颈动脉内膜中层厚度是Takayasu动脉炎病变活动性的指标

Background: Assessment of disease activity in patients with Takayasu’s arteritis(TA) is difficult due to absence of definitive tests. Presence of carotid intima-medial thickening has been suggested as a possible marker of inflammation and disease activity. Methods: We evaluated common carotid artery carotid intima-medial thickness(CCA-IMT) in 56 common carotid arteries(CCAs) in 28 healthy controls and 74 CCAs in 37 patients of TA.We correlated these findings with the presence of activity as assessed by the National Institutes of Health(NIH) cri- teria. Results: CCA-IMT was increased(>0.8 mm) in 59% of the patients with TA. In patients with disease activity, the CCA-IMT was more than in those without activity(1.5± 0.16 vs. 0.9± 0.2 mm, P< 0.005). This is presumably because of ongoing inflammation causing abnormal thickening. Even among patients without active disease, CCA-IMT was more than in controls(0.9± 0.2 vs. 0.6± 0.1 mm, P< 0.05) possibly due to a milder degree of inflammation or healing with fibrosis. All patients with angiographic carotid obstruction had increased CCA-IMT irrespective of whether they were active or not. However, in patients with angiographically normal carotid arteries, CCA-IMT was increased only among the patients who were active(1.4± 0.2 vs. 0.7± 0.04, P< 0.05). Abnormal CCA-IMT as marker of disease activity had a sensitivity of 82% and specificity of 60% . On excluding patients with increased CCA-IMT who had angiographic carotid stenosis(because the increase in CCA-IMT cannot be attributed entirely to activity alone in these patients), the specificity increased to 70% . Conclusion: Increased CCA-IMT is a reliable marker of active disease, especially in the absence of angiographically visible carotid disease.

Status of Congenital Heart Defects in Nigeria: The Role of Cardiac Surgery

Background: Unlike in developed countries, the delivery of cardiovascular services to children born with congenital heart defects in Nigeria is inadequate. There are problems at both pediatric and adult ages with high morbidity and mortality on account of inadequate surgical care. Objective: To determine the status of congenital defects and assess the impact of foreign cardiac missionary missions vis-à-vis the effects on the magnitude as well as on the educational program for the local cardiac team. Materials and Method: In the last 5.5 years, Foreign Cardiac Surgery missions were reinstituted at National Cardiothoracic Center of Excellence, Enugu, Nigeria. The participants performed cardiac interventions on a variety of patients with CHD. We performed a retrospective review of this endeavor. Patients’ demographics, number of patients, age ranges, types of CHD and clinical evaluation methodology were obtained from our hospital’s record department. We also assessed types of cardiac interventions, outcome and challenges and the impacts of the foreign cardiac surgery missions. Results:?During the study period, a total of 72 children with CHD were evaluated. They were 39 males and 33 females. The age ranged between 0 - 10 years in children and 41 - 50 years in the adult. We studied both simple and complex anomalies. A VSD was the commonest (n = 22, 27.16%). Conclusion: Foreign congenital cardiac surgery missions were not able to provide adequate services for the care of CHD that require cardiac surgery both in terms of reduction in magnitude as well as adequate educational program for the local cardiac team. Thus infants, in particular, suffer an early death. The need for governmental support to develop a comprehensive program to care for these patients is essential in Nigeria and other developing countries.

Efficacy,Safety and Characteristics of the Amplatzer Vascular Plug II and IV Utilization for Various Percutaneous Occlusions in Children under 10 Years

