Coronary revascularization in septuagenarians

Despite a 15 year experience with the aorta-coronary bypass operation, indications for its use remain unsettled, especially in the elderly. Between January, 1974, and June, 1980, 2,667 patients underwent coronary artery revascularization with an overall mortality of 3.8% (101/2,667). During the last 12 months the mortality has decreased to 1%. There were 2,562 patients below the age of 70, with a mortality of 3.5% (90/2,562), in contrast to 105 patients over the age of 70, with a mortality of 10.5% (11/105) (p = 0.002). In patients less than 70 years of age there was a significant difference between the mortality of men, 3.12% (67/2,146), and that of women, 5.53% (23/416) (p = 0.015). This disparity of operative risk was far more pronounced in patients over 70 years of age: men 6% (5/84) and women 28.6% (6/21) (p = 0.002). The overall operative mortality of women, 6.6% (29/437), was significantly different from the overall mortality of men, 3.2% (72/2,230) (p = 0.001). An in depth analysis of past medical history, risk factors, and catheterization data is presented in those patients over the age of 70. The average number of vessels bypassed was 2.40: men 2.47 and women 2.09 (p = NS). The ages varied from 70 to 81 years with a mean of 72.5. Smoking (p = 0.012) and diabetes (p = 0.0078) were significant risk factors for coronary disease. Smoking (p = 0.032) and abnormal pulmonary artery pressures (p = 0.0429) were significant variables affecting mortality. A 97.1% follow-up was obtained up to 78 months. Coronary artery revascularization can be performed in men below the age of 70 with acceptable mortality, but there is a twofold increase above the age of 70. Women can undergo revascularization below the age of 70 with a significantly higher risk than males. Those above the age of 70 are at severe risk and should undergo revascularization only after careful selection.     

碳糊电极溶出伏安法测定奋乃静等抗精神病药物

本文报道一种测定吩噻嗪类治疗精神病药物奋乃静、氟奋乃静、氯丙嗪和三氟拉嗪的灵敏电化学分析方法。该类药物在碳糊电极上预富集后,进行溶出伏安测定,溶出电流与浓度在一定范围内具有线性关系。最低检测限可达5ng/ml。用本方法可以不经分离,直接测定药片和人体液中上述药物的含量。作者提出了一种新型挤压式碳糊电极,对上述药物在该电极上的富集机理和测试条件进行了系统研究。认为药物的富集作用是由吸附和萃取引起的,并用计时库仑法定量地估价了这两部分在富集中所起的作用。     

Intraoperative balloon-catheter dilatation: University of Florida experience

Thirty-four patients with stable angina underwent coronary artery bypass surgery with supplemental intraoperative coronary artery balloon-catheter dilatation. Coronary dilatation was performed on 35 vessels at 50 sites. The balloon catheter could not be passed through one stenotic site. Intimal dissection occurred at two sites, as noted on early postoperative angiographic studies, with resolution on follow-up studies. There was one perioperative myocardial infarction, 100% early relief of angina, and one operative death. Of 25 distal arterial narrowings studied early by angiography (mean, 10 days), 15 (60%) were unchanged, two (8%) were worse, and eight (32%) were improved. Discrete narrowings improved more than diffuse narrowings; in 46% of the former there was an increase in luminal diameter, in comparison to only 17% of the latter. During a maximal 34-month follow-up period, two patients developed recurrent angina and one died of congestive heart failure. Of 13 distal coronary narrowings studied late (mean, 1 year), six (46%) were unchanged, three (23%) were worse, and four (31%) were improved. Postoperative serial catheterization (early and late) of 10 distal narrowings revealed that nine were unchanged and one was worse. Adjunctive intraoperative coronary balloon-catheter dilatation can be performed safely with acceptable clinical results. The procedure may also allow more complete revascularization of the myocardium.     

Biochemical and ultrastructural integrity of the saphenous vein conduit during coronary artery bypass grafting. Preliminary results of the effect of papaverine

