Comparative assessment of the use of skeletonized and un-skeletonized internal thoracic artery for myocardial revascularization

BACKGROUND: Skeleting of internal thoracic artery widens possibilities of a surgeon during mammary-coronary bypass grafting but this procedure is associated with augmented risk of damage of internal thoracic artery (ITA). MATERIAL AND METHODS: ITA was used for creation of anastomosis with anterior interventricular artery in 151 patients. It was harvested on pedicle in 82 (group 1) and subjected to skeleting in 69 (group 2) patients. All operations were performed with cardiopulmonary bypass. In group 2 ITA conduits were more frequently used for grafting distal anterior interventricular artery. RESULTS: There were 3 and 0 deaths in groups 1 and 2, respectively. Rates of nonfatal postoperative complications were similar in both groups. Spasms of ITA grafts were more frequent in group 1. CONCLUSION: Skeleting of ITA for mammary coronary bypass grafting compared with its harvesting on pedicle was not associated with increased risk of complications or elevated mortality in early postoperative period.     

Repeated dose inhaled budesonide versus placebo in the treatment of croup

OBJECTIVE: To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL-1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup. METHOD: Eighty-two children hospitalised with croup received either 2 mg 4 mL-1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge. RESULTS: Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02). CONCLUSION: Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.     

Recurrent parotitis

(1) Recurrent parotitis is probably caused by a congenital abnormality of the salivary gland ducts with recurrent attacks of ascending infection, perhaps aided by dehydration. The parotid gland is predominantly affected probably because of its lower rate of secretion compared with the submandibular gland. (2) The condition mainly affects children between the ages of 3 and 6, with males being more commonly affected. The symptoms peak in the first year of school, and usually, but not invariably, begin to subside at puberty. By the age of 22, most patients are completely symptom-free. When the disease starts after puberty, females are predominantly affected. (3) Ultrasound is the appropriate initial investigation, and is usually supplemented by sialography. The sialography may itself cause a resolution of symptoms. (4) Treatment is conservative in the first instance, and an expectant policy is indicated. More aggressive treatment is justified only for those adults with persistent problems. This may be parotid duct ligation, parotidectomy, or tympanic neurectomy, depending upon the preference and experience of the treating physician.     

Grafting of carotid arteries

Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.     

Minimally invasive surgery of Leriche syndrome

Successful treatment of 25 patients with Leriche syndrome with minilaparotomic approach is analyzed. This method promotes a decrease of postoperative complications and faster rehabilitation of patients compared with standard method. Mean time of surgery was 145+/-33,1 min, in one-stage carotid surgery - 182,1+/-27,4 min. Volume of infusion during surgery was 2500 ml, blood loss - 264,6+/-74,4 ml, time of aorta clamping - 24,6+/-5 min. There was no peripheral embolism after surgery. Postoperative lung ventilation lasted for 37,5+/-28,3 min. Mean stay in intensive care unit was 22,5+/-1,97 h. Patients could receive oral nutrition in 28,75+/-7,8 h. The proposed method may be used in the majority of cases as alternative to conventional surgery and doesn't require significant expenditures and expensive equipment.     

Revascularization of the myocardium in patients with occlusion of internal carotid artery and severe contralateral carotid stenosis

Experience in surgical treatment of 11 patients with ischemic heart disease combined with occlusion of internal carotid artery and severe contralateral carotid stenosis is presented. Complications are analyzed, conception of primary revascularization of the dominating region in maximal protection of the recessive zone is proposed. Efficacy of this method (a low rate of postoperative stroke, myocardial infarction and lethality) is demonstrated.     

Quercetin Attenuates Benzo(α)pyrene-induced CYP1A Expression

<正>We studied effects of nutrient quercetin on cytochromes’Р450 1А(CYP1A)activities(measured spectrofluorimetrically using 7-ethoxy-resorufin for CYP1A1 and 7-methoxy-resorufin for CYP1A2 as substrates),on mR NA levels(measured by RT-PCR),and on DNA-binding activities(evaluated by an electrophoretic mobility shift assay)of proteins regulating CYP1A expression in untreated and benzo(α)pyrene(Ba P)-treated rats.Wistar rats     

Prevalence and influence of risk factors on coronary shunting operations in patients with aterosclerosis of abdominal aorta and peripheral vessels

Retrospective study analysis concerning the prevalence of risk factors for unfavorable outcomes after coronary operations in patients with peripheral arterial atherosclerosis is presented. Meta-analysis of individual risk factors was carried out. Frequency of complications after coronary shunting in patients with various concomitant diseases is evaluated. The multifactorial relative risk affecting hospital lethality is defined. The study includes 131 patients with generalized atherosclerosis, which have underwent myocardial revascularization at the first stage (the main group) and at the second stage have been operated on abdominal aorta and peripheral arteries. 1128 patients without peripheral arterial atherosclerosis have made the control group. They underwent only coronary shunting. All patients were treated from December of 1994 till June of 2006. Relying on the results of the study cumulative relative risk for unfavorable outcomes after revascularization is 1.8 times higher in patients from the main group than in patients from the control group, and the risk for primary complications is 2.03 times higher. Concomitant atherosclerotic arterial involvement among cardiosurgical patients is associated with high risk for stroke in postoperative period. In case of chronic renal failure risk factors are cumulated. In the main group lethality made 5% , which was higher as compared with the control group. Correlation of such risk factors as heart failure and renal failure (creatinine level more than 1.8 mg/dl) with lethality has been revealed among patients from the main group. Lethality risk raises in 5.30 times in the presence of heart failure in medical history, and raises in 13.15 times in case of initially elevated creatinine level. Age of patient didn't have any influence on lethality in early postoperative period.