Effects of intravenous triiodothyronine during coronary artery bypass surgery

A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. Group B received a placebo. Serum triiodothyronine levels and hemo-dynamic parameters were serially measured. Mean postoperative cardiac index was slightly, but not significantly, higher in group A, whereas systemic vascular resistance was significantly lower in group A. Compared with preoperative values, serum triiodothyronine levels dropped significantly in group B at the end of cardiopulmonary bypass and remained low 12 hours postoperatively, while levels rose significantly in group A. No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.     

Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics

In the age of globalisation, more and more people who are members of different religions and cultures live in the same society. This situation tends to create many conflicts in different areas of life and not least in the health care system, a fact which raises a number of bioethical issues. The cultural and religious differences between patient and physician can be a cause of bioethical conflicts and therefore represent a challenge for biomedical ethics. The confrontation between Turkish Muslin patients and the German health care system is a convenient example of this situation. The Muslim Turks came to Germany 40 years ago as industrial workers. Their value system had been shaped by traditional and Islamic parameters in Turkey. With this value system, they now found themselves in the German modern health care system. In many fields of modern medicine there are areas of potential conflict of values, where a Muslin patient will argue differently from a secular or Christian person. In an ethical conflict between two individuals who are members of different cultures, it is necessary to make sure that the ethical concept which is to be used for resolving the problem is relevant. In this particular case, both the Islamic legal responses (fatwa) and the classical theories of biomedical ethics are often insufficient. This paper tries to give a brief outline of these bioethical conflicts and discuss these conflicts with regard to the principle of respect for autonomy in the concept of "principilism," as introduced by T.L. Beauchamp and J.F. Childress. The central question is whether this bioethical concept is able to analyse and to help solve the kinds of ethical conflicts which involve transcultural dimensions. This question is discussed with some consideration of the ongoing debate about universalism versus relativism in biomedical ethics.     

The effect of postmenopausal hormone therapy with or without folic acid supplementation on serum homocysteine level.

OBJECTIVE: To evaluate the effects of postmenopausal hormone therapy (HT) with or without the addition of folic acid (FA) on serum homocysteine levels in a randomized, placebo-controlled design. Additionally, a non-randomized control group with no treatment was included. METHODS: Forty non-hysterectomized healthy postmenopausal women were randomly allocated to receive either oral continuous combined HT (0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate daily) and oral folic acid (5 mg/day, n = 20) or HT and placebo (n = 20) for 3 months. A control group (n = 15) did not receive any study medication and was followed in the same manner. The fasting total serum homocysteine level was measured by fluorescence polarization immunoassay with a sensitivity of < 0.5 micromol/l. Serum levels of folate, estrogen and lipid profile were also followed. RESULTS: The mean age of the postmenopausal women was 52 +/- 6 years. Baseline homocysteine level was the highest in the HT + FA group (9.96 +/- 2.82 micromol/l), compared to HT + placebo (9.64 +/- 1.89 micromol/l) and control groups (9.01 +/- 1.83 micromol/l) (ANCOVA, p = 0.022). Low baseline folate and vitamin B12 levels contributed significantly to the high level of baseline homocysteine in the HT + FA group. The addition of FA to HT led to a significant decrease in the serum homocysteine level from the baseline level of 9.96 +/- 2.82 micromol/l to the final level of 8.92 +/- 2.53 micromol/l (p = 0.023). On the other hand, HT alone (HT + placebo group) significantly increased the serum homocysteine level from 9.64 +/- 1.89 micromol/l to 10.22 +/- 1.77 micromol/l without a decline in serum folate level (p = 0.045). The serum homocysteine level in the control group did not change significantly (from 9.01 +/- 1.83 micromol/l to 9.58 +/- 2.05 micromol/l, p = 0.29). CONCLUSIONS: Three months of oral continuous combined HT increased the fasting total serum homocysteine level without affecting the serum folate level. Lowering the homocysteine level in postmenopausal woman on HT is achievable by folic acid supplementation.     

Efficiency of olopatadine hydrochloride 0.1% in the treatment of vernal keratoconjunctivitis and goblet cell density.

