Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Objective: This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.Methods: Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.Results: Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical and demographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.Conclusion: Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery

The effect of different ß-blockers on vascular graft nitric oxide levels: comparison of nebivolol versus metoprolol.

OBJECTIVES: The aim of this study was to investigate the effects of the vasodilating ß-blocker nebivolol and the cardioselective ß-blocker metoprolol on nitric oxide (NO) levels at vascular graft endothelium and vasa vasorum compared to controls in patients undergoing coronary artery bypass graft surgery. METHODS: This was a prospective study. Fifty-five patients were divided into three groups: nebivolol group (group N, n = 23), metoprolol group (group M, n = 16), and control group (group A, n = 16). Group N received nebivolol 5 mg once daily, and group M received metoprolol 50 mg once daily for 15 days in the preoperative period. Control patients did not use ß-blocker therapy. Tissue samples of both left internal mammary artery (LIMA) and saphenous vein grafts were investigated for NO activity using immunohistochemical methods. RESULTS: Demographic characteristics and risk factors were similar between groups. We observed the highest NO activity in group N in both endothelial and vasa vasorum samples of LIMA and saphenous veins. NO activity of metoprolol group was similar to controls. CONCLUSIONS: According to our results, we think that nebivolol may be safer and preferable in order to diminish graft spasm in patients undergoing coronary artery bypass graft surgery due to the NO-mediated vasodilating effect.

Surgical treatment of unilateral iliac artery occlusive disease using a retroperitoneal approach.

OBJECTIVE: We evaluated the early and late postoperative outcome of aorto/iliofemoral bypass operations using a retroperitoneal approach. METHODS: From December 1999 until the end of December 2005, unilateral aorto/iliofemoral bypass was performed on 23 patients (3 female, 20 male) for unilateral iliac occlusive disease. The average age was 57 years (range: from 45 to 68 years). Operative indications were claudication in seven patients, rest pain in 14 patients, and non-healing ulcer or gangrene in two patients. RESULTS: Surgical procedures included aortofemoral bypass in ten patients, iliofemoral bypass in 12 patients and aortoiliac bypass in one patient. Simultaneous femoropopliteal bypass was performed on seven patients. Mean follow-up period was 2.5 +/- 0.31 years. Graft patency was 100% during this period. CONCLUSIONS: A retroperitoneal approach for unilateral iliac obstructive disease is a valuable and well-tolerated alternative to conventional aortobilateral reconstruction in unilateral symptomatic aorto-iliac disease with excellent long-term outcome.