Evaluation of oral prophylaxis during and after intensity-modulated radiotherapy due to head and neck cancer--a retrospective study.

OBJECTIVES: The aim of this study was to retrospectively analyze the influence of a prophylaxis protocol of head and neck tumor (HNT) patients during and after intensity-modulated radiotherapy (IMRT). MATERIAL AND METHOD: In this 5-year retrospective study (2009-2013), 70 (m 55, f 15; age range 28-8 years; median 58.7 years) out of 248 HNT patients of the Clinic of Cranio-Maxillofacial and Oral Surgery at the University of Zurich, Switzerland, fulfilled the inclusion criteria. Parameters of investigation were the salivary flow rates, possible dental foci and the dental status, oral side effects of radiotherapy, the prophylaxis protocol, and patient's compliance to this protocol. The following time points before during and after IMRT (6 weeks) were analyzed: prior to IMRT, 2-4 weeks, 6 weeks and 3, 6, and 12 months after the onset of radiotherapy. RESULT: Unstimulated salivary flow rate, pH value of unstimulated salivary, and stimulated salivary flow rate showed a significant reduction over time (p < 0.001). One year after IMRT, both unstimulated and stimulated salivary flow showed a statistically significant lower salivary flow. The number of caries-affected sites per patient was significantly higher for patients with low compliance to the prophylaxis protocol (mean: low compliance 1.36, high compliance 0.26). Almost 75% of the evaluated patients suffered immediate gustatory change, and 47.1% showed signs of radiostomatitis through IMRT. CONCLUSIONS: High compliance to the prophylaxis protocol during and after radiotherapy is a key factor for the reduction of radiation side effects on dental hard tissue. CLINICAL RELEVANCE: High compliance to a monitored prophylaxis program is crucial for patients after head and neck surgery.

Pharyngeal spasticity due to dantrolene.

WHAT IS KNOWN AND OBJECTIVE: Dantrolene can be combined with baclofen to better treat spasticity, but may cause muscular weakness and dysphagia. We instead describe a pharyngeal spasm due to dantrolene. CASE SUMMARY: A 12-year-old male received dantrolene 3 mg/kg/day in adjunct to baclofen 2 mg/kg/day, to improve spasticity. After 5 days of full-dose dantrolene, his dysphagia worsened and he developed pharyngeal spasm. Dantrolene was suspected for an adverse reaction and removed. The patient subsequently improved. WHAT IS NEW AND CONCLUSION: Causality analysis determined a probable relationship between dantrolene and pharyngeal spasm. This may be due to direct muscle contraction by dantrolene, an effect seen previously in vitro.

Prevalence and sport-related predictors of disturbed eating attitudes and behaviors: Moderating effects of sex and age.

Very few studies examined the prevalence and sport-related predictors of disturbed eating attitudes and behaviors (DEABs) among adolescents involved in sport practice, and their results are mixed and inconclusive. These inconsistencies are most likely due to their methodological heterogeneity and to the fact that none of these studies took into consideration the potentially relevant characteristics of the sport practice context. This study attempts to answer this limitation among French adolescents not involved or involved in various sports contexts defined based on their organization, leanness-centration, and competitive level. Participants were 335 adolescents involved in sport practice, and 435 adolescents not involved in any form of regular sport practice. The DEABs were measured using the Eating Attitudes Test-26. Global results do not showed any significant association between the status of the participants and DEAB. However, these results drastically changed when we considered the potential moderating role of sex and age on these relations. Indeed, sports involvement in general, and involvement in leanness and competitive sports were found to exert sex- and age-differentiated effects on the risks of presenting clinically significant levels of DEAB. This study suggests the importance of monitoring, preventive, and early intervention mechanisms within the context of practice, particularly for adolescent girls.

