Reference limits for blood gas analysis performed from coccygeal vessels of multiparous Holstein dairy cows: Effects of stage of lactation and season of sampling.

Blood gas analysis is a great support to the diagnostic process of critically ill patients. Its correct application to the medicine of dairy cows depends on the availability of specific reference intervals that are still difficult to find in the literature. They may vary according to the type of blood sampled, animals' age and production stage, and climatic conditions. This study aimed at calculating the reference limits for some blood gas parameters in the blood collected from the coccygeal vessels of multiparous Holstein dairy cows. This site of sampling implies the risk of withdrawing blood of unknown origin (venous, arterial, or mixed), but has a high practical interest for the easy and quick performance and the minimal animal restraint required. Data from 379 cows were used, and reference limits were produced for pH, partial pressure of carbon dioxide (pCO2), bicarbonate concentration (HCO3), total carbon dioxide concentration (tCO2), oxygen saturation (sO2), hemoglobin (Hb), hematocrit (Hct), base excess (BE), glucose, Na, K, and ionized calcium (iCa). The effects of stage of lactation (5 to 60 vs. > 60 DIM) and season of sampling (cold vs. hot) were investigated, and specific reference limits were produced for each variable and each level of the factors whenever a significant effect was detected. The pH, sO2, K, and iCa were not influenced by season or stage of lactation. All the other blood gas parameters were significantly affected by season of sampling, and Hb, Hct, glucose, and Na were also affected by stage of lactation. Reference limits provided in this study are specific to the site of sampling (coccygeal vessels) and the animal category considered. Further studies are needed to produce reference intervals for other blood gas parameters, cow categories, and blood types.

Technical note: Rapid mineral determination in forages by X-ray fluorescence.

A large portion of the cow's ration is composed of forages that can vary greatly in mineral concentrations, which may affect animal performance and health. Current methods for mineral analysis require sample destruction either through wet or dry ashing and complex analytical techniques for individual minerals. Energy dispersive X-ray fluorescence (EDXRF) is a nondestructive, multi-mineral, spectroscopy technique, which makes mineral quantification simple, direct, and affordable. The study objective was to evaluate the prediction performance of EDXRF of Na, Mg, P, S, Cl, Ca, K, Mn, Fe, Cu, and Zn concentrations in forages. Twelve certified plant samples with a wide range in mineral concentrations were used to develop calibrations, and 35 forages (18 alfalfa hays, 10 grass hays, 7 corn silages) with measured mineral concentrations, which were collected over several years from 3 proficiency programs, were used as an independent validation set. All the samples were previously dried and finely ground and were prepared by compressing them into a round dense pellet, 40 mm in diameter, using a 40-ton pneumatic laboratory press. Samples were scanned using an EDXRF instrument enhanced for lighter minerals like Na and Mg. Samples were scanned at 20 keV and at 40 KeV associated with an Al filter, for a total analysis time of approximately 6 min. Calibrations were developed with Bruker SpectraEDX (Bruker, Hamburg, Germany) software and optimized to minimize the standard error of calibration. All of the minerals had acceptable calibration performance with coefficient of determination ranging from 0.93 (P) and 0.99 (Cl, Ca, and Mn) and coefficients of variation within 5 to 14%, which are similar to the coefficients of variation of the reference analysis. The coefficients of variation for Na was an exception, with a coefficients of variation of 29%. The validation set obtained similar statistical results as that observed in calibration. The root mean square error of prediction corrected for bias was similar to the standard error of calibration, indicating that it is possible to build a robust calibrations that performed well across different type of forages by using 12 reference samples with a sufficient range in mineral concentrations that were determined accurately. A bias correction was necessary to improve prediction accuracy only for K (-0.23% dry matter) and Ca (-0.16% dry matter). Energy dispersive X-ray fluorescence demonstrated the ability to be an accurate, direct, and simple technique for forage mineral analysis.