Objectives:We aim to describe the efficacy,safety,and characteristics of the Amplatzer Vascular Plug(AVP)II and IV“off-label”use for multiple cardiovascular occlusions in children under 10 years.Methods:Observational retrospective multicenter(2007–2020,6 centers)review of paediatric procedures using AVP II or IV.Results:A total of 125 children(49.6%aged≤1 year,147 lesions)underwent 136 successive procedures(success rate:98.5%)using 169 devices(109 AVP IV,60 AVP II).The mean device diameter was 7.7±3.2 mm(4–20 mm).The median AVP size to vessel diameter ratio was 1.3(0–2).The median age and weight at implantation were 1.0 year(0.01–9.98)and 8.4 kg(1–69).Procedures were heterogeneous(55 patent ductus arteriosus(PDA),28 collaterals,18 sequestrations,22 arteriovenous/veinovenous/coronary fistulas,6 vertical veins,6 conduits,5 ventricular septal defects,7 miscellaneous).Day 1 and 6-month occlusion rates were respectively 94.8%and 98.5%.Major adverse events(MAE)occurred in 5.2%of cases(no procedure-related deaths),and more frequently in weight≤5 kg(p=0.01),younger patients(p=0.03)during PDA closure(p=0.02)of tubular types(p=0.02)using larger devices(p=0.03)and AVP II(p=0.003).Independent predictor of MAE risk was a higher AVP diameter to patient weight ratio(Odds-ratio:2.33,95%confidence interval 1.31–4.13,p=0.004,optimal cut off:1.45).Conclusions:Both AVPs are safe and effective for percutaneous occlusions in children under 10.Such devices represent an alternative“off label”use for well selected paediatric patients.

S100B and delirium in the geriatric acute care setting

Delirium and its relation to biochemical markers have been considered a study question in several research works. The relation between S100B levels and delirium is still a matter of discussion. Objective: To compare the serum level of S100B in patients with and without delirium and to detect the relation between S100B and delirium subtypes. Method: A case control study was conducted on 114 elderly (60 years and older) selected from the geriatric acute care unit at Ain Shams University Hospitals. They were classified into two groups;58 elderly cases who had delirium diagnosed by Confusion Assessment Method and 56 controls. Then delirium was reclassified according to the subtypes of delirium into Hyperactive: 46 patients, hypoactive: 2 patients, and Mixed: 10 patients. Serum S100B levels were determined by ELISA. Results: Cases were significantly older than controls (72.4 ± 9.4 versus 66.9 ± 5.3 years respectively) (P < 0.001). S100B levels were higher in cases (32.4 ± 9.8 pg/ml) than controls (30 ± 9.3 pg/ml) but the difference was not statistically significant (P = 0.19). There was no significant difference in S100B levels between the different subtypes of delirium. Conclusion: Delirious patients had higher S100B levels than controls but the difference was not statistically significant.

关于气管替代物研究的进展与展望

目前,广泛切除后气管重建仍然是胸外科领域的一大挑战。对于长度>6 cm的气管缺损,常需要气管替代物移植进行重建。气管替代物包括人工合成假体、自体组织气管、同种异体移植、异种移植和组织工程气管。理想的气管替代物尚不清楚,但一些技术已在动物或临床应用中显示出较好效果。本文回顾了过去几十年间气管替代物在应用中的成果与不足。其中,自体组织气管和同种异体主动脉移植展现出良好的应用前景。对于干细胞、组织工程气管的研究近年来引起人们的极大兴趣,但目前这种方法的长期结果欠佳,尚需要进一步的研究与优化。

Case report of a rare giant left anterior descending coronary artery aneurysm

Giant coronary artery aneurysm(CAA)is a rare condition,reportedly seen in 0.02-0.2%of patients undergoing coronary angiography.Asymptomatic in most cases,patients may present with angina pectoris,myocardial infarction,cardiac tamponade or sudden death.Given that the natural history of the CAA is still not predictable,the optimal treatment remains still debatable.In this case report,we present a male patient with a sudden non-exertional dyspnea and angina in a context of obesity,multiple large and medium vessels aneurysms and chronic kidney disease(CKD).A contrast CT detected a giant left anterior descending artery(LAD)CAA measuring 73 mm×47 mm,apparently compressing the circumflex(CX)and the pulmonary artery(PA).After undergoing a full(etiologic and aneurysm extension)panel of exams,the patient underwent a surgical exclusion of the giant CAA and a coronary artery bypass grafting(CABG)by using the left thoracic mammary artery(LITA).The hospitalization was uneventful,and the patient left the hospital completely asymptomatic.In conclusion,even in cases of giant coronary aneurysms,the treatment is surgical by excluding the aneurismatic sac and performing a surgical revascularization.