No abstract is provided for this article.
textabstractSince the introduction of coronary angioplasty in 1977, this procedure has gained increasing importance in the treatment of coronary artery obstruction. From the available evidence it can be estimated that this therapeutic tool will gain even more momentum from the tens of thousands of patients who will be treated in the next few years. Information about the indications, benefits and risks of the coronary angioplasty is accumulating rapidly, in addition to publications about refinements of the technique itself. Recently, a number of investigators have realised that coronary angioplasty, is not only a therapeutic tool, but can, during the procedure. be used as a source of diagnostic information. When the catheter is placed across a coronary artery obstruction, inflation of the balloon produces transient myocardial ischemia. Before, during and after this period of severe ischemia studies of the performance of the myocardium at risk can be carried out. The fact that therapeutic coronary angioplasty is carried out in a cardiac catheterization laboratory, which is by definition optimally equipped for the measurements of hemodynamic parameters, has probably also contributed to the execution of these investigations. The combination of hemodynamic and biochemical parameters with morphological information from the coronary angiogram can be utilized for the quantification of myocardial involvement and the success of coronary artery dilatation with angioplasty. Studies of interactions with pharmacological substances are also feasible and informative. Coronary angioplasty has a most promising future as an unique means to gather insight in the intricacies of myocardial oxygen supply and demand in patients with coronary artery disease.
No abstract is provided for this article.
Summary Directional Coronary Atherectomy has been introduced as an alternative to conventional balloon angioplasty for the treatment of selected coronary ar tery lesions characterized by a proximal localization in a large epicardial vessel and by a complex morphology at angiography. To determine the immediate efficacy of coronary atherectomy we analyzed the first 113 attempts at atherectomy using quantitative angiography obtained in 105 consecutive patients from two centers. Procedural success, defined as a residual coronary diameter stenosis :0;50% associated with effective tissue removal, was obtained in 90 (85 .7%) of 105 patients. The primary angioplas tic success rate combining atherectomy and balloon angioplasty in case of failed attempt at atherectomy was 94%. Assessed by quantitative angiogra phy analysis, a mean residual minimal luminal diameter of 2.42 ± 0.52 mm and a mean diameter stenosis of 26 ± 15% were obtained immediately after successful directional coronary atherectomy in the 98 treated lesions. Major complications (death, emergency surgery and transmural infarction) were encountered in 5.7% of the patients. In order to evaluate the results of these two interventional techniques we compared 51 atherectomy patients with 51 balloon angioplasty patients individually matched using quantitative angiography according to stenosis location and reference diameter. Atherectomy resulted in larger gains in luminal diameter as the minimal luminal diameter increased from 1.2 ± 0.4 to 2.6 ± 0.4 mm in the atherectomy group and from 1.2 ± 0.3 to 1.9 ± 0.4 mm in the angioplasty group (p < 0.01). As the exact mechanism through which at he recto my enlarges the vessel lumen remains uncompletely understood , we evaluated a potential Dotter effect in 13 patients by performing quantitative angiography analysis before atherectomy, immediately after for- and backwards crossing the stenosis with the catheter but without inflation and cutting, and finally at the end of the successful procedure. The data suggest that simply crossing the stenosis with the atherectomy catheter contributes by more than 50% to the final luminal
Fatty liver disease (FLD) consists of alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD), with a subset of these groups developing alcoholic steatohepatitis (ASH) and nonalcoholic steatohepatitis (NASH), respectively (Adams et al. 2005, Browning et al. 2004b, Hamaguchi et al. 2005).
No currently available treatments reduce the progression of chronic obstructive pulmonary disease (COPD) or suppress the inflammation in the small airways and lung parenchyma. However, several new treatments now in development for COPD are targeted at the inflammatory process. Antagonists of mediators, such as leukotriene B4, interleukin-8, tumour necrosis factor-α, transforming growth factor-β and inhibitors of oxidative and nitrative stress, are in clinical development. Broader-spectrum anti-inflammatory drugs now in development for COPD include phosphodiesterase-4 inhibitors and inhibitors of p38 mitogen-activated protein kinase, nuclear factor-κB and phosphoinositide-3 kinase-γ. There is also a search for elastase inhibitors to prevent the development of emphysema and for drugs that may even reverse the lung destruction. It will be important to identify suitable surrogate markers to predict clinical efficacy in COPD so that new anti-inflammatory approaches can be assessed. Effective delivery of drugs to the sites of disease in the peripheral lung is also an important consideration.
