Extra-anatomic coronary artery bypass graftings in patients with porcelain aorta.

AIM: Severely atherosclerotic (porcelain) ascending aorta is associated with increased morbidity and mortality during coronary artery bypass grafting (CABG) due to the increased risk of perioperative atheroembolism. Three maneuvers during CABG can cause atheromatous embolism from the diseased ascending aorta: 1) cannulation of the ascending aorta; 2) cross- clamping; 3) partial clamping for the construction of the proximal anastomosis. METHODS: In our hospital, extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aorta: 6 patients were men and 2 women. Operations were performed on the beating heart in 5 patients, 2 patients operated on beating heart and another patient on fibrillating heart with supportive cardiopulmonary bypass (CPB). Arterial cannulation was done through the right femoral artery on these patients. Apart from internal mammary artery (IMA) grafts, proximal anastomotic sites were the right axillary, right subclavian and innominate arteries. RESULTS: One patient who preoperatively had dialysis dependent chronic renal failure, died as a result of dialysis complication on the 5th day. The postoperative course was uneventful in the other patients and no patient experienced either any cerebrovascular or visceral organ injury as a result of atheroemboli. CONCLUSION: We think that extra-anatomic CABG procedures are safe and reliable in patients with severely atherosclerotic (porcelain) ascending aorta to minimize the prevalence of perioperative stroke and systemic embolization.

Atrial septal defect repair with minithoracotomy using two stage single venous cannula.

AIM: Repair of atrial septal defect (ASD) via minimal access has been the preferred method to improve cosmesis and fast rehabilitation. A 2-stage single venous cannula introduced via the femoral route allows better vision of the surgical field and improves surgical acts through a limited incision. METHODS: From February 1999 to December 2001 a minithoracotomy approach was used for closure of secundum type ASD by using single bicaval venous cannula in 17 adult patients. A 6 to 7 cm anterior minithoracotomy (submammary) approach with femoral arterial and 2-stage single venous cannula were utilized. Defects were closed primarily by running suture in 14 and with a patch in 3 patients. RESULTS: Calculated flow levels were maintained with a single venous cannula without assisted venous drainage in all patients. The postoperative course was uneventful in all patients except 1 who required revision for bleeding which was done through the same incision. Extension of the thoracotomy or shifting to the classic sternotomy was never required. CONCLUSION: Single venous bicaval cannula allows efficient drainage of both vena cavae and improves the surgical vision and manipulation through the right minithoracotomy. With this technique, repair of ASD can be done safely with good cosmesis.

Acute effect of inhaled budesonide on bronchial inflammation in asthmatic rats.

Although anti-inflammatory potency of inhaled corticosteroids is well established, little is known about their role in the acute phase. The aim of this study was to compare the acute anti-inflammatory effect of inhaled budesonide with systemic dexamethasone on allergen-induced inflammatory changes in asthmatic rats. Eighty-four Sprague Dawley rats were divided into four groups; group I (control, n = 24), group II (ovalbumin sensitized, n = 24), group III (systemic dexamethasone, n = 24), and group IV (budesonide, n = 12). All groups except group I were given ovalbumin aerosol challenges 14 days after sensitization with ovalbumin. The same procedure was applied to the control group using 0.9% saline. Group III received dexamethasone 0.3 mg/kg intraperitoneally and group IV received inhaled budesonide 10mL (0.5mg/mL) twice before the challenge. Eight hours after the challenge, bronchi of all the rats were evaluated for the degree of peribronchial inflammation. The most severe inflammation was seen in 8 of 24 rats (33%) in the second group, in 1 of 24 rats (4%) in the third group, and in 1 of 24 rats (4%) in the control group. None of the rats in group IV showed severe inflammation. No statistically significant difference was detected with respect to the presence of 3+ inflammation between the control vs. dexamethasone-, control vs. budesonide-, and dexamethasone vs. budesonide-receiving groups. Budesonide administration via nebulizer prior to exposure to an allergen may attenuate bronchial inflammation as effectively as systemic dexamethasone in rats.

[Coronary bypass surgery in octogenarians]. / Dokuzuncu dekatta koroner bypass cerrahisi.

