Effect of surgical revascularization of a right coronary artery tributary of an infarcted nonischemic territory on the outcome of patients with three-vessel disease: a prospective randomized trial

BACKGROUND: We evaluated the in-hospital and long-term effects of surgical grafting of a dominant graftable right coronary artery tributary of an infarcted nonischemic territory in patients with triple-vessel disease who were undergoing coronary artery bypass grafting. METHODS: Of 303 consecutive patients undergoing coronary artery bypass grafting with 3-vessel coronary disease and a dominant right coronary artery tributary of an infarcted nonischemic territory, 154 were randomized to right coronary artery revascularization and 149 to no right coronary artery grafting. In all cases, standard on-pump surgical myocardial revascularization was performed. RESULTS: Overall hospital mortality was 2 of 154 versus 1 of 149 (P =.97); no difference in in-hospital outcome was observed between the 2 groups. At follow-up, cardiac event-free survival was 84 of 152 in the right coronary artery grafting series and 62 of 148 in the non-right coronary artery grafting group (P =.20). However, when the analysis was limited to surviving patients without new scintigraphic evidence of ischemia (to avoid confounding factors derived from ischemia in the left coronary system or right coronary artery graft malfunction), we found that patients who received a right coronary artery graft had fewer cardiac events, a lower incidence of arrhythmia, and less left ventricular dilatation than did the non-right coronary artery revascularized series. CONCLUSIONS: Surgical grafting of a right coronary artery tributary of an infarcted nonischemic territory in patients with 3-vessel coronary artery disease submitted to coronary artery bypass grafting improved late electric stability, ventricular geometry, and event-free survival but did not affect in-hospital or 10-year survival.     

Composite Y internal thoracic artery-saphenous vein grafts: short-term angiographic results and vasoreactive profile

BACKGROUND: The angiographic patency of composite Y internal thoracic artery-saphenous vein grafts has not been investigated in detail. METHODS: Twenty-five patients who received composite Y internal thoracic artery-saphenous vein grafts had control angiography and vasoactive challenges with serotonin, acetylcholine, and isosorbide dinitrate at a mean of 2.5 +/- 1.2 years after surgery. RESULTS: The perfect patency rate of composite Y internal thoracic artery-saphenous vein grafts was 72% (18/25). The distal portion of the internal thoracic artery was stringed in 4 patients and occluded in 2. The saphenous branch of the composite Y internal thoracic artery-saphenous vein grafts was found patent in all patients except 1. No failures were reported in the proximal tract of the internal thoracic artery. The distal tract of the internal thoracic artery showed reduced capacity of endothelium-mediated relaxation. CONCLUSION: The short-term patency of composite Y internal thoracic artery-saphenous vein grafts is suboptimal and markedly influenced by distal runoff and native flow competition.     

Anatomy of the superficial peroneal nerve in relation to fixation of tibia fractures with the less invasive stabilization system

OBJECTIVE: To examine the danger to the superficial peroneal nerve during percutaneous screw placement in the distal holes of the 13-hole proximal tibia Less Invasive Stabilization System plate in a cadaver. DESIGN: Anatomic study. SETTING: Medical school anatomy laboratory. INTERVENTIONS: Fourteen adult cadaveric lower extremities were used. A 13-hole proximal tibia Less Invasive Stabilization System plate was placed as described by the manufacturer. Dissection of the superficial peroneal nerve was performed following localization of screw holes 7 through 13 using insertion sleeves, centering sleeves, and 2.0-mm Kirschner wires passed through the insertion guide. RESULTS: The average distance from the superficial peroneal nerve to the center of holes 11, 12, and 13 was 10.0 mm (range 0-21, standard deviation 5.6), 6.8 mm (range 0-16, standard deviation 4.3), and 2.7 mm (0-11, standard deviation 3.7), respectively. In 12 of 14 legs (86%), the superficial peroneal nerve was 5.0 mm or less from the center of hole 13. The nerve was touching the guide wire at hole 11 in 1 specimen (7%), at hole 12 in 2 specimens (14%), and at hole 13 in 6 specimens (43%). In 1 specimen (7%), the guide wire pierced the superficial peroneal nerve at hole 13. CONCLUSION: These findings suggest that the superficial peroneal nerve is at significant risk during percutaneous screw placement in holes 11 through 13 of the 13-hole proximal tibia Less Invasive Stabilization System plate. Use of a larger incision and careful dissection down to the plate in this region may minimize the risk of damage to the nerve.     

