Changes in BiSpecteral Index (BiS) values during cardiopulmonary bypass (CPB)

Background: BiSpecteral Index (BiS) monitoring is standard monitoring regimen in anaesthesia practice. It has also been used in cardiac surgery. It is especially important due to the high incidence of neurological injury or dysfunction that occurs following CPB. This is a retrospective study of 33 cases that were monitored with BiS during the course of coronary artery or valvular surgery, including the period of CPB.Methods: Thirty three cases monitored with BiS were studied retrospectively. Result: From the recordings it was determined that the value of BiS which was ranging between 40 to 60 after induction, dropped below 25 at the onset of CPB. This change was statistically significant (p<0.05).Conclusion: This decrease in the BiS value is probably a result of hypo-perfusion and due to clear, oxygen - poor priming fluid reaching the brain. Other periods of hypotension also correlated with the low values of BiS. This cerebral hypoxia which would occur at this time could be the cause of the incidence of neurological dysfunction that is known to occur following CPB.     

Soluble kit receptor in human serum

c-kit encodes the transmembrane receptor tyrosine kinase (Kit) for the recently described ligand stem cell factor (SCF). We have developed an enzyme-linked immunosorbent assay for measuring soluble human Kit and we have used the assay to show high levels of soluble Kit in human serum. The distribution of soluble Kit levels was investigated among 112 normal human serum donors. The mean serum level (+/- SD) was found to be 324 +/- 105 ng/mL with the values falling between 163 ng/mL and 788 ng/mL. No correlation between soluble Kit levels and the sexes or ages of the donors was found. Partial purification using immunoaffinity chromatography allowed us to characterize the soluble Kit from pooled human serum. Antibodies generated to a 497-amino acid recombinant human soluble Kit corresponding to the N-terminal extracellular domain of the receptor recognized the serum-derived soluble Kit by immunoblotting. We found that the serum-derived soluble Kit is glycosylated, with mostly N- linked but also O-linked carbohydrate, and with terminal sialic acid residues. When compared with the recombinant human soluble Kit, the serum-derived material was similar both in size and glycosylation pattern. CNBr cleavage of the isolated serum-derived material followed by amino terminal sequencing confirmed the presence of five peptides expected for the extracellular portion of the Kit molecule. The immunoaffinity purified serum-derived soluble Kit inhibited binding of [125I]SCF to membrane-bound receptor in an in vitro assay. These results indicate that soluble Kit could modulate the activity and functions of SCF in vivo.     

Perioperative myocardial infarction in coronary bypass surgery

Thirteen of 199 consecutive patients undergoing coronary artery bypass surgery revealed definite perioperative myocardial infarction (PMI) in electrocardiography (ECG). The occurrence of PMI was not higher in the group of 44 patients who had intermittent aortic cross-clamping than in those patients treated with cold chemical cardioplegia. In 83 patients serum MB isoenzyme of creatine kinase (CK) and LD1 isoenzyme of lactic dehydrogenase were determined. Patients with unchanged ECG had peak CK-MB levels of 0 to 49 U/l (mean 18.7 U/l +/- 2.6 SEM) at 18 hours postoperatively while patients with PMI showed CK-MB levels of 64-350 U/l (mean 207 +/- 53 U/l); the difference was significant (p less than 0.01). In patients with unchanged ECG, LD1 was 139 +/- 19 U/l and 594 +/- 95 U/l in those with PMI (p less than 0.01). Risk factors for PMI were: age greater than or equal to 60 years, coronary endarterectomies, or cardiopulmonary bypass time greater than or equal to 100 minutes. One patient died of PMI while the remaining patients had postoperative courses comparable to those patients without PMI.     