OBJECTIVE: The age of the patients referred for coronary bypass surgery is getting older progressively. Early and late postoperative outcome of octogenarians were evaluated and compared with younger age group in this study. METHODS: Records of 55 patients aged 80 years or older (mean age 82.7 +/- 2.8) among 3834 patients, who had coronary bypass graft procedure, operated between 1995 and 2001 were reviewed retrospectively. RESULTS: There were 39 men (70.9%) and 16 women (29.1%). Three patients had aortic valve replacement, 1 had left ventricular aneurysm repair, 1 had carotid endarterectomy additionally. Atrial fibrillation (21.8%), renal dysfunction (16.4%), and prolonged ventilation (10.9%) were the prominent complications. The hospital mortality rate was 7.27% (4 patients). Kaplan Meier Survival Analysis estimated that at the end of 5 years 83.1 + 5.2% of patients were still alive. CONCLUSION: Coronary bypass operations can be performed in octogenarians with slightly increased but acceptable hospital mortality and longer hospital stay. Early intervention and individual modifications in cardiopulmonary bypass techniques may improve the results in this patient population.

The inverse association between serum anti-streptolysin-O titers and the frequency of exacerbations of asthma in childhood

Background: the decline in infections in childhood may contribute to the rising severity and prevalence of atopic disorders in developed countries. Support for this hypothesis has been obtained from findings of an inverse association between tuberculin responses and atopy and from findings of high prevalence of asthma in certain islands with low prevalence of respiratory infections. With this regard, we investigated the association between serum antistreptolysin- O (ASO) titers and the frequency of exacerbations of asthma in childhood. Methods: thirty atopic asthmatic children who has no sign of upper respiratory tract infection at the time of presentation or during the previous two months were included in the study. Serum ASO titer was measured as an indicator of past streptococcal upper respiratory tract infections. ASO titer > or = 200 Todd units was accepted as positive. Results: a statistically significant association is found between high anti-streptolysin-O titers and decreased number of exacerbations in those children. Conclusions: our data suggests that streptococcal infections might be a factor attenuating asthma in childhood (AU)

Fundamento: la disminución de las infecciones en la infancia puede contribuir a aumentar la gravedad y prevalencia de los trastornos atópicos en los países desarrollados. Esta hipótesis ha sido respaldada a partir de los hallazgos de una asociación inversa entre las respuestas a la tuberculina y la atopia y a partir de los hallazgos de una alta prevalencia de asma en algunas islas con una baja prevalencia de infecciones respiratorias. Partiendo de esta base, investigamos la asociación entre los títulos séricos de antiestreptolisina O (ASO) y la frecuencia de exacerbaciones de asma en la infancia. Método: fueron incluidos en el presente estudio 30 niños con asma atópica sin signos de infección de vías respiratorias altas en el momento de la presentación o durante los dos meses previos. Se determinó el título ASO en suero como indicador de infecciones estreptocócicas previas de las vías respiratorias altas. Se aceptó como positivo un título ASO > o = 200 unidades Todd.Resultados: se identificó una asociación estadísticamente significativa entre unos títulos antiestreptolisina O altos y una disminución del número de exacerbaciones en estos niños. Conclusiones: los datos del presente estudio sugieren que las infecciones estreptocócicas pueden ser un factor atenuante del asma en la infancia (AU)

Heat-killed Mycobacterium bovis-bacillus Calmette Guerin-suppressed total serum IgE response in ovalbumin-sensitized newborn mice.

To determine the impact of bacillus Calmette Guerin (BCG) vaccination on IgE production in ovalbumin (OVA)-sensitized newborn mice, four groups (I, II, III, IV) of BALB/c mice were immunized on the first day of life with live BCG, killed BCG, BCG diluent, and saline, respectively. No injection was applied to mice in group V (control). All mice except group V were sensitized and challenged with OVA in the fourth and sixth weeks, respectively, and serum total IgE levels were determined at 8 weeks, 2 weeks after the second OVA challenge. IgE levels of all groups were significantly higher than the control group except for group II (p = 0.95). Mice in group II showed significantly lower IgE values than group IV and I (p = 0.007 and p = 0.003, respectively). We concluded that heat-killed BCG may downregulate IgE response to OVA in newborn mice.

The inverse association between serum anti-streptolysin-O titers and the frequency of exacerbations of asthma in childhood.

