Aneurysms of the left main coronary arteries are found in 0.1% of angiograms. This case involves an athlete with a left main coronary artery aneurysm, which was combined with chronic total occlusion of the proximal left anterior descending and proximal left circumflex coronary arteries. The extraordinary clinical presentation in this patient may be associated with good coronary collaterals, which may have developed in the patient in response to chronic total occlusion of the coronary artery by the aneurysm, and repeat myocardial hypoxia during high levels of performance as a soccer player. (Heart 2001;85:e1) Keywords: coronary aneurysm; left main coronary disease; intravascular ultrasonography; electron beam computed tomography Left main (LM) coronary artery aneurysm is very rare, occurring in 0.1% of adults undergoing coronary angiography.1 Although some of these cases had associated multivessel coronary artery disease, to the best of our knowledge there has been no previous report of an LM coronary aneurysm associated with chronic total occlusion of the left anterior descending (LAD) and left circumflex (LCx) arteries at the osteum. Such findings in a young soccer player, together with a review of the possible causes, are presented here. Case reportA 31 year old man was admitted to the coronary care unit following a non-Q wave myocardial infarction which had occurred two hours earlier. He had been a soccer player since childhood and had played regularly up until a year ago. He had no risk factors for coronary artery disease and no unusual history. His physical examination was normal. Laboratory examinations, including erythrocyte sedimentation rate, C reactive protein, complete blood count, serologic test for syphilis, rheumatoid factor, antinuclear antibody, antithrombin III, protein C, and protein S, were normal. Echocardiography showed a greatly dilated LM coronary artery and mild hypokinesia at the left ventricular apex. Fluoroscopy and coronary angiography revealed a calcified giant aneurysm of the LM artery with total occlusion of the LAD and LCx arteries at the osteum ( fig 1), with good collaterals from the normal right coronary artery (RCA). Angiographies, including the cerebrovascular and peripheral arteries, were normal. Electron beam computed tomography (EBCT) confirmed the presence of a 3.0 × 1.5 cm lobulated cystic lesion with a calcification rim from the LM to the LAD and LCx coronary arteries (fig 2A). Intravascular ultrasonography (IVUS) revealed a fusiform giant aneurysm of the LM artery ( fig 2B) and a severe intimal thickening at the osteum of the LAD artery with calcification ( fig 2C). The patient underwent coronary artery bypass surgery and was discharged in a good condition. DiscussionAneurysms of the LM coronary artery are rare.1 Most reported cases of LM artery aneurysms were incidentally noticed at coronary angiography for evaluation of myocardial ischaemic symptoms. As our case presented with a small myocardial infarction, considering the regional wall motion abnormality...

Background Although associations between various single nutrients and exacerbation of inflammatory bowel disease (IBD) have been reported, more recent attention has focused on overall dietary patterns and quality rather than a single nutrient. This study was to investigate the association of dietary inflammatory potential and dietary quality with disease severity in young adult Crohn’s disease (CD) patients. Methods Non-consecutive 3-day food records were investigated in 25 patients with CD aged 19-40 years. Patients with moderate or severe active disease were excluded to investigate their usual dietary habits. A survey on dietary behavior was conducted and clinical data including the disease progress were collected. To investigate potential pro-inflammatory dietary habits in a patient's usual diet, food-based index of dietary inflammatory potential score (FBDI), glycemic index (GI), and glycemic load (GL) were calculated. Diet quality was evaluated using a tool called Diet Quality Index-international (DQI). Results Although most patients showed adequate caloric intake, 72% of the enrolled patients had a potential pro-inflammatory pattern identified as FBDI. The FBDI was significantly associated with intake of mixed coffee and sweeten drinks, beef, and pork (P < 0.05). Patients who had a serious clinical course such as history of surgery or the use of biologics, tended to have a higher FBDI (6.45 vs 2.44, P = 0.08), and showed a higher proportion with a low DQI (53% vs 20%, P = 0.06). Only 30% of the high FBDI group showed deep remission after 12 to 18 months of follow-up endoscopic or image study, whereas 72.7% of the low FBDI group showed deep remission (P =0.05). A significantly positive correlation was derived between FBDI and GL (r =0.452, P = 0.02). Conclusion For the care of patients with CD, it is necessary to evaluate the dietary quality as well as the total nutrient intake, and we need to educate the patients that dietary habits can affect the disease prognosis.

Background It has been suggested that changes in gut microbiota have an important effect on the development of inflammatory bowel disease (IBD). In studies using germ-free mice, it has been reported that the absence of microbiota rarely causes dextran sulfate sodium (DSS)-colitis. This study was to investigate whether the changes in DSS-colonic inflammation in mice treated with antibiotics were comparable to the results in germ-free mice. Methods Ampicillin + enrofloxacin were treated in six 9-week-old C57BL/6 mice for initial 3 days and stools were sampled daily to measure the total amount of bacterial 16S rRNA. The time of loss and restoration of gut microbiota was investigated after repeated antibiotics. The severity of colitis and barrier damage were compared between the following groups: (i) control group, (ii) DSS group, and, and (iii) DSS + antibiotics group. The DSS group was allowed to drink 3% DSS from day 5 and maintained for 7 days, and colon tissues were obtained from all groups on day 12. The inflammatory markers (IL-1α, IL-6, IL-17, tumor necrosis factor (TNF)-α) and gut barrier markers (Zonular occludens (ZO)-1, occludin, claudin-1, claudin-4) in colon tissues were comparatively analyzed between groups. Results Bacterial 16S rRNA was not detected from day 4 after the antibiotics, and restoration started from day 11. After repeated antibiotics, microbial depletion was re-confirmed on day 14, but restoration appeared on day 18, confirming faster recovery. The expression levels of IL-1α, IL-17, and TNF-α in the DSS + antibiotics group did not differ from the control but were significantly lower than the DSS group (all p < 0.01). However, the expression of ZO-1 and claudin-4 was significantly lower in the DSS + antibiotics treatment group than in the control group (p < 0.05). Conclusion The antibiotic cocktail could dramatically reduce gut microbiota over a period, but the effect would decrease as it is repeated. Depletion of gut microbiota after antibiotics would dramatically reduce DSS-colonic inflammation but could damage the gut barrier or at least not prevent barrier dysfunction.