Factors associated with early and late graft patency related to aorta-coronary artery bypass grafting with a reversed segment of saphenous vein are clinically important. The present investigation examines the biochemical and electron microscopic integrity of this venous conduit intraoperatively with regard to pharmacologic manipulation with papaverine. Portions of saphenous vein were analyzed in 22 patients undergoing coronary artery bypass operations. Levels of a stable derivative of prostacyclin, 6-keto-PGF1 alpha, were measured by radioimmunoassay. Scanning as well as transmission electron microscopy was also performed. In particular, the efficacy of local vein treatment with papaverine, a phosphodiesterase inhibitor, was evaluated. We found that levels of 6-keto-PGF1 alpha in venous effluent showed a biphasic response with initial elevation followed by a relative depression after papaverine exposure. There were no such changes observed in veins subjected to a balanced electrolyte solution (Plasma-Lyte). In addition, levels of the platelet-inhibitory substance 6-keto-PGF1 alpha in venous tissue were less in papaverine-treated veins than those found in veins treated only with the balanced electrolyte solution (Plasma-Lyte). Furthermore, evidence for ultrastructural damage was also somewhat greater in the papaverine-treated group. An alternative method of dilating the saphenous vein after harvesting, which involves the creation of the proximal aorta-coronary anastomosis first and gentle finger manipulation subsequently, appeared to minimize venous injury. Under present clinical conditions, it appears that some amount of injury is inevitable during harvesting and suturing of the human saphenous vein during coronary bypass grafting.     

Physical exercise according to nursing students' perceptions

This study aimed to get to know the perceptions of undergraduate students from the University of S?o Paulo College of Nursing about physical exercise as an instrument to maintain health and well being. Data were collected through the application of a questionnaire in class, involving 122 undergraduate students. In this group, 52.23% believed that physical exercise should only be recommended to people with health problems. Only 8% thought that exercise can prevent diseases, and only 6.61% uses protection equipment. Therefore, we concluded that nursing students need to be better prepared to be able to intervene correctly as professionals.     

用GITC手性试剂衍生化高效液相色谱法拆分β-氨基醇类药物对映体

A convenient and rapid procedure for enantiomeric resolution of β-amino alcohol drugs, such as oxprenolol, propafenone, timolol and phenylephrine, is described. The method is based on derivatization with the chiral reagent 2,3,4,6-tetra-O-acetyl-β-D-glucopyranosyl isothiocyanate (GITC), and resolution of the resulting diastereomeric thioureas by reversed-phase HPLC using methanol-aqueous monobasic ammonium phosphate mixture as the mobile phase. The salt forms of these drugs can be directly derivatized with GITC reagent instead of being converted into their free bases and without protection of the phenolic hydroxyl group of phenylephrine.     

Minimal acute rejection in pediatric lung transplantation – Does it matter?

Benden C, Faro A, Worley S, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, Eichler I, Elidemir O, Goldfarb S, Mallory GB, Mogayzel PJ, Parakininkas D, Solomon M, Visner G, Sweet SC, Danziger‐Isakov LA. Minimal acute rejection in pediatric lung transplantation – Does it matter?.
Pediatr Transplantation 2010: 14:534–539. © 2010 John Wiley & Sons A/S. Abstract: In adult lung transplantation, a single minimal AR episode is a significant predictor of BOS independent of other factors. However, the significance of single minimal AR episodes in children is unknown. A retrospective, multi‐center analysis was performed to determine whether isolated single AR episodes are associated with an increased BOS risk in children. Risk factors for BOS, death, or re‐transplantation, and a combined outcome of BOS, death, or re‐transplantation were assessed. Original data included 577 patients (<21 yr of age). A total of 383 subjects were eligible for the study. Fifteen percent of patients developed BOS, and 13% of patients either died or underwent re‐transplant within one‐yr post‐transplant. In the multivariable survival model for time to BOS, there was no significant risk to developing BOS after a single minimal AR (A1) episode (HR 1.7, 95% CI 0.64–4.8; p = 0.28). Even after a second minimal AR episode, no significant risk for BOS was appreciated. However, a single episode of mild AR (A2) was associated with twice the risk of BOS within one‐yr post‐transplant. In this select cohort, a single minimal AR episode was not associated with an increased risk for BOS within one yr following lung transplantation, in contrast to previous reports in adults.     

Comparison of vaginal cytokine collection methods

OBJECTIVE: The objective of our study was to correlate the interleukin-6 (IL-6) concentrations detected in patient-collected specimens with provider-collected specimens and compare the reproducibility of the methods. STUDY DESIGN: All enrolled participants underwent pelvic examination with collection of cytokine samples by the provider and also collected samples themselves using vaginal swabs. The order of sample collection was randomly assigned. All samples were frozen at -80 degrees C for batch analysis. A commercial enzyme-linked immunosorbent assay was used to determine the concentrations of IL-6 in all samples. RESULTS: IL-6 concentrations from wicks and swabs were correlated in a linear fashion (r = 0.67, P < 0.001). IL-6 concentrations in the two swabs (r = 0.94, P < 0.001) and the two wicks (r = 0.71, P < 0.001) were correlated in a linear fashion, although there was more variability in wick specimens. CONCLUSION: IL-6 concentrations can be reproducibly measured using either method. The ease of patient swab collection and the correlation with provider-collected specimens may make frequent assessment of the vaginal cytokine environment more acceptable to patients.