Encephalopathy and stroke after coronary artery bypass grafting: incidence,consequences, and prediction

BACKGROUND: In contrast to perioperative stroke, much less attention has been paid to those with evidence of diffuse brain encephalopathy, presenting as delirium, confusion, coma, and seizures in the immediate postoperative period. OBJECTIVE: To determine the incidence, consequences, and predictive factors for encephalopathy and stroke following coronary artery bypass grafting. METHODS: In a prospective evaluation of 2711 patients operated on between January 1, 1997, and December 31, 2000, preoperative risk factors were obtained before surgery and postoperative outcomes, encephalopathy and stroke, were determined on a daily basis. All strokes were confirmed by neurologic consultation and, in most instances, by imaging. Logistic regression analyses were performed to determine risk factors for these outcomes. RESULTS: The incidence of encephalopathy was 6.9% and of stroke, 2.7%. For patients without either of these outcomes, the average length of stay in the hospital was 6.6 days and the mortality was 1.4%. In contrast, patients with encephalopathy had a length of stay of 15.2 days and a mortality of 7.5%, and those with stroke, a length of stay of 17.5 days and a mortality of 22.0%. Predictive models were developed for encephalopathy involving 5 preoperative factors (age, past stroke, carotid bruit, hypertension, and diabetes) and 1 perioperative factor (time on cardiopulmonary bypass). The model for stroke involved only 3 preoperative risk factors (past stroke, hypertension, and diabetes). CONCLUSIONS: Encephalopathy or stroke is associated with significant increases in length of stay and mortality after coronary artery bypass grafting. Patients at higher risk for these outcomes can be identified before surgery.     

Interleukin-10 reverses acute detrimental effects of endotoxin-induced inflammation on perinatal cerebral hypoxia-ischemia

Dithiocarbamates, a class of compounds widely used in medicine and agriculture, have been reported to impair sleep structure. These effects have been attributed to the decrease in norepinephrine levels induced by these drugs. However, it has also been recently demonstrated that most of the mechanisms by which dithiocarbamates damage cell function involve changes in oxidative environment. To verify the potential relevance of the latter mechanism in the sleep impairment, we examined the sleep response of adult rats to an acute administration of diethyldithiocarbamate (DDTC). At the dose of 0.6 g/kg, DDTC induced fragmentation and a decrease in slow wave sleep (SWS), and a dramatic loss of paradoxical sleep (PS). These changes occurred soon after the treatment (day 0), persisted the following day (day 1), partially recovered on day 3, and regained near basal values on day 6. No sleep anomalies were observed with a lower dose of DDTC (0.06 mg/kg). On the other hand, when the higher dose of DDTC was given in association with either one of two antioxidants, alpha-tocopherol or melatonin, the amounts of SWS and PS significantly improved even on day 1, suggesting that the DDTC effects on sleep involved an impairment of the brain oxidative balance. Likewise, administration of the lower dose of DDTC 5 days before the higher dose induced a much earlier recovery of normal sleep, presumably due to the development of a tolerance to DDTC. On the whole, the data suggest that the brain oxidative environment may play a role in the mechanisms subserving sleep regulation.     

Risk of multiple myeloma following medication use and medical conditions: a case-control study in Connecticut women.

BACKGROUND: Certain commonly used drugs and medical conditions characterized by chronic immune dysfunction and/or antigen stimulation have been suggested to affect important pathways in multiple myeloma tumor cell growth and survival. We conducted a population-based case-control study to investigate the role of medical history in the etiology of multiple myeloma among Connecticut women. METHODS: A total of 179 incident multiple myeloma cases (21-84 years, diagnosed 1996-2002) and 691 population-based controls was included in this study. Information on medical conditions, medications, and medical radiation was obtained by in-person interviews. We calculated odds ratios (OR) as measures of relative risks using logistic regression models. RESULTS: A reduced multiple myeloma risk was found among women who had used antilipid statin therapy [OR, 0.4; 95% confidence interval (95% CI), 0.2-0.8] or estrogen replacement therapy (OR, 0.6; 95% CI, 0.4-0.99) or who had a medical history of allergy (OR, 0.4; 95% CI, 0.3-0.7), scarlet fever (OR, 0.5; 95% CI, 0.2-0.9), or bursitis (OR, 0.4; 95% CI, 0.2-0.7). An increased risk of multiple myeloma was found among women who used prednisone (OR, 5.1; 95% CI, 1.8-14.4), insulin (OR, 3.1; 95% CI, 1.1-9.0), or gout medication (OR, 6.7; 95% CI, 1.2-38.0). CONCLUSIONS: If our results are confirmed, mechanistic studies examining how prior use of insulin, prednisone, and, perhaps, gout medication might promote increased occurrence of multiple myeloma and how antilipid statins, estrogen replacement therapy, and certain medical conditions might protect against multiple myeloma may provide insights to the as yet unknown etiology of multiple myeloma.     

