Coronary artery bypass surgery in high-risk patients

BACKGROUND: In high-risk coronary artery bypass patients; off-pump versus on-pump surgical strategies still remain a matter of debate, regarding which method results in a lower incidence of perioperative mortality and morbidity. We describe our experience in the treatment of high-risk coronary artery patients and compare patients assigned to on-pump and off-pump surgery. METHODS: From March 2002 to July 2004, 86 patients with EuroSCOREs > 5 underwent myocardial revascularization with or without cardiopulmonary bypass. Patients were assigned to off-pump surgery (40) or on-pump surgery (46) based on coronary anatomy coupled with the likelihood of achieving complete revascularization. RESULTS: Those patients undergoing off-pump surgery had significantly poorer left ventricular function than those undergoing on-pump surgery (28.6 ± 5.8% vs. 40.5 ± 7.4%, respectively, p < 0.05) and also had higher Euroscore values (7.26 ± 1.4 vs. 12.1 ± 1.8, respectively, p < 0.05). Differences between the two groups were nonsignificant with regard to number of grafts per patient, mean duration of surgery, anesthesia and operating room time, length of stay intensive care unit (ICU) and rate of postoperative atrial fibrillation CONCLUSION: Utilization of off-pump coronary artery bypass graft (CABG) does not confer significant clinical advantages in all high-risk patients. This review suggest that off-pump coronary revascularization may represent an alternative approach for treatment of patients with Euroscore ≥ 10 and left ventricular function ≤ 30%

The Use of Flow-Injection Analysis with Chemiluminescence Detection of Aqueous Ferrous Iron in Waters Containing High Concentrations of Organic Compounds

An evaluation of flow-injection analysis with chemiluminescence detection (FIA-CL) to quantify Fe2+(aq) in freshwaters was performed. Iron-coordinating and/or iron-reducing compounds, dissolved organic matter (DOM), and samples from two natural water systems were used to amend standard solutions of Fe2+(aq). Slopes of the response curves from ferrous iron standards (1 – 100 nM) were compared to the response curves of iron standards containing the amendments. Results suggest that FIA-CL is not suitable for systems containing ascorbate, hydroxylamine, cysteine or DOM. Little or no change in sensitivity occurred in solutions of oxalate and glycine or in natural waters with little organic matter

Calcium sulfoaluminate based cements

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN031666 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Non-penetrating deep sclerectomy and collagen implant surgery in glaucoma patients with advanced field loss

PubMed ID: 11456247Purpose: The aim of the study was to determine the medium term intraocular pressure (IOP) lowering effects and the potential complications of non-penetrating deep sclerectomy and collagen implant (DSCI) surgery in glaucoma patients. Patients and methods: 54 eyes of 52 patients with medically uncontrolled open angle glaucoma with advanced field loss underwent DSCI under topical anaesthesia. Follow-up period was 24 months. Results: The mean preoperative IOP was 24.7 ± 6.2 mmHg and decreased to 15.1 ± 4.0 mmHg at 24 months (p = 0.0068). During the follow-up period, 36 of 54 eyes (66%) received no topical antiglaucomatous medications. In 18 eyes, monotherapy with topical beta blockers (Betaxolol HCl) was added to the regimen. At last visit, only two patients (3.8%) had IOP greater than 18 mmHg. We did not detect any additional optic disc changes, visual field or visual acuity defects postoperatively. Detailed slit-lamp examination revealed no anterior segment complications regarding the probable complications of trabeculectomy. None of the patients developed surgery related cataract. As a complication, we diagnosed one case of self-limited, shallow choroidal detachment. Conclusion: DSCI appears to provide considerable medium term IOP decrease with few postoperative complications without deteriorating visual acuity. Owing to our medium term results, we believe that DSCI could be a valuable alternative to trabeculectomy especially in cases of advanced medically uncontrolled open angle glaucoma

Comparison of outcomes of viscocanalostomy and phacoviscocanalostomy

WOS: 000187426100006PubMed ID: 14740800Background: Many adults who undergo glaucoma filtering surgery also need surgical treatment of coexisting cataract. Recent reports of the use of new alternative non-penetrating techniques in combination with phacoemulsification have given encouraging results. The purpose of this study was to compare the safety and efficacy of viscocanalostomy and phacoviscocanalostomy in the management of medically uncontrolled open-angle glaucoma. Methods: Twenty patients who underwent phacoviscocanalostomy in one eye each were enrolled in the study. Twenty matching patients who underwent viscocanalostomy in one eye each at our institution were selected as the control group. Postoperative reductions in intraocular pressure (IOP) and number of antiglaucoma medications were compared between the groups. Visual acuity and complications were secondary outcomes. Results: Significant reductions of IOP and of use of antiglaucoma medication occurred in both groups (p 0.05). The mean IOP reduction was 34% in the eyes that underwent viscocanalostomy alone and 38% in the eyes that underwent phacoviscocanalostomy. The success rates of the two procedures were also comparable (p > 0.05). In the combined-surgery group the best-corrected visual acuity improved by 2 or more lines in 18 eyes (90%). Intraoperative complications did not occur in either group. Interpretation: Combining phacoemulsification with viscocanalostomy did not have a negative effect on the IOP control achieved by viscocanalostomy alone and did not increase the complication rate. Phacoviscocanallostomy was safe and effective in the surgical management of eyes with both glaucoma and cataract

Axial length changes accompanying successful nonpenetrating glaucoma filtration surgery