Extensive feeding on sockeye salmon Oncorhynchus nerka smolts by bull trout Salvelinus confluentus during initial outmigration into a small, unregulated and inland British Columbia river.

Stomach contents were collected and analysed from 22 bull trout Salvelinus confluentus at the edge of the Chilko Lake and Chilko River in British Columbia, Canada, during spring outmigration of sockeye salmon Oncorhynchus nerka smolts. Twenty of the 22 (>90%) stomachs contained prey items, virtually all identifiable prey items were outmigrant O. nerka smolts and stomach contents represented a large portion (0·0-12·6%) of estimated S. confluentus mass. The results demonstrate nearly exclusive and intense feeding by S. confluentus on outmigrant smolts, and support recent telemetry observations of high disappearance rates of O. nerka smolts leaving large natural lake systems prior to entering high-order unregulated river systems.

Does among-population variation in burst swimming performance of sockeye salmon Oncorhynchus nerka fry reflect early life migrations?

Using a fixed-speed test, burst swimming performance was found to vary among nine populations of emergent sockeye salmon Oncorhynchus nerka fry reared in a common-garden environment. No consistent relationship was, however, detected between difficulty of fry migration (upstream v. downstream) to rearing areas and total burst swimming duration or bursting rate.

Testing the synergistic effects of GnRH and testosterone on the reproductive physiology of pre-adult pink salmon Oncorhynchus gorbuscha.

To test the hypothesis that the hypothalmic gonadotropin-releasing hormone (GnRH) and testosterone (T) co-treatment stimulates both the hypothalmo-pituitary-gonadal (HPG) and hypothalmo-pituitary-interrenal axes, the reproductive and osmoregulatory responses of pre-adult pink salmon Oncorhynchus gorbuscha were compared after GnRH and T administration either alone or in combination. Relative to controls, neither GnRH nor T treatment resulted in significantly greater ovarian or testicular growth, but co-treatment significantly increased ovarian growth after 5 months. Interestingly, the stimulation was undetectable after 3 months. However, once daily photoperiod began shortening after the summer solstice, c. 2 months before the natural spawning date, GnRH+T-treated females were stimulated to produce larger ovaries. Final fish body length and the size of individual eggs did not differ among treatment groups. GnRH+T eggs, however, showed signs of advanced vitellogenesis relative to GnRH-treated and control eggs, whereas T-treated eggs became atretic. Testis size increased significantly from initial values and most males were spermiating, but this growth and development were independent of hormone treatments. Final plasma ion, metabolite and cortisol concentrations did not differ among treatment groups. It is concluded that GnRH+T co-treatment was effective in stimulating female but not male maturation. GnRH and T treatment, however, presumably had little effect on the hypothalmo-pituitary-interrenal axis as observed by ionoregulatory status.

Aortopexy for the management of paediatric tracheomalacia - the Alder Hey experience.

BACKGROUND: Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre. METHOD: A retrospective case note review was conducted. Mean follow up was five years. RESULTS: Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy. CONCLUSION: Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

Routine and active metabolic rates of migrating adult wild sockeye salmon (Oncorhynchus nerka Walbaum) in seawater and freshwater.

We present the first data on the differences in routine and active metabolic rates for sexually maturing migratory adult sockeye salmon (Oncorhynchus nerka) that were intercepted in the ocean and then held in either seawater or freshwater. Routine and active oxygen uptake rates (MO2) were significantly higher (27%-72%) in seawater than in freshwater at all swimming speeds except those approaching critical swimming speed. During a 45-min recovery period, the declining postexercise oxygen uptake remained 58%-73% higher in seawater than in freshwater. When fish performed a second swim test, active metabolic rates again remained 28%-81% higher for fish in seawater except at the critical swimming speed. Despite their differences in metabolic rates, fish in both seawater and freshwater could repeat the swim test and reach a similar maximum oxygen uptake and critical swimming speed as in the first swim test, even without restoring routine metabolic rate between swim tests. Thus, elevated MO2 related to either being in seawater as opposed to freshwater or not being fully recovered from previous exhaustive exercise did not present itself as a metabolic loading that limited either critical swimming performance or maximum MO2. The basis for the difference in metabolic rates of migratory sockeye salmon held in seawater and freshwater is uncertain, but it could include differences in states of nutrition, reproduction, and restlessness, as well as ionic differences. Regardless, this study elucidates some of the metabolic costs involved during the migration of adult salmon from seawater to freshwater, which may have applications for fisheries conservation and management models of energy use.

