Plasma vitamin D levels and inflammation in the aortic wall of patients with coronary artery disease with and without inflammatory rheumatic disease.

OBJECTIVES: Vitamin D modulates inflammation, and this may explain the observed associations between vitamin D status and disorders driven by systemic inflammation, such as coronary artery disease (CAD) and inflammatory rheumatic diseases (IRDs). The aims of this study were to assess vitamin D status in patients with CAD alone and in patients with CAD and IRD, and to explore potential associations between vitamin D status and the presence of mononuclear cell infiltrates (MCIs) in the aortic adventitia of these patients. METHOD: Plasma levels of 25-hydroxyvitamin D3 [(25(OH)D3] were determined by radioimmunoassay and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] by enzyme immunoassay in the 121 patients from the Feiring Heart Biopsy Study (FHBS) who had available histology data on adventitial MCIs; 53 of these had CAD alone and 68 had CAD and IRD. RESULTS: In the crude analysis, vitamin D levels were similar in CAD patients with and without IRD. After adjustment for potential confounders, IRD was associated with an increase of 8.8 nmol/L [95% confidence interval (CI) 1.0-16.6; p = 0.027] in 25(OH)D3 and an increase of 18.8 pmol/L (95% CI 4.3-33.3; p = 0.012) in 1,25(OH)2D3, while MCIs in the aortic adventitia were associated with lower levels of 1,25(OH)2D3 (ß = -18.8, 95% CI -33.6 to -4.0; p = 0.014). CONCLUSIONS: IRD was associated with higher levels of both 25(OH)D3 and 1,25(OH)2D3. These findings argue against the hypothesis that patients with high systemic inflammatory burden (CAD+IRD) should have lower vitamin D levels than those with less inflammation (CAD only). Of note, when controlled for potential confounders, low 1,25(OH)2D3 levels were associated with adventitial aortic inflammation.

Lipopolysaccharide induced monocyte thromboplastin synthesis and coagulation responses in patients undergoing coronary bypass surgery after preoperative supplementation with n-3 fatty acids.

Twenty patients with coronary heart disease (CHD) and elevated serum lipids were randomized into 2 groups of 10 to receive encapsulated preparations of either a concentrated ethylester form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or corn oil in doses of 6 g per day, given double blindly for approximately two months prior to coronary bypass surgery. Lipopolysaccharide (LPS) induced monocyte thromboplastin synthesis was studied during the preoperative period and one week following surgery. The ability of n-3 fatty acids to modify tissue factor pathway inhibitor (TFPI) and tissue plasminogen activator inhibitor (PAI-1) was also evaluated along with fibrinogen and thrombin-antithrombin III (TAT) complexes. No significant changes were noted preoperatively. Monocyte reactivity, PAI-1, fibrinogen and TAT increased significantly after surgery. These changes were not modified by preoperative loading with n-3 fatty acids.

Does admission to a medical department improve patient life expectancy?

Doubts about the effectiveness of medical care in improving patient health have been raised by epidemiological studies and by studies of geographical variation and inappropriate use of health care. To investigate this problem, the life expectancy gain (LEG) from consecutive admissions to a department of internal medicine during a six-week period was assessed by two expert panels, each consisting of an internist, a surgeon, and a general practitioner. The mean LEG for all admissions was 2.25 years (n = 422). Sixty-one percent had a LEG of 0.10 years or less, while 5% had a LEG of more than 9.98 years. In a probabilistic sensitivity analysis, the mean LEG remained greater than zero under assumptions of overestimated positive LEG and underestimated negative LEG. We conclude that the life expectancy of the majority of the patients was not influenced by the admission, but that a minority had substantial gains, resulting in a high overall mean LEG.

Perioperative cardiac function and predictors for adverse events after transmyocardial laser treatment.