WOS: 000182241800004PubMed ID: 12660483We aimed to evaluate the effect of nonpenetrating glaucoma filtration surgery on axial length (AL). Thirty patients (30 eyes) who underwent successful nonpenetrating glaucoma filtration surgery were prospectively analyzed. AL was measured preoperatively and postoperatively at 1 and 12 months. Associations between change in AL and age, gender, diagnosis, preoperative and postoperative visual acuity, refraction and intraocular pressure (IOP) were analyzed. AL decreased in 22 of 30 eyes postoperatively. The mean change in AL measurement was -0.15 +/- 0.27 mm (range -1.37 to +0.12 mm) at 1 month. Regression analysis showed that young age, a high preoperative IOP and a greater change in IOP were associated with a greater decrease in AL (p 0.2), but was significantly greater than the mean AL 1 month postoperatively (p = 0.001). There was no statistically significant difference between the IOP levels obtained postoperatively at 1 and 12 months (p >0.1). Nonpenetrating glaucoma surgery can result in a small decrease in AL which can reverse during the follow-up period. Copyright (C) 2003 S. Karger AG, Basel

Erythrocyte deformability in high-tension and normal tension glaucoma

WOS: 000078775700002PubMed ID: 10090442The exact cause of primary open angle glaucoma is still unknown. Intraocular pressure is a major factor but it is impossible to explain the whole mechanism of glaucomatous optic nerve damage with only increased intraocular pressure. Other factors play important roles in the development of glaucoma. With this point of view, vascular factors have been implicated in the pathogenesis of glaucoma. We tried to determine the etiopathogenetic role of decreased erythrocyte deformability in normal tension glaucoma and high-tension glaucoma. The study group consisted of 16 patients with the diagnosis of normal tension glaucoma, 17 patients with the diagnosis of high-tension glaucoma, and 24 patients as controls. Independent t-tests were used to compare the three groups two by two for age, hematocrit, mean cell volume, plasma protein level, cardiovascular risk factors, and erythrocyte deformability. There was no statistically significant relationship (p > 0.05) between the groups concerning the erythrocyte deformability. When we consider all of 57 patients, we found that both increasing age (> 60 years) and greater mean cell volume (> 84 fl) had a statistically significant relationship with decreased erythrocyte deformability (p < 0.05). When we performed Pearson correlation analysis, we found that only mean cell volume and erythrocyte deformability had a statistically significant relationship (r = 0.31, p = 0.02). We conclude that decreased erythrocyte deformability is not a major factor in the ethiopathogenesis of normal tension glaucoma and high-tension glaucoma

A three-dimensional lead(II) polymer with bridging saccharinate and unusually coordinated acetate ligands - Synthesis, IR spectra, and crystal structure of [Pb(H2O)(mu-OAc)(mu-sac)](n)

Andac, Omer/0000-0003-3641-9690; Yilmaz, Veysel/0000-0002-2849-3332;WOS: 000182160800025The complex [Pb(H2O)(mu-OAc)(mu-sac)]n with acetate (OAc) and saccharinate (sac) ligands was characterized by IR, elemental analysis and X-ray crystallography The mixed-anion lead(II) complex crystallizes in the triclinic crystal system with the space group of P1. The single crystal X-ray analysis shows that the complex is a coordination polymer in which the lead(II) ions have a highly distorted pentagonal bipyramidal coordination geometry. Lead(II) ions are bridged by carboxylate groups in a zigzag arrangement forming one-dimensional infinite chains, which are also linked by sac bridges and aromatic pi-pi contacts between the adjacent phenyl rings of sac ligands, resulting in a three-dimensional network. One water molecule coordinates the lead(II) ion and also forms weak hydrogen bonds with the sulfonyl oxygen atoms of the neighboring sac ligands. The sac ligand acts as a bridging ligand through the nitrogen and carbonyl oxygen atoms, while the carboxylate moiety of the acetate ligand shows an unusual (bidentate, and bridging) coordination behaviour, which was observed for the first time in the structure

Deep sclerectomy with a nonabsorbable implant (T-Flux): preliminary results

WOS: 000186001700006PubMed ID: 14620036Background: Deep sclerectomy is one of the two main types of nonpenetrating surgical methods of treating open-angle glaucoma. We aimed to determine, in a prospective study, the efficacy, success rate and complications of deep sclerectomy with implantation of a nonabsorbable drain made of highly hydrophilic acrylic (T-Flux). Methods: Twenty-five patients (25 eyes) with medically uncontrolled open-angle glaucoma were treated by deep sclerectomy with implantation of the T-Flux drain. We determined the rates of intraocular pressure (IOP) reduction, surgical success (four categories) and complications. To evaluate the efficacy of this new implant in detail, we compared the success rates with those in a group of patients matched for age, sex, diagnosis, preoperative IOP, number of preoperative antiglaucoma medications and previous ocular surgery who underwent successful viscocanalostomy. Results: For two eyes in the deep-sclerectomy group, surgery was converted to standard trabeculectomy owing to perforation of the trabeculo-Descemet's membrane during dissection of the corneal stroma. The following results apply to the remaining 23 eyes. After a mean follow-up period of 16.21 (standard deviation [SD] 3.93) months, the mean IOP had fallen from 26.26 (SD 4.3) mm Hg preoperatively to 17.60 (SD 4.35) mm Hg at the last postoperative visit (p = 0.000). The rate of complete success (IOP 0.05). Interpretation: A statistically significant drop of IOP with few postoperative complications over the short term was achieved with deep sclerectomy and T-Flux implantation. The success rates were comparable to, and not significantly better than, those of viscocanalostomy