Chromosomal duplication accompanies allelic loss in non-small cell lung carcinoma.

Hemizygous deletion in the short (p) arm of chromosome 3 is a common finding in non-small cell lung carcinoma (NSCLC) and is postulated to be a crucial early change in lung tumorigenesis. Yet one of the most frequent nuclear abnormalities in both NSCLC and premalignant bronchial epithelium is increase in chromosomal copy number. Deletion and duplication have not been assessed in the same tumor set by both molecular and cytogenetic methods to determine whether allelic loss correlates with chromosomal duplication in the same tumor cell populations. It is also not established what biological mechanisms might lead to allelic deletion and chromosomal duplication. We have investigated changes in the copy number of chromosome 3 in touch preparations of 38 NSCLCs (19 adenocarcinomas and 19 squamous cell carcinomas) using dual-target, dual-color fluorescence in situ hybridization (FISH) assays. Chromosome 3 centromere probe was matched with a 3p14.2 probe [intron 4 of the fragile histidine triad (FHIT) gene] and a 3p21.31 probe (HSemaIV gene). We then correlated FISH results with results of molecular analyses for allelic losses at loci in the regions to which the FISH probes mapped in 20 of these cases. Although various combinations of FISH abnormalities were sometimes detected within the same specimens, individual cases could be classified according to the predominant FISH pattern, usually with one abnormality present in >60% of tumor cells. Chromosomal duplication, indicated by the presence of more than two centromeric signals, was the most frequent abnormality observed by FISH and was accompanied by loss of specific sequences on 3p in approximately one-half of the specimens in which it was observed. The most frequent abnormality observed by molecular analysis was loss of heterozygosity (LOH) in both of the chromosomal regions tested and was demonstrated in 83% of cases with chromosomal duplication. We conclude that LOH may occur in the presence of chromosomal duplication, suggesting that the duplicated chromosome is homozygous. Our findings imply that LOH occurs before chromosomal duplication during lung carcinogenesis.

GISSI trial: early results and late follow-up. Gruppo Italiano per la Sperimentazione della Streptochinasi nell'Infarto Miocardico.

In the GISSI trial, 11,712 patients with acute myocardial infarction were randomized to receive either standard care or standard care with 1.5 million units streptokinase intravenously. A highly significant reduction in mortality during hospitalization in streptokinase-treated patients was observed. The mortality at 1 year was determined in 98.3% of the patients who had been originally randomized; the 1 year mortality of patients discharged alive was similar in those patients treated with streptokinase and those who were not; that is, the beneficial effects of streptokinase treatment on survival that were observed in the hospital phase of the study persisted unchanged and with comparable statistical significance for 1 year. However, a higher incidence of reinfarction occurred in the treated versus the control groups both during the hospital phase and at the 6 month follow-up. Streptokinase treatment had no detectable effect in patients with a history of previous infarction.

Which variable of stenosis severity best describes the significance of an isolated left anterior descending coronary artery lesion? Correlation between quantitative coronary angiography, intracoronary Doppler measurements and high dose dipyridamole echocardiography.

