The effect of preoperative digitalis and atenolol combination on postoperative atrial fibrillation incidence.

PURPOSE: The most frequent arrhythmia after coronary artery bypass surgery is atrial fibrillation (AF). The prevention and treatment of this type of arrhythmia is subobtimal. Digitalis, beta-blockers, diltiazem and amiodarone are the preferred drugs for the treatment. This study was designed to compare the effects of preoperatively started digitalis and atenolol in combination and separately, on the incidence of AF that occurs within 7 days following the operation. MATERIALS AND METHOD: One-hundred and sixty patients who had similar demographic properties were randomly grouped as group I, that preoperatively received combined drug therapy (n=40), group II preoperatively used digitalis (n=40), group III atenolol (n=40), and group IV was the control group (n=40). RESULTS: Postoperative AF incidence was 25, 15,4, and 17,9% in groups IV, III, and II, respectively, whereas it was 5% in group I which was lower than all other groups, but the difference was only significant between groups I and IV (P=0.012). CONCLUSION: The combined use of atenolol and digitalis preoperatively was considered as an efficient treatment for lowering the incidence of AF following coronary artery bypass surgery.     

Spontaneous bacterial peritonitis due to Brucella Melitensis in a cirrhotic patient.

Spontaneous bacterial peritonitis is a well-known entity, with a reported incidence of 15-20% in advanced cirrhotic patients. Escherichia coli and Klebsiella pneumoniae are the most common causes of spontaneous bacterial peritonitis; Brucella is extremely rare. We aimed to present one case of such a rare condition in a cirrhotic patient who also had hepatocellular carcinoma. Routine laboratory tests, abdominal ultrasonography and peritoneal fluid examinations were studied in a cirrhotic patient with ascites. Peritoneal fluid white blood cell count was 1300/mm3, with lymphocyte predominance (80%). Peritoneal fluid and blood culture both yielded Brucella melitensis. The patient also had a mass in the right lobe of the liver confirmed as hepatocellular carcinoma by biopsy. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments and with immunodeficiency such as hepatocellular carcinoma.     

Lipid peroxidation and antioxidant enzyme activities in cancerous bladder tissue and their relation with bacterial infection: a controlled clinical study

It is well known that antioxidants and reactive oxygen species play an important role in carcinogenesis. In this sudy, we attempted to evaluate antioxidant enzyme activities and lipid peroxidation levels in cancerous bladder tissue and to determine their relationship with bacterial infection. Bacterial culture was made from all urine samples using Blood and Eosin Methylene Blue agars for checking the presence of bacterial infections. We measured thiobarbituric acid reactive substances (TBARs) and activities of xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH‐PX), and catalase (CAT) in cancerous tissues of 25 bladder cancer patients, in noncancerous adjacent bladder tissues of 13 out of these 25 patients, and in control bladder tissues of 15 patients with a non‐neoplastic genitourinary disease. TBARs levels increased and XO, SOD, GSH‐PX, and CAT activities decreased significantly in cancerous bladder tissues. TBARS, XO, and SOD levels were not significantly different between noncancerous adjacent tissue and control bladder tissue. Statistically significantly lower GSH‐PX and higher CAT activities were observed in noncancerous adjacent bladder tissue compared with cancerous tissue. GSH‐PX level of tumor tissue was correlated significantly with tumor grade (r=−0.425, P=0.034). Results suggested that pathway activity of free radicals were accelerated in the cancerous human bladder tissues via increased TBARs levels and decreased enzyme activities of XO, SOD, GSH‐PX, and CAT, which implicated a severe exposure of cancerous tissues to oxidative stress. J. Clin. Lab. Anal. 24:25–30, 2010. © 2010 Wiley‐Liss, Inc.     

