Does multi-vessel off-pump coronary artery bypass grafting reduce post operative morbidity compared to on-pump CABG?

Background Cardiopulmonary bypass (CPB) may contribute to the complications and it is assumed that eliminating cardiopulmonary bypass has the potential of reducing post operative morbidity after coronary artery bypass grafting (CABG). The study was carried out to compare mortality and morbidity in the off-pump and on-pump CABG groups. Methods We prospectively analysed 200 patients undergoing CABG. Group A consists of 100 patients underwent multi-vessel off-pump CABG and group B consists of 100 patients underwent CABG with CPB. The incidence of complications (mortality, re-exploration for bleeding, myocardial infarction, atrial fibrillation, neurological events, new onset renal failure (s. creatinine>1.6 mg/dL) pulmonary complications, length of ICU stay and hospital stay were recorded, analysed and compared. Results OPCAB patients received 2.73±0.61 grafts/patient and on-pump CABG patients received 3.39±0.75 grafts/patient (p value<0.00001). There was no significant statistical difference in mortality, incidence of stroke between OPCAB and CABG with CPB patients. Length of ICU stay was 32.84±4.22 vs 44.85±7.18 hrs (p value<0.00001) and hospital stay was 6.52±0.69 vs 7.94±0.92 days (p value<0.00001) between group A and group B respectively. Incidence of atrial fibrillation was less in OPCAB group 7% vs 12% although it was statistically not significant (p value 0.33). It was observed in our study that there was no significant deference in worsening of existing renal failure between on-pump CABG and OPCAB 6% vs 2% (P value 0.28). Blood utilization was significantly less in OPCAB group (p value<0.001). Conclusion There was no statistically significant difference in terms of mortality, incidence of stroke and new onset renal failure in both groups. But there was lesser incidence of post operative atrial fibrillation, worsening of existing renal failure in off-pump group though statistically not significant. There was significant reduction in blood utilization, length of ICU and hospital stay in OPCAB group.     

The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases

BACKGROUND: Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. METHOD: Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions. RESULTS: Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm). CONCLUSIONS: The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases.     

The effects of calcium channel blockers on cyclosporine and its metabolites in renal transplant recipients

Although calcium channel blockers have been reported to increase trough cyclosporine (CsA) blood levels, few studies have systematically examined the effects of calcium channel blockers on CsA pharmacokinetics. In the present investigation, complete pharmacokinetic profiles of CsA and its major metabolites (M1, M17, and M21) were determined in 11 verapamil-treated patients, 7 nifedipine-treated patients, and in 78 controls. Whole blood and urine levels were analyzed using high-performance liquid chromatography. Verapamil caused a 45% increase in CsA area under the curve, maximum concentration, steady-state concentration, and trough level. Metabolite 17 levels were increased in a parallel fashion, suggesting that altered CsA bioavailability rather than decreased metabolism may have caused the higher CsA levels in verapamil-treated patients. However, verapamil-induced reductions in CsA metabolism by other routes could not be ruled out. No changes in CsA or its metabolites were observed in nifedipine-treated patients. Unlike previous reports in patients treated with higher CsA doses, verapamil and nifedipine did not improve renal function in the present study. Nevertheless, the increase in CsA blood levels seen with verapamil may enhance the therapeutic cost-effectiveness of this agent in hypertensive renal transplant recipients.     

Influence of glucose amendment on the toxicity of two nitrophenols to Chlorella vulgaris

Glucose amendment (0.5%) to the culture medium of Chlorella vulgaris reversed the algal toxicity caused by p-nitrophenol (PNP) and m-nitrophenol (MNP), only at their algistatic levels. Algistatic and algicidal concentrations of PNP and MNP, in the absence of glucose, led to the liberation of more nitrite in the culture medium. However, addition of glucose inhibited nitrite formation.     

Hypoglycemic effect of gelatin microspheres with entrapped insulin and protease inhibitor in normal and diabetic rats

Insulin containing gelatin microspheres (IGM) with and without soyabean trypsin inhibitor (TI) were pre-pared and coated with enteric polymers to protect them from degradation in stomach and to release the insulin upon reaching the intestine. Four types of coated IGM were prepared: (i) IGM coated with natural polymers (chitosan inner coat-alginate outer coat), (ii) IGM-TI coated with cellulose acetate phthalate; (iii) IGM-TI coated with cellulose acetate butyrate, and (iv) IGM-TI coated with natural polymers (chitosan inner coat-alginate outer coat). The protective efficiency of uncoated and four types of coated microspheres to-ward digestive enzymes such as pepsin and trypsin was evaluated under simulated physiological conditions. The microspheres were characterized for their insulin content and particle size. The morphology of the micro-spheres was studied using scanning electron micros-copy. The in vitro release studies of insulin from uncoated and coated microspheres indicated that the release followed a zero-order pattern, prolonging for 6 days from 2 days in the case of uncoated spheres. The uncoated and coated microspheres containing insulin (20 IU/kg) were orally administered to albino Wistar rats by stomach tube, and insulin absorption was evaluated by assessing the hypoglycemic effect in normal and diabetic rats. A significant and continuous hypoglycemic effect was observed in diabetic rats following oral administration of coated IGM containing TI when compared to the effect following administration of coated IGM without TI.     

长春西汀片中阿朴长春胺酸乙酯含量的紫外分光光度法测定

采用紫外分光光度法测定长春丁汀片的含量。长春西汀片在２７４ｍｍ波长处有最大吸收，方法线性范围是１０－２０μｇ／ｍｌ，回归方程Ｙ＝３０．０９２Ｘ＋０．０５３３，ｒ＝０．９９９９，平均回收率为１０１．３８％（ｎ＝５，ＲＳＤ＝０．７１％）。