Reduced transfusion requirements with a closed cardiopulmonary bypass system.

AIM: The aim of this investigation is to reduce blood transfusion in cardiac surgery patients with preoperative conditions predictive for transfusion requirements. We compared the amount of blood transfused in two groups of patients undergoing cardiopulmonary bypass (CPB) with two different circuit systems. METHODS: Sixty patients undergoing cardiac surgery were randomly assigned to two groups: in group A (N=30) cardiopulmonary bypass was accomplished with an open circuit and in group B (N=30) with a closed circuit. The open circuit consisted of a cardiotomy reservoir, a membrane oxygenator and an arterial line filter, while the closed circuit was made up of a collapsible venous reservoir, a membrane oxygenator, an arterial line filter and a cardiotomy reservoir. The amount of transfused packed red cells in each patient was measured until discharge from the hospital. RESULTS: Groups were similar regarding age, gender, body surface area (BSA), New York Heart Association (NYHA) class and comorbidity risk factors. Moreover, there were no significant differences between groups regarding the type of procedures, CPB and aortic cross-clamp times, total amount of cardioplegia and urinary output during CPB. Priming volume was 1180+/-84 mL (group A) and 760+/-72 mL (group B) (P<0.001). Significant differences in transfusion requirements emerged in the two groups: the total volume of packed red cells transfused for each patient was significantly higher in the open system group compared to the closed system group (717+/-486 mL versus 378+/-364 mL) (P=0.003). Clinical outcomes were similar in both groups. CONCLUSION: In patients with preoperative conditions predictive for the need of transfusions, the use of a closed cardiopulmonary bypass circuit can diminish the amount of transfused blood products.

[Off pump total arterial revascularization--clinical and technical considerations]. / Revascularizarea coronariana off pump integral arteriala--consideratii tehnice si clinice.

Integral arterial myocardial revascularization seems to become the standard method in coronary surgery, but the international experience is still limited. We are communicating our results in arterial off pump coronary artery grafting (OFF CABG) in a centre specialized in "on pump" total arterial revascularisation. Between January 2004 and June 2006 we performed off pump CABG in 58 patients, using skeletonized arterial grafts; the vein grafts was rarely used. In 94.95% of cases we used only arterial grafts, and we achieved complete arterial revascularization in 47 (81.03%) of cases. We didn't noted major postoperative complications, the mean UCU stay was 1.7 days, mean hospital stay was 7.3 days, and no postoperative deaths were noted. The off pump CABG using arterial grafts is a secure method, without postoperative complications, which offers viable solutions of complete revascularization of the heart.

Influence of underfeeding on the spontaneous contraction and on metabolism of labelled arachidonic acid in uteri isolated from intact and ovariectomized rats.

The effects of restricted diet (50% of the normal intake during 25 days) on the isometric developed tension (IDT), and on the metabolism of labelled arachidonic acid in uteri from intact and spayed (25 days) rats, were studied. Underfeeding produced a fall in the contractile activity of intact rats, while in ovariectomized rats contractile activity increased. Indomethacin reduced uterine contractile activity in all the cases under study. The metabolism of arachidonic acid into different eicosanoids, PGE2, PGF2 alpha, 6-keto-F1 alpha, and TXB2, showed that the restricted diet diminished PGE2 and PGF2 alpha levels in intact rats significantly. The reduction in uterine contractile activity and reduced levels of the arachidonic acid metabolites, PGE2 and PGF2 alpha, were not seen in ovariectomized animals.

Effects of ovarian steroids on glucose metabolism in uterus horns isolated from underfed rats. Influence of castration.

The effect of a restricted diet (50% of the normal intake) during 25 days, on the glucose metabolism was explored in uterus horn strips isolated from intact and ovariectomized rats. In intact underfed rats, the formation of 14CO2 from U14C-glucose was significantly lower than in their controls. In castrated rats, the formation of 14CO2 increased after underfeeding. The return to ad libitum feeding increased glucose metabolism in both groups. Total food deprivation for 4 days diminished 14CO2 formation both in non-ovariectomized rats and in ovariectomized ones as measured at the end of this fasting period. This diminution was greater in intact rats. The increase of glucose metabolism provoked by the administration of s.c. estradiol, progesterone or their combination was more important in underfed intact animals. In intact rats, blood levels of endogenous estradiol and progesterone decreased as a result of underfeeding. In spayed ones, their low concentration increased in relation to their controls.