OBJECTIVES: This study sought to investigate the angiographic or intracoronary Doppler variables of stenosis severity that best correlate with the results of dipyridamole echocardiography. BACKGROUND: Quantitative coronary angiography and intracoronary Doppler flow velocity assessments are the commonly used techniques for the objective identification of significant coronary artery stenosis. METHODS: Thirty patients with an isolated lesion of the left anterior descending coronary artery (LAD) were studied by means of on-line quantitative coronary arteriography, intracoronary Doppler flow velocity measurements and dipyridamole echocardiography 6 months after percutaneous transluminal coronary angioplasty. The quantitative arteriographic analyses were performed on-line; post-stenotic Doppler flow velocities were measured at baseline and after adenosine infusion. Angiographic and Doppler measurements were compared with the corresponding dipyridamole echocardiographic data and analyzed by discriminant analysis. RESULTS: The dipyridamole echocardiographic response was positive in 11 patients (37%). The best cutoff values for predicting an abnormal echocardiographic response were 1) stenotic flow reserve of 2.8 (p = 0.0001); 2) 59% diameter stenosis (p = 0.0001); 3) minimal lumen diameter of 1.35 mm (p = 0.001); 4) coronary flow reserve of 2.0 (p = 0.0002); and 5) maximal peak velocity of 60 cm/s during hyperemia (p = 0.04). Multivariate analysis identified stenotic flow reserve as the only independent predictor of ischemia during dipyridamole echocardiography. CONCLUSIONS: Stenotic flow reserve is the variable that best describes the functional significance of an isolated LAD lesion, and a value of 2.8 is the best predictor of a positive dipyridamole echocardiographic response. Furthermore, angiographic variables of stenosis severity relate to echocardiographic test results better than intracoronary Doppler variables.

N-acyl-2-substituted-1,3-thiazolidines, a new class of non-narcotic antitussive agents: studies leading to the discovery of ethyl 2-[(2-methoxyphenoxy)methyl]-beta-oxothiazolidine-3-propanoate.

The synthesis of a novel class of antitussive agents is described. The compounds were examined for antitussive activity in guinea pig after cough induction by electrical or chemical stimulation. Ethyl 2-[(2-methoxyphenoxy)methyl]-beta-oxothiazolidine-3-propanoate (BBR 2173, moguisteine, 7) and other structurally related compounds showed a significant level of activity, comparable to that of codeine and dextromethorphan. The compounds presented in this paper are characterized by the N-acyl-2-substituted-1,3-thiazolidine moiety, which is a novel entry in the field of antitussive agents. The serendipitous discovery of the role played by the thiazolidine moiety in determining the antitussive effect promoted extensive investigations on these structures. This optimization process on N-acyl-2-substituted-1,3-thiazolidines led to the initial identification of 2-[(2-methoxypheoxy)methyl]-3-[2-(acetylthio)acetyl]- 1,3-thiazolidine (18a) as an interesting lead compound. The careful study of the rapid and very complicated metabolism of 18a provided further insights for the design of newer related derivatives. The observation that the metabolic oxidation on the lateral chain's sulfur of 18a to sulfoxide maintained the antitussive properties suggested the introduction of isosteric functional groups with respect to the sulfoxide moiety. Subsequent structural modifications showed that hydrolyzable malonic residues in the 3-position of the thiazolidine ring were able to assure high antitussive activity. This optimization ultimately led to the selection of moguisteine (7) as the most effective and safest representative of the series. Moguisteine is completely devoid of unwanted side effects (such as sedation and addiction), and its activity was demonstrated also in clinical studies.

Effect of ventricular fibrillation complicating acute myocardial infarction on long-term prognosis: importance of the site of infarction.