BACKGROUND: The decline in infections in childhood may contribute to the rising severity and prevalence of atopic disorders in developed countries. Support for this hypothesis has been obtained from findings of an inverse association between tuberculin responses and atopy and from findings of high prevalence of asthma in certain islands with low prevalence of respiratory infections. With this regard, we investigated the association between serum anti-streptolysin-O (ASO) titers and the frequency of exacerbations of asthma in childhood. METHODS: Thirty atopic asthmatic children who has no sign of upper respiratory tract infection at the time of presentation or during the previous two months were included in the study. Serum ASO titer was measured as an indicator of past streptococcal upper respiratory tract infections. ASO titer > or = 200 Todd units was accepted as positive. RESULTS: A statistically significant association is found between high anti-streptolysin-O titers and decreased number of exacerbations in those children. CONCLUSIONS: Our data suggests that streptococcal infections might be a factor attenuating asthma in childhood.

Effect of pre-immunization by killed Mycobacterium bovis and vaccae on immunoglobulin E response in ovalbumin-sensitized newborn mice.

A recently advanced hypothesis suggests that decreased exposure to T-helper (Th) 1-inducing agents causes Th2-biased differentiation in response to concomitant allergens. We therefore examined the effect of pre-immunization with killed Mycobacterium bovis and killed M. vaccae which are known to be very potent inducers of Thl immune response, on serum IgE response in ovalbumin (OVA)-sensitized newborn mice. Eighty-four newborn Balb/c mice were divided into four groups and were immunized intraperitoneally 24 h after birth with 50 microl of 5 x 10(4) colony-forming units (c.f.u.) of killed M. bovis in group I (M. bovis group, n = 19), with 25 microl of 2.5 x 10(8) c.f.u. of killed M. vaccae plus 25 microl of 5 x 10(4) c.f.u. of killed M. bovis in group II (M. vaccae + M. bovis group, n = 28) and with 50 microl of only phosphate-buffered saline (PBS) in group III (no mycobacterial immunization, n = 18). No injection was applied to mice in group IV (control group, n = 19). Starting from 8 weeks of age, all mice except the control group were sensitized with 0.5 ml of 20 mg/ml OVA administered intraperitoneally 7 times every other day. Thirty days after the final injection, all animals except those in the control group were challenged with an aerosol of 2 mg/ml OVA. Forty-eight hours later, blood was collected from all mice for determination of serum IgE levels. A statistically significant difference was observed in the serum total IgE levels between groups III and IV (p = 0.0099), indicating that the mice were successfully sensitized with OVA. Serum total IgE values of the female mice in M. bovis group were found to be significantly lower than group III (p = 0.009), while no difference was observed in males. Serum total IgE levels of the M. vaccae + M. bovis group were found to be significantly lower than group III both in male and female mice (p < 0.0001 and p = 0.0001, respectively). Female values were even lower than controls (p = 0.0092). Pre-immunization in the newborn period with killed M. bovis alone or in addition to M. vaccae may potentially be helpful in down-regulating an IgE response.

Serum TNF-alpha, sCD8 and sIL-2R levels in childhood tuberculosis.

In this study we have determined the serum tumor necrosis factor-alpha (TNF-alpha), soluble CD8 (sCD8) and soluble interleukin-2 receptor (sIL-2R) levels in children with active pulmonary tuberculosis (n = 66) and healthy controls (n = 20). Measurable serum TNF-alpha levels were detected in nine of 86 children (10.5%), all of whom belonged to the group with active disease. Serum sCD8 and sIL-2R determinations revealed a significant difference between the group with active pulmonary tuberculosis and the controls (p < 0.05). Deeper insight into the involvement of cytokines and T cells will provide a better understanding

Effect of interferon-alpha therapy on serum IgE, IL-4, and sCD23 levels in childhood asthma.

Seven children with asthma were included in a trial of recombinant interferon-alpha 2a (rIFN-alpha 2a). Patients received either 2 million U/m2 rIFN-alpha 2a (n = 4) or placebo (n = 3) three times a week for 4 weeks. Pulmonary function test, peak expiratory flow rates (PEFR), and clinical symptom scores were monitored throughout the trial. Serum interleukin-4, soluble low-affinity receptor for IgE Fc epsilon RII/CD23 (sCD23), and immunoglobulin E (IgE) levels were measured at the beginning of the trial, and at the second week, fourth week, and sixth week. Compared with placebo, rIFN-alpha 2a therapy did not result in a significant change in the above-mentioned parameters. Further studies with a larger number of patients are needed to draw firmer conclusions in regard to efficacy of rIFN-alpha 2a therapy in childhood asthma.