ABSTRACT
Postoperative spasm of the internal mammary artery graft can cause morbidity and mortality after myocardial revascularization. To our knowledge, the ability of systemic vasodilators to overcome internal mammary artery spasm has not been studied clinically. In 50 patients in whom the left internal mammary artery was used for myocardial revascularization, we have investigated the effect of five agents on internal mammary artery free flow: normal saline, dobutamine, glyceryl trinitrate, sodium nitroprusside, and enoximone, a phosphodiesterase III inhibitor. After the internal mammary artery was harvested, free flow was measured under controlled hemodynamic conditions before any pharmacologic intervention (flow 1) and a mean of 18.5 +/- 3 (standard deviation) minutes after a systemic infusion of one of the five agents was begun (flow 2). The increase in free flow expressed as a percentage of initial flow was greater for enoximone (94% +/- 24%) than for normal saline (18% +/- 11%), dobutamine (40% +/- 27%), and glyceryl trinitrate (52% +/- 36%) (all three p < 0.01). The increase in flow for sodium nitroprusside (78% +/- 37%) was greater than for normal saline and dobutamine (both p < 0.05). We therefore recommend the systemic use of enoximone and sodium nitroprusside, in rank order, to prevent and treat postoperative spasm of the internal mammary artery.
Subject(s)
Internal Mammary-Coronary Artery Anastomosis , Mammary Arteries/physiology , Postoperative Care , Vasodilator Agents/administration & dosage , Blood Flow Velocity/drug effects , Dobutamine/administration & dosage , Enoximone/administration & dosage , Female , Humans , Male , Mammary Arteries/drug effects , Middle Aged , Nitroglycerin/administration & dosage , Nitroprusside/administration & dosage , Postoperative Complications/drug therapy , Postoperative Complications/prevention & control , Spasm/drug therapy , Spasm/etiology , Spasm/prevention & control , Vasoconstriction/drug effectsABSTRACT
One hundred and three consecutive cases of breast cancer in Trinidadian women were evaluated for steroid receptor status and c-erbB-2 receptor along with conventional parameters including age, ethnicity, tumour size, histological type and grade, and lymph node status: The molecular markers were studied by immunohistochemistry (IHC) on paraffin sections. Tumour size > 2 cm was seen in 60% of the cases. Oestrogen receptor (ER), progesterone receptor (PR) and c-erbB-2 showed 54%, 46% and 63% positivity, respectively. There was no correlation between c-erbB-2 and steroid receptors. Forty-one per cent of cases showed double negativity for steroid receptors (ER-/PR-). No correlation was found between the markers and conventional parameters except for a negative correlation with the tumour grade. The high percentage of c-erbB-2 positivity and the high proportion of steroid receptor negativity suggest a need for studies on adjuvant therapy. Integration of selected markers with conventional parameters could help define subgroups for treatment and prognosis.
Subject(s)
Breast Neoplasms/chemistry , Carcinoma, Intraductal, Noninfiltrating/chemistry , Receptor, ErbB-2/analysis , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Adult , Aged , Biomarkers, Tumor/analysis , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/chemistry , Carcinoma, Ductal, Breast/genetics , Carcinoma, Ductal, Breast/pathology , Carcinoma, Intraductal, Noninfiltrating/genetics , Carcinoma, Intraductal, Noninfiltrating/pathology , Female , Humans , Immunohistochemistry , Middle Aged , Trinidad and Tobago/epidemiologySubject(s)
Cholecystectomy , Drainage , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , Postoperative Care , Postoperative ComplicationsABSTRACT
One hundred and three consecutive cases of breast cancer in Trinidadian women were evaluated for steroid receptor status and c-erbB-2 receptor along with conventional parameters including age, ethnicity, tumour size, histological type and grade, and lymph node status: The molecular markers were studied by immunohistochemistry (IHC) on paraffin sections. Tumour size > 2 cm was seen in 60 of the cases. Oestrogen receptor (ER), progesterone receptor (PR) and c-erbB-2 showed 54, 46 and 63 positivity, respectively. There was no correlation between c-erbB-2 and steroid receptors. Forty-one per cent of cases showed double negativity for steroid receptors (ER-/PR-). No correlation was found between the markers and conventional parameters except for a negative correlation with the tumour grade. The high percentage of c-erbB-2 positivity and the high proportion of steroid receptor negativity suggest a need for studies on adjuvant therapy. Integration of selected markers with conventional parameters could help define subgroups for treatment and prognosis.