Use of a branch patch with the cystic artery in living-related liver transplantation

Technical aspects in living-related liver transplantation are still under debate: the main pitfall is the arterial reconstruction due to the small diameter and the discrepancy between stumps, with a subsequent increased risk of arterial thrombosis. The gold standard is the microsurgical technique, that reports the lowest risk of thrombosis, but it is a time consuming procedure requiring a long training. Our method of choice reconstructing hepatic artery in right lobe is the use of the cystic artery as a branch patch with the recipient hepatic artery by loop magnification, saving time and with a low incidence of hepatic artery thrombosis.     

Evaluation of 84 elderly donors in renal transplantation

BACKGROUND: The use of elderly donors (ED) and dual kidney transplantation (DKT) procedures have become common in clinical practice. A correct evaluation of kidneys from ED is crucial to avoid unsuccessful transplantation or the use of DKT when a single transplant (ST) would be equally successful. The aim of this investigation was to assess the role of renal biopsy (RB) in the assessment of kidneys from ED. PATIENTS AND METHODS: A total of 84 ED aged > or = 60 yr were evaluated. In 19 cases, the kidneys were not used, mainly because of atherosclerotic vascular lesions. A histological score (HS) from 0 to 12 was awarded, considering the proportion of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arterial and arteriolar narrowing. On the basis of the HS, 37 donors were selected for 40 ST and 21 for DKT, three were discarded. All recipients received triple-drug therapy based on calcineurin inhibitors, mycophenolate mofetil and steroids. RESULTS: Primary non-function was observed in three of 40 ST and one of 21 DKT. Acute tubular necrosis occurred in 22/40 ST and in 11/21 DKT. Acute rejection occurred in 16/40 ST and four of 21 DKT. Renal function was satisfactory in both groups, with 1-yr S-Cr = 171 micromol/L and 137 micromol/L, respectively in the ST and DKT groups. One-year patient survival was 92% in ST and 100% in DKT; 1-yr graft function was 87% in ST and 95% in DKT. CONCLUSION: The histological assessment of kidneys from ED enables a correct selection of kidneys for ST or DKT and prevents the transplantation of high-risk kidneys.     

Neoral dose adjustment after conversion from C0 to C2 monitoring in stable renal transplant recipients: a prospective single center study

To determine the clinical impact of conversion from C0 to C2 Neoral monitoring, we conducted a 6-month prospective study in 62 stable renal transplant recipients. Neoral was given alone (19%), with steroids (31%), combined with azathioprine (Aza) or mycophenolate mofetil (MMF) (50%). C0 and C2 target ranges were, respectively, 130-190 and 700-900 ng/mL. Neoral dosages were adjusted according to the C2 range. At baseline, mean C0 and C2 were 157 and 762 ng/mL. After 6 months C0 was 173 ng/mL (p<0.02) and C2 was 804 ng/mL (ns). Although the mean Neoral dose at 6 months was unchanged from baseline, the dose was reduced in 24 patients from 3.6+/-1.2 to 3.0+/-0.9 mg/kg/day, with a mean reduction in serum creatinine (Cr) from 1.4+/-0.4 to 1.3+/-0.3 mg/dL (p<0.001), stable in 8 patients and increased in 30 patients from 3.3+/-1.0 to 3.8+/-1.2 mg/kg/day with no change in serum Cr. Serum transaminases and blood pressure (BP) were unchanged in the three groups. C0 and C2 showed a positive correlation, but with a large dispersion of values (r2=0.14, p<0.001). Overall concordance between the C0 and C2 ranges was 49%. Therefore, in stable transplant patients C0 cannot be considered a C2 surrogate. The conversion from C0 to C2 led to a Neoral dose reduction in approximately 40% of patients with significant improvement in renal function. Most of the remaining patients required an increased dose; however, without an increased incidence of cyclosporin-induced side-effects.     