BACKGROUND: Previous studies have reported that mortality and morbidity after transmyocardial laser treatment (TML) mainly occur perioperatively. The present study was designed to evaluate left-ventricular function and identify risk factors for cardiac-related adverse events in this phase. METHODS: Forty-nine patients were studied. The inclusion criteria were angina pectoris Canadian Cardiovascular Society Angina Score (CCSAS) class III and IV refractory to medical therapy and untreatable by coronary artery bypass graft or percutaneous transluminal coronary angioplasty, age less than 75 years, left ventricular ejection fraction greater than or equal to 30%, and myocardial regions with reversible ischemia. Hemodynamic data and cardiac adverse events were registered. The follow-up time was 30 days. RESULTS: A transient decrease in mean cardiac index (CI) was observed, reaching its minimum immediately after end of the surgical procedure (1.8+/-0.4, p<0.01 vs. baseline). Two patients (4%) died during the postoperative period (30 days). Seventeen patients (35%) experienced adverse cardiac-related events, where CCSAS class IV, unprotected left main stem stenosis, and diabetes mellitus were identified as risk factors in a multivariate analysis. CONCLUSIONS: A transient impairment of left ventricular function was observed after TML. The morbidity and mortality after TML were almost exclusively cardiac-related, identifying CCSAS class IV, unprotected left main stem stenosis, and diabetes as risk factors.

Experimental gram-negative septicemia: thromboplastin generation in mononuclear phagocytes from different anatomical sites.

Rats were subjected to gram-negative septicemia induced by cecal perforation or were sham-operated. Thromboplastin values increased in blood monocytes (40-fold), peritoneal macrophages (115-fold) pleural macrophages (5-fold), splenic macrophages (3-fold), and lung alveolar macrophages (1.4-fold) in septic animals as compared to controls. In septic animals disseminated intravascular coagulation was evidenced by a significant (p less than 0.05) fall in fibrinogen, factor VII, X and platelets. A simultaneous and significant (p less than 0.05) decrease in thromboplastin content of tissue-specimens from lung and spleen was observed in rats with septicemia, whereas increased thromboplastin values were demonstrated in tissue-samples from cecum - the infectious focus. This might reflect mobilization of mononuclear phagocytes in favour of the site of infection.

Activities of mitochondrial aspartate aminotransferase and creatine kinase isoenzyme MB in serum following coronary bypass surgery.

The mitochondrial isoenzyme of aspartate aminotransferase showed only slight increases in serum of twenty-seven patients after uncomplicated coronary bypass surgery, which contrasted the rapid and substantial increases in creatine kinase MB. In seven patients suffering perioperative infarction or serious complications, substantial increases in mitochondrial aspartate aminotransferase were detected and the elevations in creatine kinase MB were prolonged. Mitochondrial aspartate aminotransferase may appear as a specific marker of myocardial necrosis following coronary bypass surgery. The elevations of creatine kinase and creatine kinase MB were detected as early as 5 minutes after onset of coronary reperfusion and slightly higher activities were measured in coronary sinus blood than in systemic blood sampled simultaneously. Increases in mitochondrial aspartate aminotransferase, however, could first be measured 8 hours after reperfusion.

Organ changes in pigs after longterm parenteral nutrition.

When nutritional substrates used in clinical parenteral nutrition are given to rats a number of organ changes have been reported. These could be a species-related effect without significance outside the experimental laboratory. The reproduction of such organ changes in a large unrelated species would increase their importance. Longterm complete parenteral nutrition (CPN) was given to piglets. Nutritional substrates accepted in human parenteral nutrition were used, and the animals were parenterally fed for 6 and 12 weeks. Autopsy demonstrated an increased splenic weight. Epithelioid cell infiltration was found in the liver, spleen and lung. Osmiophilic fat droplets and vascular inflammation were seen in the pulmonary arteries. No signs of infections were found.

Spondyloarthritis: a strong predictor of early coronary artery bypass grafting.

OBJECTIVES: The main aim of the study was to examine whether patients with spondyloarthritides underwent their first coronary artery bypass grafting (CABG) at a younger age than those without spondyloarthritides. METHODS: Patients who underwent their first CABG at the Feiring Heart Clinic during 2001-2005 were preoperatively screened for spondyloarthritides, and the cardiological assessment was registered. We compared the characteristics of patients with and without spondyloarthritides. RESULTS: Of the 3852 patients undergoing their first CABG, 30 (0.78%) had spondyloarthritides. No statistically significant differences in traditional cardiovascular risk factors were found. The mean ages of patients with and without spondyloarthritides were 60.1 (SD = 8.7) and 66.9 (SD = 10.1) years, respectively. Spondyloarthritis was found by multivariate analysis to be a stronger independent predictor of early CABG than traditional cardiovascular risk factors [adjusted beta -6.2, p<0.001, 95% confidence interval (CI) -9.5 to -2.8]. Sixty per cent of spondyloarthritis patients and 52% of control patients had already suffered a myocardial infarction (p = 0.4). CONCLUSION: Spondyloarthritis was a stronger predictor of early CABG than most of the registered traditional cardiovascular risk factors. The prevalence of spondyloarthritis seemed to be higher in the CABG population than in the general population. These findings may indicate accelerated coronary artery disease (CAD) in spondyloarthritides.

