Abstract:Background: Most patients with coronary-bronchial fistulas are asymptomatic. However, some patients present with congestive heart failure, infective endocarditis, myocardial ischemia induced by a coronary steal phenomenon, or rupture of an aneurysmal fistula. Our case of coronary-bronchial steal presented with massive hemoptysis and anginal pain. Methods: CT scan chest showed an emphysematous bulla and focal bronchiectatic changes involving right upper lobe. Coronary angiography revealed a large fistula connecting left circumflex coronary artery to right bronchial artery. A covered stent was placed in proximal left circumflex artery and collaterals excluded. Result: His angina resolved and dyspnea improved. Hemoptysis reduced from about 500 ml per day to about 50 ml a day, in ten days. 6-month follow-up has been uneventful without recurrence of angina or hemoptysis. Conclusion: This report highlights the importance coronary angiography in detecting coronary artery abnormalities in patients with hemoptysis. Although previously treated with surgical ligation, interventional therapies are justifiably becoming more widely used to correct vascular insufficiencies.

Suaeda maritima(L.) Dumort, an annual halophyte known to be a salt-accumulator is also known for the accumulation of the osmolyte, glycine betaine (GB). This study is an attempt to understand the growth and GB accumulation under optimal concentration of 200 mM NaCl in S. maritima. Salt treatment with 200 mM NaCl showed a significant increase in shoot growth after two weeks. The shoots appeared succulent and turgid after two weeks of salt treatment compared to that of the control which appeared slender and wilted. The treated seedlings also exhibited a significant increase in GB content after two weeks of salt treatment. In order to determine the molecular basis of GB accumulation, qRT PCR of three key genes involved in the pathway, choline monooxygenase, betaine aldehyde dehydrogenase and phospho-ethanolamine N-methyl transferase was performed. Transcript level expression of the three genes revealed a high up-regulation of choline monooxygeanse transcripts when compared to that of the other two transcripts at two days of salt treatment. The results indicate that S. maritima requires salt for its growth and is a natural accumulator of GB. Although all the three genes were salt inducible, the high up-regulation of choline monooxygenase greatly contributes to the accumulation of GB under optimal growth as well as NaCl concentration.