Fractional Flow Reserve Assessment of a Significant Coronary Stenosis Masked by a Downstream Serial Lesion

Fractional flow reserve (FFR) has been recognized as an effective tool to determine functional significance in intermediate coronary lesions and FFR-guided percutaneous coronary intervention (PCI) improves clinical outcomes. However, hemodynamic interaction between serial stenoses within one coronary artery complicates the assessment of functional severity of each individual lesion. We present a case in which FFR measurement by intracoronary bolus injection of adenosine helps to make appropriate revascularization decision in serial stenoses when the procedures are performed systemically and properly.

Effects of serial lesions of telencephalic components of the visual system in pigeons

A serial-lesion technique was used to investigate interactions in visual processing between telencephalic components of the pigeon visual system. Pigeons were trained to discriminate pairs of stimuli that differed in color, intensity or pattern. After mastering the discrimination tasks, they were assigned to one of three groups. The first group (WI-EII) received lesions of the visual Wulst and were retested. After the discrimination tasks were again mastered, a second set of lesions was made, this time in the ectostriatum. The birds were tested once again after the second surgery. The second group (EI-WII), underwent the same sequence of events except that the order of the lesions was reversed. In the third group (E + W), lesions of both the visual Wulst and ectostriatum were made in a single operation, followed by retesting. The performance after the first lesion of the subjects in each of the two-stage lesion groups was typical of performance after such lesions; i.e. the birds with visual-Wulst lesions showed little or no impairment on any of the tasks, whereas the pigeons with ectostriatum lesions showed considerable deficits in intensity and pattern discrimination, which diminished after prolonged retraining. In contrast, the pigeons in the one-stage group (E + W) showed profound deficits that appeared to be permanent. The performance after the second operation of the WI-EII group was the same as that of pigeons with lesions of ectostriatum alone; i.e. destruction of ectostriatum first or second resulted in the same duration of impairment. The performance of the EI-WII group after its visual Wulst lesion, however, was similar to that observed in the E + W group. The results are interpreted as a reflection of parallel processing within the avian visual system; i.e. the presence of an intact tectofugal pathway may mask the effects of thalamofugal pathway interruption.