Physiopathology of the renin-angiotensin system in the ovary

The present review confirms the existence of the so-called "ovarian-derived prorenin-angiotensin cascade". It also describes the physiopathology of the system and, consequently, its role in the genesis of phenomena concerning reproductive function such as ovulation, steroid synthesis and folliculogenesis. Moreover, the "ovarian-derived prorenin-angiotensin cascade" appears to play an important role in the aetiopathogenesis of diseases such as ovarian tumours, ovarian hyperstimulation syndrome and ectopic pregnancy.     

Screening the 3' region of the polycystic kidney disease 1 (PKD1) gene in 41 Bulgarian and Australian kindreds reveals a prevalence of protein truncating mutations

Screening for disease-causing mutations in the unique region of the polycystic kidney disease 1 (PKD1) gene was performed in 41 unrelated individuals with autosomal dominant polycystic kidney disease. Exons 34-41 and 43-46 were assayed using PCR amplification and SSCP analysis followed by direct sequencing of amplicons presenting variant SSCP patterns. We have identified seven disease-causing mutations of which five are novel [c.10634-10656del; c.11587delG; IVS37-10C>A; c.11669-11674del; c.13069-13070ins39] and two have been reported previously [Q4010X; Q4041X]. Defects in this part of the gene thus account for 17% of our group of patients. Five of the seven sequence alterations detected are protein-truncating which is in agreement with mutation screening data for this part of the gene by other groups. The two other mutations are in-frame deletions or insertions which could destroy important functional properties of polycystin 1. These findings suggest that the first step toward cyst formation in PKD1 patients is the loss of one functional copy of polycystin 1, which indirectly supports the "two-hit" model of cystogenesis where a second somatic mutation inactivating the normal allele is necessary to occur for development of the disease condition.     

Combined Surgery for Cardiac and Carotid Disease: Management and Results of a Rational Approach

OBJECTIVES: The aim of the present study was to apply a rational plan for simultaneous cardiac and carotid surgery in high-risk patients. MATERIALS AND METHODS: A consecutive series of 89 patients with coexisting severe cardiac and carotid disease were operated on during a 5-year period with routinary carotid shunting, moderate hypothermia and balanced anaesthesia. The combined surgical procedures were coronary artery by-pass grafts (CABG) + carotid endarterectomy (CEA) in 81 patients, CABG + CEA + aortic valve replacement (AVR) in four patients, and four cases of CEA + AVR. RESSULTS: Two deaths (2%), three acute myocardial infarctions (3%) and one (1%) major stroke occurred in five patients during the perioperative (30 days) period for a combined rate of death and/or disabling stroke of 3%. There were five reversible neurological deficits. Carotid and aortic mean clamping times were 9 and 60 min respectively. Patients were discharged after a mean length of stay in Intensive Care Unit (ICU) of 131 h and 7 days of hospitalisation post-ICU. CONCLUSIONS: Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic cardiac disease. The management of these patients needs careful and appropriate pre-intra and post-operative assessment and timing aimed to reduce the ischaemic injuries, both cardiac and cerebral, especially during CBP time.     

The role of antithrombin III in the perioperative management of the patient with unstable angina

Background. To evaluate the effectiveness of intraoperative administration of antithrombin III (AT III) to improve anticoagulation and preserve the hemostatic mechanisms during cardiopulmonary bypass (CPB) in patients with unstable angina under heparin treatment.

Methods. We divided 22 patients, scheduled for coronary artery bypass grafting, into two groups. Group A (11 patients) received 3000 International Units (IU) of AT III concentrates plus heparin before aortic cannulation. Group B (11 patients) received only heparin. Blood drainage, allogeneic blood transfusions, and intraoperative activated coagulation time were recorded. Also, AT III, thrombin-antithrombin complex (TAT), fragment 1.2 (F 1.2), and -dimers were measured during the operation and the first postoperative day.