[Severe hypoglycemia induced by tramadol: two new cases of an unlisted side effect]. / Hypoglycémies sévères au tramadol : deux nouvelles observations d'un effet indésirable non référencé

INTRODUCTION: Tramadol is a weak opioid analgesic used as a step two analgesic, approved in France for the treatment of moderate to severe pain in adult patients. The most common side effects are gastrointestinal and neurologic. Hypoglycaemia is an almost unknown side effect. CASE REPORTS: We report two patients who presented with severe hypoglycaemia related to oral administration of tramadol in non diabetic patients. The underlying mechanisms of hypoglycaemia induced by tramadol are unclear. The only weak opioid analgesic drug reported to cause hypoglycaemia is propoxyphene, which has been widely used in France. The recent withdrawal of dextropropoxyphene in France might increase the prescriptions of tramadol and healthcare professionals should be aware of the risk of hypoglycaemia. CONCLUSION: The risk of hypoglycaemia should be added to the summary of product characteristics of tramadol.

Non-apoptotic programmed cell death induced by a copper(II) complex in human fibrosarcoma cells.

A0, a Cu(II) thioxotriazole complex, produces severe cytotoxic effects on HT1080 human fibrosarcoma cells with a potency comparable to that exhibited by cisplatin. A0 induced a characteristic series of changes, hallmarked by the formation of eosin- and Sudan Black-B-negative vacuoles. No evidence of nuclear fragmentation or caspase-3 activation was detected in cells treated with A0 which, rather, inhibited cisplatin-stimulated caspase-3 activity. Membrane functional integrity, assessed with calcein and propidium iodide, was spared until the late stages of the death process induced by the copper complex. Vacuoles were negative to the autophagy marker monodansylcadaverine and their formation was not blocked by 3-methyladenine, an inhibitor of autophagic processes. Negativity to the extracellular marker pyranine excluded vacuole derivation from the extracellular fluid. Ultrastructural analysis indicated that A0 caused the appearance of many electronlight cytoplasmic vesicles, possibly related to the endoplasmic reticulum, which progressively enlarge and coalesce to form large vacuolar structures that eventually fill the cytoplasm. It is concluded that A0 triggers a non-apoptotic, type 3B programmed cell death (Clarke in Anat Embryol (Berl) 181:195-213, 1990), characterized by an extensive cytoplasmic vacuolization. This peculiar cytotoxicity pattern may render the employment of A0 to be of particular interest in apoptosis-resistant cell models.

[Isolation and identification of Listeria monocytogenes and Listeria spp. in dry sausages obtained in markets in the city of La Plata, Argentina]. / Aislamiento e identificación de Listeria monocytogenes y Listeria spp. en embutidos secos obtenidos en mercados de la ciudad de La Plata, Argentina.

A total of 60 samples of dry sausages were analyzed (50 of "salami" and 10 of "chorizo" "candelario" type) obtained at random in markets authorized for their commercialization, for the purpose of evidencing the presence of bacteria of the genus Listeria (Listeria monocytogenes and Listeria spp.). The results obtained in salami were the following: 10 (20%) isolates of Listeria spp., were characterized: 1 (2%) strain as L. monocytogenes type 1, 7 (14%) strains as L. innocua, 2 (4%) strains as L. welshimeri. In chorizo candelario type 6 (60%) isolates of Listeria spp., were characterized: 2 (33%) strains as L. monocytogenes type 1 and 4 (66%) strains as L. innocua. The total percentages of isolations were: 26.6% of Listeria spp., 5% of L. monocytogenes type 1, 18.3% of L. innocua and 3.3% of L. welshimeri. In conclusion, we consider that methodologies of control must be developed and implemented in order to guarantee the inocuity of these products.

Aislamiento e identificación de Listeria monocytogenes y Listeria spp. en embutidos secos obtenidos en mercados de la ciudad de La Plata, Argentina / [Isolation and identification of Listeria monocytogenes and Listeria spp. in dry sausages obtained in markets in the city of La Plata, Argentina]

A total of 60 samples of dry sausages were analyzed (50 of [quot ]salami[quot ] and 10 of [quot ]chorizo[quot ] [quot ]candelario[quot ] type) obtained at random in markets authorized for their commercialization, for the purpose of evidencing the presence of bacteria of the genus Listeria (Listeria monocytogenes and Listeria spp.). The results obtained in salami were the following: 10 (20

) isolates of Listeria spp., were characterized: 1 (2

) isolates of Listeria spp., were characterized: 2 (33

) strains as L. monocytogenes type 1 and 4 (66

) strains as L. innocua. The total percentages of isolations were: 26.6

of L. innocua and 3.3

of L. welshimeri. In conclusion, we consider that methodologies of control must be developed and implemented in order to guarantee the inocuity of these products.

