ABSTRACT
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare cause of pulmonary hypertension; less than 5% of pulmonary hypertension is caused by recurrent pulmonary thromboembolism (PTE). By definition, CTEPH happens within the first two years after symptomatic PTE; however, cases are often diagnosed without a history of acute PTE. Because of the poor functional status and chronicity of this disease, the classic and curative strategy of open pulmonary endarterectomy cannot be applied in some patients with lesions that involve the distal subsegmental pulmonary artery. Bridging therapy is needed for cases that are technically operable but have an unacceptable risk-benefit assessment or residual symptomatic pulmonary hypertension following surgical removal. Groups in Europe and Japan recently introduced balloon pulmonary angioplasty or percutaneous transluminal pulmonary angioplasty, which has led to significant improvement in functional and hemodynamic parameters in patients with CTEPH. This article introduces recent updates in patient selection and interventional procedures for this chronic and devastating disease.
ABSTRACT
Although it is very important in view of public health to understand the mosquito breeding sites and key reservoirs existing around residential areas, such information is lacking in temporary housing sites constructed after the serious tsunami strikes on 26 December 2004 in Sri Lanka. This study clarified the situation regarding mosquito breeding 14 months after the tsunami in Sri Lanka by surveying temporary housing and non-damaged village areas, and also by examining people‘s knowledge related to mosquito breeding sites and mosquito-borne diseases. The relative frequency of mosquito larvae in wastewater pools was significantly higher in temporary housing than in village areas. The prevalence of storage containers at temporary housing and village areas was not significantly different. It was found that wastewater pools in temporary housing sites were the main breeding site of <I>Culex quinquefasciatus</I> Say, <I>Cx. tritaeniorhynchus</I> Giles, and <I>Aedes albopictus</I> Skuse whereas storage containers in village areas were the main breeding site of <I>Cx. quinquefasciatus</I> and <I>Ae. albopictus.</I> No mosquitoes bred in storage containers in the temporary housing but some <I>Ae. albopictus</I> did so in village areas. The questionnaires indicated a significant difference between residents of temporary housing and villages in response to the question: Do you know where mosquitoes breed? The proportion of the “wastewater pools” response was higher among temporary housing residents than among village residents. This knowledge among temporary housing residents may relate to the fact that wastewater pools are latent breeding sites for mosquitoes in temporary housing sites. Although residents in the temporary housing sites put salt and abluent into storage containers to prevent mosquitoes from breeding, wastewater pools receiving a constant supply of wastewater provided the best breeding site for mosquitoes.
ABSTRACT
BACKGROUND: Primary pulmonary hypertension (PPH) is a rare disease characterized by progressively increased resistance of the pulmonary arteries associated with vascular remodeling. Infiltration of inflammatory cells in affected vessels is a common pathological finding. Monocyte chemoattractant protein-1 (MCP-1) is recognized as a potent chemotactic and activating factor for monocytes and leukocytes, but its significance in PPH is unclear. METHODS AND RESULTS: Serum MCP-1 concentrations were measured in 16 PPH patients and the results were compared with those in 16 normal controls. MCP-1 concentrations in PPH patients (265.6+/-29.5 pg/ml) were significantly elevated compared with those in normal controls (119.6+/-6.9 pg/ml, p<0.0001). In 9 patients (3 men, 6 women; mean age, 29+/-3 years), repeated MCP-1 and hemodynamic measurements were performed prior to and during intravenous epoprostenol therapy. During a mean follow-up period of 7+/-1 months, MCP-1 concentrations were significantly reduced (288.8+/-122.8 to 185.9+/-117.5 pg/ml, p<0.01). CONCLUSIONS: Circulating MCP-1 concentrations are increased in PPH patients, but can alleviated by chronic intravenous epoprostenol therapy. The increase in MCP-1 might be one of the important factors responsible for the disease development in patients with PPH.
