RESUMO
Interleukin-4 exerts anti-inflammatory effects through decreased macrophage production of tumor necrosis factor-alpha and interleukin-1 beta. We investigated genetic predisposition in the interleukin-4 response to coronary revascularization and studied the association between C-590T polymorphism, interleukin-4 levels, and outcome of surgery. DNA was obtained from 96 consecutive patients undergoing elective coronary revascularization. Patients were genotyped for interleukin-4 C-590T polymorphism using a sequence-specific primer polymerase chain reaction. Interleukin-4 levels were measured using an enzyme-linked immunosorbent assay in serum samples taken 3 hr postoperatively. The frequency of interleukin-4 C-590T genotypes CC, CT, and TT was 33.3%, 27.1%, and 39.6%, respectively. Patients with the TT genotype had significantly higher circulating levels of interleukin-4 (3.4 +/- 4.6 pg x mL(-1)) postoperatively compared to CC (2.5 +/- 0.1 pg x mL(-1)) and CT (2.7 +/- 0.5 pg x mL(-1)) genotypes. Interleukin-4 C-590T polymorphism is the main determinant of postoperative interleukin-4 levels. The TT genotype is the highest producer of interleukin-4. Neither the genotype nor the serum levels seem to play any role in recovery from coronary artery bypass surgery.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Interleucina-4/genética , Polimorfismo Genético , Idoso , Ponte Cardiopulmonar , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/genética , Procedimentos Cirúrgicos Eletivos , Feminino , Frequência do Gene , Genótipo , Humanos , Interleucina-4/sangue , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: A systemic inflammatory response is not uncommonly observed after coronary revascularization. Tumor necrosis factor alpha is one of a number of modulators of this response. A functional polymorphism within the TNFalpha gene at position G-308A has been associated with increased TNFalpha levels. The relationship between predicted TNFalpha genotype and circulating TNFalpha levels in patients undergoing coronary revascularization surgery has yet to be defined. We examined the relationship between TNFalpha G-308A polymorphism, TNFalpha postoperative levels, and clinical outcome after coronary revascularization surgery. METHODS: We obtained DNA from 96 consecutive patients who underwent elective coronary revascularization. Patients were genotyped for TNFalpha G-308A polymorphism using sequence specific primer-polymerase chain reaction (SSP-PCR). Tumor necrosis factor alpha levels were measured on serum samples taken 3 hours postoperatively using enzyme-linked immunosorbent assay (ELISA). RESULTS: The prevalence of AA, AG, and GG TNFalpha-308 genotype was 12%, 40%, and 48%, respectively. Patients homozygous for A had higher circulating levels of TNFalpha (p = 0.009). Higher levels of TNFalpha were significantly associated with prolonged intensive care unit stay (p = 0.008), increase usage of an inotropic agent (p = 0.024), increased mortality risk (p = 0.018), and diabetes (p = 0.019). These remained statistically significant after risk stratification. CONCLUSIONS: Patients of the AA-308 TNFalpha genotype showed significantly higher TNFalpha plasma levels. Higher plasma levels of TNFalpha were associated with less favorable outcome after coronary revascularization surgery. It may prove useful to utilize TNFalpha serum levels as a marker for identifying high-risk patients in the future.
Assuntos
Ponte Cardiopulmonar/efeitos adversos , Revascularização Miocárdica , Complicações Pós-Operatórias/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Fator de Necrose Tumoral alfa/fisiologia , Idoso , Análise Mutacional de DNA , Procedimentos Cirúrgicos Eletivos , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/genética , Resultado do Tratamento , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/genéticaRESUMO
Erythroderma-induced cardiogenic shock is a rare but known manifestation of erythrodermic psoriasis. Erythrodermic psoriasis is an aggressive form of the disease and can be precipitated by numerous factors including stress to the body. In this article we present a case of persistent severe vasodilatation after coronary artery bypass surgery that required prolonged epinephrine administration. This was caused by a flareup of erythrodermic psoriasis that was previously only controlled by methotrexate. This drug was omitted in the perioperative phase. Vasodilatation disappeared after treatment was reinstituted.
Assuntos
Dermatite Esfoliativa/complicações , Insuficiência Cardíaca/etiologia , Complicações Pós-Operatórias/etiologia , Psoríase/complicações , Idoso , Dermatite Esfoliativa/tratamento farmacológico , Feminino , Humanos , Metotrexato/uso terapêutico , Psoríase/tratamento farmacológico , VasodilataçãoRESUMO
Gastrobronchial fistula is a very rare condition with only 27 reported cases. Previous gastro-oesophageal surgery, subphrenic abscess, and gastric ulcers are the most commonly reported causes. We are reporting two recent cases of gastrobronchial fistula that presented to us. A review of the literature discussing possible causes, investigation and management of this condition is also provided.