Hemoptisis como manifestación inusual de aneurisma de aorta torácica / Hemoptysis as an unusual manifestation of thoracic aortic aneurysm

Los aneurismas aórticos corresponden a una dilatación focal de la pared de la arteria que supera el 50% de su diámetro normal. La mayoría de los casos corresponden a la localización abdominal, siendo una pequeña proporción descritos a nivel de la aorta torácica. En este segmento, menos del 10% de los pacientes experimentan síntomas e incluso, la ruptura puede constituir la primera manifestación. Se presenta el caso de una mujer octogenaria con hemoptisis e inestabilidad hemodinámica en la que se realizó el diagnóstico de aneurisma de aorta torácica a través angiotomografía contrastada para luego recibir manejo endovascular de manera exitosa. Dado el pronóstico de esta patología, es vital un adecuado uso de los estudios de imagen para un acertado diagnóstico radiológico que permita un enfoque terapéutico oportuno. (AU)

Aortic aneurysms correspond to a focal dilation of the artery wall that exceeds 50% of its normal diameter. Most cases correspond to the abdominal location, being a small proportion described at the level of the thoracic aorta. In this segment, less than 10% of patients experience symptoms and even rupture may constitute the first manifestation. It is presented an octogenarian woman with hemoptysis and hemodynamic instability in which the diagnosis of thoracic aortic aneurysm was made through contrasting angiotomography and then she receives a successfully endovascular management. Given the prognosis of this pathology, an adequate use of imaging studies is vital for a successful radiological diagnosis that allows for a timely therapeutic approach. (AU)

Nueva prótesis traqueobronquial metálica autoexpandible. Indicaciones y técnica: A propósito de nuestra experiencia en tres casos / New self-expanding metal tracheobronchial prothesis. Indications and technique. Our experience in tree cases

Si bien hasta el momento los stents más utilizados en vía aérea son los de silicona, desde hace un tiempo se utilizan los stents metálicos. Su indicación principal es la estenosis neoplásica maligna traqueal o bronquial. Hemos tenido la oportunidad de colocar un nuevo tipo de SMA en dos indicaciones distintas a la mencionada, por lo que nos parece interesante la descripción de los casos.

Although the most commonly used stents in the air are silicone, stents have been used for some time. Its main indication is malignant tracheal or bronchial neoplastic stenosis. We have had the opportunity to place a new type of SMA in two different indications to the mentioned one, reason why we consider interesting the description of the cases.

Meta-analysis of Trials Comparing Drug-eluting Stents with Bare Metal Stents: Safety and Efficacy.

Background: Effects of drug-eluting stents (DESs) on clinical outcomes as well as stent thrombosis are still under debate. Methods: Our meta-analysis included 26 randomized trials comparing DESs with bare metal stents (BMSs). The endpoints analyzed were all-cause mortality, cardiac death, myocardial infarction (MI), target lesion (TLR) and target vessel (TVR) revascularization, restenosis, and stent thrombosis. Results: In-stent (Risk Ratio = 0.23 [95% confidence interval: 0.17 - 0.32]) and in-segment restenosis (RR = 0.31 [0.24 - 0.40]) significantly reduced in patients with DESs compared with BMSs. Nonetheless, the all-cause mortality (RR = 0.98 [0.79 - 1.21]) and cardiac death (RR = 0.93 [0.71 - 1.21]) were not significantly different for patients receiving DESs compared with BMSs. DESs versus BMSs resulted in a significant decrease in MI (RR = 0.79 [0.67 - 0.93]), TLR (RR = 0.33 [0.29 - 0.38]), and TVR (RR = 0.47 [0.42 - 0.52]). Stent thrombosis incidence that did not differ in DESs versus BMSs until the first year after implantation, showed an upward trend in DESs compared with BMSs from then on (RR = 3.09 [1.37 - 6.99]). Conclusions: The use of DESs versus BMSs led to benefits in angiographic restenosis and clinical outcomes. However, higher incidence of long-term stent thrombosis warrants their cautious usage in patients at high-risk of stent thrombosis.

Effect of transplantation of mesenchymal stem cells transfected with the human receptor activity modifying protein 1 gene on post-angioplasty proliferation and apoptosis of vascular smooth muscle cells in rabbits / 中华老年医学杂志

