The postoperative effects of use of trimetazidine before the coronary artery bypass graft surgery.

BACKGROUND: In this study, postoperative cardiac functions were observed in patients undergoing coronary artery bypass grafting (CABG) surgery following preoperative administration of the anti-ischemic drug trimetazidine. MATERIALS AND METHODS: The study included a total of 50 CABG patients; 25 were administered with trimetazidine preoperatively and 25 did not receive trimetazidine. A retrospective evaluation was made of the parameters of age, gender, preoperative echocardiography (ECHO) results, cross-clamping durations, postoperative inotropic requirements, and postoperative 4th-h troponin-I levels and the groups were compared. RESULTS: There was no statistically significant difference determined between the 2 groups in respect of the data of age, gender, comorbidity, preoperative ECHO signs [(ejection fraction (EF), left ventricle end systolic diameter (lvsd), left ventricle end diastolic diameter (lvdd), left atrium diameter (LA), and intraventricular septum thickness (IVS)], inotropic requirements, and postoperative troponin-I levels. In the control group, a positive correlation was determined between postoperative troponin-I levels and DM (r: 0.597, p: 0.002). There was no correlation determined in the trimetazidine group (r:-0.042, p: 0.844). CONCLUSION: The results of this study demonstrated a positive correlation between postoperative troponin-I levels and DM in the group not administered with trimetazidine. There was no such correlation determined in the group administered with trimetazidine. This result may suggest that DM may increase troponin-I levels in the absence of trimetazidine, and therefore that the drug may be cardioprotective in such cases. Further studies on more extensive patient populations are required to confirm these results.

Protection of the spinal cord from ischemia: comparative effects of levosimendan and iloprost.

BACKGROUND: The purpose of the study was to investigate and compare iloprost and levosimendan on spinal cord ischemia in an experimental model. MATERIALS AND METHODS: The study was done in two stages. For the 4-hour short survival study, 50 New Zealand white rabbits were randomly allocated into five groups. Spinal cord ischemia was induced by clamping the aorta just below the left renal artery and just proximal to the aortic bifurcation with bulldog artery clamps. The aortic clamps were removed after 40 min and restoration of blood flow was verified visually. The groups were analyzed at 1 and 4 h after reperfusion. For the 48-hour survival study, two different groups (iloprost plus levosimendan, n = 10; saline-treated controls, n = 10) were analyzed at 24 and 48 h after reperfusion. RESULTS: The neurologic status of the animals in the treatment and sham groups was better than that in the control group both at 1 and 4 h after reperfusion. Viability index values in the levosimendan, iloprost and iloprost plus levosimendan groups were statistically higher than in the control group indicating less or no neuronal damage. DISCUSSION: The results suggest that levosimendan, as well as iloprost, may reduce ischemic damage in transient spinal ischemia and provide better neurologic outcome.

Effects of Iloprost and pentoxifylline on renal ischemia-reperfusion in rabbit model.

OBJECTIVE: In ischemia-reperfusion, Iloprost decreases neutrophil activation and aggregation besides inhibition of oxygen-free radical production. Pentoxifylline (Ptx) attenuates reperfusion-associated membrane injury and tissue edema, suppresses leukocyte adhesion and improves hindlimb blood flow during the reperfusion period. The primary hypothesis in this study was that Iloprost could present better protection than pentoxyfillin on renal ischemia-reperfusion in rabbit model. MATERIALS AND METHODS: Forty rabbits were grouped into four. Iloprost was continuously infused starting half an hour before the reperfusion after 2 hours ischemia and during the 4 hours reperfusion period in Group 1 whereas the Group 2 was treated with pentoxyfillin. Group 3 was the control group which didn't receive any medication. Forth group was sham group. Renal tissues were histologically and biochemically evaluated. RESULTS: The histologic scores were obtained according to presence of tubuler necrosis and atrophy, regenerative atypia, hydropic degeneration (Group 1 vs Group 3; p<0.001, Group 2 vs Group 3; p = 0.001, Group 1 vs Group 2; p = 0.331). Malondialdehyde levels of the medicated groups were 109 +/- 11 nmol/gr tissue in Group 1, 119 +/- 15 nmol / gr tissue in Group 2 and 132 +/- 14 nmol / gr tissue in Group 3 (Group 1 vs Group 2; p = 0.130, Group 1 vs Group 3, p = 0.002, Group 2 vs Group 3; p = 0.045). Malondialdehyde levels and histologic scores of all of the groups were significantly different from the sham group. CONCLUSION: Iloprost and pentoxyfillin reduced renal ischemia-reperfusion injury in rabbit model. There was not a significant difference between these two medications.

A novel approach: ascending venous arterialization for atherosclerosis obliterans.

OBJECTIVE: Lower limb arterial occlusion with no patent distal artery suitable for revascularisation is a common problem. The aim of this study was to assess the role of revascularisation to distal veins (ascending venous arterialization) in patients not reconstructable by conventional bypass. METHOD: Ascending venous arterialization is a distal arteriovenous fistula. Reversed great saphenous vein grafts, from above the knee, were anastomosed to the common femoral artery, superficial femoral artery or popliteal artery and distally to the saphenous vein at the level of medial malleolus. No intervention was done to destroy the venous valves. The great saphenous vein was ligated below the knee. In this way, oxygenated blood could reach to dorsal venous arch and the tissues below the knee in an ascending fashion through the great saphenous vein, which was not removed. RESULTS: All of the patients recovered immediately after the operation. The lesions on the feet and on the toes of the patients improved in a short time. Intermittent claudication of the patients disappeared. Strong pulses were detected on the dorsal venous arch with manual Doppler in 3 weeks. The below knee tissues were perfused with the applied technique. CONCLUSION: Ascending venous arterialization can be applied for limb salvage to the patients who do not have a suitable arterial bed to revascularize with conventional techniques.