The effects of volatile induction and maintenance of anesthesia and selective spinal anesthesia on QT interval, QT dispersion, and arrhythmia incidence

OBJECTIVE: The effects of sevoflurane general anesthesia and bupivacaine selective spinal anesthesia on QT dispersion (QTd) and corrected QT (QTc) interval were investigated. METHODS AND MATERIALS: This prospective, randomized, double-blind study was conducted between July and September 2009 in the Urology and General Surgery operating rooms. Forty ASA I-II patients undergoing noncardiac surgery were randomized into two groups: Group R (n=20) and Group V (n=20). In Group R, 5 mg bupivacaine was administered into the spinal space. Anesthesia induction in Group V was established with sevoflurane + 0.1 mg/kg vecuronium using the maximum vital capacity technique. Anesthesia was maintained with 2-3% sevoflurane + 50% N2O/O2 inhalation. All patients were tested with a 24-hour Holter ECG device. QT, QTc, and QTd intervals were measured using 12-lead ECG records at 1 and 3 minutes during preinduction, postinduction, postincision and postextubation periods. Mean arterial pressure (MAP), heart rate and ECG records were measured simultaneously. RESULTS: None of the patients displayed arrhythmia. There was no significant difference between the groups with regard to QTd values (p>0.05). However, QTc was longer in Group V than in Group R after the induction of anesthesia at 3 minutes, after the intubation at 1 and 3 minutes, and after the incision at 1 and 3 minutes. MAP and heart rate were generally higher in Group V (

Effect of maintenance hemodialysis on diastolic left ventricular function in end‐stage renal disease

PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed. RESULTS: Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment. DISCUSSION: The acute and long-term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end-stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end-stage renal disease. CONCLUSION: It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end-stage renal disease. However, in patients with endstage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term

Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent

An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session

Związek stężenia serglicyny z izolowanym tętniakowatym poszerzeniem tętnic wieńcowych

Background: Serglycin plays an important role in the inflammatory status, but the relationship between coronary artery ectasia (CAE) and serglycin is still unknown. Aim: In this study, we aimed to investigate the association of serglycin level with isolated CAE. Methods: Fifty-two patients with isolated CAE and 35 individuals with normal coronary angiography were included into the study. The Markis classification and number of ectatic coronary arteries were recorded. Plasma serglycin levels were measured. Results: Multivariate logistic regression analysis revealed that serglycin and high-sensitivity C-reactive protein were indepen­dently associated with the presence of CAE. In receiver operating characteristics curve analysis the cut of serglycin level for the prediction of isolated CAE was 13.5, with a sensitivity of 88.5% and a specificity of 84.8%. However, there was no association between serglycin levels and Markis classification. Conclusions: Serglycin levels are significantly and independently higher in patients with CAE.Wstęp: Wiadomo, że serglicyna odgrywa istotną rolę w stanie zapalnym, lecz zależności między tętniakowatym poszerzeniem tętnic wieńcowych (CAE) a serglicyną nadal nie są znane. Cel: Celem badania była analiza związku między stężeniem serglicyny a izolowanym CAE. Metody: Do badania włączono 52 chorych z izolowanym CAE i 35 osób z prawidłowym obrazem tętnic wieńcowych w ko­ronarografii. Określono klasyfikację tętniaków wg Markisa oraz liczbę poszerzonych tętnic wieńcowych. Oznaczono stężenie serglicyny. Wyniki: W analizie regresji logistycznej wykazano, że stężenia serglicyny i białka C-reaktywnego były niezależnie związane z obecnością CAE. W analizie krzywych ROC punkt odcięcia dla prognozowania izolowanego CAE wynosił 13,5, a czułość i swoistość metody — odpowiednio 88,5% i 84,8%. Nie stwierdzono jednak żadnych zależności między stężeniem serglicyny a klasyfikacją wg Markisa. Wnioski: Stężenie serglicyny jest istotnie wyższe u osób z CAE i stanowi niezależny czynnik predykcyjny tego zaburzenia

