2% and 11.2 ± 2.9%, respectively (p < 0.0001). Registration did not influence O2 relative enhancement ratio (p = 0.06).

Conclusion

Fully automatic non-rigid image registration improves the quality of multislice oxygen-enhanced MRI of the lung.     

抗白细胞介素2受体单克隆抗体在肝移植中的应用

目的 探讨抗白细胞介素2受体单克隆抗体(抗IL—2R单克隆抗体)的不同给药时间对肝移植后排斥反应的影响。方法 将21例肝移植患者分为两组，均于手术当天及术后第4d分别应用20mg的抗IL—2R单克隆抗体，不同的是前10例患者的首次剂量于移植肝恢复血流后给予(术中组)，而后11例患者在移植术开始前2h给予(术前组)。两个组术后均同时使用环抱素A和激素。术后随访3个月。结果 经活检病理证实的急性排斥反应，术中组的发生率为5／10(50％)，术前组为3／11(27％)；术中组还有3例急性排斥反应未经病理证实，但抗排斥治疗有效，而术前组无类似病例，若综合考虑，则术前组急性排斥反应发生率(3／11)明显低于术中组(8／10，P＜0．05)。在抗IL—2R单克隆抗体应用的过程中没有发现明显的不良反应。结论 术前2h给予抗IL—2R单克隆抗体预防急性排斥反应的效果优于移植肝恢复血流后用药。     

The clinical value of transpedicular thoraco-lumbar spine stabilisation]

The authors present the results of treatment of spine neoplastic disease using transpedicular stabilisation. The clinical material of 2004 year are 20 cases, 15 males (75%) and 5 female (25%), 19 of them were qualified to the surgical treatment (95%). Obtained outcomes permit authors to make confirmation that the transpedicular stabilisation of thoraco-lumbar spine as a surgical treatment of it's neoplastic disease decrease pain, improve neurological condition if spinal cord damage are not durable, makes easer the rehabilitation process and nursing care.     

The cardiac endothelium: Functional morphology, development, and physiology

Cardiac endothelial cells, regardless of whether they are from endocardial or from coronary (micro)vascular origin, directly modulate performance of the subjacent cardiomyocytes, resulting in control of the onset of ventricular relaxation and rapid filling of the heart. This review summarizes major features of the morphology, embryology, and comparative physiology of cardiac endothelial cells as well as the experimental observations on how cardiac endothelial cells affect the mechanical performance of the heart. As for the underlying mechanisms of the interaction between cardiac endothelial cells and cardiomyocytes, two working hypotheses have been postulated over the past years; (1) interaction mediated through a trans-endothelial physicochemical gradient for various ions (active blood-heart barrier), and (2) interaction mediated through the release by the cardiac endothelial cells of various cardioactive substances, eg, nitric oxide, endothelin, and prostacyclin. These two mechanisms may act in concert or in parallel.     

Total elbow arthroplasty]

The authors describe indications and contraindications for total elbow arthroplasty. The brief characteristic of total elbow replacement is done. The authors describe its own case of clinical use of the Coonrad-Morrey implant.     

External fixation of fractures using Dysnastab-S stabilizers for massive ankle fractures of tibial bone epiphyseal articulations ]

Massive ankle fractures lead to joint stiffness and resulting decrease in range of motion. This can be avoided by functional treatment. In cases where severe soft tissue trauma coexists with bone fractures surgical treatment is limited and external fixation is the method of choice. Modern external fixation technique allows for stabilisation and maintaining range of motion in the affected joint. This paper presents the results of application of the Dynastab-S external fixator. The construction of this fixator allows dorsal and plantar, reducing postraumatic joint stiffness. It also allows appropriate insight into soft tissues and debridement of devitalised tissues as well as their forthcoming surgical reconstruction. In our material (27 cases) treated with the Dynastab-S fixator for an average of 16 weeks a satisfactory bone healing process in all cases was noted. Appropriate function of the extremity was maintained, with comparable plantar flexion to the contralateral, not affected joint. Only in one case post operative treatment was complicated by algodystrophy. Our observations showed that implementation of modern external stabilisation techniques leads to appropriate fracture healing with full function of the inferior extremity.