New approach to the chemistry of polysulfides using diphosphanylmethanide complexes of manganese(I).

The study of the nucleophilic degradation of S8 by the methanide complex [Mn(CO)4[(PPh2)2CH]] (2) has led to the preparation of a unique class of polysulfide derivatives of formula [(CO)4Mn[(PPh2)2C-Sn-C(PPh2)2]-Mn(CO)4]. The structures of 3 (n = 6), 4 (n = 2), and 7 (n = 1) have been determined by X-ray crystallography, whereas those polysulfides with the sulfur chains S7, S5, S4, and S3 have been detected by spectroscopic methods. The polysulfides with n > 2 lose sulfur spontaneously, a process that can be accelerated by treatment with PPh3 or Na/Hg. Complexes 3, 4, and 7 were protonated at the two methanide carbon atoms to give the cationic dinuclear derivatives [(CO)4Mn[(PPh2)2C(H)-Sn-C(H)-(PPh2)2]Mn(CO)4]2+ (8, n=6; 9, n=2; 10, n = 1). The 1H NMR spectrum of 9 suggests the existence of intramolecular C-H...S interactions, in agreement with the X-ray structural determination of this complex. By treatment of 4 and 7 with one equivalent of HBF4 it is possible to selectively protonate just one methanide carbon atom, which allows the isolation of the mixed cationic derivatives R(CO)4Mn[(PPh2)2C(H)-Sn-C(PPh2)2]Mn(CO)4]+ (11, n = 2; 6, n = 1). Additionally, heterometallic complexes containing a bridging disulfide unit, of general formula [(CO)4Mn[(PPh2)2C(AuPPh3)S-SC-(AuPPh3)(PPh2)2]Mn(CO)4]2+ (12) and [(CO)4Mn[(PPh2)2C(H)S-SC(AuPPh3)-(PPh2)2]Mn(CO)4]+ (13), were prepared by reaction of 4 and 11, respectively, with [AuCl(PPh3)] in the presence of TlPF6.

Hydridotris(thioxotriazolyl)borate (Tt), an ambidentate (N(3)/S(3)) tripodal ligand. X-ray crystal structures of sodium, bismuth(III), tin(IV), and manganese(I) complexes.

Treatment of the heterocycle 5-thioxo-4,5-dihydro-3,4-dimethyl-1,2,4-triazole (thioxotriazole) with sodium tetrahydroborate at 210 degrees C provides the new [N(3)/S(3)] ambidentate tripod ligand hydridotris(thioxotriazolyl)borate (Tt) as its sodium complex salt. Complexes of this ligand with sodium, bismuth(III), tin(IV), and manganese(I) have been synthesized and characterized by X-ray crystallography. The structures of these complexes illustrate the ambidentate character of the ligand with the softer metals bismuth and tin exhibiting sulfur coordination, while sodium and manganese(I) bond via the ligand nitrogen donors. In the [S(3)] coordination mode the ligand creates eight-membered chelate rings with the metal with the consequence that the metal ligand unit adopts a propeller-type conformation with C(3)-symmetry. However, in the [N(3)] mode six-membered chelate rings are formed analogous to the familiar hydrotris(pyrazolyl)borate (Tp) ligand.

Flight qualification of a diode laser for path difference determination of a high-resolution fourier transform spectrometer.

Diode lasers offer a lightweight, rugged, and economic alternative to other types of laser source, but they often do not provide long-term stability and spectral purity of emission. We have developed a stabilized, near-infrared diode laser source that is capable of as much as 20 mW of single-mode output power for the effective replacement of a He-Ne laser in the path difference measuring system of a high-resolution (1.25-m maximum path difference) Fourier transform spectrometer. Laser characterization has been performed both in laboratory measurements and in flight tests, resulting in a relative frequency stability of better than 10(-6) on a 6-h flight.

