Carbon monoxide poisoning – Asix year reviewat University Hospital Dubrava

Aim

Carbon monoxide (CO) poisoning is a common cause of population morbidity and mortality in Croatia and worldwide. Here we offer our experience.

Methods

During the period 2000–2006, 20 patients were admitted to the hospital for suspected CO poisoning; consequently carboxyhemoglobin (COHb) levels were measured. According to clinical manifestations, patients were described as having a mild, moderate, or severe intoxication level. Complications, treatment and outcome were analyzed.

Results

All intoxications were accidental; 18 of them occurred in winter months. Most represented were females (14 cases), age groups 20–30 and older than 60 yrs. Moderate levels (9 patients) having a COHb median of 18.5% (30–38) and mild levels (8 patients) with a COHb median of 24.6% (19.5–31) dominated. The most common symptoms and complications were the central nervous (20 cases), cardiovascular (8 cases), respiratory (7 cases) and gastrointestinal systems (7 cases). Only one female patient developed MOF syndrome. All patients were given 100% oxygen, 2 were mechanically ventilated, and 2 underwent hyperbaric oxygen therapy. Length of ICU treatment was 2.3 days for mild, 3.1 days for moderate, and 12.7 days for severe poisoning (p = 0.05). Only one patient died, the others were discharged in good condition.

Conclusion

CO poisoning, if detected early and the patient is supplied with oxygen, has good prognosis. Nonetheless, prevention is even more important, considering the high prevalence of accidental intoxications.     

Further Deterioration of LV Ejection Fraction and Mechanical Synchrony During RV Apical Pacing in Patients with Heart Failure and LBBB

Electrocardiographic left bundle branch block (LBBB) may be due to intrinsic disease of the left bundle branch or induced by right ventricular apical (RVA) pacing. Prior reports clearly delineate the derogatory impact of LBBB on left ventricular (LV) mechanical function but suggest equivalent impact between varieties. We hypothesized that their effects were disparate and performed a within-patient comparison to test this notion. Patients (n?=?20) with heart failure, intrinsic LBBB, and an implanted pacing device with right atrial and RVA leads were studied. Each patient underwent transthoracic three-dimensional speckle-tracking echocardiography during atrial pacing (intrinsic LBBB) and short atrioventricular delay atrial-RVA pacing, and these studies were compared. Relative to intrinsic LBBB, RVA pacing-induced LBBB produced greater intra-LV and interventricular dyssynchrony, a deterioration in LV function, and a shift in the site of latest activation. In patients with heart failure and LBBB, acute RVA pacing induces greater mechanical dyssynchrony and further impairs LV function.     

Butyric acid and pivaloyloxymethyl butyrate, AN-9, a novel butyric acid derivative, induce apoptosis in HL-60 cells

A novel butyric acid derivative, pivaloyloxymethyl butyrate, AN-9, was previously shown to be a potent differentiating agent. AN-9 exerts a significant anticancer activity in vitro and in vivo. In all the activities examined, AN-9 was more potent than butyric acid. Here we show that AN-9 and butyric acid induce cell death by apoptosis. Exposure of HL-60 cells to butyric acid and AN-9 decreased cell numbers and induced cell differentiation and the appearance of typical apoptotic features. Induction of apoptosis and/or differentiation by AN-9 and butyric acid was dependent on the concentration and the time of exposure to the drugs. The advantage of AN-9 over butyric acid was further confirmed. Apoptosis induced by AN-9 occurred after a shorter exposure and at lower drug concentrations than that induced by butyric acid. Apoptosis by AN-9 was accompanied by reduction in Bcl-2 expression. Preincubation with antioxidants did not protect HL-60 cells from apoptosis induced by AN-9. HL-60 cells that were induced to differentiate by preincubation with retinoic acid or low AN-9 concentrations were more resistant to apoptosis, induced later by high concentrations of AN-9, than were undifferentiated cells.Abbreviation AN-9 pivaloyloxymethylbutyrate This work is part of the Ph.D. thesis of Yael Zimra of the Sackler School of Medicine, Tel Aviv University     

Performance of the Ionescu-Shiley pericardial valve in the aortic position: 100 months clinical experience

From August 1977 through August 1984, 239 patients underwent aortic valve replacement (AVR) with the Ionescu-Shiley pericardial valve. Isolated AVR was performed in 112 patients and associated cardiac surgery in 127 patients (53.1%). One hundred twenty-eight patients were males and 111 females, with an average age of 50.6 years (range 15 to 78 years). There were 24 hospital deaths (10%) and 15 late deaths (8.9%). The expected 100 months survival rate was 82.8 +/- 5.5 (91.3 +/- 5.6% for isolated AVR, and 75 +/- 7.8% for associated AVR). All patients were postoperatively studied until December 1985. The cumulative duration of follow-up was 894.08 patient-years, with a mean follow-up of 44.9 months per patient. There were 10 thromboembolic episodes in this series (3 peripheral and 7 central), with a linearized incidence of 1.1% per patient-year. The actuarial projection of freedom from thromboembolic episodes at 100 months follow-up was 94.4 +/- 3.4% (96.9 +/- 2.2% for isolated AVR, and 92.6 +/- 3.9% for associated AVR). Twenty-five patients required reoperation (2.79% per patient-year): 6 for infective endocarditis, 3 for paravalvular leak, one for valve thrombosis, 3 for another valve explantation, and 12 for primary tissue failure (1.3% per patient-year). In conclusion, the Ionescu-Shiley valve has a satisfactory performance in the aortic position at long-term follow-up. In our experience, the higher rate of postoperative complications occurred among patients with concomitant cardiac surgery, so not necessarily related to this pericardial valve.