Sensitive and quantitative, 10-min immunofluorometric assay for D-Dimer in whole blood

INTRODUCTION: Normal concentrations of D-Dimer can be used to exclude venous thromboembolism (VTE). However, methods for sensitive and quantitative D-Dimer measurements at the point-of-care (POC) are still limited. MATERIALS AND METHODS: We developed a 10-min, non-competitive immunofluorometric assay for D-Dimer in citrated whole blood and plasma using pre-dispensed reagents dried in single assay wells. The simple, automated assay procedure comprises a 1:50 sample dilution, one-step incubation, washing, and time-resolved fluorometric measurement directly from the wet well surface. RESULTS: The limits of detection (background + 3SD) and quantification (CV <15%) were 0.05 and 0.2 mg/L D-Dimer, respectively, and the assay was linear up to 400 mg/L. Correlations to Roche TinaQuant (r=0.726, n=200) and Biopool Auto.Dimer (r=0.190, n=149) were carried out using citrated plasma. Diagnostic sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values were 98.7%, 64.4%, 99.1% and 55.1%, and 92.2%, 81.0%, 95.9% and 68.3%, respectively, using cut-off values of 0.6 and 1.0 mg/L, respectively, in outpatients with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) (n=77) compared with outpatients with various other diseases (n=174). The within- and between-run CVs near the cut-off values were < or =10% in both whole blood and plasma. The 95th percentile upper range in apparently healthy individuals was 0.68 mg/L of whole blood (n=101). CONCLUSIONS: The high sensitivity and NPV suggest that the rapid immunofluorometric assay could be valuable for rapid exclusion of VTE in outpatients. With appropriate cut-offs, the assay could potentially be used as a stand-alone test or combined with clinical probability assessment, but further studies are required.     

INTRAHEPATIC CHOLANGIOJEJUNOSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: APPROACH TO THE LEFT HEPATIC DUCT

Biliary enteric anastomosis for relief of biliary obstruction caused by malignancy at the confluence of the bile ducts can be difficult due to non availability of an adequate length of duct for anastomosis. This paper describes an approach to the left hepatic duct to decompress the biliary tree and its successful application in 11 of 12 patients who presented with malignant hilar obstruction.KEYWORDS: Hepaticojejunostomy, Malignant biliary obstruction     

MEASUREMENT OF ROOT CANAL LENGTH – USE OF AN ELECTROMETRIC DEVICE

The measurement of root canal length is a pre-requisite for successful pulpectomy. The conventional manual and radiographic methods are not very accurate. In the present study, odontometer was used [Group B) to assess its efficacy over the conventional methods (Group A) for recording root canal length. In group A, 36 teeth were treated with pulpectomy while in group B, 51 teeth were managed by the same treatment. It was observed that post operative complications in group B were significantly less (p < 0.05). The odontometer proved to be an excellent device for rapid and accurate measurement of root canal length.KEY WORDS: Pulpectomy, Root canal length, Odontometer     

Report of four cases ofYersinia pseudotuberculosis septicemia and a literature review

Yersinia pseudotuberculosis is a rare cause of disease in humans, the most common manifestation being mesenteric lymphadenitis accompanied by abdominal pain and fever. A septicemic form ofYersinia pseudotuberculosis infection has been reported only rarely. It is usually seen in patients with underlying disorders such as diabetes, hepatic cirrhosis or iron overload. Fifty-four cases of septicemic infection were found in the literature. The earlier published cases are reviewed, and four cases occurring in Finland during the period February to June 1992 are reported.     

Cerebrovascular disease: evaluation with transbrachial intraarterial digital subtraction angiography using a 4-F catheter

Three hundred sixty-one patients underwent intraarterial digital subtraction angiography for definite or probable occlusive vascular disease of the carotid arteries. Examinations were performed with 65-cm-long, 4-F aortic catheters. A transbrachial approach was used. Images were good or excellent in nearly all cases. No postprocedural neurologic deficits or hematomas occurred. Permanent pulse deficit occurred in two patients, and temporary deficit occurred in three patients, an improvement over the frequency found in previous transbrachial series using 6-8-F catheters. While these results establish the efficacy of this technique, they also indicate a possible greater relative safety in men than in women.