PURPOSE: The aim of this study was to investigate the effect of topical 0.1% olopatadine hydrochloride on goblet cell density, clinical signs, and symptoms of patients with vernal keratoconjunctivitis. METHODS: Between December 2002 and April 2003, 40 eyes of 20 patients with vernal keratoconjunctivitis and 10 healthy eyes of 5 control patients were evaluated prospectively and treated with 0.1% olopatadine hydrochloride. Both groups were observed clinically, subjective complaints were recorded, and changes in goblet cell density were obtained with brush cytology. RESULTS: After the 2-month therapy, subjective complaints and clinical signs improved with therapy. Also, the clinical signs were improved with the therapy. As the severity of the signs and symptoms were reduced, goblet cell numbers in the brush cytologic specimens were reduced. CONCLUSION: Olopatadine hydrochloride 0.1% is an effective agent for relieving the signs and symptoms of vernal keratoconjunctivitis. Also, it reduces the number of goblet cells, which, in turn, decreases the amount of mucus discharge in vernal keratoconjunctivitis during treatment.     

Surgical approaches used in the reconstruction of the eyelids after excision of malignant tumors

The choice of reconstructive technique for eyelid defects after malignant tumors was based on tumor location and defect size after tumor excision. Treatments included direct closure for defects measuring less than 25%, Tenzel flap for defects measuring 25–50%, lid-sharing procedures for defects measuring more than 50%, skin grafts for tumors affecting the inner canthus advancement flap for outer canthus tumors, and orbital exenteration for malignant tumors demonstrating orbital invasion. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacture or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or diveces.     

The effect of glutamine supplementation on hematopoietic stem cell transplant outcome in children: A case–control study

Abstract:  HSCT associated morbidity and mortality is usually attributed to high-dose chemotherapy/radiotherapy regimens used for conditioning. Glutamine (Gln), a conditionally essential amino acid during severe catabolic states, has been shown to have favorable effects in patients with malignancies and in those undergoing HSCT. However, controversy exists regarding its routine use. Studies in children investigating gln supplementation are very limited. In the present study, including 21 gln-supplemented and 20 control pediatric patients, gln supplementation was shown to reduce the duration of fever and decrease the incidence of SOS during the HSCT course. In addition, a decrease in drug-related toxicity and a trend toward reduced incidence of severe mucositis were observed.     

Evaluation of the alpha-adrenoceptor antagonistic action of berberine in isolated organs.

The selectivity and specificity of berberine (CAS 2086-83-1) for alpha-adrenoceptor subtypes have been studied. alpha 1-Adrenoceptors were investigated in rat and rabbit aorta and alpha 2-adrenoceptors in guinea-pig ileum preparations. Subtype selectivity was then assessed by calculating the selectivity ratios from Ke (equilibrium constant) values. Berberine was found to be more potent for the postsynaptic alpha 1-adrenoceptors than presynaptic alpha 2-adrenoceptors. The selectivity ratios were 1.9 and 3.1 for rabbit and rat aorta, respectively. In the rabbit aorta, responses to norepinephrine and phenylephrine were both inhibited by berberine with lower affinity than that in the rat aorta. The pA2 values for berberine obtained from the norepinephrine and phenylephrine experiments were also found significantly different in rat aorta. However, similar pA2 values were found in rabbit aorta for those agonists.     

Different glomerulopathies accompanying non-small-cell lung cancer

The coexistence of lung cancer and glomerular lesion is not commonly reported. Malignancy-related glomerulopathy is commonly membranous glomerulonephritis. Other glomerulopathies are seldom reported. We report two cases presenting with non-small-cell lung cancer, acute renal failure and nephrotic syndrome secondary to membranoproliferative glomerulonephritis and amyloidosis.     

Intestinal obstruction due to rectal endometriosis

We report a case of a premenopausal woman with severe constipation causing intermittent obstruction. Colonoscopy revealed a tight rectal stricture; however, mucosal biopsies were normal. Exploratory surgery revealed an intense fibrotic reaction involving the rectum and uterus, necessitating a simultaneous low anterior resection and hysterectomy. Pathology established a diagnosis of endometriosis. Preoperative diagnosis of rectal endometriosis can be difficult to establish. Endometrial deposits do not invade the mucosa; therefore, colonoscopy with biopsies are frequently non-diagnostic. Surgery may be the only definitive way to obtain a certain diagnosis. In cases involving rectal strictures of unknown etiology in premenopausal women, rectal endometriosis must be included in the differential diagnosis.