The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100ß level in blood plasma in the aging brain.

INTRODUCTION: The risk of air microembolism during cardiopulmonary bypass (CPB) is high and influences the postoperative outcome, especially in elderly patients. The use of carbon dioxide (CO2) atmosphere during cardiac surgery may reduce the risk of cerebral air microembolism. The aim of our study was to assess the influence of CO2 field flooding on microembolism-induced brain damage assessed by the level of S100ß protein, regarded as a marker of brain damage. MATERIALS AND METHODS: A group of 100 patients undergoing planned mitral valve operation through median sternotomy using standard CPB was recruited for the study. Echocardiography was performed prior to and after the CPB. CO2 insufflation at 6 L/minute was conducted in the study group. Blood samples for S100ß protein analysis were collected after induction of anesthesia, 2 hours after aorta de-clamping, and 24 hours after operation. RESULTS: The S100ß level in blood plasma did not differ significantly between the study and the control group (0.13±0.08 µg/L, 1.12±0.59 µg/L, and 0.26±0.23 µg/L and 0.18±0.19 µg/L, 1.31±0.62 µg/L, and 0.23±0.12 µg/L, P=0.7, 0.14, and 0.78). The mean increase of the S100ß concentration was 13% lower in the group with CO2 protection than in the control group (0.988 µg/L vs 1.125 µg/L), although statistically insignificant. Tricuspid valve annuloplasties (TVAs) had significant impact on the increase in S100ß concentration in the treatment group after 24 hours (TVA [-] 0.21±0.09 vs TVA [+] 0.42±0.42, P=0.05). In patients <60 years, there were significant differences in the S100ß level 2 and 24 hours after the procedure (1.59±0.682 µg/L vs 1.223±0.571 µg/L, P=0.048, and 0.363±0.318 µg/L vs 0.229±0.105 µg/L, P=0.036) as compared with younger patients. CONCLUSION: The increase in S100ß concentration was lower in the group with CO2 protection than in the control group. Age and an addition of TVA significantly influenced the level of S100ß concentration in the tests performed 2 hours after aortic clamp release.

[Assessment of the quality of ambulatory care in type 2 diabetes mellitus]. / Ocena poziomu ambulatoryjnej opieki nad chorymi na cukrzyce typu 2.

INTRODUCTION: Long asymptomatic course of diabetes and insufficient treatment lead to many chronic complications. AIM OF STUDY: Assessment of the quality of ambulatory diabetes care in Szczecin and nearest region. MATERIAL AND METHODS: In year 2001 patients with previously diagnosed diabetes hospitalized in 35 wards of several hospitals in Szczecin were inquired for data concerning ambulatory care before hospitalization. STUDY GROUP: 120 subjects (60 women and 60 men), aged 65 +/- 13 years, diabetes duration 9.1 +/- 7.1 years. Type 2 diabetes--104 cases, type 1-10 cases, other types of diabetes--6 cases. RESULTS: Health care was provided by general practitioners (GPs) for 63% of patients, by diabetologist for 31% of them; 6% stayed out of control. In the proceeding month 49% of subjects attended visit related to diabetes; in 10% such a visit was reported in the period longer than 6 months. Glucose measurement performed every day was reported by 28% of subjects, once a month--by 36%, rarely--by 15%. Blood pressure measurements were performed by doctors in 43% of subjects, self control was performed by 42% of them and in 10% blood pressure was not measured at all. In the proceeding year eyes examination related to diabetes was performed in 63% of patients; in 26% such examination was never done. Foot examination was never done in 66% of diabetics. ECG examination was done in 57% of subjects last year, in 39% it was never done. Cholesterol serum level was measured last year in 52% of subjects. CONCLUSIONS: 1. Quality of ambulatory diabetes care is highly unsatisfactory and insufficient. 2. To improve health care for diabetics obligatory training in practical diabetology was conducted for all GPs from north-west region of Poland in 2002 y.