Identification of high-risk subgroups of patients after acute myocardial infarction (AMI) is essential for evaluation of targeted preventive strategies. A case-control study was performed in 250 post-AMI patients to examine whether an episode of ventricular fibrillation (VF) during the in-hospital period modifies the long-term prognosis for patients with either an anterior or an inferior AMI. After identification of 70 patients with an anterior AMI and 55 patients with an inferior AMI, all complicated by VF and discharged alive, we selected 125 additional patients who had an AMI not complicated by VF (control subjects). To minimize the potential sources of differences in outcome, cases and controls were matched for the following variables: sex (all men), age (same +/- 2 years), coronary care unit (same), epoch of AMI (same +/- 3 months), and site of AMI (same). Left ventricular dysfunction and prior AMI were present in only a few patients. Patients receiving either acute or long-term treatment with beta-adrenergic blocking agents were not included. The average follow up was 59 months (range 12 to 120). The cumulative mortality during the first 5 years for the patients with inferior AMI without VF (6%, 11%, 13%, 13% and 13%) was modest and not significantly different from that of inferior AMI complicated by VF (6%, 11%, 20%, 20%, and 26%). In contrast, a striking difference appeared when the cumulative mortality of patients with anterior AMI without VF (9%, 13%, 17%, 27%, and 29%) was compared with that of patients with anterior AMI complicated by VF (32%, 40%, 46%, 49% and 54%) (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Inflammatory response after coronary revascularization with or without cardiopulmonary bypass.

BACKGROUND: We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response. METHODS: Sixty patients undergoing CABG were randomly assigned to one of two groups: (A) on pump with conventional CPB and cardioplegic arrest, and (B) off pump on the beating heart. Serum samples were collected for estimation of neutrophil elastase, interleukin 8 (IL-8), C3a, and C5a preoperatively and at 1, 4, 12, and 24 hours postoperatively. Furthermore, white blood cell (WBC), neutrophil, and monocyte counts were carried out preoperatively and at 1, 12, 36 and 60 hours postoperatively. Overall incidence of infection and perioperative clinical outcome were also recorded. RESULTS: The groups were similar in terms of age, weight, gender ratio, extent of coronary disease, left ventricular function, and number of grafts per patient. Neutrophil elastase concentration peaked early after CPB in the on-pump group, with a decline with time. Repeated-measures analysis of variance between groups and comparisons at each time point (modified Bonferroni) showed elastase concentrations were significantly higher in the on-pump than the off-pump group (both p < 0.0001). IL-8 increased significantly after surgery in the on-pump group, with no decline during the observation period (p = 0.01 vs off pump). C3a and C5a rose early after surgery in both groups when compared with baseline values. Postoperative WBC, neutrophil, and monocyte counts were significantly higher in the on-pump than the off-pump group (p < 0.01). Finally, the incidence of postoperative overall infections was significantly higher in the on-pump group (p < 0.0001 vs off pump). CONCLUSIONS: CABG on the beating heart is associated with a significant reduction in inflammatory response and postoperative infection when compared with conventional revascularization with CPB and cardioplegic arrest.

Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study.

BACKGROUND: Emphasis on cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. The revival of interest in off-pump (beating heart) coronary artery bypass surgery may influence the economic outcome. This study examines these effects. METHODS: Two hundred patients undergoing first-time coronary artery bypass surgery were prospectively randomized to either conventional cardiopulmonary bypass and cardioplegic arrest or off-pump surgery. Variable and fixed direct costs were obtained for each group during operative and postoperative care. The data were analyzed using parametric methods. RESULTS: There was no difference between the groups with respect to pre- and intraoperative patient variables. Off-pump surgery was significantly less costly than conventional on-pump surgery with respect to operating materials, bed occupancy, and transfusion requirements (total mean cost per patient: on pump, $3,731.6+/-1,169.7 vs off-pump, $2,615.13+/-953.6; p < 0.001). Morbidity was significantly higher in the on-pump group, which was reflected in an increased cost. CONCLUSIONS: Off-pump revascularization offers a safe, cost-effective alternative to conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest.

Mid-term follow-up of 183 arterial myocardial revascularization procedures.

