[Co-existence of severe aortic valve stenosis and recoarctation of the aorta treated surgically in childhood]. / Wspolistnienie ciezkiej stenozy aortalnej i restenozy skorygowanej w dziecinstwie koarktacji aorty.

Coarctation of the aorta is treated surgically in most of patients during childhood. However, some of them experience recoarctation in future. A 57 year-old woman suffering from chest pain and decreased activity tolerance was admitted to the cardiac department. Physical examinations, lab tests and cardiovascular imaging revealed severe aortic valve stenosis and insignificant narrowing of the aorta. The patient underwent a surgical replacement of the aortic valve without recoarctation repair.

Albuminuria and VEGF as early markers of cardiovascular disturbances in young type 1 diabetic patients.

AIMS: The aim of the study was to assess myocardial perfusion by means of non-invasive diagnostic methods and measurement of the plasma concentration of vascular endothelial growth factor (VEGF) in patients with long-lasting type 1 diabetes. METHODS AND RESULTS: The study was performed on 41 Type 1 diabetic patients (23 females, 18 males), aged 30±7.6 with a duration of disease 15.2±5.5years. 17 patients exhibited microalbuminuria (10 females, 7 males) and 24 subjects were without microalbuminuria (13 females, 11 males). The methods used included a 24-h ECG tape, an exercise treadmill test, echocardiological evaluation with dobutamine and atropine challenge and single photon emission computer tomography (SPECT) at rest, and after dipyridamol induction of ischemia. All the exercise and stress echocardiography tests were negative. There were significant differences between microalbuminuric and normoalbuminuric subjects in the duration of their exercise tests (586.9±110.5 vs. 664.9±133.2s, p=0.027), performed work (11.4±1.6.vs. 12.6±1.8 METs, p=0.045), achieved pulse limit (89.1±3.6 vs. 92.6±5.2%, p=0.037), rest ejection fraction (55.8±8.7 vs. 62.0±4.4%, p=0.040), abnormal changes in SPECT (53 vs. 21%, p=0.047) and VEGF concentration (101.5±7.8 vs. 75.15±16.5pg/ml, p<0.05). The presence of retinopathy increased 12-fold the probability of significant changes in the SPECT (OR 12.1, 95% CI 1.38-105.64, p=0.02) and nephropathy (OR 4.27; 95%CI 1.09-16.83, p=0.03). CONCLUSION: Asymptomatic patients with long lasting type 1 diabetes may have disturbances in myocardial perfusion, especially these with microalbuminuria.

Prospective evaluation of glucose metabolism in patients undergoing coronary artery bypass grafting.

INTRODUCTION: Disturbances of glucose metabolism are associated with increased risk of ischaemic heart disease (IHD). It is not uncommon that IHD and its complications precede diagnosis of glucose metabolism disturbances. Since publication of the American Diabetes Association's 2004 Guidelines for the assessment of glucose metabolism, no prospective evaluation of prevalence of carbohydrate metabolism disorders in patients referred for coronary artery bypass grafting (CABG) has been performed. AIM: Evaluation of prevalence of glucose balance disturbances in consecutive patients with stable IHD who underwent elective CABG procedures. METHODS: Prospective analysis of glucose metabolism was carried out on a group of 117 consecutive IHD patients (including 31 women) aged below 80 years, selected for elective CABG surgery. In all patients, history assessment and physical examination as well as basic biochemical studies and resting echocardiography were performed. Additionally, in all individuals without previous diagnosis of diabetes mellitus, oral glucose tolerance test (OGTT) was carried out. RESULTS: History analysis revealed glucose balance disturbances in 35 (29.9%) patients, including diabetes mellitus in 33 (28.2%) subjects and impaired glucose tolerance in 2 (1.7%) individuals. Based on OGTT results, among the remaining 82 (70.1%) subjects without previously known glucose metabolism disturbances 4 (3.4%) patients had abnormal fasting glycaemia, 32 (27.4%) subjects had impaired glucose tolerance, and diabetes mellitus was diagnosed in 12 (10.3%) individuals. No impaired glucose balance was found in only 34 (29.1%) examined subjects. CONCLUSIONS: Over 70% of all patients undergoing elective CABG procedure presented various forms of carbohydrate metabolism disturbances that were not diagnosed previously. Thus, it seems that the assessment of glucose regulation should be mandatory in all patients undergoing elective CABG surgery.

Adrenal pheochromocytoma associated with dramatic cyclic hemodynamic fluctuations.

A 52-year-old woman with a right adrenal pheochromocytoma had repetitive attacks of symptomatic hypotension/shock with systolic blood pressure (SBP)<50 mmHg followed by hypertension/hypertensive crises with SBP>300 mmHg. A non-invasive recording of beat-to-beat SBP, diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) was collected for 346 min. Twenty hemodynamic cycles occurred during this time, lasting 17 min on average, with the most dramatic changes of TPR. The ratio of the highest to the lowest observed values was nearly 12:1 for TPR, over 6:1 for both SBP and DBP, over 4:1 for CO, and nearly 4:1 for SV and 2:1 for HR. The fluctuations of TPR preceded changes of all other hemodynamic variables.

Neutrophils are active in total joint implant loosening.