Abdominal operations: effect on subsequent experimental faecal peritonitis.

Rats were subjected to laparotomy, anaesthesia only (controls), laparotomy plus 1-cm-segment ileum isolation, or no treatment (controls) and were challenged with endogenous faecal peritonitis 1 and 2 weeks later, respectively. Survival rates were 40% for the laparotomy group and 100% for the ileum isolation group, whereas all controls died. The number of peritoneal leucocytes, particularly macrophages and neutrophils, was significantly (p less than 0.05) higher in the laparotomy group than in the control group. The data show that abdominal operations alone--and especially in combination with a minor infectious challenge--entail an increased tolerance to subsequent peritonitis, possibly mediated by the previously stimulated and sensitized leucocytes.

Semisoluble aminated glucan: long-term efficacy against an intraperitoneal E. coli challenge and its effect on formation of abdominal adhesions.

The first part of this study in the rat was designed to assess the immediate and, in particular, the long-term effects of semisoluble aminated glucan (SAG) with regard to an intraperitoneal (i.p.) E. coli challenge and side-effects. The severity of the E. coli peritonitis was evaluated by quantification of the concomitant bacteremia. The animals randomly received either 10 ml normal saline i.p. (controls) or 10 ml (50 mg) SAG i.p. (experimental groups). It was found that SAG had no immediate protective effect against the infectious challenge as no difference was detected in the bacterial clearance between saline- and SAG-treated rats at day 0. However, 2 days after injection of saline/SAG a substantial protection of SAG was noted as no blood-borne bacteria could be detected at 1, 2, 3, 4 and 5 h after the E. coli challenge in SAG-treated animals, whereas by contrast matching blood cultures were positive in all controls. A likewise protective effect against E. coli bacteremia of a single i.p. injection of SAG was demonstrated at 7, 21, and 49 days after the administration of the compound. During the 7-week experimental period no clinical side-effects of SAG were observed. At autopsy (days 0, 2, 7, 21, and 49, respectively) no gross pathologic conditions were found. Lung, spleen, and kidney sections from SAG-treated rats were normal, whereas tiny granulomas were exhibited in liver sections, possibly related to the hyperfunctional macrophage state which SAG induced. The second main object of the study was to evaluate SAG's effect on adhesion formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of antibiotics on gram-negative sepsis in the rat. Lack of endotoxin burst.

Endotoxin and monocyte thromboplastin activity were evaluated in rats with gram-negative septicaemia induced by caecal perforation or intravenous Escherichia coli challenge and treated with antibiotics or placebo. Endotoxin burst was not detected in either form of septicaemia during antibiotic treatment. Thromboplastin synthesis in monocytes is known to be stimulated by endotoxin, but the rats showed no increase of monocyte thromboplastin activity after antibiotic treatment, which constituted further evidence against the concept of massive endotoxin liberation during antibiotic therapy for gram-negative septicaemia.

Experimental gram-negative peritonitis: decreased thromboplastin activity in organs with a simultaneous rise of thromboplastin in blood monocytes and peritoneal macrophages.

Thromboplastin values in blood monocytes, peritoneal macrophages, and in tissue samples from lung, aortic wall, liver, spleen, pancreas, kidney, jejunum, and colon were determined at 4, 10, and 16 h after induction of acute peritonitis (cecal perforation) or sham operation in rats. A maximum 35-fold and 100-fold rise of values was respectively demonstrated in monocytes and peritoneal macrophages in septic animals as compared to controls. This monocyte-macrophage-derived thromboplastin is probably central to the activation of blood coagulation and fibrin depositions/adhesion formation in septic peritonitis. A simultaneous and significant fall in thromboplastin content of standardized specimens from lung, aortic wall, liver, spleen, pancreas, and jejunum was observed in rats with peritonitis. This could reflect mobilization of thromboplastin in favor of the infectious focus. No significant changes were detected in tissue from kidney, whereas samples from the colon of septic animals showed a consistent increase as compared to controls.

Fasciotomy for chronic compartment syndrome.