Trinuclear N,N-bridged copper(II) complexes involving a Cu3OH core: [Cu3(mu 3-OH)L3A(H2O)2]A.(H2O)x (L = 3-acetylamino-1,2,4-triazolate; a = CF3SO3, NO3, ClO4; x = 0, 2) synthesis, X-ray structures, spectroscopy, and magnetic properties.

The reaction of Haat [Haat = (3-acetylamino-1,2,4-triazole)] with aquated Cu(CF3SO3)2, Cu(NO3)2, and Cu(ClO4)2, respectively, in water results in the trinuclear complexes [Cu3(OH)(aat)3(CF3SO3)(H2O)2](CF3SO3) (1), [Cu3(OH)(aat)3(NO3)(H2O)2](NO3).(H2O)2 (2), and [Cu3(OH)(aat)3(ClO4)(H2O)2](ClO4) (3). The synthesis, X-ray structure, and magnetic and spectroscopic properties of the three title complexes are described. The cation of the three complexes is trinuclear with a Cu3OH skeleton which has the N-N diazine grouping of a triazole ring as bridge between each pair of copper atoms. The Cu3OH units have an average Cu-O distance of 1.991(6) (1), 2.000(6) (2), and 2.007(6) (3) A, an average Cu-Cu' distance of 3.355(2) (1), 3.341(1) (2), and 3.371(3) (3) A, and an average Cu-O-Cu' angle of 114.6(3) degrees (1), 112.4(2) degrees (2), and 115.4(3) degrees (3). The existence of the Cu3OH fragment is confirmed by a pseudotetrahedral oxygen environment, by detection of the OH hydrogen atom, and by stoichiometry. In the trinuclear unit the metal ions show, in the first approximation, a pseudo-square-planar pyramidal environment forming a CuN2O3 chromophore; three of the basal positions are occupied by N,N,O aat ligand atoms, the fourth one is occupied by the oxygen of the central OH group, and the apical site is occupied by an oxygen atom from a water molecule in the case of two of the copper(II) atoms and by an oxygen atom from the coordinating anion in the case of the third metal ion. The three compounds exhibit strong antiferromagnetic interaction, with similar J constants [J = -197.7 (1), J = -190.9 (2), J = -198.2 (3) cm-1], reaching complete spin coupling at ca. 75 K (1)/55 K (2)/95 K (3). At very low temperature the magnetic moment (magnetic susceptibility) falls below that expected for one unpaired electron. Magnetic parameters are discussed on the basis of the structural results and compared with those reported in the literature for related trimeric Cu(II) compounds with N-O or N-N peripheral bridges. Solid state EPR spectra of the three complexes recorded at liquid N temperature show axial signals. Crystal data: C14H20Cu3F6N12O12S2 (1) (Mw = 917.16) crystallizes in the monoclinic space group, P2(1)/c, Z = 4, with cell dimensions a = 13.080(2) A, b = 17.202(2) A, c = 13.840(2) A, beta = 92.40(1) degrees, and V = 3111.3(7) A3, Dcalcd = 1.958 Mg m-3; the final agreement values were R1 = 0.0582 and wR2 = 0.1462 for 7107 unique reflections. C12H24Cu3N14O14 (2) (Mw = 779.07) crystallizes in the triclinic space group, P1, Z = 2, with cell dimensions a = 9.647(2) A, b = 9.985(2) A, c = 15.314(2) A, alpha = 84.080(10), beta = 87.694(10), gamma = 65.030(10) degrees, and V = 1330.1(4) A3, Dcalcd = 1.945 Mg m-3; the final agreement values were R1 = 0.0397 and wR2 = 0.0950 for 7728 unique reflections. C12H20Cl2Cu3N12O14 (3) (Mw = 817.92) crystallizes in the monoclinic space group, P2(1)/a, Z = 4, with cell dimensions a = 14.238(5) A, b = 16.387(6) A, c = 11.678(4) A, gamma = 90.45(2) degrees, and V = 2724.6(18) A3, Dcalcd = 1.994 Mg m-3; the final agreement values were R1 = 0.0616 and wR2 = 0.1279 for 4038 unique reflections.