OBJECTIVE: To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits. METHODS: From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 56 +/- 8.7 years, the redo-operation rate was 16.9% (31/183), two-vessel disease was present in 61 patients (33.3%), three-vessel disease in 122 (66.7%). RESULTS: The LIMA was used in 179 patients (97.8%), the RIMA in 116 (63.4%), the rGEA in 66 (36.1%) and the IEA in 41 (22.4%). In-hospital mortality was 1.1% (2/183), while the perioperative myocardial infarction (MI) rate was 2.2% (4/183). The angiographic restudy, performed on 87 (47.5%) patients during the early postoperative period (median 38 days) showed the following grafts patency rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05 (33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35 months. Kaplan-Meier survival was 96 +/- 2% at 3 and 5 years, freedom from angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-Meier freedom from cardiac events was 90 +/- 3% at 3 years and 88 +/- 3% at 5 years. Cox regression analysis identified perioperative MI (P = 0.03, relative risk 3.6) as the only prognostic factor for mortality at follow-up. With regards to recurrence of angina, multivariate analysis has shown that incremental risk factors for the return of angina are redo-operation (P < 0.01, relative risk 2.7) and the persistence of hypertension after surgery (P < 0.01; relative risk 3.2), while the use of the RIMA in the operation has emerged as a protective factor (P = 0.02; relative risk 0.43). Finally, only redo-operation (P < 0.01; relative risk 2.3), has emerged as a predictor of cardiac complications. CONCLUSION: Myocardial revascularization with at least two arterial grafts can be performed with very low perioperative morbidity and mortality and good mid-term follow-up. The mid-term results of arterial myocardial revascularization are less favourable in cases of redo-operations or when the RIMA is not used.

Video-assisted minimally invasive coronary bypass surgery without cardiopulmonary bypass.

BACKGROUND: There is a growing interest in cardiac surgery towards minimally invasive approach to coronary bypass operations without cardiopulmonary bypass. PATIENTS AND METHODS: From March 1995 to March 1997, 41 patients underwent a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) coronary grafting without cardiopulmonary bypass through a small left anterior thoracotomy (MIDCABG). The mean age was 61.2+/-8.7 years (range 43-77 years), 28 patients. were male (68.2%) and the redo rate was 4.8% (2/41). In all patients the coronary artery disease involved the LAD, which was occluded in seven patients (17.1%). Thirty-eight patients (96.2%) selected for MIDCABG had a monovascular disease on LAD not suitable for percutaneous coronary angioplasty; two (4.8%) a bivascular disease, and one (2.4%) a trivascular disease. Skin incision was performed in the 4th anterior intercostal space from the left parasternal line for a 10.5 cm length on average. The LIMA harvesting was partially video-assisted by thoracoscopy. RESULTS: The LAD temporary occlusion was achieved with two double 5/0 polypropilene round-LAD sutures. The mean LAD ischemic time was 22+/-8 min (range 4-35 min). No thoracotomy procedure was changed into a sternotomy approach. We had one (2.4%) perioperative AMI; two patients (4.8%) were reoperated for bleeding. All patients underwent a postoperative angiographic reinvestigation within 1 month after surgery. All anastomoses were perfectly patent but two (4.8%). One patient was reoperated via a sternotomy access recycling the LIMA graft, the other one underwent successful PTCA. All patients also underwent an early and mid-term (6 months after surgery) echo-Doppler study of the LIMA flow and patency. At follow-up, performed at a mean of 8.7 months (range 1-23) after discharge, all patients were alive; no one experienced recurrence of angina. All patients also performed a mid-term negative treadmill stress test. CONCLUSIONS: MIDCABG is, in selected patients, reliable and safe, and offers encouraging early and mid-term clinical results.

Evaluation of myocardial metabolism and function during beating heart coronary surgery.

Coronary artery bypass surgery on the beating heart either via a left anterior small thoracotomy (LAST) or a median sternotomy is becoming increasing popular world-wide. Concern still remains about the potential for a temporary regional myocardial ischaemia associated with the stabilisation and occlusion of the coronary during construction of the anastomosis. This review summarises the results of a series of studies intended to evaluate the effect of beating heart coronary revascularization on myocardial function, myocardial tissue injury and clinical outcome.

Cardiologic abnormalities in patients with long-term lupus nephritis.

