Awake off- pump coronary artery bypass surgery in 25 patients

Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n= 11, double n = 5, triple n = 6, quadruple n =3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off- pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 . 2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing muhiple coronary artery bypasses in conscious patients without endotracheal general anesthesia.     

Hepatic Met‐enkephalin immunoreactivity is enhanced in primary biliary cirrhosis

Abstract: Background/aims: In contrast to the normal adult liver, the fetal human and rat livers, and the liver of rats with cholestasis secondary to bile duct resection (BDR) express the preproenkephalin (ppENK) mRNA, which codes for the endogenous opioid peptide Met‐enkephalin. In addition, Met‐enkephalin immunoreactivity (MEIR) is detected in hepatocytes and in proliferating bile ductules in the cholestatic rat liver. These data suggest that cholestasis is associated with the resurgence of cells that produce Met‐enkephalin. To explore further the status of opioids in cholestasis, we studied the expression of MEIR in liver tissue. Methods: The MEIR was sought in paraffin‐preserved liver tissues from patients with primary biliary cirrhosis (PBC) (n = 10). Results: The MEIR was detected in all the PBC livers. Its intensity varied from weak to strong on hepatocytes and bile ducts and the strongest expression appeared as coarse granules. The MEIR was either absent or only faintly expressed by some hepatocytes from disease and nondisease control biopsies, but absent from bile ducts. Conclusion: These results suggest that the human liver in cholestasis may be a source of endogenous opioids.     

The Burden of Migraine in Real Clinical Practice: Clinical and Economic Aspects

Neuroscience and Behavioral Physiology - Objectives. To assess the value of using different treatment schemes in chronic migraine by comparing clinical results and the economic burdens of disease...     

Evidence of persistent central sensitization in chronic headaches: a multi-method study

The aim of this study was to investigate central sensitization (CS) in chronic headaches and compare this phenomenon between chronic migraine (CM) and chronic tension-type headache (CTTH). We recruited 69 patients with chronic headaches and 18 control subjects. Questionnaires of headache history, allodynia and the Hospital Anxiety and Depression scale were administered. We recorded thresholds for pinprick and pressure pain, blink (BR) and nociceptive flexion reflex (NFR) R3 component coupled with wind-up ratios. Thresholds for pressure and pinprick pain, BR and NFR R3 were lower and wind-up ratios higher in patients. No differences of CS parameters between CM and CTTH were observed. CS is persistent and prevalent in patients with various types of chronic headache. CS levels are unrelated to the predominant side of pain, disease duration or depression. Neither is CS related to the headache type, suggesting similar mechanisms of headache chronification and chronicity maintaining and possibly explaining clinical similarity of various forms of chronic headache.     

Pseudodominant inheritance of spondylocostal dysostosis type 1 caused by two familial delta-like 3 mutations

Spondylocostal dysostoses (SCD) are a heterogeneous group of disorders of axial skeletal malformation characterized by multiple vertebral segmentation defects and rib anomalies. Sporadic cases with diverse phenotypes, sometimes including multiple organ abnormalities, are relatively common, and monogenic forms demonstrating autosomal recessive (AR) and, more rarely, autosomal dominant (AD) inheritance have been reported. We previously showed that mutations in delta-like 3 (DLL3), a somitogenesis gene that encodes a ligand for the notch signaling pathway, cause AR SCD with a consistent pattern of abnormal segmentation. We studied an SCD family previously reported to show AD inheritance, in which the phenotype is similar to that in AR cases. Direct DLL3 sequencing of individuals in two generations identified the affected father as homozygous for a novel frameshift mutation, 1440delG. His two affected children were compound heterozygotes for this mutation and a novel missense mutation, G504D, the first putative missense mutation reported in the transmembrane domain of DLL3. Their two unaffected siblings were heterozygotes for the 1440delG mutation. Pseudodominant inheritance has been confirmed, and the findings raise potential consequences for genetic counseling in relation to the SCD disorders.     

Determination of catechelamines, serotonin, and 5-hydroxyindoleacetic acid in a blood

The specific features of chromatographic electrochemical detector determination of plasma catecholamines, serotonin, and 5-hydroxyindoleacetic acid (5-HIAA) are considered. Platelet-poor plasma catecholamines were concentrated on alumina. The concentrate was injected into a chromatograph. Serotonin and 5-HIAA were measured in platelet-poor plasma and thrombocytic clot. The data available in the literature and their authors' own findings of the sample preparation parameters that could minimize the artificially increased platelet-poor plasma concentrations of serotonin via thrombolysis, as well its loss on protein sedimentation.     

Dimethylarginines and Serotonin in the Blood of Spontaneously Hypertensive Rats

The serotoninergic system and nitric oxide system were studied in spontaneously hypertensive rats SHR and Wistar rats (control). The contents of serotonin, 5-hydroxyindoleacetic acid (serotonin metabolite), L-arginine, monomethylarginine, and asymmetric and symmetric dimethylarginines were measured in blood plasma. Serotonin content in hypertensive animals was much higher than in Wistar rats. No interstrain differences were found in the concentration of 5-hydroxyindoleacetic acid. The concentration of asymmetric dimethylarginine in SHR rats was higher than in Wistar rats. However, the concentration of monomethylarginine in SHR rats was lower than in Wistar rats. Our results and published data on the serotoninergic system indicate that SHR rats serve as a convenient model of hypertension.