Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

Objective

This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.

Methods

Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn''t receive diltiazem infusion.

Results

Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.

Conclusion

We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.     

Robotic radical prostatectomy in high-risk prostate cancer: current perspectives

Around 20%–30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.Prostate cancer (PCa) accounts for almost 30% of all newly diagnosed cancers in men in the United States and is the second most frequent cause of cancer death in men.1 Due to serum prostate specific antigen (PSA) screening, there is an increase in the percent of patients diagnosed with localized PCa.2 However, around 20%–30% of patients diagnosed with PCa still have high-risk, nonmetastatic disease.3In 1998, D’Amico et al. first proposed a three-group risk stratification system to predict posttreatment biochemical failure following radical prostatectomy (RP) and external-beam radiotherapy.4 This system classified nonmetastatic PCa into low-, intermediate- and high-risk PCa according to initial serum PSA, clinical T stage and biopsy Gleason score (4 On the other hand, Loeb et al. defined HRPC using two definitions including: (i) 1992 TNM of cT2b and biopsy Gleason score 8–10, or PSA ≥15 ng ml⁻¹, and (ii) those with 1992 TNM of cT3.5

Table 1

Classification of nonmetastatic PCa into risk groups by D’Amico et al. according to initial serum PSA, clinical T stage and biopsy Gleason score4Open in a separate windowAggressive treatment is required in HRPC otherwise this disease might progress and cause serious symptoms and complications and eventually patient death.6 Although treatment of HRPC is controversial, radiation therapy, androgen deprivation therapy, surgery and most importantly multimodality therapy combining surgery and radiation have been suggested in various studies7,8 meaning that RP could only cure a percentage of this patient group.9,10,11 The outcomes of the Swedish Registry Study that has been very recently published suggested that surgery seems to be superior to radiation therapy and longer cancer-specific survival (CSS) was achieved in the surgery group in patients with HRPC as per a 15-year CSS data.12 Therefore, there has been a trend toward performing RP in HRPC patients.13Although open RP (ORP) is a well-established and standard surgical technique in the surgical management of patients with PCa, robotic approach has become the most common approach for PCa surgery in USA.14 Many authors have published their outcomes related with robot-assisted laparoscopic RP (RARP) with promising results particularly in low- and intermediate-risk PCa patients with similar oncological and functional outcomes to open surgery suggesting the advantages of decreased blood loss, shorter duration of hospital stay, decreased postoperative analgesic requirement and earlier convalescence in the robotic surgery group.15,16,17,18 On the other hand, the number of publications related to the use of robotic surgery in HRPC is very limited in the literature. They mostly have limited numbers of patients and short follow-up periods. Herein, we summarized the literature on RARP and HRPC.     

Genotype and Phenotype Heterogeneity in Neonatal Diabetes: A Single Centre Experience in Turkey

Objective:Neonatal diabetes mellitus (NDM) may be transient or permanent, and the majority is caused by genetic mutations. Early diagnosis is essential to select the patients who will respond to oral treatment. In this investigation, we aimed to present the phenotype and genotype of our patients with NDM and share our experience in a single tertiary center.Methods:A total of 16 NDM patients from 12 unrelated families are included in the study. The clinical presentation, age at diagnosis, perinatal and family history, consanguinity, gender, hemoglobin A1c, C-peptide, insulin, insulin autoantibodies, genetic mutations, and response to treatment are retrospectively evaluated.Results:The median age at diagnosis of diabetes was five months (4 days-18 months) although six patients with a confirmed genetic diagnosis were diagnosed >6 months. Three patients had KCNJ11 mutations, six had ABCC8 mutations, three had EIF2AK3 mutations, and one had a de novo INS mutation. All the permanent NDM patients with KCNJ11 and ABCC8 mutations were started on sulfonylurea treatment resulting in a significant increase in C-peptide level, better glycemic control, and discontinuation of insulin.Conclusion:Although NDM is defined as diabetes diagnosed during the first six months of life, and a diagnosis of type 1 diabetes is more common between the ages of 6 and 24 months, in rare cases NDM may present as late as 12 or even 24 months of age. Molecular diagnosis in NDM is important for planning treatment and predicting prognosis. Therefore, genetic testing is essential in these patients.     

Evaluation of the circulating serum endotrophin in women with and without gestational diabetes mellitus during second trimester

International Journal of Diabetes in Developing Countries - Endotrophin is a newly discovered adipokine, and its clinical utility in diagnosing gestational diabetes mellitus (GDM) remains unclear....     

Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach–Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach–Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.     

Brief Report: Homozygous IL37 mutation associated with infantile inflammatory bowel disease

Interleukin (IL)-37, an antiinflammatory IL-1 family cytokine, is a key suppressor of innate immunity. IL-37 signaling requires the heterodimeric IL-18R1 and IL-1R8 receptor, which is abundantly expressed in the gastrointestinal tract. Here we report a 4-mo-old male from a consanguineous family with a homozygous loss-of-function IL37 mutation. The patient presented with persistent diarrhea and was found to have infantile inflammatory bowel disease (I-IBD). Patient cells showed increased intracellular IL-37 expression and increased proinflammatory cytokine production. In cell lines, mutant IL-37 was not stably expressed or properly secreted and was thus unable to functionally suppress proinflammatory cytokine expression. Furthermore, induced pluripotent stem cell–derived macrophages from the patient revealed an activated macrophage phenotype, which is more prone to lipopolysaccharide and IL-1β stimulation, resulting in hyperinflammatory tumor necrosis factor production. Insights from this patient will not only shed light on monogenic contributions of I-IBD but may also reveal the significance of the IL-18 and IL-37 axis in colonic homeostasis.