Use of minimal extracorporeal circulation circuit for left ventricular assist device implantation

We describe successful use of a minimal extracorporeal circulation circuit (MECC) as an alternative to conventional cardiopulmonary bypass (CPB) for the implantation of left ventricular assist device (LVAD) in a 65-year-old patient with ischemic dilated cardiomyopathy. A Jarvik 2000 was implanted through a median sternotomy with the outflow graft anastomosed to the ascending aorta. MECC circuit provides optimal circulatory support throughout the procedure and prevents hemodynamic instability caused by marked displacement of the heart for exposure of the left ventricular apex, while minimizing the adverse effects of conventional CPB.     

Endometriosis-associated ovarian cancer. Presentation of a case report and review of the literature

Endometriosis is a frequent benign disease presenting in more than 10% of women in reproductive age. Although its course is usually benign, it has characteristics of malignant disease, such as progressive course, implantation at distant sites, creation of a microenvironment that renders its course independent and mobilization of the immune system in order to prevent its destruction. Endometriosis-associated ovarian cancer (EAOC) is encountered in 0.3-1.0% of cases of endometriosis. We present in the current article a case of EAOC, reviewing the literature for epidemiological data and data of genetics, and other possible associated factors that lead to the pathogenesis of the disease.     

Influence of fast-track recovery after coronary artery bypass in the elderly

We retrospectively analyzed 711 consecutive patients who had isolated coronary artery bypass grafting between January 2000 and December 2004; 572 younger patients (< 70 years) were compared with 139 elderly patients (> or = 70 years). A rapid recovery program based on an anesthetic protocol for early extubation was applied to all patients. The overall hospital mortality rate was 3.3% for the younger group and 4.3% for the elderly group. There were no significant differences in rates of hospital mortality and postoperative complications between the two groups. Early extubation was achieved in significantly more younger (71%) compared to elderly (57%) patients. Rapid recovery with discharge before the 5(th) postoperative day was achieved in 19% of the elderly compared to 48% of the younger patients. Patients in the younger group were discharged from hospital earlier (6.8 +/- 0.3 vs 8.0 +/- 8.5 days). Application of fast-track treatment in an elderly population appears to be a safe and effective approach if used on a selective basis when criteria for early extubation are met.     

Beneficial effects of statins on endothelial dysfunction and vascular stiffness

Endothelial dysfunction and increased arterial stiffness are considered independent predictors of cardiovascular risk. Endothelial dysfunction primarily reflects decreased availability of nitric oxide, a critical endothelium-derived vasoactive factor with vasodilatory and anti-atherosclerotic properties. Techniques for assessing endothelial dysfunction include ultrasonographic measurement of flow-mediated vasodilatation of the brachial artery and plethysmographic measurement of forearm blood flow responses to vasoactive agents. Arterial stiffness can be assessed using pulse wave analysis to generate measures of pulse wave velocity, arterial compliance and wave reflection. It has been demonstrated that the preventive effect of statins on coronary events is not only attributed to cholesterol-lowering, but also to various effects on the vascular wall, which include improved endothelial function as well as antioxidant and anti-inflammatory activity. Previous studies have reported improvement of arterial stiffness by the antioxidant and anti-inflammatory effects of statin therapy in patients with or without hypercholesterolemia. The present review considers the pathophysiology underlying endothelial dysfunction and increased arterial stiffness associated with atherosclerotic disease and the beneficial effects of statins on these markers of atherosclerosis.