Results. Group A patients had fewer transfusions and had less chest-tube drainage. In group A, AT III levels increased after AT III concentrates administration and were always higher than in group B. In group B, F 1.2 and TAT increased significantly more after CPB and at the end of operation. Differences in -dimers between the groups were not significant.

Conclusions. Intraoperative administration of AT III concentrates allowed adequate anticoagulation during CPB and attenuated the coagulative cascade activation and the consequent consumptive coagulopathy.     

Effect of oral and intravenous hydration on oligohydramnios

OBJECTIVE: To investigate whether oral or intravenous hydration affects oligohydramnios in cases with normal biophysical profile scores. STUDY DESIGN: One hundred twenty-four gravidas with singleton pregnancies at or near term were identified during a 16-month period retrospectively as having oligohydramnios. A total of 50 subjects with normal biophysical profiles (8 of 10) whose labor was not induced at once fell into two nonrandom, convenience sample groups: (1) 20 who were advised to drink fluids, and (2) 30 given intravenous hydration. The remaining 74 cases with oligohydramnios consisted of 60 gravidas with normal biophysical profile scores and another 14 with low scores (< or = 6 of 10), all of whom had labor induced promptly. RESULTS: Cases with normal fetal status showed comparably favorable amniotic fluid index changes. In all, 62.5% and 44.0% demonstrated improved indices after oral and intravenous hydration, respectively; mean change in amniotic fluid index was +0.7 and +0.6. The amount of intravenous hydration did not correlate with the frequency of amniotic fluid index change (46.6% increase with intravenous volumes of < or = 2,000 mL, 40.0% with volumes > or = 2,500 mL), or with magnitude of change (average +1.3 and +0.6). CONCLUSION: Oral and intravenous hydration may correct uncomplicated oligohydramnios, but neither appears to be particularly advantageous over the other.     

Managing latex-free mitral valve replacement

The management of cardiac surgery patients with latex allergy can be challenging. We describe successful mitral valve replacement in a latex-allergic patient using an integrated multidisciplinary approach. We also provide a list of some available latex-free products or latex-free alternatives.     

Gaseous myelography. Accidents and complications. Case reports

Attention is called to the risks of gas myelography and two cases of complications are described. One of these, observed personally, was fatal and its possible pathogenetic mechanisms are illustrated. Stress is laid on certain rules and precautions that should be respected in radiological and anaesthesiological practice. Insufflation pressure and volumes of injected air deserve particular attention and scrupulous intraoperative control cut of vital parameters must be carried and appropriate attention paid to patient hydration during the postoperative period.     

Control of postoperative pain in heart surgery. Comparison of analgesics

BACKGROUND: Evaluation of the efficacy of three analgesic drugs (tramadol, ketorolac, and morphine) for the control of postoperative pain in cardiac surgery. METHODS: Design: prospective randomized study. Setting: University Hospital, Postoperative intensive care unit. Participants and intervention: sixty patients, who underwent cardiac surgery, were studied. They were randomly allocated in four groups, treated with a different postoperative analgesic therapy: A) tramadol in continuous infusion; B) ketorolac in continuous infusion; C) tramadol, in repeated boluses; D) morphine, in repeated boluses. Measurements: the analgesic efficacy of each drug and administration protocol was evaluated by hemodynamic stability, arterial blood gases analysis, Visual Analogue Scale (VAS), resting and after cough, the VAS derivatives PID and SPID, the concentration of plasma epinephrine and norepinephrine, at eight postoperative times. Adverse effects were also registered. RESULTS: Only tramadol, in continuous i.v. infusion, achieves the required analgesic effect, significantly decreasing both VAS scores, at the end of the administration of the drug. This treatment reduced epinephrine plasma levels in the first postoperative day, when the residual analgesic effect of surgical anesthesia can be considered disappeared. CONCLUSIONS: Tramadol in continuous infusion (dose 12 mg/h) proved to be effective for the control of postoperative pain after cardiac surgery. The proposed dose represents a good compromise between analgesic efficacy and interference with the vital functions of operated patients.