Objective To explore the effect of transplantation of mesenchymal stem cells (MSCs) transfected with the human receptor activity modifying protein 1 (hRAMP1) gene on proliferation and apoptosis of vascular smooth muscle cells (VSMCs) after carotid balloon angioplasty was performed in rabbits with carotid atherosclerosis.Methods Density gradient centrifugation and adherent culture were carried out to obtain MSCs,which were then transinfected with an adenovirus vector carrying the hRAMP1 gene or an empty adenovirus vector.A rabbit model of atherosclerotic stenosis and balloon angioplasty was successfully established.Results were randomly divided into three groups:the hRAMP1-MSCs group,theadipose-derived MSCs (Ad-MSCs) group and the control group.MSCs were transinfected with Ad-EGFP-hRAMP1,Ad-EGFP or PBS by transplantation into the injured carotid arteries.Homing and differentiation were assessed with MSCs harvested at 7 d.With MSCs collected at 28 d,Western blotting was used to measure the expression of the hRAMP1 target gene in the carotid artery; the neointima and media area in the injured carotid arteries were estimated; carotid artery morphology was examined with H&E staining; and the proliferation and apoptosis of VSMCs were determined by immunohistochemistry and TUNEL.Results The expression of CD31 and EGFP was found in proliferating neointima lesions at 7d in the hRAMP1-MSCs group and the Ad-MSCs group.At 28d of MSC transplantation,the level of RAMP1 significantly increased in the hRAMP1-MSCs group,compared with the Ad-MSCs and control groups [(63.0±4.9) vs.(28.3±2.5) and (27.2±7.2),all P＜0.05],but there was no differencein the RAMP1 level between the Ad MSCs group and the control group (P＞0.05).Positive expression of the α-smooth muscle antibody (α-SMA) was found in all three groups at 28 d of MSC transplantation.The thickness of the hyperplastic neointima significantly decreased in the hRAMP1-MSCs group,compared with the other two groups (P＜0.05),and was lower in the Ad-MSCs group than in the control group (P＜0.05).The expression of proliferating cell nuclear antigen (PCNA) was lower in the hRAMP1-MSCs group than in the Ad-MSCs and control groups at 28d of MSC transplantation (P ＜0.05),while the PCNA level was lower in the Ad-MSCs group than in the control group (P＜ 0.05).The VSMC apoptosis rate significantly increased in the hRAMP1-MSCs group,compared with the Ad MSCs and control groups (P＜0.05),and was the lowest in the control group (P＜0.05).Conclusions Gene-modified stem cell therapy can effectively inhibit vascular intimal hyperplasia,thereby reducing restenosis after angioplasty.

The clinical application of single channel and double Chinese-made biliary stent in high biliary malig-nant obstructive jaundice / 实用肿瘤学杂志

Objective To discussion the efficacy and safety of single channel and double chinese -made biliary stent in high biliary malignant hilar obstructive jaundice .Methods We reviewed the clinical data of 24 malignant hilar obstructive jaundice patients treated with single channel and double chinese -made biliary stent from October 2012 to December 2013 retrospectively.Of which 9 cases(study group)were used for single channel and double stenttreatment,and 15 cases(control group)were treated by the bilateral channel;We compared the number of intraoperative percutaneous puncture hepatic duct , radiation exposure doses , operation time , drainage effectiveness and complication rates in the two groups .Results The average number of percutaneous puncture hepatic duct in the study group was 1.44 ±0.53 times,which was significantly lower than the control group (3.73 ±0.70 times).The fluoroscopy time and radiation exposure dose of study group was 1152.22 ±335.61 s and 653.22 ±207.02 mGy,which was slightly less than the control group (1236.93 ±463.43 s and 727.00 ±348.52 mGy),the difference was not statistically significant (P=0.638;P=0.572).Liver function was tested after 4 W, the drainage effectiveness of study group and the control group were 88.9%(eight-nineths),86.7%(thirteen-fifteenths),the difference was not statistically significant .One case occurred bile leakage in the study group ,2 pa-tients with hemobilia in control group ,both groups showed no serious complication .Conclusion The single chan-nel and double chinese -made biliary stent to treat high biliary malignant hilar obstructive jaundice is minimally injured and effective ,which can be selectively applied to treat patients with hepatic hilum malignant obstructive jaundice .

Estudio del envejecimiento con un modelo celular del síndrome de progeria de Hutchinson-Gilford / Study of the agening with a cellular model of Hutchinson-Gilford progeria syndrome

Se presenta en forma resumida los principales hallazgos del trabajo de Liu y col (1), investigadores del Instituto Salk, California, publicado en abril de 2011, donde se describe un modelo celular in vitro del síndrome de progeria de Hutchison-Gilford (SPHG), basado en células madre pluripotentes inducidas po reprogramación de fibroblastos. Tiene gran interés porque ofrece la posibilidad de estudiar la fisiopatología de las enfermedades que cursan con envejecimiento rápido, prematuro y ayudar a compreder mejor los procesos de envejecimiento que ocurren en la población humana general. Se incluye información básica relacionada con la progeria

A summary of the main findings published in April 2011 by Liu et al (1), researchers at the Salk Institute, California, where a cellular in vitro model of Hutchinson-Gilford progeria syndrome (HGPS) was described based on induced pluripotent stem cells derived from reprogrammed fibroblasts. It is of great interest because it allows the study of the pathogenesis of premature, rapid aging and helps understand ageing of the general human population. Basic information about progeria is included

Nickel-Titanium Shape-Memory alloy net-like stent for the management of high risk patients with benign prostatic hyperplasia / 中国微创外科杂志

Objective To evaluate the effectiveness of Nicked-Titanium Shape-Memory alloy net-like stent in the treatment of high risk patients with benign prostatic hyperplasia Methods 35 high risk patients with benign prostatic hyperplasia were treated with Nicked-Titanium Shape-Memory alloy net-like stent from 1995 to 1998. The results were analyzed retrospectirely. Results 34 cases of the disease were treated successfully at the first session, 30 of whom could urinate immediately after treated. 4 patients had a normal urination in 3 days after operation, the total efficacy rate being 97.1% (34/35). Conclusions The present study shows that Nickel-Titanium Shape-Memory alloy net-like stent for patients with benign prostatic hyperplasia is a safe, efficient and ideal method. The long term efficacy of the stent is in progress.