To assess the cardiological status of patients with long-term lupus nephritis we evaluated 30 patients (mean age 43 +/- 11 years) with lupus nephritis lasting from at least 10 years (mean 15 +/- 5 years). At the time of cardiological evaluation the mean plasma creatinine was 132.6 +/- 11.1 mumol/l and in 28 patients lupus had been quiescent for at least 3 years. Fourteen patients (46.6%) showed one or more cardiac abnormalities: 10 had valvular lesions (1 verrucous endocarditis, 9 thickening and stiffness of one or more valves)--4 patients had regional myocardial akinesis as a consequence of a previous cardiac infarct (one had valvular abnormalities too). One patient had pulmonary hypertension probably secondary to pulmonary vasculitis. No patient had pericarditis. These cardiac abnormalities proved to be statistically correlated with the number of ARA criteria (p = 0.045), the number of lupus flares (p = 0.004), the serum levels of cholesterol (p = 0.04) and of triglycerides (p = 0.025) as well as the duration of hypercholesterolemia (p = 0.005) and of hypertriglyceridemia (p = 0.007). In conclusion, in patients with long-term lupus nephritis cardiac lesions are frequent. The main lesions are non-verrucous valvulopathy (probably a consequence of healing verrucous endocarditis) and cardiac infarct (caused by an accelerated atherosclerosis). On the contrary cardiac lesions caused by active lupus as pericarditis, myocarditis and verrucous endocarditis are rare.

Myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using cold or warm blood cardioplegia.

OBJECTIVES: Myocardial protection techniques during cardiac surgery have been largely investigated in the clinical setting of coronary revascularisation. Few studies have been carried out on patients with left ventricular hypertrophy where the choice of delivery, and temperature of cardioplegia remain controversial. This study investigates metabolic changes and myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using antegrade cold or warm blood cardioplegia. METHODS: Thirty-five patients were prospectively randomised to intermittent antegrade cold or warm blood cardioplegia. Left ventricular biopsies were collected at 5min following institution of cardiopulmonary bypass, 30min after cross-clamping the aorta and 20min after cross-clamp removal, and used to determine metabolic changes during surgery. Metabolites (adenine nucleotides, amino acids and lactate) were measured using high pressure liquid chromatography and enzymatic techniques. Postoperative myocardial troponin I release was used as a marker of myocardial injury. RESULTS: Ischaemic arrest was associated with significant increase in lactate and alanine/glutamate ratio only in the warm blood group. During reperfusion, alanine/glutamate ratio was higher than preischaemic levels in both groups, but the extent of the increase was considerably greater in the warm blood group. Troponin I release was markedly (P<0.05, Mean+/-SD) lower at 1, 24 and 48h postoperatively in the cold compared to the warm blood group (0.51+/-0.37, 0.37+/-0.22 and 0.27+/-0.19 vs. 0.75+/-0.42, 0.73+/-0.51 and 0.54+/-0.38ng/ml for cold vs. warm group, respectively). CONCLUSIONS: Cold blood cardioplegia is associated with less ischaemic stress and myocardial injury compared to warm blood cardioplegia in patients with aortic stenosis undergoing valve replacement surgery. Both cardioplegic techniques, however, confer sub-optimal myocardial protection.

Serum myoglobin, total CK and MB CK isoenzyme after D.C. cardioversion and during the early phase of acute myocardial infarction.

Myoglobin, total CK and MB CK isoenzyme were determined in the sera of 6 patients admitted with arrhythmias and treated with D.C. countershock and also in 37 patients with acute myocardial infarction or anginal syndrome. All the three tests were increased in patients with myocardial infarction. Serum myoglobin seems sufficiently sensitive and specific but the time required for the assay is a limiting factor for practical use in emergencies. After electrical cardioversion, myoglobin and CPK remain normal, although MB isoenzyme was increased in two of six patients. These results suggest that electrical cardioversion in itself does not influence serum levels of myoglobin. The occasional increase of MB CK observed after cardioversion seems to be the consequence of an easier release of the enzyme due to a myocardial injury.