El síndrome de inmunodeficiencia adquirida en la unidad de terapia intensiva el Hospital Angeles del Pedregal / Acquired immunodeficiency syndrome in the intensive care unit of the hospital Angeles del Pedregal of Mexico

El presente trabajo describe retrospectivamente las características clínicas y la evolución de 24 pacientes con VIH/SIDA que requirieron manejo en la Unidad de Terapia Intensiva (UTI) del Hospital Angeles del Pedregal durante su hospitalización. En cinco pacientes (21 por ciento) el diagnóstico de infección por VIH se realizó al momento de su ingreso a la UTI. La causa más frecuente de ingreso a la UTI fue insuficiencia respiratoria que requirió ventilación mecánica en 81 por ciento de los casos. La mortalidad relacionada con el accidente que provocó ingreso a la UTI fue cercana a 80 por ciento. Sin embargo, en aquellos pacientes en los que la causa del ingreso a terapia intensiva fue una neumonía por P. carinii, la mortalidad fue de 55 por ciento. En conclusión, el uso de unidades de cuidados intensivos en el manejo de pacientes con VIH/SIDA puede ser de utilidad en algunos pacientes con SIDA que tienen insuficiencia respiratoria, particularmente cuando ésta es debida a neumonía por P. carinii. Sin embargo, en otras situaciones la utilidad del manejo en la UTI no es tan clara. Con frecuencia el diagnóstico de infección por VIH se realizó por vez primera en la UTI, pero en aquellos pacientes en los que ya se conoce su infección por VIH es indispensable que el médico tratante discuta con el paciente acerca de sus deseos de ingresar o no a una unidad de terapia intensiva durante el curso de su padecimiento, con el fin de evitar intervenciones no deseadas en aquellos pacientes que así lo indiquen

Active infective endocarditis: surgical approach.

From January 1982 to December 1991, 65 interventions were performed in 61 patients with active infective endocarditis (IE): 32 on native valves (Group 1) and 33 on prosthetic valves (Group 2). In Group 1, 23 patients had a known previous valve disease; major preoperative clinical complications occurred in 16 patients (50%); 84% were in NYHA classes III and IV. In Group 2 major preoperative clinical complications occurred in 13 patients (44.8%); 86% were in NYHA classes III and IV. The mean time interval between the onset of hemodynamic impairment of varying degrees and surgery was 13 +/- 15 days for Group 1, and 8 +/- 11 days for Group 2. In all cases, the native valves or prostheses were replaced by mechanical valve prostheses. Particular procedures were performed in three patients in Group 1 and five patients in Group 2. In Group 1 there were 8 hospital deaths (25%) and 11 (34.4%) non-fatal complications. In Group 2 there were 9 deaths (31%) and 14 (48.3%) non-fatal complications. Risk factors for hospital death were "preoperative low cardiac output syndrome" and "time interval between the onset of cardiac failure and surgery" in Group 1, "cardiac failure+sepsis" in Group 2, "time interval between the onset of cardiac failure and surgery" and "particular procedures" in all 61 patients. Sepsis alone and the type of pathogenic agent does not significantly affect the risk of death. The recurrence of acute IE was 12.6% in Group 1, and 20% in Group 2. The incidence of reintervention was 12.6% in Group 1 and 35% in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Total gastrectomy: a comparison between manual and mechanical sutures]. / Gastrectomia totale: confronto tra suture manuali e meccaniche.

The authors report their experience of the use of mechanical staplers in total gastrectomy. The advantages of their use can above all be seen in anastomosis, in particular in high-risk areas like esophago-jejunal anastomosis, in which there is a lower incidence of dehiscence and mortality than when manual suturing techniques are used.

Posterior annuloplasty in the surgical treatment of mitral insufficiency.

