Higher probability of compound flooding from precipitation and storm surge in Europe under anthropogenic climate change.

In low-lying coastal areas, the co-occurrence of high sea level and precipitation resulting in large runoff may cause compound flooding (CF). When the two hazards interact, the resulting impact can be worse than when they occur individually. Both storm surges and heavy precipitation, as well as their interplay, are likely to change in response to global warming. Despite the CF relevance, a comprehensive hazard assessment beyond individual locations is missing, and no studies have examined CF in the future. Analyzing co-occurring high sea level and heavy precipitation in Europe, we show that the Mediterranean coasts are experiencing the highest CF probability in the present. However, future climate projections show emerging high CF probability along parts of the northern European coast. In several European regions, CF should be considered as a potential hazard aggravating the risk caused by mean sea level rise in the future.

Valve preservation in acute type A aortic dissection: 13-year experience.

AIM: Aortic dissection is frequently complicated by regurgitation of the aortic valve resulting from leaflet prolapse or tearing of the annulus or leaflet. The authors have evaluated the results using the technique of aortic valve preservation in patients with acute type A aortic dissection (AAD). METHODS: In a consecutive series of 79 AAD observed from January 1994 to September 2007, 51 (64.6%) presented aortic valve insufficiency (AI). All patients were emergency operated on via median sternotomy and femoral (46/79, 58.2%) or axillary artery-right atrium (33/79, 41.8%) cardiopulmonary bypass with 60 cases (75.9%) of antegrade selective cerebral perfusion. The dissected aorta was resected and the aortic valve was replaced in 2 patients/51 (3.9%) and was preserved in the remaining 49 cases as follows: 42 (85.7%) commissural resuspensions due to commissural prolapse, 3 (6.1%) resuspensions due to cusp prolapse, 3 (6.1%) commissural plication and 1 (2.1%) circumclusion due to annular dilatation. RESULTS: The overall hospital mortality was 20.3% (16/79) with a percentage of 19.6% (10/51) in the AI group. 1 patient presented a type B dissection at 1 months and died after reoperation. The remaining 40 patients with a preserved native valve were followed by echocardiography and computed tomography (CT) (follow-up ranged from 3 to 165 months) with 4 late deaths. Twenty-six patients had absent or grade I AI (72.2%), 8 had grade II AI (22.2%) and 2 presented grade III or IV AI (5.6%). Actuarial freedom from significant AI was 96.2+/-2.4% and 94.2+/-2.3% at 5 and 10 years respectively. CONCLUSION: The experience with this technique demonstrates the effectiveness of valve conservative treatment within a vascular graft. The reconstruction of the sinotubular junction reducing annular dilatation with appropriated sized graft is obviously mandatory. Although this procedure is not applicable to every patient, we firmly believe that is a valid option when a morphologically intact valve is present.

Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of atrial and brain natriuretic peptides (ANP and BNP, respectively) as indicators of recovery of left ventricular (LV) function after coronary surgery. METHODS: We measured the concentrations of these peptides in 31 patients with poor LV function (ejection fraction, EF<35%) undergoing coronary artery bypass, and evaluated their correlation with the echocardiographic indexes of LV function. RESULTS: Pre-operatively, the plasma levels of both ANP and BNP were markedly higher in coronary patients than in normal control subjects, and strongly correlated with both EF (BNP: r=-0.8, P<0.001; ANP: r=-0.6, P<0.001) and wall motion score index (WMSI). At post-operative follow up, plasma levels of both natriuretic peptides were markedly reduced compared with pre-operative values in 21 patients. In addition, the post-operative-pre-operative differences of BNP (Delta(BNP)) and ANP (Delta(ANP)) plasma levels strongly correlated with the differences of both EF (r=-0.7, P<0.0001 vs. Delta(BNP); r=-0.6, P=0.0003 vs. Delta(ANP)) and WMSI (r=0.6, P=0.002 vs. Delta(BNP); r=0.6, P=0.04 vs. Delta(ANP)). Finally, by logistic regression analysis, BNP appeared a significant predictor of LVEF recovery after surgery. CONCLUSION: Plasma levels of ANP and BNP might be used in routine clinical practice as a support to echocardiography in detecting recovery of the LV function after coronary surgery.

Duromedics original prosthesis: what do we really know about diagnosis and mechanism of leaflet escape?

