Patent ductus arteriosus in adults – indications and possibilities for closure

Patent ductus arteriosus (PDA) is a rare diagnosis in adults, since symptoms and signs usually occur in infancy and most cases are treated shortly after diagnosis. We present two patients who were first diagnosed with PDA during adulthood. The first case represents a more severe form of PDA, where the need for closure of the PDA is obvious. In the second case the sequelae of the PDA are less clear. In both patients, closure of the PDA (surgically in one case, percutaneously in the other) was successful.     

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Aim

To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF).

Materials and methods

We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954–2010.

Results

The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70–87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset.

Conclusions

A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.     

血浆脑钠肽对不同年龄急性冠脉综合征患者介入治疗术后临床预后的意义

目的：探讨并比较血浆脑钠肽（BNP）对不同年龄组急性冠脉综合征（ACS）患者经皮冠脉介入（PCI）术后临床主要不良心脏事件（MACE）的预测价值。方法：回顾分析2007年12月至2010年3月因ACS在我院行PCI的患者,分为260岁和〈60岁两组,入院常规检验BNP,随访住院期间及出院后6个月内MACE（包括死亡、心源性休克、再发心绞痛、非致命性再次心肌梗死、非致命性心力衰竭、心律失常、靶血管血运重建、再次入院复合终点）的发生情况。结果：随访269例260岁患者,失访7例（2．6％）,118例〈60岁患者,失访3例（2．5％）,262例≥60岁患者的年龄与BNP水平显著正相关（r=0．368,P〈0．01）,而115例〈60岁患者无显著相关性（r=-0．014,P〉0．05）。年龄≥60岁患者BNP水平与〈60岁患者比较,差异显著（P〈0．01）,年龄260岁患者MACE与〈60岁患者比较,差异显著（P〈0．01）,两组患者BNP水平与LVEF呈显著负相关（P均〈0．01）。多因素logistic回归分析显示：BNP可独立预测两组患者住院期间及出院后6个月内MACE（≥60岁OR=4．369P〈0．01;〈60岁OR=7．773P〈0．01）发生率。两组患者BNP水平对MACE预测的ROC曲线结果比较,差异无统计学意义（P〉0．05）。结论：不同年龄患者BNP水平及MACE发生率存在差异,但年龄并不影响BNP对ACS患者临床预后的预测价值。     

冠状动脉介入治疗对冠心病患者Caspase-3,9 水平的影响

目的:通过对冠心病患者经皮冠状动脉介入治疗(PCI)前后血清Caspase-3,9水平变化的观察,探讨冠状动脉介入治疗对冠心病患者血清Caspase-3,9水平的影响。方法:冠状动脉介入组(PCI组)30例和单纯造影组(CAG组)29例,在术前0.5h,术后3h,术后6h,术后12h,术后24h,术后48h分别测定血清Caspase-3,9水平。结果:CAG组术前与术后的血清Caspase-3,9水平差异均无统计学意义,PCI组术后3h、6h的Caspase-3水平较术前0.5h均有降低趋势,差异均有统计学意义(P<0.05),PCI组术后48h的Caspase-9水平与术后3h、6h相比均有升高趋势,差异均有统计学意义(P<0.05)。结论:PCI术后狭窄或闭塞的冠状动脉血管重新恢复血供,血清中Caspase-3,9水平在PCI术后先降低后又逐渐升高,提示再灌注后可出现细胞的凋亡程度加重,血清中Caspase-3,9的水平可作为心肌再灌注损伤后细胞凋亡程度的评估指标并可作为诊断临床症状不典型的再灌注损伤的一个指标。PCI术可有效改善心肌血供,减少因术前缺血缺氧造成的细胞凋亡,但PCI术后再灌注损伤可进一步加重细胞凋亡。     

游离植皮联合负压封闭引流治疗骨科创面的临床研究

目的:观察游离植皮联合负压封闭引流(vacuumsealingdrainage,后文简称VSD)对骨科创面的疗效,并与植皮后传统加压包扎相比较,为临床实践提供更好的治疗方法。方法:对广州中医药大学第一附属医院创伤骨科2008年3月至2010年2月收治的65例感染创面病例采取手术清创后予VSD引流,合理应用抗生素,创面感染得到控制后,创面干净,肉芽生成良好,外露的肌腱、骨膜表面有新鲜的肉芽组织覆盖,达到植皮的要求后,随机分成两组,其中30例(实验组)采用游离植皮联合VSD法闭合创面,35例(对照组)采用游离植皮加压包扎植皮区,对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间(植皮后)、平均抗生素应用次数(植皮后)进行统计学分析,采用t检验和卡方检验,对此两种方法进行评价。结果:植皮联合VSD组与植皮加压包扎组,在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间(植皮后)、平均抗生素应用次数(植皮后)的对比,有显著性差异(P<0.05)。结论:创面达到游离植皮条件后,游离植皮联合VSD负压引流可以促使皮片黏附,保持创面洁净,避免皮下渗液积聚,有利于皮片的存活,与植皮加压包扎组相比,减少了平均换药次数,缩短创面平均愈合时间及平均住院时间(植皮后),减少抗生素平均应用次数,提高了植皮成活率,说明游离植皮联合VSD组优于游离植皮加压包扎组,游离植皮联合VSD法治疗骨科创面有显著疗效。该手术方法操作简单,术后护理方便,是一种较理想的植皮后的固定方法,有利于创面的愈合,值得临床推广应用。     

