Coronary artery bypass surgery with arterial grafts in familial hypercholesterolemia

AbstractObjective: Familial hypercholesterolemia is a dominantly inherited disorder caused by mutations at the locus for the low-density lipoprotein receptor and is frequently associated with premature coronary artery disease. This study was performed to determine whether arterial grafting was associated with long-term benefits for patients with familial hypercholesterolemia. Methods: During the past 18 years, 101 patients with heterozygous familial hypercholesterolemia underwent primary coronary artery bypass grafting, with one hospital death. Group 1 patients (n = 31) received only saphenous vein grafts. Group 2A patients (n = 47) received one internal thoracic artery graft and supplemental vein grafts, and group 2B patients (n = 23) had multiple arterial grafts. After operation, all patients received diet therapy and intensive cholesterol-lowering drug therapy. Thirteen patients received low-density lipoprotein apheresis. Results: During a mean follow-up period of 95 months, 8 patients died, 9 underwent reoperation, and 12 received catheter intervention. The overall survival was 82% (95% confidence limits, 65%-97%) at 18 years after operation. The survival in group 2 was higher than that found in group 1 (P = .01). The overall freedom from major cardiac events (myocardial infarction, cardiac death, reoperation, and catheter intervention) was 57% (95% confidence limits, 40%-74%) at 16 years after operation. The freedom from reoperation in group 2 was higher than that found in group 1 (P = .03). There was no difference in the survival or freedom from major cardiac events between groups 2A and 2B. Conclusion: Arterial grafting improved the long-term freedom from reoperation in patients with familial hypercholesterolemia. Additional benefit of multiple arterial grafting could not be identified. (J Thorac Cardiovasc Surg 2000;119:1008-14

近赤外光を利用した連続的心筋酸素飽和度測定による warm blood cardioplegia の検討

金沢大学医薬保健研究域医学系Continuous infusion of warm blood cardioplegic solution is often interrupted during coronary artery bypass grafting to obtain a bloodless operating field. We measured myocardial oxygen saturation continuously using near-infrared spectroscopy to determine myocardial oxygen metabolism during intermittent warm blood cardioplegia (IWBC). In 7 adult mongrel dogs undergoing cardiopulmonary bypass IWBC was administered using the Buckberg-Shiley system. Cardiac arrest was induced by a warm blood cardioplegic infusion of 100 ml/min for 5 minutes followed by a maintenance infusion of 40 ml/min for 5 minutes. The infusion of warm blood cardioplegia was then stopped for 15 minutes. Measurement of myocardial oxygen saturation was performed continuously throughout cardiopulmonary bypass. IWBC produced an increase in myocardial oxygen saturation for the first 5 minutes and a slight decrease for the second 5 minutes. After the termination of IWBC, myocardial oxygen saturation showed a marked reduction for 3 minutes and plateaued after 5 minutes. Measurement of myocardial oxygen saturation revealed myocardial oxygen metabolism during IWBC. This procedure may be a useful way to monitor myocardial oxygen metabolism during open heart surgery

Flexibility chart 2.0: An accessible visual tool to evaluate flexibility resources in power systems

ABSTRACT: Various aspects of power system flexibility are evaluated within the multi-country study framework of IEA Wind Task 25. Grid components and actions which have been adopted for enhancing flexibility in different areas, countries, regions are addressed, as well as how Transmission System Operators, Independent System Operators, Utilities intend to manage variable generation in their operating strategies. A visual assessment to evaluate the diversity of flexibility sources, called a “flexibility chart”, is further developed to illustrate several flexibility parameters (e.g., hydropower, pumped hydro, gas turbine, combined heat and power, interconnection and battery) in a polygonal radar (fan-shaped) chart. This enhanced version of the Flexibility Chart is an “at-a-glance” and “easy-to-understand” tool to show how to estimate the potential of flexibility resources in a given country or area, and is accessible for non-technical experts. The Flexibility Chart 2.0 is also a useful tool to compare the past and future flexibility of a system. Comparing the historical change of flexibility resources may not only be helpful to discuss energy policy in regions with high installed variable renewable generation, but also to contribute to the discussion in other regions where renewables have not been widely adopted yet.info:eu-repo/semantics/publishedVersio

Wind and solar curtailment

High penetrations of wind and solar generation on power systems are resulting in increasing curtailment. Wind and solar integration studies predict increased curtailment as penetration levels grow. This paper examines experiences with curtailment on bulk power systems internationally. It discusses how much curtailment is occurring, how it is occurring, why it is occurring, and what is being done to reduce curtailment. This summary is produced as part of the International Energy Agency Wind Task 25 on Design and Operation of Power Systems with Large Amounts of Wind Power

冠状動脈瘻の外科治療の検討

金沢大学医薬保健研究域医学系Coronary artery fistula is one of the most common coronary malformations and is being diagnosed with increasing frequency with widespread use of selective coronary arteriography. Twenty-one patients with coronary artery fistulas underwent surgical treatment at our institute between 1973 and 1994. The left coronary artery was most commonly involved, and the fistula communicated primarily with the pulmonary artery. Associated cardiovascular disease include: mitral stenosis (1), mitral insufficiency (1), partial anomalous pulmonary venous return (1), ventricular tachycardia (1), atrial septal defect (1), aortitis syndrome (1), and coronary arteriosclerotic narrowing (1). In five patients, the coronary artery fistulas were selectively ligated without CPB. In sixteen patients, in addition to selective ligation, the fistula ostia were closed from inside using CPB. There were no operative or late deaths in the patients who underwent operations. Thus, the risks of surgical correction appear to be considerably less than the potential development of serious and possibly fatal complications, even in asymptomatic patients

冠状動脈バイパス術における微温体外循環の効果

金沢大学医薬保健研究域医学系The effect of systemic temperature during cardiopulmonary bypass (CPB) surgery was evaluated in 100 patients. The patients were divided into three groups, based on systemic temperature during CPB; 28 degrees C, 30 degrees C, or 32 degrees C (tepid). Multidose cold crystalloid cardioplegia was administered for myocardial protection. Pump flow was maintained at 75 ml/kg/min. Methoxamine hydrochloride and phenothiazine were used to maintain systemic perfusion pressures between 60 and 80 mmHg. Preoperatively, there were no differences between groups in left ventricular ejection fraction or extent of coronary artery disease. The time required for CPB and weaning from CPB were significantly shorter in the 32 degrees C group than in either the 28 degrees C or the 30 degrees C group. There were significant differences in the doses of methoxamine hydrochloride and phenothiazine required in each group. Postoperatively, there were no significant differences in the incidence of myocardial infarction, stroke, or 30-day mortality between groups. In conclusion, tepid systemic perfusion shortens the length of CPB and does not differ significantly from cold perfusion with respect to mortality and morbidity

Search for Kaluza-Klein Graviton Emission in ppˉp\bar{p} Collisions at s=1.8\sqrt{s}=1.8 TeV using the Missing Energy Signature

We report on a search for direct Kaluza-Klein graviton production in a data sample of 84 ${pb}^{-1}$ of \ppb collisions at $\sqrt{s}$ = 1.8 TeV, recorded by the Collider Detector at Fermilab. We investigate the final state of large missing transverse energy and one or two high energy jets. We compare the data with the predictions from a $3+1+n$-dimensional Kaluza-Klein scenario in which gravity becomes strong at the TeV scale. At 95% confidence level (C.L.) for $n$=2, 4, and 6 we exclude an effective Planck scale below 1.0, 0.77, and 0.71 TeV, respectively.Comment: Submitted to PRL, 7 pages 4 figures/Revision includes 5 figure