Influence of dipyridamole stress echocardiography on galectin-3, amino-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T.

Non-invasive assessment using a pharmacological provocative test is an essential part of the workup of patients admitted to the emergency department with chest pain. Some doubts, however, remain about the safety of dipyridamole stress echocardiography in patients with non-diagnostic troponin and ECG. Methods and results: Twenty-nine consecutive patients admitted to the emergency department with chest pain and no evidence of acute coronary syndrome were subjected to standard dipyridamole stress echocardiography. Blood samples for measurement of galectin-3, NT-proBNP and high-sensitivity troponin T (HS-TnT) were collected at the baseline and after provocative testing. The provocative test was positive in 7/29 patients. As compared with baseline measurements, no significant differences were observed in 1-h values of HS-TnT (10.7 versus 10.5 ng/L; P = 0.085) and galectin-3 (14.3 versus 13.7 ng/mL; P = 0.128), whereas values of NT-proBNP were slightly higher (126 versus 111 ng/L; P = 0.002). The 1-h delta variation of patients with a positive provocative test was significantly higher than that of patients with negative provocative testing for galectin-3 (1.12 versus 1.00; P 1 in all patients with a positive provocative test as compared with 50% of patients with a negative provocative test (P = 0.018). Conclusions: Dipyridamole stress testing did not trigger clinically meaningful injuries to the myocardium. Galectin-3 testing may hence be preliminarily regarded as a complementary means for enhancing the diagnostic value of provocative testing. It is also worthwhile investigating whether patients with abnormal response to a provocative test and increased galectin-3 values may be targeted with specific therapy

THYROIDECTOMY FOR DIFFERENTIATED CARCINOMA IN OLDER PATIENTS ON A SHORT STAY BASIS

BACKGROUND: Total thyroidectomy is the treatment of choice for thyroid cancer and for selected benign thyroid conditions. The aging of the general population and the improvements in surgical technique induced an extension of the surgical indications to major thyroid surgery to older patients also on a short stay basis. METHODS: From January 2004 to December 2006, 152 patients affected by thyroid carcinoma underwent total thyroidectomy on a short stay basis. We divided our series in 2 groups of patients according to the age (> or < of 65 yrs) and considered the outcome analysing several factors including: ASA score, mean operative time, mean hospital stay, tumour size, and post-operative complications. RESULTS: The groups consisted of: 115 pts with a mean age of 46.81 +/- 11.63 years and 37 pts with a mean age of 74.53 +/- 3.71 years for the younger and older group respectively. The differences in ASA score and hospital stay were statistically significant between the groups (P < 0.007 and P < 0.004); neither postoperative haemorrage nor permanent hypocalcemia was observed. One permanent paralysis of the recurrent laryngeal nerve was noted at 12 months follow up; transient hypocalcemia, which resolved in all cases within 30 days from surgery, was reported in 23 and in 7 patients in the younger and older group respectively. CONCLUSIONS: Although a longer length of stay was noted in the older group and possibly related to a higher ASA score and a worse preoperative airways condition, total thyroidectomy for differentiated thyroid carcinoma may be safely carried out in older patients on a short stay basis if performed by an expert staff and in the setting of a multidisciplinary and exhaustive preoperative assessment

MINIMALLY INVASIVE VIDEO-ASSISTED THYROIDECTOMY:THE LEARNING CURVE

BACKGROUND: MIVAT (minimally invasive video-assisted thyroidectomy) is a recent technique that requires a learning curve. MATERIALS AND METHODS: From July 2005 to December 2006, we treated 100 from a total of 467 thyroidectomy patients with MIVAT. We divided the patients into 3 groups. The first 2 groups consisted of 25 patients each: group A (cases 1-25) and group B (26-50). We also divided patients into 2 groups based on our surgical experience: group A + B (cases 1-50) and group C (cases 51-100). RESULTS: The operative times for groups A and B were 101.7 and 84.6 min, respectively (p < 0.03); those for groups A + B and C were 91.07 and 63.06 min, respectively (p < 0.004). Complications of hypocalcemia were observed in 6 cases (4 in the first 50 cases and 2 in the second 50), and complications of nerve palsy were observed in 2 cases from group A. CONCLUSIONS: After 25 cases, we observed that the MIVAT procedure allows for a lower mean operative time and a reduction of complication

Early kinetics of heart-type fatty acid binding protein in patients undergoing dipyridamole stress echocardiography and relationship with high-sensitivity troponin.

BACKGROUND: The assessment of cardiospecific troponins is the main stay for diagnosing myocardial injury, although their diagnostic sensitivity remains suboptimal at patient admission to the emergency department (ED), thus paving the way for translational research to identify early and complementary biomarkers which may help improve the diagnostic sensitivity of high-sensitivity troponin immunoassays at patient presentation to the ED. AIM: To investigate whether heart-type fatty acid binding protein (H-FABP) provides distinctive and/or adjunctive information over high-sensitivity troponin I (HS-TnI) in ED patients undergoing dipyridamole stress testing. METHODS: Thirty consecutive ED patients with chest pain but no myocardial ischaemia were challenged with dipyridamole-atropine and followed by echocardiography. Blood samples for assessing H-FABP and HS-TnI were collected before the dipyridamole challenge, immediately after, and 6 h afterwards. RESULTS: The concentration of HS-TnI in the whole cohort of patients did not vary significantly throughout the study period, whereas H-FABP significantly increased after the test (4.2 ng/mL, p = 0.003), but not 6 h afterwards (3.8 ng/mL, p = 0.372) compared to baseline (4.0 ng/mL). The kinetics was similar in patients with positive or negative results of stress testing. The frequency of biomarker increase after the test was greater for H-FABP than for HS-TnI immediately after the pharmacological challenge (77% vs. 53%), but was lower 6 h afterwards (30% vs. 63%). The number of patients with values exceeding the diagnostic threshold of both biomarkers remained constant throughout the study period. CONCLUSIONS: These results suggest that dipyridamole stress echocardiography does not trigger substantial myocardial injury. We have also shown that release of H-FABP from stressed myocardium occurs without progression towards irreversible necrosis, and is more precious than that of TnI

Protective activity of inhaled frusemide against immunological respiratory changes and mediator release in guinea-pigs

The antianaphylactic activity of inhaled frusemide was studied in ovalbumin-sensitized guinea-pigs. The exposure of the animals to frusemide aerosol (1% solution for 20 min) attenuated the respiratory response to ovalbumin challenge (aerosol 1% solution) and was associated with a significant reduction of blood histamine (70%; P less than 0.01) and thromboxane-B2 (35%; P less than 0.01) compared to control animals. Similar results were obtained in isolated lungs perfused via the trachea excised from ovalbumin-sensitized guinea-pigs exposed to frusemide aerosol (1% solution for 20 min). In this series of experiments frusemide significantly prevented the increase in tracheal perfusion pressure (45%; P less than 0.01) and the concomitant release into the pulmonary effluent of both histamine (75%; P less than 0.01) and thromboxane-B2 (39%; P less than 0.01). In another series of experiments, frusemide (1 x 10(-4) M) significantly reduced the immune release of histamine from mast cells of ovalbumin-sensitized rats. The inhibitory activity of frusemide was in the same range of potency (66%; P less than 0.01) as that of disodium cromoglycate (1 x 10(-4) M). These data taken together indicate that frusemide when given by inhalation prevents histamine release secondary to antigen-antibody reaction