Surgical Treatment of a Catheter-Induced Iatrogenic Dissection of the Right Coronary Artery following Cardiac Catheterization.

Iatrogenic dissections of the ascending aorta are an uncommon and severe complication during cardiac catheterization. A 68-year-old female patient underwent diagnostic cardiac catheterization due to non-ST-elevation myocardial infarction. During the procedure, a catheter-induced 360(°) Class I dissection of the right coronary artery occurred. The patient developed severe bradycardia, which was treated with a temporary pacemaker. She underwent an emergency operation with ligation and a saphenous vein graft in the right coronary artery. The postoperative course was uneventful; and on postoperative day 6, she was discharged home.

Melatonin treatment in the prevention of postoperative delirium in cardiac surgery patients.

INTRODUCTION: Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. AIM OF THE STUDY: It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. MATERIAL AND METHODS: This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. RESULTS: The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). CONCLUSIONS: Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery.

Intestinal ischemia-reperfusion injury mediates expression of inflammatory cytokines in rats.

The small intestine is an organ with very well developed immunological activity, responsible for synthesis of specific inflammatory mediators that participate in causing the systemic inflammation that can occur after ischemia-reperfusion injury. The aim of our work was to study mRNA expression and protein concentration of inflammatory cytokines IL-10 and TNFα in the jejunal wall after intestinal ischemia-reperfusion injury (IRI). Cytokine concentration levels confirmed the direct effect of IRI on the inflammation process. The results refer to the changes in balance between pro-inflammatory and anti-inflammatory mediators and indicate that the predominant disturbance of homeostasis after intestinal IRI is present after 1 hour of reperfusion.

Breast carcinoma progression and tumour vascular markers related to apoptotic mechanisms.

BACKGROUND: In the last few years, the cancer research had tried to identify and characterize new biochemical and molecular pathways in which the inhibition induces prosurvival mechanisms. Our work describes the expression of two different members of apoptotic regulatory pathway and their relationship with a progression of breast carcinoma. MATERIALS AND METHODS: We compared expression of genes related to apoptosis (DR6 and Gpm6B) in the blood of patients suffering from stage I of breast cancer in different grades (I-IV), with healthy controls. After isolation of mRNA, transcription of mRNA into the cDNA was performed. The quantification of gene expression changes in DR6 and Gpm6B was detected by RT-PCR method. Analysis at the protein level was performed by the Western blot. RESULTS: In statistical analysis of Dr6 mRNA level changes we detected significant increase starting in Grading 1 (G1) and reached maximal level in G3.This expression on mRNA levels was similar to protein levels, which copy rising tendency with maximal value in G3. The results of Gpm6B were significantly lower. CONCLUSION: This result showed that antiapoptotic signalling during neovascularization is increased significantly. It would be advisable in the future to study the influence of cytostatic treatment on the expression of genes related to apoptotic pathways and their relationship with progression of breast cancer tumours.

Naturally occurring substances and their role in chemo-protective effects.

Cancer chemoprevention is defined as the use of natural, synthetic or biological chemical agents to reverse, suppress or prevent carcinogenic progression of invasive cancer. Carcinogenesis is a complex multi-step process; therefore, it is necessary to attack cell proliferation, stimulate apoptosis and inhibit angiogenesis. There have been more than 60 randomised trials using chemopreventive potential agents. The success of several recent clinical trials in preventing cancer in high-risk populations suggests that chemoprevention is a rational and appealing strategy. In this review, we describe the conceptual basis for the chemoprevention of cancer, proven concepts of efficiency and current trends in the use of chemopreventive agents according to place and mechanism of action. We classify chemopreventive substances into seven groups based on their chemical structure and their effects, namely, deltanoids (paracalcitriol), retinoids (13-cis retinoic acid), non-steroidal anti-rheumatics (Deguelin), antiestrogens (genistein), polyphenols (curcumin), sulphur containing compounds (sulforaphane) and terpenes (lycopene). Chemoprevention is one of several promising strategies for reducing the incidence of malignant tumours or helping to prolong the time before recurrence.

Intestinal ischemia-reperfusion injury - the histopathological status of remote vital organs in acute and subacute phases.

BACKGROUND: Improvement of graft recovery and function follows current trends in intestinal transplantation; however, the alteration of remote organs (RO) predicts complicated systemic rejection. This study was conceived to describe the histopathological status of RO arising in both acute and subacute stages after intestinal ischemia-reperfusion injury (IIR) injury. MATERIAL/METHODS: Wistar rats (n=54) were divided into 7 experimental groups (n=7 each). All the animals were subjected to 60 min mesenteric ischemia and subsequently to reperfusion 2 h, 4 h, 24 h, 72 h, 10 days, 20 days and 30 days following the groups IR2 h, IR4 h, IR24 h, IR72 h, IR10 d, IR20 d and IR30 d. As a control group (S; n=5) sham-operated animals were used. Histopathological scores (HPS) were evaluated in biopsies of the right kidney, heart and colon ascendens. RESULTS: Statistically significant increase in kidney HPS was seen during reperfusion, with the peak in IR4h group (p<0.01). Thereafter, improved morphology was observed; however, increased HPS was seen even in the subacute stage, and significant deterioration of HPS up to 10 days of reperfusion was detected (p<0.05). Heart biopsies also showed statistically increased HPS value in IR4h group (p<0.05). Intact morphology of the colon was detected in all reperfusion periods. CONCLUSIONS: IIR causes a systemic reaction affecting RO. The peak of alteration for kidney and heart morphology was induced by 60 min of ischemia followed by 4 h of reperfusion. Thereafter, improved morphology was observed, although latent persistence of histopathological changes was seen even in the subacute stage. The colon remained intact during the whole experiment despite its anatomical proximity, confirming its high immunological capacity.