Evaluation of nitric oxide synthase activity, nitric oxide, and homocysteine levels in patients with active Behcet’s disease

Behcet’s disease (BD) is a chronic, progressive disorder that affects many systems of the body including the eye. The aim of this study was to examine the effects of nitric oxide synthase activity (NOS), nitric oxide , and homocysteine (Hcy) levels in patients with active BD. Included in this study were 18 male BD patients and 16 male healthy volunteers as controls. Erythrocyte NOS activity, , erythrocyte sedimentation rate, serum C-reactive protein, and plasma Hcy values in the patients with BD were significantly higher than those of the control group. Our results show that these parameters play a major role in the inflammatory reactions observed in BD.     

Do All Antioxidant Supplements Have the Same Potential Effect on Preventing Myringosclerosis?

ObjectivesMyringosclerosis is an irreversible pathological healing mechanism of the tympanic membrane which can result in the formation of sclerotic plaques. Antioxidant treatment is a recognised prevention therapy and coenzyme Q10 (CoQ10), lycopene, and grape seed extract (GSE), were used in this manner.MethodsForty-four Wistar rats were used in this experiment, and, following myringotomies, the animals were randomly divided into four groups. CoQ10, lycopene or GSE was administered orally to the respective groups, starting from the day of surgery. Otomicroscopy examination was performed on the 14th day. All tympanic membrane lesions were evaluated and compared otomicroscopically and histopathologically.ResultsThe otomicroscopy and histopathological findings, compared against a control (saline) group, showed the CoQ10, lycopene, and GSE groups had statistically significant differences of degree of sclerosis (P<0.001).ConclusionCoQ10, lycopene, and GSE were compared against a saline group and their antioxidative and anti-inflammatory effects were similar. The formation of myringosclerotic plagues after experimental myringotomy in rats significantly decreased and diminished after systemic administration of the three different antioxidant supplements.     

Prooxidant activities of alpha-lipoic acid on oxidative protein damage in the aging rat heart muscle

In the present study, we investigated whether alpha-lipoic acid (ALA) supplementation could have prooxidant or antioxidant effects on protein oxidation parameters such as protein carbonyl (PCO), nitrotyrosine (NT), advanced oxidation protein products (AOPP), and protein thiol (P-SH), as well as oxidative stress parameters such as total thiol (T-SH), non-protein thiol (Np-SH), and lipid hydroperoxide (LHP) in the heart muscle tissue of aged rats. ALA (100 mg/kg body wt/day) was administered intraperitoneally to the experimental animals for 14 days. PCO, NT, AOPP, and P-SH levels were increased, T-SH and Np-SH levels were not changed, and only LHP levels were decreased in the heart muscle tissue of aged rats with ALA supplementation. When compared with non-supplemented aged rats, increasing levels of protein oxidation markers such as PCO, NT, and AOPP in ALA-supplemented aged rats may suggest that oxidative protein damage is increased in ALA-supplemented aged rats. We assume that an explanation for our findings regarding ALA supplementation on protein oxidation markers in the heart muscle tissue of aged rats may be due to the prooxidant effects of ALA. The prooxidant effects of ALA supplementation should be considered in future studies.     

Decrease in mitochondrial oxidative protein damage parameters in the streptozotocin-diabetic rat

BACKGROUND: Many authors have shown that hyperglycemia leads to an increase in oxidative protein damage in diabetes. The aim of this study was to reveal the susceptibility of mitochondria from liver, pancreas, kidney, and skeletal muscle of diabetic Sprague-Dawley rats, a model of type 1 diabetes, to oxidative protein damage. METHODS: Mitochondrial fractions were obtained by differential centrifugation. To show the effect of hyperglycemia in promoting oxidative protein damage, we determined mitochondrial protein carbonyl, total thiol, nitrotyrosine, advanced oxidation protein products, and lipid hydroperoxide levels. The levels of the studied markers, except nitrotyrosine, were determined by colorimetric methods. Nitrotyrosine levels were measured by ELISA. All values were compared with those of the controls by using the Mann-Whitney U-test. RESULTS: Nitrotyrosine and lipid hydroperoxide levels were decreased and other parameters were not changed in liver mitochondria of diabetic rats. Protein carbonyl, nitrotyrosine, advanced oxidation protein products, and lipid hydroperoxide levels were decreased and total thiol levels were not changed in pancreas mitochondria of diabetic rats. Only advanced oxidation protein products and lipid hydroperoxide levels were decreased in kidney mitochondria of diabetic rats. The levels of the same parameters were not significantly different in muscle mitochondria of diabetic rats. CONCLUSIONS: The decrease in mitochondrial oxidative protein damage in diabetes may correspond to either an increase in antioxidant defense mechanisms or a different adaptive response of the cells to the increased extramitochondrial oxidative stress in diabetes. The mitochondrial oxidative protein damage-lowering mechanisms in diabetes remain to be clarified.     

