Common origin of left anterior descending artery and right coronary artery from right aortic sinus: presentation of rare variant.

The authors discuss a case of 55-year-old man admitted to hospital with clinical symptoms and electrocardiac signs of myocardial infarction, who underwent invasive diagnosis and one of most rare coronary arteries anomaly was observed: common origin of right coronary artery and anterior interventricular artery (left anterior descending artery) from right aortic sinus. Anatomical variants of coronary arteries are rare amongst general population, ranging between 0.29% to 1.3% and such anomaly is found in 0.03% of all coronarographies and is responsible for 2.3% of all coronary variations. Knowledge about coronary arteries anomalies is helpful not only in making better diagnosis but also in making better therapeutic decisions.

The body constitution of patients and intubation scales as predictors of difficult intubation considered in relation to the experience of the intubator.

The aims of the study were to identify factors that may result in difficulties in intubation, and to compare the results obtained when an experienced and when a less experienced anaesthesiologist was involved. The 96 patients included in the study were evaluated for difficult intubation according to the following scales: Mallampati, upper lip bite test (ULBT) and Patil. The mobility of the cervical segments of the vertebral column, the distance between the jugular notch of the sternum and the chin and the anatomical constitution of the body were other factors that were taken into consideration. Statistical analysis was performed in order to identify factors that may result in difficulties in intubation for an experienced and for a less experienced anaesthesiologist.

Use of drotrecogin alpha (recombinant human activated protein C, rhAPC) in the treatment of severe sepsis induced by graft pancreatitis after simultaneous pancreas and kidney transplantation: a case report.

We present our experience with recombinant human activated protein C (rhAPC) to treat a 40-year-old preemptive simultaneous pancreas-kidney transplant (spktx) recipient who developed septic shock due to graft pancreatitis. We diagnosed intra-abdominal septic complications with septicemia induced by multiple pathogens and cardiopulmonary insufficiency. Until the 59th posttransplant day, 21 peritoneal lavages were performed to treat peritonitis and intra-abdominal abscesses. On the 53rd day when septic shock was diagnosed, rhAPC was administered, after which the patient improved, vasoconstrictive agents were reduced, and respiratory insufficiency resolved. The Physiologic and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scale showed a decrease in predicted mortality from 93% to 17% on day 7 after rhAPC initiation. The patient was discharged at 128 days after spktx with good function of both grafts. Administration of rhAPC limited systemic inflammatory response syndrome (SIRS) and may be considered when faced with the dilemma of stopping immunosuppression to save a recipient's life but at the cost of rejection of a functioning graft.

Comparison of 1-year patient and graft survival rates between preemptive and dialysed simultaneous pancreas and kidney transplant recipients.

It is well known that the main decrease in graft and recipient survival rates is observed during the first 12 months after transplantation. Improving results during this period seems to be crucial for the late outcome. The aim of this study was to compare 1-year survival rates of dialyzed and preemptive pancreas and renal graft recipients and their graft function. From November 1999 to January 2005, 42 whole simultaneous pancreas and kidney transplantations (spktx) were stratified into group I (n = 13): recipients who received a preemptive pancreas and kidney transplant versus group II (n = 29): previously dialyzed spktx recipients. The mean time of dialysis for group II was 39 +/- 16.5 months. We assessed 1-year cumulative survival rates for recipients and grafts for each group. The 1-year cumulative survival rate for preemptive graft recipients was significantly higher than that for dialyzed patients before spktx (100% vs 69%; P = .05). For groups I and II 1-year cumulative graft survival rates for kidney grafts were 100% and 89%, respectively, and for pancreatic grafts 84% and 65.5%, respectively. There was a significant improvement in the 1-year survival rate of preemptive spktx recipients compared with patients dialyzed before spktx. However, 1-year pancreas and kidney graft function did not differ significantly between the groups.

Proinsulinemia in simultaneous pancreas and kidney transplant recipients.

It has been shown that lipid profiles do not differ between pancreas recipients with systemic and portal venous anastomosis. However, it is unclear whether venous drainage from the transplanted pancreas has an impact on recipient atherogenesis and if other factors should be considered. Increased concentration of proinsulin correlates with tachycardia and other risk factors for ischemic heart disease. The aim of this study was to compare proinsulin levels in different types of pancreatic graft venous drainage. Twenty-four simultaneous pancreas and kidney transplantation (SPK) recipients with systemic venous drainage (group S, n = 12) and portal venous drainage (group P, n = 12) under identical immunosuppressive treatment were prospectively observed during 24 months. Following transplantation, only recipients with normoglycemia, normal HbA1c, and normal serum creatine were evaluated. Proinsulin was assessed in fasting state; after glucagon stimulation (Delta-proinsulin), and during oral 75-g glucose tolerance test twice: between 3 and 6 months and 12 to 24 months posttransplantation. All SPK patients had higher proinsulin concentration in fasting state compared with age-matched healthy controls. After stimulation, proinsulin level did not significantly differ between groups; the type of the pancreas venous anastomosis did not change the release of proinsulin and should not have impact on cardiovascular risk factors.

Duodenal patch and sphincterotomy: modification of an old technique to prevent graft pancreatitis.

The aim of this study was to preliminarily evaluate the duodenal patch technique combined with open sphincterotomy in terms of prevention of graft pancreatitis. From April 2003 to March 2005, 17 simultaneous pancreas and kidney transplantations were performed using this technique. All recipients are alive with good renal transplant function. Directly after sphincterotomy in 16 pancreatic grafts a good outflow of clear pancreatic juice and a lessening of graft tenseness were observed during surgery. In two transplants an additional sphincterotomy of the Santorini duct sphincter was necessary. In one recipient no pancreatic juice secretion was observed and insulin independence was not obtained. This graft was explanted shortly afterward. In 13 recipients no graft pancreatic or peripancreatic fluid collection requiring intervention was observed. Of the three recipients who developed graft pancreatitis, two required graft pancreatectomy. In conclusion, Sphincterotomy facilitates pancreatic juice outflow by reducing intraoperative graft edema, which could lead to subsequent inflammation. Further studies on the factors inducing graft pancreatitis are necessary to eliminate this severe complication.