The Edwards-Duromedics (ED) is a bileaflet pyrolitic carbon mechanical valve introduced by Hemex Scientific Inc in 1982, subsequently acquired by Baxter Healthcare Corp, withdrawn from the market in 1988, and modified and reintroduced in 1990. From 1982 to date, 46 cases of leaflet escape have been registered by the manufacturer of an estimated total of 20,000 valves implanted. Disc embolization 12 years after an ED mitral prosthesis implantation is reported in a 45-year-old man operated on when he was in cardiogenic shock because a preliminary transthoracic Doppler echocardiography did not show malfunction of the valve. A correct diagnosis was made four days after the onset of the symptoms by transesophageal echocardiography. During the operation, the posterior leaflet of the ED valve was not found, a 29 mm St Jude Medical bileaflet mechanical prosthesis was implanted and the patient died in the intensive care unit because of low cardiac output syndrome. Cavitation damage is generally considered the most frequent mechanism in cases of such fracture. Thus, any patient with a mechanical valve presenting with acute pulmonary edema must be immediately transferred to a surgical unit; cinefluoroscopy or transesophageal echocardiography may be performed rapidly to achieve successful management of patients with leaflet embolization.

Neutrophil-endothelial cells modulation in diabetic patients undergoing coronary artery bypass grafting.

OBJECTIVE: Diabetes mellitus is a well-known risk factor in patients undergoing coronary artery bypass grafting. Myocardial and pulmonary injury often occurs after cardiopulmonary bypass (CPB), mediated in part by neutrophil activation and adhesion to endothelial cells. The objectives of the present study are to compare the degree of neutrophil activation and neutrophil-endothelial cells adhesive interactions in diabetic patients after CPB. METHODS: Nitro-blu tetrazolium scores, CD 11b expression and neutrophil-endothelial cells adhesion were assessed in blood samples from 15 diabetic and 15 control patients who had undergone elective coronary bypass grafting. Blood samples were obtained at baseline, 30 min after beginning CPB, at the end of CPB and 60 min postoperatively. At the same sampling points as above, blood glucose levels were also checked in all patients. RESULTS: Diabetes was associated with a significant basal increase in neutrophil CD1 lb expression and adhesion to endothelial cells as well as with an increased superoxide anion production. The increased adhesion of diabetic neutrophils persisted by the end of the CPB to 60 min postoperatively independently of the blood glucose levels. Antibodies directed against CD1 lb and CD18 significantly reduced the degree of neutrophil adhesion observed 60 min postoperatively. CONCLUSIONS: These results indicate that diabetes mellitus is associated with an increased neutrophil-endothelial cell adhesion probably mediated by the CD1 1b/CD18 molecule; this, in turn, might be responsible for the increased risk of postoperative complications observed in diabetic patients undergoing coronary artery bypass grafting.

Protection by coenzyme Q10 of tissue reperfusion injury during abdominal aortic cross-clamping.

PURPOSE: To evaluate the effect of coenzyme Q10 in reducing the skeletal muscle reperfusion injury following clamping and declamping the abdominal aorta. METHODS: 30 patients undergoing elective vascular surgery for abdominal aortic aneurysm or obstructive aorto-iliac disease were randomly divided into two groups: patients in group I were treated with coenzyme Q10 (150 mg/day) for seven days before operation, and those in group II received a placebo. We studied the hemodynamic profile in each patient during clamping and declamping of the abdominal aorta. The plasma concentrations of thiobarbituric acid reactive substances (malondialdhehyde), conjugated dienes, creatine kinase and lactate dehydrogenase were measured in samples from both arterial and inferior vena cava sites. Serial sampling was performed after induction of anesthesia, 5 and 30 minutes after abdominal aortic cross clamping, 5 and 30 minutes after aortic cross-clamp removal. RESULTS: The concentrations of malondialdehyde, conjugated dienes, creatine kinase and lactate dehydrogenase in patients who received CoQ10 were significantly lower than in the placebo group. Decrease of plasma malondialdehyde concentrations correlated positively (p < 0.01) with decrease of both creatine kinase and lactate dehydrogenase release in samples from the inferior vena cava. The hemodynamic profile during clamping and declamping the abdominal aorta was similar in both groups. CONCLUSIONS: Our findings suggest that pre-treatment with coenzyme Q10 may play a protective role during routine vascular procedures requiring abdominal aortic cross clamping by attenuating the degree of peroxidative damage.

Pericardial cyst with partial erosion of the superior vena cava. An unusual case.