尿液转流在尿道下裂术后复杂性尿瘘术中的应用

目的:评价尿液转流在修复尿道下裂术后复杂性尿瘘术中的作用。方法:将40例尿道下裂术后复杂性尿瘘患者随机分为尿液转流组和非尿液转流组两组进行比较。结果:尿液转流组:25例患者术后尿道皮肤瘘复发两例,手术成功率99.2%。非尿液转流组:15例患者中有6例(40%)发生尿瘘复发。结论:尿道下裂术后复杂性尿瘘修复术中应用尿液转流有较好的效果。     

Epidemiology of typhoid carriers among blood donors and patients with biliary, gastrointestinal and other related diseases

Enteric fever due to Salmonella Typhi is a major public health problem. Typhoid carriers have high titres of Vi agglutinins in their sera. We worked out the baseline data for Vi agglutinins from 705 healthy blood donors (controls) by ELISA and compared it with 446 patients with biliary, gastrointestinal and other related diseases (cases). The samples were divided into five groups based on the disease condition of the patients from whom they were collected. Group A (n=196) consisted of patients with stones in the gall bladder/common bile duct and Group B (n=27) with gall bladder carcinoma. Group C (n=33) comprised patients with carcinoma of the pancreas/ampulla, obstructive jaundice and/or cholangiocarcinoma. Group D (n=112) had patients with acute/chronic pancreatitis, abdominal pain, intestinal obstruction, peritonitis, carcinoma oesophagus, chronic diarrhoea, gastrointestinal bleeding and dyspepsia. Group E (n=78) included patients with miscellaneous diseases. The mean absorbance value obtained for healthy subjects +3 standard deviations was taken as the cut-off value for a positive typhoid carrier. In Group A, 10.2% samples were positive; in Group B, 7.4%; in Group C, 12.0%; in Group D, 9.8% and in Group E, 9.0%. There was a highly significant (P <0.001) increase in the presence of Vi agglutinins in the cases compared to the controls. High prevalence of typhoid carriers occurs in patients with biliary, gastrointestinal and other related diseases. Vi serology employing highly purified Vi antigen offers a practical and cost-effective way of screening for S. Typhi carriers.     

Laboratory Scale Bioremediation of Acid Mine Water Drainage from a Disused Tin Mine

Real acidic mine-water drainage was seeded with Acidithiobacillus ferrooxidans to catalyse the removal of iron contained therein. The addition of At. ferrooxidans increased metal precipitation kinetics and decreased the water iron content by ~70%. Supplementing non-sterile mine water with a bacterial growth medium accelerated metal removal by indigenous micro-organisms both at the 500 ml shake-flask and 5 l bioreactor scale.     

The role of Helicobacter spp. in the pathogenesis of primary biliary cirrhosis and primary sclerosing cholangitis

Helicobacter species DNA has been detected in liver tissue of patients affected by primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). To investigate a potential causative relation between Helicobacter species and PBC/PSC, we compared the presence of Helicobacter species-specific DNA in liver tissue of patients with PBC/PSC (n=18/n=13) with those of a control group of patients with various liver diseases with known cause (n=29). A PCR with Helicobacter genus-specific 16S rRNA primers was performed on DNA isolated from paraffin embedded liver tissue. Control patients had hepatitis-B (n=9), alcoholic cirrhosis (n=14), or non-cirrhotic metabolic liver disease (n=6). There was no significant difference between the incidence of Helicobacter spp.-specific DNA in PBC/PSC (9/31; 29%) and the control group (10/29; 34%). Sequence analysis confirmed Helicobacter spp. DNA. Because Helicobacter spp. DNA can be found in approximately one-third of all samples tested, it is unlikely that PSC and PBC are caused by Helicobacter infection.     

Transient expression of laminin alpha1 chain in regenerating murine liver: restricted localization of laminin chains and nidogen-1

Most interstitia between epithelial and endothelial cells contain basal laminae (BLs), as defined by electron microscopy. However, in liver, the sinusoidal interstitium (called space of Disse) between hepatocytes and sinusoidal endothelial cells (SECs) lacks BLs. Because laminins are major components of BLs throughout the body, whether laminins exist in sinusoids has been a controversial issue. Despite recent advances, the distribution and expression of laminin chains have not been well defined in mammalian liver. Here, using a panel of antibodies, we examined laminins in normal and regenerating mouse livers. Of alpha chains, alpha5 was widely observed in all BLs except for sinusoids, while the other alpha chains were variously expressed in Glisson's sheath and central veins. Laminin gamma1 was also distributed to all BLs except for sinusoids. Although the beta2 chain was observed in all BLs and sinusoids, the expression of beta1 chain was restricted to Glisson's sheath. Detailed analysis of regenerating liver revealed that alpha1 and gamma1 chains appeared in sinusoids and were produced by stellate cells. The staining of alpha1 and gamma1 chains reached its maximum intensity at 6 days after two-thirds partial hepatectomy (PHx). Moreover, in vitro studies showed that alpha1-containing laminin promoted spreading of sinusoidal endothelial cells (SECs) isolated from normal liver, but not other hepatic cells. In addition, SECs isolated from regenerating liver elongated pseudopodia on alpha1-containing laminin more so than did cells from normal liver. The transient expression of laminin alpha1 may promote formation of sinusoids after PHx.