One hundred and twenty-nine patients underwent posterior mitral annuloplasty with a Gore-Tex tube for mitral regurgitation between January 1982 and June 1991. The hospital mortality was 1.5% (CL = 0.5%-2.5%). The overall survival of hospital survivors was 96.5% +/- 2.7% at five and 86.2% +/- 7.6% at nine years, freedom from cardiac death was 99.1% +/- 0.9% and 95.2% +/- 3.9%, respectively. The actuarial freedom from embolism was 96.1% +/- 2.3% at five and 88.5% +/- 5.5% at nine years. The freedom from endocarditis (one patient) was 100% and 92.6 +/- 7.1%, respectively. Reoperation was necessary in six cases between one and 72 months after the operation (mean 38.5 +/- 30.5 months). The etiology of the valvular insufficiency was rheumatic in all reoperated cases. The freedom from reoperation was 94.1% +/- 3.2% at five and 87.2% +/- 5.6% at nine years. There was no mortality at reoperation. Of the 117 patients alive at the end of follow up and not requiring reintervention, 113 (96.6%) showed good functional improvement and were in NYHA functional class I or II. We conclude that both the immediate and long-term results of reconstructive surgery using the technique of inserting a half-ring on the posterior mitral annulus compare favorably with those obtained using other annuloplasty methods.

[A bleeding jejunal schwannoma. The complications of a rare neoplasm of the small intestine]. / Schwannoma digiunale sanguinante. Complicanze di una rara neoplasia del tenue.

The authors report a rare case of jejunal Schwannoma which appeared as hematemesis and melaena. No preoperative test, even selective angiography, enabled a correct clinical diagnosis to be made. Only after explorative laparotomy and careful palpation of the small intestine was the bleeding lesion located. Resection and termino-terminal anastomosis were then performed. The preparation of immunohistochemical reactions now allow forms which were previously diagnosed in different terms to be precisely classified.

[Effects of beta blocking agent iontophoresis by modulated sinusoidal current]. / Effetti della ionoforesi con beta-bloccanti con corrente sinusoidale modulata.

The action of the transcutaneous application of propranolol using modulated sinusoidal current iontophoresis was studied. When this way of administration is used, the drug, while maintaining its negative chronotropic effect, loses the negative inotropic one. Investigations were performed on 58 men aged 32 to 62 who underwent an aortocoronary bypass for myocardial ischemia. Thirty-four patients had already had myocardial infarction. The drug reduced the heart rate and increased cardiac contractility. Moreover, the study showed that only the levogyral isomer of propranolol (the only active one) passes through the skin.

[Repeat myocardial revascularization]. / Reinterventi di rivascolarizzazione miocardica.

Eighty-two consecutive patients undergoing reoperation for coronary revascularization from January 1980 to November 1990 were reviewed to determine early and late results and predictors of survival. Seventy patients were male and 12 female; age ranged from 36 to 75 years (mean 56.4 +/- 8.1). All were symptomatic for angina. The mean interval between first and second operation was 62.8 +/- 47.8 months (range 1 to 220 months). Angiographic indications for reoperation were: graft failure (34.1%), progression of atherosclerosis in the native coronary circulation (6.1%) and combination of the two (59.8%). Mean ejection fraction was 45.9 +/- 10.2 (range 11 to 67). Surgical indication was elective in 79.3%, urgent in 14.6% and emergent in 6.1%; 199 grafts were performed (2.4 +/- 1 grafts/patient). Hospital mortality was 6.1% (5 cases). Late mortality was 5.2% (4 cases). Actuarial survival rate (including hospital mortality) was 87.9% at 3, 5 and 10 years. Multivariate analysis identified left main stenosis (p = 0.00001), family history of coronary disease (p = 0.003), urgent/emergency operation (p = 0.015) as predictors of increased in-hospital mortality; postoperative myocardial infarction (p = 0.002) and preoperative heart failure (p = 0.01) as predictors of increased late mortality. Follow-up of in-hospital survivors (mean interval 42.7 +/- 25.8 months, range 3 to 120 months) documented 27 cardiac major events (other than death) in 24 patients (32.9%). Actuarial rates of freedom from major cardiac events were 70%, 52.9% and 48.1% at 3, 5 and 10 years respectively. Multivariate analysis identified preoperative ejection fraction (p = 0.01) as predictor of recurrence of angina and preoperative heart failure (p = 0.02) as predictor of occurrence of cardiac major events.