Zależność między stężeniem albuminy modyfikowanej niedokrwieniem a dobrze rozwiniętym krążeniem obocznym

Background: It is important to determine the grade of the coronary collateral circulation (CCC) in patients with stable coronary artery disease. Aim: In this study, we aimed to investigate the relationship between the ischaemia-modified albumin (IMA) level and good CCC. Methods: A total of 95 patients with coronary angiography and at least one epicardial coronary artery obstruction were included in the study. The Rentrop classification was used with CCC grading, where 0 and 1 were defined as poor collateral, and 2 and 3 were defined as good collateral. The IMA level of the patients was measured using an enzyme-linked immunosorbent assay (ELISA). The receiver–operating characteristic curve was used to show the sensitivity and specificity of IMA levels and the optimal cut-off value for predicting good CCC. Results: The multiple logistic regression analysis revealed that the IMA level in the good CCC group was higher (p &lt; 0.045). Conversely, the high-sensitivity C-reactive protein level was lower in the good CCC group (p &lt; 0.023). We found an IMA cut-off value (4.7 ng/mL) that indicated good CCC level, and this shows good CCC with 70.2% sensitivity and 60.3% specificity. Conclusions: The IMA level could serve as a simple and useful predictor of well-developed CCC.Wstęp: U chorych ze stabilną chorobą wieńcową (CAD) istotne jest ustalenie stopnia rozwoju wieńcowego krążenia obocznego (CCC). Cel: Badanie przeprowadzono w celu oceny zależności między stężeniem albuminy modyfikowanej niedokrwieniem (IMA) a dobrze rozwiniętym CCC. Metody: Do badania włączono 95 chorych z dostępnym wynikiem koronarografii, u których stwierdzono co najmniej jedno zwężenie nasierdziowej tętnicy wieńcowej. Do określenia stopnia CCC używano klasyfikacji Rentropa, w której oceny 0 i 1 oznaczały słabe krążenie oboczne, natomiast 2 i 3 — dobre krążenie oboczne. Stężenie IMA mierzono za pomocą metody immunoenzymatycznej (ELISA). Wyznaczono krzywe ROC w celu określenia czułości i swoistości oznaczania stężeń IMA oraz optymalnej wartości granicznej pozwalającej na predykcję dobrze rozwiniętego CCC. Wyniki: W analizie wielokrotnej regresji logistycznej wykazano, że stężenie IMA było wyższe w grupie z dobrym CCC (p < 0,045). Z kolei stężenie białka C-reaktywnego oznaczane metodą wysokoczułą było niższe u osób z dobrym CCC (p < 0,023). Autorzy określili wartość graniczną stężenia IMA (4,7 ng/ml), która wskazywała na obecność dobrze rozwiniętego CCC z czułością wynoszącą 70,2% i swoistością równą 60,3%. Wnioski: Stężenie IMA może służyć jako łatwy w zastosowaniu i użyteczny predyktor dobrze rozwiniętego CCC

Short stature is an independent risk marker for mortality and incident coronary heart disease only in women: a structural relationship?

Objective: We evaluated the associations of short stature with coronary heart disease (CHD) risk or overall mortality, which vary with sex and ethnicity/race

Clinical biomarkers of high-density lipoprotein dysfunction among middle-aged Turks

Objective: Impaired function of high-density lipoprotein (HDL) particles generates cardiometabolic disorders in people prone to impaired glucose tolerance for which clinical biomarkers need delineation

Aggregation of lipoprotein(a) to apolipoprotein A-I underlying HDL dysfunction as a major coronary risk factor

Objective: Dysfunction of high-density lipoprotein (HDL) may contribute to coronary heart disease (CHD) risk. We determined whether aggregation to lipoprotein (Lp)(a) of apolipoprotein (apo) A-I underlies HDL dysfunction conferring incident CHD risk