[Echographic monitoring of the endometrium with a transvaginal probe in the menopause. A clinical study of 185 women in the menopause]. / Monitoraggio ecografico dell'endometrio con sonda transvaginale in menopausa. Studio clinico su 185 donne in menopausa.

The aim of our study was to verify the efficacy of transvaginal ultrasound scanning as an indicator of the endometrial status in healthy menopausal women. One hundred eighty five healthy women in natural menopause were examined by vaginal sonography; the endometrial patterns were analyzed and the influence on it of body weight, menopausal age, and hormonal therapy was considered. The presence of irregular and the endometrial histology were related to the ultrasound findings. 38% of the women assumed estrogen plus progestin replacement treatment since one-two years, for menopausal complaints. 17% of all patients reported irregular bleeding during the last month. The majority of women (90%), regardless of the hormone assumption, presented en endometrial thickness less than 10 mm. 10% of untreated and treated women had an endometrial thickness between 10 and 20 mm. Among the subjects with elevated menopausal age is more frequent the imaging of endometrial layer minor than 5 mm in comparison with women in early menopause. 4% of untreated and 10% of treated women without irregular bleeding had an endometrial thickness higher than 10 mm, while 67% of women with irregular bleeding presented an endometrial layer higher than 10 mm. In treated group all women with endometrial thickness greater than 10 mm had amenorrhoea. 86% of patients had endometrial atrophy detected by biopsy; hyperplastic endometrium or endometrial cancer was not demonstrated. In conclusion, vaginal sonography is a simple and reliable method in the study of the endometrial pattern in healthy menopausal women.

Different effect of a restricted diet on isolated uteri of ovariectomized and non-ovariectomized rats. Influence of indomethacin and prostaglandins.

The effect of restricted diet (50% of the normal intake during 25 days) on the metabolism of labelled glucose, in uteri isolated from ovariectomized (25 days) and non-ovariectomized rats, was explored. In intact rats subjected to dietary restriction, the formation of 14CO2 from U 14C-glucose is significantly lower than in controls. Indomethacin increases glucose metabolism, being even higher in underfed rats' uteri. This effect is not altered by the addition of prostaglandins E1, E2 or F2 alpha to the medium. In castrated rats, the formation of 14CO2 increases due to underfeeding and this result is not altered by indomethacin. Glycogen and triglyceride values in the isolated uterus were measured immediately after killing (O time) and after 60 min of incubation in a glucose-free KRB medium. The post-incubation levels of glycogen from intact normal fed animals diminished in comparison to initial values, and this result was not altered by the addition of indomethacin. In rats subjected to dietary restriction, glycogen did not decline further after incubation, and the addition of indomethacin led to a significant fall. In spayed rats, glycogen diminished after 60 min both in normal fed rats and in underfed ones, and they were not affected by the indomethacin. In intact underfed rats, uterine triglycerides fall after 60 min. Indomethacin changes this situation, which is again evoked by the addition of PGF2 alpha. In ovariectomized rats, uterine triglycerides are neither altered by a restricted diet nor affected by indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a restricted diet on in vitro spontaneous activity and glucose metabolism in isolated rat uterus. Influence of castration.

The effects of a restricted-diet (50% of the normal intake during 25 d) on the isometric developed tension (IDT), the metabolism of labelled glucose, and the levels of glycogen, of uteri isolated from ovariectomized (25 d) and non-ovariectomized rats were explored. The restriction of food intake produced a fall in the contractile activity of normal, non-ovariectomized, rats in permanent diestrous compared to normally fed rats in diestrous. On the contrary, in castrated rats, the IDT of isolated uterus from underfed rats, was significantly higher than its normal-fed controls. In normal rats the formation of 14CO2 from U 14C-glucose was significantly lower in uterine preparations from restricted-diet animals than the control one. On the other hand, in castrated rats, the formation of 14CO2 increased as a result of underfeeding. The post-incubation levels of glycogen in uteri from normal-fed animals diminished significantly in comparison to 0 time values. In uteri from rats subjected to a dietary restriction, the initial glycogen values were lower than in normal-fed controls, but they did not decline further after incubation in KRB medium. On the contrary, even when the levels of glycogen were significantly lower at 0 time than in diestrous animals, they diminished in ovariectomized rats after incubation, no matter the diet. The above results indicate that the effects of restricted-diet on contractile activity, levels of glycogen and glucose metabolism were not observed in ovariectomized rats. Further researches are needed to clarify that point.