Lung function testing — useless in ventilated newborns?

Several methods have been used for lung function testing in the ventilated newborn. The interest in the field has been stimulated by the recent appearance of commercially available equipment for assessment of mechanical parameters and of functional residual capacity in this group. Nevertheless, lung function testing is rarely used as a clinical routine, even such simple variables as tidal volume and minute ventilation. Among the many possible reasons for this condition, the fragile nature of the infants and the hands-off policy usually exercised, the difficulties in measuring flow accurately, and the complexity of the present methods deserve special attention. In order to change this situation more work needs to be done to elucidate basal physiology of the ventilated lung and the relationships between ventilator settings, lung function and side-effects in different conditions. If then sufficiently simple, safe and accurate methods to assess the most important functions can be offered, lung function testing would be likely to become a useful component of routine care in future neonatal intensive care.     

Ultrasonic scanning after percutaneous renal biopsy

Renal ultrasonic scanning was performed before and after 57 consecutive kidney biopsies in order to assess the value of this method in the diagnosis of complications. One large and six small perirenal haematomas were found, corresponding to an incidence of 13%. This figure is considerably larger than the incidence found with conventional diagnostic methods, but smaller than with computed tomography. One hydronephrosis and a blood clot in the urinary bladder were also diagnosed. No clinically significant complications were missed. We recommend ultrasonography as the first diagnostic procedure when biopsy complications are suspected.     

The Evolution of Vascular Smooth Muscle Responses to Histamine and 5-Hydroxytryptamine

Studies on the vascular smooth muscle responses to histamine and 5-hydroxytryptamine and on the distribution of these amines in different tissues were performed in several species of reptiles. The responses to adrenaline, noradrenaline and acetylcholine were studied for comparison. Vascular actions were recorded both in vivo as changes in systemic arterial blood pressure and in vitro as changes in vascular resistance in perfused preparations. The specificity of the action of each drug was evaluated by means of pharmacological blocking agents. Tissue levels of histamine and 5-hydroxytryptamine were determined spectrofluorometrically. Fluorescence microscopy was used for histochemical localization of the histamine stores. The results indicate that histamine and 5-hydroxytryptamine exert dual actions (inhibitory and stimulatory) on reptilian vascular smooth muscles which have thus acquired response patterns towards these amines similar to those found in mammals. Inhibitory as well as stimulatory actions of adrena line, noradrenaline and acetylcholine are also present in reptiles. Levels of 5-hydroxytrypt amine are apparently low in most tissues, whereas many species show very high tissue levels of histamine. Histamine, except that of the stomach, is mainly located in tissue mast cells and blood basophils. Nutritional-dependent variations in mast cell number are parallelled by varia tions in tissue histamine content. By comparing the present results with those previously ob tained in jawless vertebrates, fish and amphibians, a general outline of the evolution of vascular actions and tissue stores of histamine and 5-hydroxytryptamine is presented.     

Mapping and characterization of the amplicon near <Emphasis Type="Italic">APOA2</Emphasis> in 1q23 in human sarcomas by FISH and array CGH

Background  

Amplification of the q21-q23 region on chromosome 1 is frequently found in sarcomas and a variety of other solid tumours. Previous analyses of sarcomas have indicated the presence of at least two separate amplicons within this region, one located in 1q21 and one located near the apolipoprotein A-II (APOA2) gene in 1q23. In this study we have mapped and characterized the amplicon in 1q23 in more detail.     

Pharmacokinetics and D2 receptor occupancy of long-acting injectable risperidone (Risperdal Consta) in patients with schizophrenia

Thirteen patients with schizophrenia received injections of 25, 50, or 75 mg of long-acting risperidone every 2 wk. Brain D2 receptor occupancy was assessed with [11C]raclopride 2 wk after the last (fifth) injection (day 71) in seven subjects and 2 wk after the third injection (day 44) in one subject. Stable plasma concentrations were reached after the third injection and steady-state concentrations of the active moiety (risperidone + 9-hydroxyrisperidone) after the fourth injection. Steady-state plasma concentrations were maintained for 4-5 wk after the last injection and then declined rapidly. After injections of 25, 50 and 75 mg on day 44 or day 71, D2 receptor occupancy ranged from 25-48%, 59-83% and 62-72% respectively, while plasma active-moiety levels ranged from 4.4-8.8, 15.0-31.1 and 22.5-26.3 ng/ml respectively. The results indicate that brain D2 receptor occupancy at steady state after injections of long-acting risperidone was in the range found in patients effectively treated with 2-6 mg of oral risperidone.