During 1977 and 1978, we operated on 34 patients with chronic anterior tibial compartment syndrome. Surgery consisted of subcutaneous fasciotomy of the anterior crural compartment under local anesthesia. Twenty-three patients were operated on bilaterally. The mean follow-up was 10 years. One patient was lost to follow-up, leaving a total of 56 legs for assessment. The long-term result was excellent in 31 legs, good in 10, fair in 11, and poor in 4. There was one recurrence. This was relieved by refasciotomy.

[Omentoplasty in bronchopleural fistulas after pneumonectomy]. / Omentplastikk ved bronkopleurale fistler etter pneumonektomi.

A bronchopleural fistula after pneumonectomy is a serious complication, and successful healing is a therapeutic challenge. Increasing evidence indicates that closing of the fistula combined with wrapping the bronchus with omentum (omentoplasty) can secure permanent healing in the majority of cases. The omentum is highly vascularized, and has angiogenetic and anti-inflammatory properties. We describe two patients with bronchopleural fistulas after surgery for lung cancer. The fistulas were diagnosed respectively one and fifteen months after operation. Both were treated successfully with antibiotics, surgical debridement, secondary closure and wrapping of the fistulas with omentum transposed from the abdomen with its attachment to the right gastroepiploic artery preserved.

Compartment syndrome with muscle necrosis following repair of hernia of tibialis anterior. Case report.

Repair of a hernia of m. tibialis anterior was followed by acute compartment syndrome with complete muscular necrosis. If surgical treatment of a muscle hernia is found to be justified, it should consist of fasciotomy and not closure of the fascial defect.

Splenectomy in the rat. Immediate and late effects on clearance of gram-negative bacteria and on monocyte activation as expressed by thromboplastin synthesis.

Young rats (weight 190-200 g) were subjected to splenectomy or sham laparotomy and gram-negative bacteraemia was induced by caecal perforation or by injection of viable Escherichia coli intraperitoneally (10(9) bacteria) or intravenously (2 X 10(8]. Clearance of bacteria was significantly less in the splenectomized than in the sham-laparotomized rats, irrespective of the mode of microbial inoculation. Monocyte thromboplastin activity, shown to be a sensitive indicator of gram-negative bacterial presence, was heightened in the asplenic rats. When the infectious challenge was made 15 weeks postoperatively, however, no significant difference in bacterial clearance or in monocyte thromboplastin values was found between splenectomized rats and controls. Nor was increased susceptibility to gram-negative bacteria found in asplenic rats when both operation (splenectomy vs. sham laparotomy) and bacterial challenge were performed at a late age (weight 530-580 g). The postsplenectomy clearance of gram-negative bacteria thus seemed to be age-dependent.

[Varices of the great saphenous vein]. / Varicer i vena saphena magna.

During a 7-year period, 237 patients were treated surgically at Tromsø Hospital for varices of the great saphenous vein. At follow-up (mean 7.5 years) the overall results were excellent in 30%, good in 47%, and poor in 21% of the patients. The recurrence rate of varicose veins was 47%. However, 50% of these patients had no symptoms or only minor symptoms, from the recurrence. 37 patients noticed the occurrence of troublesome varicose veins within one year after operation. At clinical reexamination it was found that in 32 of these patients the surgery had been inadequate. This probably explains the rapid recurrence.

[Spinal anesthesia in young adults]. / Spinalanestesi hos unge voksne.

In a prospective study, 69 young adults, range 19-28 years, were given spinal anesthesia. Three patients developed postspinal puncture headache and three patients experienced transient backache. No other complications were observed. The results indicate that spinal anesthesia may be used even in young adults. This seems to contrast with the practice in most other Norwegian hospitals, where spinal anesthesia is given mainly to patients older than 40 years of age, based on the notion that the frequency of postspinal puncture headache is unproportionally high in younger patients.

Platelet trapping and haemodynamics in unilateral and bilateral experimental pulmonary macroembolism.

Cat lungs were embolized with autocoagulated autologous blood clots and the platelet-trapping ability of the lung vessels and the haemodynamic responses were studied. Embolization was bilateral or strictly unilateral. It elicited on average a twofold increase in 51Cr-labelled platelets in embolized parts of the lungs. Microscopy revealed platelet aggregates in arteries with diameter 50-100 microns. A temporary decrease in systemic platelets immediately postembolus was found. In the nonembolized lung at unilateral embolization the pulmonary platelet aggregation did not occur and no haemodynamic response was detected, indicating that platelet-aggregating substances or humoral factors did not recirculate from affected to unaffected parts of the lungs.