A case of pericardial cyst with partial erosion of the superior vena cava occasionally discovered is presented. The involvement of the vein was found on operation and the excision of the cyst was performed without cardiopulmonary bypass, repairing the vena cava by a direct suture. The pathologic examination showed multiple areas of acute and chronic inflammation without signs of infection. This exceedingly rare report indicates that both computed tomography and magnetic resonance are useful to localize the mediastinal mass and to characterize the cystic content. The cardiopulmonary bypass must be available to allow an easy repair of the structures possibly involved particularly in the case of infection.

Protection by coenzyme Q10 from myocardial reperfusion injury during coronary artery bypass grafting.

To evaluate the effect of coenzyme Q10 in reducing postoperative cardiac complications after ischemia and reperfusion, we randomly divided 40 patients undergoing elective coronary artery bypass into two groups: patients in group 1 received coenzyme Q10 (150 mg/day) for 7 days before operation, and those in group 2 were the control group. Concentrations of thiobarbituric acid-reactive substances (malondialdehyde), conjugated dienes, and cardiac isoenzymes of creatine kinase were measured in samples from both arterial and coronary sinus sites. Serial sampling was performed 5 minutes after heparin administration, at 10 and 30 minutes during cardiopulmonary bypass, 15 and 30 minutes after aortic cross-clamp removal, and 5 minutes after protamine administration. The concentrations of malondialdehyde, conjugated dienes, and creatine kinase in group 1 were significantly lower than those in group 2. The decrease in plasma malondialdehyde concentrations correlated positively with the decrease in creatine kinase levels in the coronary sinus. The treatment group showed a significantly lower incidence of ventricular arrhythmias during the recovery period than did the control group (p < 0.05). Although the percentage of patients requiring inotropic agents was not significantly different between the two groups, the mean dosage of dopamine required to maintain stable hemodynamics was significantly lower in patients of group 1 than in those of group 2 (p < 0.01). Our findings suggest that pretreatment with coenzyme Q10 may play a protective role during routine bypass grafting by attenuating the degree of peroxidative damage.

Comparación de la acción broncodilatadora del salbutamol inhalado con dos regimenes diferentes de administración en niños asmáticos / Salbutamol (albuterol) treatment in asthmatic children: comparative study according to two different methods

A 10 niños asmáticos en intercrisis estables cuyas edades estaban comprendidas entre 9 y 16 años, presentando un VEF 1 basal mayor del 80% y un FEF 25-75 mayor del 60% de los valores teóricos, les fueron administrados 300mcg de salbutamol en aerosol en dos regímenes diferentes en días distintos. En el primero el paciente recibió toda la dosis inicialmente, seguida a los diez y veinte minutos de disparos de placebo y en el segundo la medicación fue fraccionada en tres dosis de 100 mcg, con intervalos de diez minutos entre cada una. Se midieron frecuencia cardíaca y espirometrías a los 10, 20, 30 y 60 minutos. El análisis estadístico de los resultados mostró cambios significativos en ambos regímenes en VEF 1 y EFE 25-75 en las mediciones de todos los tiempos en relación a los basales. No se observaron diferencias significativas entre los dos regímenes en ningun punto de la secuencia, aunque hay que remarcar que la diferencia a los diez minutos fue más significativa en el grupo que recibió la dosis total inicial (300 mcg). La frecuencia cardíaca no mostró diferencias significativas en ninguno de los dos grupos

Comparación de la acción broncodilatadora del salbutamol inhalado con dos regimenes diferentes de administración en niños asmáticos / Salbutamol (albuterol) treatment in asthmatic children: comparative study according to two different methods

A 10 niños asmáticos en intercrisis estables cuyas edades estaban comprendidas entre 9 y 16 años, presentando un VEF 1 basal mayor del 80% y un FEF 25-75 mayor del 60% de los valores teóricos, les fueron administrados 300mcg de salbutamol en aerosol en dos regímenes diferentes en días distintos. En el primero el paciente recibió toda la dosis inicialmente, seguida a los diez y veinte minutos de disparos de placebo y en el segundo la medicación fue fraccionada en tres dosis de 100 mcg, con intervalos de diez minutos entre cada una. Se midieron frecuencia cardíaca y espirometrías a los 10, 20, 30 y 60 minutos. El análisis estadístico de los resultados mostró cambios significativos en ambos regímenes en VEF 1 y EFE 25-75 en las mediciones de todos los tiempos en relación a los basales. No se observaron diferencias significativas entre los dos regímenes en ningun punto de la secuencia, aunque hay que remarcar que la diferencia a los diez minutos fue más significativa en el grupo que recibió la dosis total inicial (300 mcg). La frecuencia cardíaca no mostró diferencias significativas en ninguno de los dos grupos