N-Acetylcysteine for Preventing Pump-Induced Oxidoinflammatory Response During Cardiopulmonary Bypass

Purpose To investigate the effect of N-acetylcysteine on preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass (CPB).Methods Forty patients undergoing coronary artery bypass grafting (CABG) were randomly divided into a study group (n = 20), given 50mgkg^–1 N-acetylcysteine intravenously for 3 days, and a control group (n = 20) given saline. Serum samples were collected for measurement of myeloperoxidase (MPO), malondialdehyde (MDA), interleukin-6, ₁-acid glycoprotein (AAGP), and C-reactive protein (CRP) during surgery and postoperatively.Results The MPO and MDA values showed a similar pattern during and after CPB in the study group, with significantly less variance than in the control group. Interleukin-6 showed similar patterns in the two groups, but the data from 30min after the start of CPB and from 6h post-CPB were significantly different. The AAGP and CRP values were both elevated during CPB in the two groups without a significant difference, but 6 and 24h post-CPB, the values were significantly higher in the control group than in the study group.Conclusions N-Acetylcysteine decreased pump-induced oxidoinflammatory response during CPB, suggesting that it could be a novel therapy for assisting in the prevention of CBP-induced oxidoinflammatory damage.     

Ethical issues in non-heart-beating donation

A shortage of organ donors and the large number of patients desperately waiting for kidney transplant have led to the search for new sources of transplantable organs. The waiting list has grown at an alarming rate resulting in increased waiting times and deaths. The introduction of non heart beating (NHB) donation programmes generates a lot of ethical issues. How should death of a patient be defined in the case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation)? How should consent be obtained? Is sufficient respect and care given to the patient and his family? How is the viability of the organs assessed and how should the organs be allocated? We believe that it is very important to debate these issues and to try to outline an ethical framework for NHB donation that can enjoy the widest possible community support.     

Long-term results of transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy

We assessed the long-term efficacy of a modified transvaginal needle bladder neck suspension, combined with vaginal hysterectomy, for the treatment of female stress incontinence. Thirty-two women who underwent this procedure were followed up clinically and urodynamically 1 and 5 years postoperatively. A total of 27 women (84.4%) were cured 1 year postoperatively. Of the 29 women who were followed up 5 years postoperatively, 21 (72.4%) had a satisfactory result (p = 0.157). No significant differences were observed in maximum urine flow rate, residual volume of urine, and functional length of the urethra. On the contrary, the maximum urethral closure pressure was significantly decreased (p = 0.004). Although the results of our study show a decline in success rate by time, the overall long-term efficacy of this technique is undoubtedly satisfactory. This technique is promising as an easy and minimally invasive surgical procedure for bladder neck suspension.     

A very late onset urethral fistula coexisting with skin bridge after neonatal circumcision: a case report

Complications of neonatal circumcision are generally minor and occur early; a few reports exist on the late or serious kind. The authors describe a case of urethrocutaneous fistula occurring 13 years postcircumcision. The patient also had a skin bridge, another late complication of circumcision. The authors suggest erections in puberty as the triggering factor for onset of fistula. To our knowledge, neither such a late occurrence of fistula nor coexistence of these complications have been reported.     

Diffuse alveolar hemorrhages and hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction

Thrombolytic therapy with streptokinase is commonly used in acute myocardial infarction and has markedly reduced morbidity and mortality from this condition. However, it can cause various hemorrhagic and immunological complications. We report a patient who developed diffuse pulmonary hemorrhages and bilateral hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction. This was recognized by a drop of hematocrit, pulmonary infiltrates, hemorrhagic pleural effusion and hypoxemia. The diagnosis was confirmed by demonstration of iron-laden macrophages (siderophages) in bronchoalveolar lavage. The patient required mechanical ventilation and recovered successfully. This combination of pulmonary hemorrhages and hemorrhagic pleural effusion following streptokinase therapy is extremely unusual and has not been reported previously.     

Calcium and vitamin D intake influence bone mass,but not short-term fracture risk,in Caucasian postmenopausal women from the National Osteoporosis Risk Assessment (NORA) study

