内镜下植入支架非手术治疗儿童外伤性胰管破裂

胰管损伤是儿童胰脏钝性损伤高死亡率及高致残率的主要原因和决定因素。在确诊了损伤类型和解剖学部位的基础上，必须实施正确的治疗。CT检查不能明确胰管损伤的类型和部位。内镜逆行胰管造影（ERP）是确定患儿胰管状况的可靠手段，并可以对合适的患实施支架植入术以治疗胰管损伤。目前仅有一项报道，对2例钝性创伤患儿应用治疗性ERP加支架植入术治疗胰管损伤。本报道中，作介绍1例11岁的胰管损伤患儿，经ERP术获得诊断并接受内镜下支架植入术。患儿平稳康复并出院。内镜逆行胰管造影可能是胰管破裂的有效诊断和治疗手段。     

Coronary artery perforation successfully treated with tris-acryl gelatin microsphere embolisation

We describe a case of coronary artery perforation in a 76-year-old man, successfully treated by tris-acryl gelatin microsphere embolisation. This novel interventional embolic material is used in interventional radiology for arterial embolisation. We believe that this is the first report of its use for a coronary artery perforation.     

Occupational health in Saudi Arabia

The Kingdom of Saudi Arabia is rapidly industrializing, and the economy is now less dependent on oil. The future of industrial growth is very bright. Two industrial complexes (at the Arabian Gulf and the Red Sea coasts) of eight provide the basis for the Kingdom s programs to develop hydrocarbon-based and energy-intensive industries. Expatriates form the driving workforce in industry. Today, more Saudis are being recruited and trained to man the factories. Occupation-related disorders in industry vary from minor irritations to injuries and cancers. However, the risk of massive releases of toxic chemicals is not great. The national Occupational Health Service directorate is based at the Ministry of Health. Together with the Ministry of Labor, it assumes the overall supervision of industrial health and safety. However, there are constraints the most important of which is the lack of enough qualified Saudis in this field.     

Pulmonary effects of occupational exposure to Portland cement: a study from eastern Saudi Arabia

A cross-sectional study was conducted in a randomly selected factory producing Portland cement in eastern Saudi Arabia to determine the prevalence of respiratory symptoms and diseases and chest x-ray changes consistent with pneumoconiosis in the employees. A sample of 150 exposed and 355 unexposed employees was selected. A questionnaire about respiratory symptoms was completed during an interview. Chest x-rays were read according to the ILO criteria for pneumoconiosis. Dust level was determined by the gravimetric method. Concentrations of personal respirable dust ranged from 2.13 mg/m3 in the kilns to 59.52 mg/m3 in the quarry area. Cough and phlegm were found to be related to cigarette smoking, while wheezing, shortness of breath, and bronchial asthma were related to dust levels. It is recommended that engineering measures be adopted to reduce the dust level in this company, together with health monitoring of exposed employees.     

Distal embolization during native vessel and vein graft coronary intervention with a vascular protection device: predictors of high-risk lesions

OBJECTIVE: We sought to define clinical and angiographic variables that may predict patients and lesions at increased risk for distal embolism during percutaneous intervention (PCI), as assessed by debris retrieval from a distal-protection filter device. BACKGROUND: Distal thrombo- and atheroembolism may contribute to periprocedural myocardial necrosis during PCI, which may in turn affect long-term outcomes. Distal protection devices have been used to reduce this occurrence with variable outcomes depending on lesion and patient subsets. METHODS: 194 consecutive patients in whom the FilterWire(R) device (FW) [Boston Scientific Corp., Natick, MA] was used for native coronary vessel (n =129) or vein graft (n = 65) PCI were studied. FW debris was visually analyzed using a semi-quantitative grading score. Patients with "significant" debris (particles > or = 1 mm diameter) were compared with those with "nonsignificant" debris (no debris or particles <1 mm) with respect to clinical (age, gender, coronary disease risk factors, clinical presentation, periprocedural medications), and angiographic (vessel treated, vessel size, lesion length, lesion characteristics, angiographic thrombus and TIMI flow before and after PCI) variables. RESULTS: Significant debris was retrieved in 55% of patients, more frequently from vein graft (69%) than native vessel lesions (48%, p = 0.006). No clinical characteristics predicted significant debris retrieval. Angiographic predictors of significant debris by multivariate analysis were longer stent length and final TIMI flow <3 (p = 0.009 and 0.007, respectively). CONCLUSION: Longer stent length, likely reflecting increased lesion length and plaque burden, predicted significant distal embolism during PCI in native vessel and vein graft lesions, as assessed by debris collected in a distal vascular protection device. This suggests that use of vascular protection devices should be considered during PCI of long lesions.     

Extraction of challenging intracoronary thrombi: multi-device strategies using guide catheters, distal vascular protection devices and aspiration catheters

Patients with large intracoronary thrombi represent a difficult management problem for the interventional cardiologist. We report 10 cases of challenging thrombi treated percutaneously using varying combinations of deep guide catheter engagement, guide aspiration, dedicated catheter aspiration and withdrawal of a distal filter vascular protection device. These cases demonstrate interventional options which may be considered for such patients.     

An uncommon cause of myocardial infarction

A 73 year-old lady with hypertension and chronic atrial fibrillation (AF) developed chest pain followed by ventricular fibrillation (VF) cardiac arrest. Her electrocardiogram post-cardioversion revealed inferior ST-elevation myocardial infarction (MI). Her coronary arteries were angiographically normal. Contrast-enhanced cardiac magnetic resonance(CE-CMR) demonstrated both an inferior subendocardial infarction and left atrial (LA) appendage thrombus suggesting cardioembolism as the most likely cause of her presentation.