BACKGROUND: Polymorphonuclear neutrophils (PMN) are the first cells to take part in the local foreign body reaction in aseptic loosening of endoprostheses. The aim of this study was to evaluate the systemic host reaction to total joint replacement by measuring the production of nitric oxide by neutrophils before and after total joint replacement. PATIENTS AND METHOD: Blood samples were collected from 33 patients (27 hips and 6 knees) before surgery, and 2 weeks, 2 months and 2.5-3 years after surgery. The levels of nitric oxide produced by PMN were measured by the method described by Markert et al. (1994). RESULTS: Patients reporting pain in the region of the implant 3 years after surgery, and also patients with radiographic signs of loosening, had higher production of NO in the early period and 3 years after the implantation than those with good clinical results. INTERPRETATION: We propose that elevated levels of nitric oxide production by PMNs may serve as a marker of total joint prosthesis loosening.

The oxygen stress index and levels of circulating interleukin-10 and interleukin-6 in patients with chronic heart failure.

OBJECTIVES: We sought to study circulating levels of pro- and anti-inflammatory cytokines together with the oxygen stress index in patients with chronic heart failure (CHF). BACKGROUND: Patients with CHF exhibit elevated levels of inflammatory and anti-inflammatory cytokines but the relative level of these cytokines with the oxygen stress index have not been reported. METHODS: Twenty-two patients with CHF and 10 control subjects were studied. Plasma levels of IL-6 and IL-10 were determined and the oxygen stress index was evaluated by urine 8-iso-PGF2alpha estimations. RESULTS: Plasma levels of IL-6 and IL-10 in CHF patients were significantly higher than those observed in the control subjects. Patients with more advanced disease (higher NYHA class) showed higher concentrations of IL-10 and IL-6 than those with less serious disease. 8-iso-PGF2alpha urine concentration (and therefore the oxygen stress index) was significantly higher in patients with CHF in comparison with control subjects. IL-6 plasma levels, but not IL-10 concentrations, correlated significantly with 8-iso-PGF2alpha levels in urine. CONCLUSIONS: Inflammatory and anti-inflammatory cytokine levels, as well as the oxidative stress index, are increased in patients with chronic heart failure. Inflammatory cytokine IL-6, but not anti-inflammatory cytokine Il-10, levels correlated significantly with the oxygen stress index.

Transcardiac release of soluble adhesion molecules during coronary artery bypass grafting: effects of crystalloid and blood cardioplegia.

BACKGROUND: Dysfunction of myocardium as a result of ischemia/reperfusion during coronary artery bypass grafting (CABG) is currently one of the biggest problems in cardiovascular surgery. In previous studies, it has been well established that activated leukocytes and coronary vascular endothelial cells play an important role in the development of cardiac tissue damage during ischemia followed by reperfusion. Interactions between both of these cell types require the expression of adhesion molecules on their surface. In certain conditions, on cell activation, the adhesion proteins may be released from activated cells in soluble form into circulation. The purpose of our study was to establish whether the use of blood cardioplegia modifies plasma levels of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), and soluble L-selectin (sL-selectin) in comparison with crystalloid cardioplegia in patients undergoing CABG. METHODS: Patients undergoing CABG were classified into two groups to receive cold crystalloid cardioplegia (St. Thomas' Hospital) or cold blood cardioplegia (method of Buckberg), followed by a "warm-shot" of the solution. Coronary sinus and arterial blood samples were obtained from 50 patients (42 men and 8 women; age range, 34 to 73 years) before aortic cross-clamping, at the beginning of reperfusion, and after 30 min of reperfusion. Plasma levels of soluble adhesion molecules were measured using sensitive enzyme-linked immunosorbent assays. RESULTS: The transcardiac release of sICAM-1 and sVCAM-1 following myocardial ischemia/reperfusion during CABG was evident in both groups of patients. However, the increase of soluble forms of both of these adhesion proteins was more significant in the group of patients receiving crystalloid cardioplegia. Crystalloid cardioplegia resulted in decreased plasma level of sE-selectin in the coronary sinus blood sample after 30 min of reperfusion. No significant changes in plasma levels of sL-selectin in either group were observed. CONCLUSION: Cardioplegia may affect the release of soluble forms of adhesion molecules from ischemic myocardium and modify endothelium activation in patients undergoing CABG.

[Polymorphonuclear leucocytes and the production of reactive oxygen species after total hip and knee replacement]. / Granulocyty obojetnochlonne i produkcja wolnych rodników tlenowych po endoprotezoplastyce.

Aseptic loosening of the prosthesis is caused by the mechanical instability of it's components or it depends on direct tissue reaction--foreign body reaction to implant's wear debris. Former studies showed a significant role of macrophages in the process of the chronic inflammation leading to the aseptic loosening. There are few studies concerning the early reaction against the implant and concerning in this process the role of neutrophils--the cells which form the primary defence of the body and are activated during contact with the foreign body. The examined group consisted of 33 patients aged 59-79 with implanted cemented hip or knee endoprosthesis due to the primary osteoarthritis. The count of granulocytes, production of the nitric oxide and hydrogen peroxide with Pick's and Market's method was evaluated in samples collected before the surgery, 2 months and 3 years after the operation. 3 years postoperatively 8 patients reported pain of the operated joint and in two cases aseptic loosening was recognized. In this group the level of production of the nitric oxide and hydrogen peroxide by the neutrophils 2 months postoperatively was significantly higher in comparisons to the levels in the patients without pain and the control group. In patients without pain the production of nitric oxide and the hydrogen peroxide did not change significantly after the surgery. The presented results suggest the neutrophil's activation by the cytokines, which appear as a result of a local response to a foreign body, may be a factor initiating a chronic inflammation around the implant leading to the aseptic loosening.