Evaluation and treatment of secondary tricuspid insufficiency.

To define the role of functional tricuspid insufficiency and right ventricular (RV) failure in patients with mitral disease, the data of 121 patients with secondary tricuspid insufficiency that underwent mitral valve replacement (MVR) from January 1982 to December 1987 were analyzed. The mitral hemodynamic lesion was: stenosis in 41 patients (33.9%); insufficiency in 11 (9.1%) and mixed stenosis and insufficiency in 69 (57.0%). NYHA functional class was: II in 4 patients (3.3%), III in 78 (64.5%) and IV in 39 (32.2%). In 100 cases (group 1) with tricuspid insufficiency defined as moderate or severe, a De Vega annuloplasty was performed while in 21 (group 2) with mild tricuspid insufficiency, no tricuspid surgical procedure was performed. Hospital deaths occurred in 17 of 121 patients [14% (CL 10.8-17.0)]. There was no significant difference in hospital mortality between group 1 and group 2 (15% vs 9.5%; P = 0.75). Incremental risk factors for hospital mortality as determined by multivariate analysis, include: cardiothoracic ratio (P = 0.0016), total aortic cross-clamp time (P = 0.006), associated cardiac disease (P = 0.0209) and emergency operations (P = 0.0318). Mean follow-up of surviving patients was 50.1 +/- 28.1 months. Late deaths occurred in 16 patients [15.4% (CL 11.7-18.7)]. The actuarial survival rate was 85.6% and 73.8% at 5 and 9 years, respectively. Nine patients [8.6% (CL 5.9-11.3)] required reoperation. There was no significant difference between group 1 and group 2 in the rate of late cardiac related deaths (5.9% vs 5.3%, P = 0.66) and of tricuspid reoperations (4.7% vs 5.3%, P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical revascularization in acute myocardial infarct]. / Rivascolarizzazione chirurgica nell'infarto miocardico acuto.

To determine the potential role of emergency surgical revascularization as treatment of acute myocardial infarction (AMI), results in 79 patients undergoing operation for myocardial revascularization during AMI from January 1986 to January 1991 were reviewed. Clinical characteristics for inclusion in the study were: 1) emergency operation; 2) persistent angina not controlled by medical therapy; 3) fixed ST segment elevation until surgical procedure, independently from magnitude of enzymatic levels. The 79 patients were divided in 2 groups: 27 with AMI or evolving AMI (Group 1); 52 with AMI due to complications during PTCA (Group 2). Twenty-eight patients had extremely severe clinical conditions. Mean interval between the beginning of AMI and operation was 4.2 +/- 6.7 hours, with a statistically significant difference between Group 1 (8.7 +/- 10.0) and Group 2 (1.9 +/- 1.0). One hundred ninety-two grafts were performed (2.4 +/- 1.1 grafts/patient). Overall hospital mortality was 10.1% (CL 6.7-13.3) (8 deaths) with a difference between Group 1 [18.5% (CL 10.7-25.3)] and Group 2 [5.8% (CL 4.7-6.6)] (p = 0.074). The incidence of perioperative myocardial infarction was 30.4% (CL 24.9-35.1) for that one in the area of ischemic muscle and 2.6% (CL 0.8-4.1) for infarction in remote muscle. Multivariate analysis for the entire series (79 patients) identified as independent predictors of increased in-hospital mortality: preoperative cardiogenic shock (p = 1.000E-4) and hyperlipidemia (p = 0.008). In Group 1 multivariate analysis identified as independent predictors of increased in-hospital mortality: the attempt of revascularization by PTCA and hyperlipidemia; in Group 2: preoperative need of mechanical ventilatory support.(ABSTRACT TRUNCATED AT 250 WORDS)