Noninvasive ventilation initiation in clinical practice: A six-year prospective, observational study

BACKGROUND:

Despite evidence supporting the role of noninvasive ventilation (NIV) in diverse populations, few publications describe how NIV is used in clinical practice.

OBJECTIVE:

To describe NIV initiation in a teaching hospital that has a guideline, and to characterize temporal changes in NIV initiation over time.

METHODS:

A prospective, observational study of continuous positive airway pressure ventilation (CPAP) or bilevel NIV initiation from January 2000 to December 2005 was conducted. Registered respiratory therapists completed a one-page data collection form at NIV initiation.

RESULTS:

Over a six-year period, NIV was initiated in 623 unique patients (531 bilevel NIV, 92 CPAP). Compared with bilevel NIV, CPAP was initiated more often using a nasal interface, with a machine owned by the patient, and for chronic conditions, especially obstructive sleep apnea. Whereas CPAP was frequently initiated and continued on the wards, bilevel NIV was most frequently initiated and continued in the emergency department, intensive care unit and the coronary care unit. Patients initiated on bilevel NIV were more likely to be female (OR 1.8, 95% CI 1.08 to 2.85; P=0.02) and to have an acute indication compared with CPAP initiations (OR 7.5, 95% CI 1.61 to 34.41; P=0.01). Bilevel NIV was initiated more often in the emergency department than in the intensive care unit (OR 5.8, 95% CI 0.89 to 38.17; P=0.07). Bilevel NIV initiation increased from 2000 to 2005.

CONCLUSIONS:

The present study illustrates how NIV is used in clinical practice and confirms that NIV initiation has increased over time.     

Variation in the Use of Percutaneous Biopsy for Diagnosis of Breast Abnormalities in Ontario

Background Preoperative diagnosis of breast abnormalities is currently the standard of care. A population-based study to determine the use of percutaneous needle biopsy for breast diagnosis in Ontario was performed. Methods A total of 17,068 women undergoing breast tissue sampling (percutaneous needle biopsy or surgical excision) for diagnosis between April 1, 2002, and December 31, 2002, and without a previous cancer diagnosis were identified. Univariate and multivariate analyses examined the association of age, residence in a particular local health integration network (LHIN), income quintile, urban or rural residence, primary care provider, any prior mammogram, and prior regular screening mammography, as well as whether the biopsy was initiated by a screening mammogram with different methods of tissue diagnosis. Results A total of 10,459 women (61%) underwent percutaneous biopsy for diagnosis. A total of 10,131 women underwent surgery, of whom 6637 received a benign diagnosis and 3494 had cancer, for a benign-to-malignant ratio of 1.9:1. Women with cancer were slightly more likely to undergo percutaneous biopsy than women without (64.7% vs. 60.3%). There was variation among LHINs in the use of percutaneous biopsy (range, 24%–72%). Women with the highest incomes, urban residence, a primary care provider, or history of any prior mammography were more likely to receive percutaneous biopsy. On multivariate analysis, age 50 to 69 years, LHIN, urban residence, primary care provider, and screen-initiated evaluation were associated with percutaneous biopsy. Conclusions Variation in the use of percutaneous biopsy by factors unrelated to indications for biopsy indicate that strategies to identify and overcome barriers to its use are needed.