'Healthy weight' at what cost? 'Bulimia' and a discourse of weight control

Public health messages emphasizing 'healthy weight' link good health to a narrow range of body weights and stress energy regulation to achieve this. We examined whether women who practise bulimia deploy notions of 'healthy weight' in their talk about body management activities. Analysis is based on interviews with 15 women who practise bulimia and on material collected from cultural locations containing 'health promotion' advice. Poststructuralist discourse analysis revealed that slenderness was constituted as healthy in both sites and that the careful regulation of energy intake and output was similarly reified as a healthy practice. We conclude that a discourse of 'healthy weight' cannot be unhinged from a cultural imperative of slenderness for women, and that paradoxically 'health' practices provide a rationality that supports the practices of binge eating and compensating.     

Effect of molar mass of an experimental primer on shear bond strength to dentin

A novel oligomer was synthesized in different molecular masses and used as a primer in dentin bonding. The hypothesis was that an intermediate molecular mass would optimize the conflicting needs for diffusion into etched dentin (low M(w)) and high mechanical properties (high M(w)). The initial oligomer synthesized was tert butylmethacrylate-co-maleic anhydride, which was further reacted to add hyrdoxyethyl methacrylate (HEMA) across the anhydride. The oligomer was synthesized in a series of molecular masses from approximately 800-6000 amu. The oligomer with an average M(w) of approximately 1000 amu provided the highest bond strength (16 MPa), with both lower and higher molar mass oligomers producing lower bond strengths. A polynomial model was fitted to the data with an R(2) = 0.606, while a linear model only had an R(2) = 0.534. This implies that the graph of molar mass to bond strength has a maximum in the range of molar masses examined, and that an optimum molar mass can be found between 800 and 6000 amu.     

Towards a fully-synthetic substitute of alginate: development of a new process using thermal gelation and chemical cross-linking

We have previously described a gelation process based on the occurrence of both physical and a chemical mechanisms ('tandem process'), in which a telechelic linear poly(propylene glycol)-bl-poly(ethylene glycol)-bl-poly(propylene glycol) is first thermally gelled and subsequently covalently cross-linked by the reaction of polymer end groups at the termini of the copolymer. The quick kinetics of the reverse thermal gelation and the harmless character of the Michael-type addition between two sets of terminal groups, acrylates on one set and thiols on the other, allows irreversibly cross-linked hydrogels to be obtained in a rapid and biocompatible fashion, even when gelation was conducted in direct contact with cells. This allows in principle for an application of the tandem process in cell encapsulation. In the present work, we have optimized the macromolecular architecture and functionality of the precursors for allowing the use of the tandem process in encapsulation devices designed for calcium alginate. The mechanical, diffusional and biocompatibility properties of these materials were characterized; the comparison of mass transport properties of the tandem gels with those of calcium alginate suggests a similar or even better immunoisolation effect.     

The protective role of tiopronin in cisplatin ototoxicity in Wistar rats

The purpose of this study was to evaluate cisplatin-induced ototoxicity and the protective effects of tiopronin. Twenty-four adult Wistar rats served as subjects and were divided into three groups. Eight rats receiving only saline (group A) were used as controls. Eight rats received cisplatin (2 mg/kg) injections (group B) and eight rats received cisplatin and tiopronin (300 mg/kg) (group C) for 8 consecutive days. Both ears of all animals were tested by DPOAE before treatment and on the 4th and 9th days. Seventy-two hours after the final recording session, all animals were killed, and the left cochleas were prepared for electron microscopy and analysed. DPOAE responses were significantly reduced in group B compared to controls (p<0.05). When tiopronin was added, DPOAE responses were significantly increased compared to those obtained with the administration of cisplatin alone (p<0.05). The cochleogram showed that tiopronin had a significant protective effect in the basal half and in the lower half of the middle turn. We conclude that tiopronin, a drug effective in protecting against cisplatin nephrotoxicity, is also effective in protecting against cisplatin ototoxicity.