Do high levels of serum triglycerides in pancreas graft recipients before transplantation promote graft pancreatitis?

OBJECTIVE: Graft pancreatitis is a serious complication following pancreas transplantation. The aim of this study was to evaluate the influence of pretransplant serum lipid levels on the development of graft pancreatitis among patients undergoing simultaneous pancreas and kidney transplantation (spkTx). METHODS: We reviewed data from spkTx patients engrafted between 1999 and 2002. Group 1 consisted of 10 recipients with well-established pancreas and kidney graft function without postoperative pancreatitis; group 2 5 spkTx recipients who developed fatal graft pancreatitis in the first posttransplant month. The lipid parameters evaluated within 1 hour before transplantation and after hemodialysis included total cholesterol, HDL, LDL, VLDL, triglicerides and apoproteins A and B. RESULTS: Triglycerides, apoprotein B and VLDL were significantly increased just before transplantation among patients who developed fatal pancreatitis compared to those patients with good graft function. CONCLUSION: Recipient hypertriglyceridemia promotes graft pancreatitis in previously injured pancreatic graft.

Investigation of the free radical scavenging activity of Ginkgo biloba L. leaves.

The free radical scavenging activity of methanolic, ethanolic and aqueous extracts from Ginkgo biloba leaves, has been determined by EPR (electron paramagnetic resonance) using the DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging method. The investigation has also included selected constituents of G. biloba leaves, protocatechuic and p-coumaric acids, quercetin, rutin, isoginkgetin and (+)-catechin.

Phenolic acids from Ginkgo biloba L. Part I. Qualitative analysis of free and liberated by hydrolysis phenolic acids.

The presence of phenolic acids in the leaves, roots and seed testas of Ginkgo biloba L. (Ginkgoaceae) was analyzed. Seven free and liberated by hydrolysis phenolic acids were identified by chromatographic (TLC) and spectral (UV) methods as protocatechuic, p-hydroxybenzoic, vanillic, caffeic, p-coumaric, ferulic and chlorogenic acids.

Phenolic acids from Ginkgo biloba L. Part II. Quantitative analysis of free and liberated by hydrolysis phenolic acids.

HPLC was applied to the quantitative assay of seven free phenolic acids from the leaves, roots and seed testas of Ginkgo biloba L. (Ginkgoaceae). The concentration of the free phenolic acids amounted to: 19.693 micrograms/g of fresh leaves, 345.321 micrograms/g of roots and 2.708 micrograms/g of testas: protocatechuic acid is a dominant one. The concentration of the phenolic acids liberated by acid-mediated and alkaline hydrolysis was determined as well.

Analysis of the content of flavonoids, phenolic acids as well as free radicals from Ginkgo biloba L. leaves during the vegetative cycle.

The content of flavonoids, total phenolic acids and free radicals has been determined respectively by Christ-Muller method, HPLC and EPR in leaves of Ginkgo biloba L. during the vegetative cycle. The relationship between these parameters has been discussed.

Computed tomographic angiography and perfusion in the diagnosis of brain death.

INTRODUCTION: According to Polish brain death (BD) criteria, instrumental confirmatory tests should be used in certain clinical situations, particularly any case for which clinical examinations seem inadequate. Electrophysiological tests are often unavailable. Therefore, cerebral perfusion testing is the method of choice with four-vessel digital subtraction angiography (DSA), the gold standard. Unfortunately, DSA is an expensive and invasive examination that requires an experienced neuroradiologist and the availability of an angiography suite. Recently, multirow computed tomographic devices became available, even in smaller hospitals in Poland. Despite this fact, computed tomographic angiography (CTA) and computed tomographic perfusion (CTP) are not accepted in BD diagnosis protocols in Poland because of limited experience and a lack of widely accepted criteria. In this situation, we started a multicenter trial to determine the accuracy of CTA and CTP to confirm BD. METHODS: We examined 24 patients who fulfilled standard clinical BD criteria. We recognized the absence of brain perfusion in CTA examination following the criteria proposed by the French Society of Neuroradiology, namely, the absence of opacification of M4 middle cerebral artery segments (M4-MCA) and of deep cerebral veins. RESULTS: In all of our patients, CTA showed absence of opacification of M4 segments and of deep cerebral veins. In addition, three patients had CTA showing weak opacification of A2 segments of the anterior cerebral artery (A2-ACA) and M2 or M3-MCA. Opacification of the basilar artery or of the posterior cerebral arteries was not noted in any case. In all patients, CTP revealed zero values of regional cerebral blood volume and regional cerebral blood flow. Conventional angiography confirmed cerebral circulatory arrest in all 24 cases. CONCLUSION: CTA and CTP seem to be promising radiological examinations for the diagnosis of BD. They may be noninvasive alternatives to conventional cerebral angiography, and to the other instrumental confirmatory tests, that are unavailable or inadequate.

In vitro studies on the cytostatic activity of propolis extracts.

Extracts from propolis have been investigated for cytostatic activity in vitro, by method of tissue culture on human KB and HeLa cell lines. Diethyl ether extract (DEEP) sowed the greatest activity and therefore it was further fractionated. Secondary DEEP fractions obtained by extraction with BuOH (ED50 = 2.6 micrograms/ml) and AcOEt (ED50 = 3.3 micrograms/ml) have been qualified to further in vivo studies.