Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial

<p>Abstract</p> <p>Background</p> <p>The blood saving effect of aprotinin has been well documented in cardiac surgery. In thoracic surgery, very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime.</p> <p>Methods</p> <p>Fifty-nine patients, mean age 58 ± 13.25 years (mean ± SD) undergoing general thoracic procedures were randomized into placebo (Group A) and treatment group (Group B). The group B (n = 29) received 500.000 IU of aprotinin after induction to anesthesia and a repeat dose immediately after chest closure. A detailed protocol with several laboratory parameters was recorded. Patients were transfused when perioperative Ht was less than 26%.</p> <p>Results</p> <p>The two groups were similar in terms of age, gender, diagnosis, pathology, co-morbidity and operations performed. The mean drainage of the first and second postoperative day in group B was significantly reduced (412.6 ± 199.2 vs. 764.3 ± 213.9 ml, p < 0.000, and 248.3 ± 178.5 vs. 455.0 ± 274.6, p < 0.001). Similarly, the need for fresh frozen plasma transfusion was lower in group B, p < 0.035. Both the operation time and the hospital stay were also less for group B but without reaching statistical significance (84.6 ± 35.2 vs 101.2 ± 52.45 min. and 5.8 ± 1.6 vs 7.2 ± 3.6 days respectively, p < 0.064). The overall transfusion rate did not differ significantly. No side effects of aprotinin were noted.</p> <p>Conclusion</p> <p>The perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery.</p

Identification of Lysine 37 of Histone H2B as a Novel Site of Methylation

Recent technological advancements have allowed for highly-sophisticated mass spectrometry-based studies of the histone code, which predicts that combinations of post-translational modifications (PTMs) on histone proteins result in defined biological outcomes mediated by effector proteins that recognize such marks. While significant progress has been made in the identification and characterization of histone PTMs, a full appreciation of the complexity of the histone code will require a complete understanding of all the modifications that putatively contribute to it. Here, using the top-down mass spectrometry approach for identifying PTMs on full-length histones, we report that lysine 37 of histone H2B is dimethylated in the budding yeast Saccharomyces cerevisiae. By generating a modification-specific antibody and yeast strains that harbor mutations in the putative site of methylation, we provide evidence that this mark exist in vivo. Importantly, we show that this lysine residue is highly conserved through evolution, and provide evidence that this methylation event also occurs in higher eukaryotes. By identifying a novel site of histone methylation, this study adds to our overall understanding of the complex number of histone modifications that contribute to chromatin function

Global Health Governance and the Commercial Sector: A Documentary Analysis of Tobacco Company Strategies to Influence the WHO Framework Convention on Tobacco Control

Heide Weishaar and colleagues did an analysis of internal tobacco industry documents together with other data and describe the industry's strategic response to the proposed World Health Organization Framework Convention on Tobacco Control

The Toxic Effects of Cigarette Additives. Philip Morris' Project Mix Reconsidered: An Analysis of Documents Released through Litigation

Stanton Glantz and colleagues analyzed previously secret tobacco industry documents and peer-reviewed published results of Philip Morris' Project MIX about research on cigarette additives, and show that this research on the use of cigarette additives cannot be taken at face value

Komplikationen und Mortalität nach Pneumonektomie bei Rauchern mit NSCLC

Objective: Perioperative morbidity and mortality in patients receiving pneumonectomy because of non-small cell lung cancer (NSCLC) remains quite high. The aim of this study is to identify risk factors to minimize perioperative mortality and morbidity. Patients and method: The results of 156 Patients who received pneumonectomy between 1995 and 2004 were reviewed retrospectively. All patients had stage I or II NSCLC. In 81 cases a right sided and in 75 a left sided pneumonectomy was performed. Cardiopulmonary function tests were sufficient for pneumonectomy. Results: Overall perioperative 30-day mortality was 7.1% (n=11), in hospital mortality 8.3% (n=13). The cause was sepsis in 6 cases, cardiac failure in 4 cases, and respiratory insufficiency in 3 cases. In univariable and multivariable regression analysis considering mortality, none of the prognostic factors reached significance. The odds ratio for postoperative death was 1.6 fold for smokers in comparison to non smokers. Complications after pneumonectomy were seen in 34.6%, with arrhythmia in 16.0%, sepsis in 1.9% and bronchopleural fistula (BPF) occurring in 6.4%. Smoking and intraoperative blood loss >500 ml were highly significant perioperative risk factors. Conclusion: Smoking until operation and intraoperative blood loss were independent postoperative risk factors leading to complications after pneumonectomy for NSCLC. The risk for complications was 2.8-fold higher for smokers.Ziel: Nach wie vor ist die perioperative Morbidität und Mortalität bei Patienten, die sich auf Grund eines nicht-kleinzelligem Lungenkarzinoms einer Pneumonektomie unterziehen müssen, sehr hoch. Das Ziel dieser Studie ist, Risikofaktoren zu identifizieren und dadurch die Morbidität und Mortalität zu senken. Patienten und Methode: Die Daten von 156 Patienten, die zwischen 1995 und 2004 auf Grund eines nicht-kleinzelligen Lungenkarzinoms im Stadium I und II pneumonektomiert werden mussten, wurden retrospektiv ausgewertet. In 81 Fällen wurde die Pneumonektomie rechts und in 75 Fällen links vorgenommen. Sowohl kardiale als auch pulmonale Funktionsparameter qualifizierten die Patienten für eine Pneumonektomie. Resultate: Die 30-Tage-Mortalität betrug 7,1% (n=11), die Krankenhausletalität 8,3% (n=13). Die Ursachen waren eine Sepsis bei 6 Patienten, Herzversagen bei 4 Patienten und pulmonale Probleme bei 3 Patienten. Bezüglich der Letalität erreichte keiner der Prognosefaktoren sowohl in der univariablen als auch der multivariablen Regression statistische Signifikanz. Die Odds-Ratio, postoperativ zu versterben, betrug bei den Rauchern 1,6. Komplikationen traten in 34,6% auf, am häufigsten Arrhythmie bei 16,0%, Sepsis in 1,9% und Bronchusstumpfinsuffizienz in 6,4%. Rauchen und intraoperativer Blutverlust >500 ml waren hoch signifikante perioperative Risikofaktoren. Schlussfolgerung: Rauchen bis zur Operation und intraoperativer Blutverlust sind unabhängige perioperative Risikofaktoren nach Pneumonektomie bei nicht-kleinzelligem Lungenkarzinom. Das Risiko, postoperativ Komplikationen zu entwickeln, war 2,8-mal höher bei Rauchern