Summary The impact of calcium and vitamin D intake on bone density and one-year fracture risk was assessed in 76,507 postmenopausal Caucasian women. Adequate calcium with or without vitamin D significantly reduced the odds of osteoporosis but not the risk of fracture in these Caucasian women. Introduction Calcium and vitamin D intake may be important for bone health; however, studies have produced mixed results. Methods The impact of calcium and vitamin D intake on bone mineral density (BMD) and one-year fracture incidence was assessed in 76,507 postmenopausal Caucasian women who completed a dietary questionnaire that included childhood, adult, and current consumption of dairy products. Current vitamin D intake was calculated from milk, fish, supplements and sunlight exposure. BMD was measured at the forearm, finger or heel. Approximately 3 years later, 36,209 participants returned a questionnaire about new fractures. The impact of calcium and vitamin D on risk of osteoporosis and fracture was evaluated by logistic regression adjusted for multiple covariates. Results Higher lifetime calcium intake was associated with reduced odds of osteoporosis (peripheral BMD T-score ≤−2.5; OR = 0.80; 95% CI 0.72, 0.88), as was a higher current calcium (OR = 0.75; (0.68, 0.82)) or vitamin D intake (OR = 0.73; 95% CI 0.0.66, 0.81). Women reported 2,205 new osteoporosis-related fractures. The 3-year risk of any fracture combined or separately was not associated with intake of calcium or vitamin D. Conclusions Thus, higher calcium and vitamin D intakes significantly reduced the odds of osteoporosis but not the 3-year risk of fracture in these Caucasian women. Sources of support: This work was supported by grant AG1406701 from the National Institute on Aging. The National Osteoporosis Risk Assessment (NORA) was funded and managed by Merck & Co Inc.     

Alveolar hydatid disease of the brain. Report of four cases

Four cases of alveolar hydatid disease of the brain encountered within 27 months in eastern Turkey are reported. All of the patients were male farmers who presented with signs of cerebral tumor. Two of the patients were shown to harbor hepatic lesions and one of them had pulmonary metastases. The cerebral lesions were removed in toto and neurological recovery was obtained in all four patients. A review of the literature revealed only five previously reported cases treated surgically. It is concluded that cerebral Echinococcus multilocularis lesions are amenable to surgery, and that their removal provides useful prolongation of life despite the presence of hepatic or pulmonary disease.     

Unusual complication of femoro-popliteal saphenous vein bypass--aneurysm formation

An aneurysm as an unusual complication of saphenous vein bypass for femoro-popliteal occlusive disease is reported. The aneurysm developed 1 year following the bypass procedure. A diagnosis of Beh?et's disease based on microscopic immunological examination and the clinical picture was suspected following successful aneurysmectomy.     

Effects of simultaneous dual-site TENS stimulation on experimental pain

Transcutaneous electrical nerve stimulation (TENS) is commonly used for pain relief. However, little robust research exists regarding the combination of parameters required to provide effective doses. This study investigated the hypoalgesic effects of different parameter combinations, applied simultaneously at two sites (segmental and extrasegmental), on pressure pain threshold (PPT) in pain-free humans. Two-hundred and eight volunteers (median age 22 years, range 20–26) were randomized to eight groups: six active TENS groups, placebo and control. Parameter combinations were such that frequency always differed at each site (110 Hz or 4 Hz), but intensity could be either the same or different levels: high (to tolerance without pain) or low (strong but comfortable). TENS was administered to the forearm over the radial nerve and the ipsilateral leg below the fibular head for 30 min with monitoring for 30 further minutes. PPT measurements were taken bilaterally from the mid-point of first dorsal interosseous muscle, by an independent blinded rater, at baseline and at six subsequent 10-min intervals. Log-transformed data were analysed using repeated-measures analysis of covariance (baseline values and gender as covariates). Those groups using high-intensity stimulation at the segmental stimulation sites showed significantly greater hypoalgesia than placebo (p < 0.025 in each case). The largest hypoalgesic effect was for simultaneous high-intensity stimulation at segmental and extrasegmental sites, using different frequencies. These results reaffirm that high-intensity stimulation (regardless of frequency) is of fundamental importance in effective dosage.     

Acupuncture treatment for chronic knee pain: a systematic review

Objectives. To evaluate the effects of acupuncture on pain andfunction in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlledtrials of adequate acupuncture. Computerized databases and referencelists of articles were searched in June 2006. Studies were selectedin which adults with chronic knee pain or osteoarthritis ofthe knee were randomized to receive either acupuncture treatmentor a control consisting of sham (placebo) acupuncture, othersham treatments, no additional intervention (usual care), oran active intervention. The main outcome measures were short-termpain and function, and study validity was assessed using a modificationof a previously published instrument. Results. Thirteen RCTs were included, of which eight used adequateacupuncture and provided WOMAC outcomes, so were combined inmeta-analyses. Six of these had validity scores of more than50%. Combining five studies in 1334 patients, acupuncture wassuperior to sham acupuncture for both pain (weighted mean differencein WOMAC pain subscale score = 2.0, 95% CI 0.57–3.40)and for WOMAC function subscale (4.32, 0.60–8.05). Thedifferences were still significant at long-term follow-up. Acupuncturewas also significantly superior to no additional intervention.There were insufficient studies to compare acupuncture withother sham or active interventions. Conclusions. Acupuncture that meets criteria for adequate treatmentis significantly superior to sham acupuncture and to no additionalintervention in improving pain and function in patients withchronic knee pain. Due to the heterogeneity in the results,however, further research is required to confirm these findingsand provide more information on long-term effects. KEY WORDS: Acupuncture, Systematic review, Meta-analysis, Chronic knee pain, Osteoarthritis, WOMAC, Function Submitted 4 July 2006; revised version accepted 7 November 2006.