The Anti-Apoptotic Effect of Ranolazine on Cerebral Protection during Cardiopulmonary Bypass and Carotid Artery Surgery

Background

We aimed to determine the usability of ranolazine (Rn) as a neuroprotective during cardiac surgeries and carotid artery interventions where cerebral blood flow is interrupted.

Methods

Female Wistar albino rats were used. The rats were divided into 4 groups of 8 rats each. The first group (Group 1) was the control group. Group 2 underwent ischemia induction but was not treated with Rn. Group 3 received 25 mg/kg/day and Group 4 50 mg/kg/day Rn intraperitoneally, starting 3 days before ischemia induction. Bilateral carotid arteries were explored and clamped simultaneously. Ischemia was induced for 15 minutes. After 72 hours, the experimental animals were sacrificed.

Results

Superoxide dismutase, alkaline phosphatase, and interleukin 6 levels were similar among the 4 groups. Acetylcholine esterase (Group 3: p = 0.007, Group 4: p = 0.002), tumor necrosis factor-alpha (Group 4: p = 0.01), and annexin V (Group 3: p = 0.001) levels were statistically significantly lower in the Rn-treated groups. Malondialdehyde (Group 3: p = 0.003, Group 4: p = 0.009), reduced glutathione (Group 4: p = 0.04), acid phosphatase (Group 3: p = 0.04), noradrenaline (Group 3: p = 0.01), and Bcl-2 (Group 4: p = 0.004) levels were significantly higher in the Rn-treated groups.

Conclusions

The results of this study demonstrated the antiapoptotic effect of Rn in a brain ischemia-reperfusion model of rats receiving Rn before the procedure.

The inpatient costs related to revascularization of lower extremity artery disease in terms of amputation and mortality rates

OBJECTIVE

With the initial utilization of endovascular treatment options in 1970s, the number of procedures performed for lower extremity artery disease (LEAD) both with open surgical (OS) and endovascular (EV) treatment increased, but this did not result in a decrease in the number of amputations. The burden of LEAD still constitutes a huge proportion among the health care costs over the world.

METHODS

The patients who admitted to our clinic between October 2014 and December 2019 with LEAD and required revascularization were enrolled. The total hospitalization costs related to LEAD were registered and divided into two groups as care costs and medical supplies costs.

RESULTS

181 procedures were performed to 133 patients. Mean age was 63.98 ± 11.65 and 115 (86.5%) patients were male. Mean follow-up period was 31.19 ± 17.99 months (95% CI). The most frequent comorbidities were diabetes mellitus (DM) (n = 86, 66.2%) and active smoking (n = 59, 44.4%). Total costs and medical supplies costs were increased in EV group when compared with OS group ($4347.26 ± 3352.96, $3339.28 ± 3459.53 p = .005 v.s. $3318.67 ± 2874.55,$904.42 ± 1209.97 p < .001, respectively). Care costs were increased in OS group when compared with EV group ($2434.85 ± 2641.89 v.s. $1028.56 ± 1397.77 p < .001). The highest total, medical supplies, and care costs were determined in EV + OS group ($13071.32 ± 13717; $6784.91 ± 8332.04; $6286.41 ± 7652.12, respectively).Graft/wound infection related and amputation related costs were 21% of all costs. Amputation-free survival was 71.42% (95% CI) with 21 total amputations. There were linear correlations between mortality and amputation (p = .002); also between mortality and cost (p = .001).

CONCLUSIONS

In mid-long-term period, the care costs are increased with OS; however, EV treatment significantly increases the medical supplies and total costs. The increase in cost is correlated with poor outcome. Although the comorbidities and risk factors of these patients lead the clinicians to perform more challenging endovascular approaches, in mid-long-term period, particularly failed endovascular procedures are not promising in terms of outcomes and costs. We consider that the best-fit therapy on time is cost-effective, life and extremity-saving either, by avoiding deleterious effects of severe ischemia, such as severe pain, tissue loss, and related major adverse cardiaovascular events.

Investigation of the Effect of Preoperative Hypoalbuminemia, Blood Urea Nitrogen and Creatinine Levels on Postoperative Atrial Fibrillation on Off-Pump Coronary Bypass Surgery Patients

BACKGROUND

Postoperative atrial fibrillation (PoAF) is one of the most common complications to occur after open heart surgery. It has been shown that hypoalbuminemia accompanies some cardiovascular disorders. The present study evaluates the effects of pre-procedural albumin, blood urea nitrogen (BUN), and creatinine levels on PoAF.

METHODS

The data of 81 patients who underwent off-pump coronary artery bypass graft (CABG) surgery was evaluated. Patients who developed atrial fibrillation (AF) in the first 48 hours post surgery constituted the PoAF (+) group, while those without AF constituted the PoAF (-) group. The pre-procedural hematological parameters of patients in both groups were included in the analysis.

RESULTS

The PoAF (+) group was comprised of 57 patients (70.3%) with a mean age of 65.5 ± 9.8 years, while the PoAF (-) group was comprised of 24 patients (29.7%) with a mean age of 60.6 ± 9.6 years. A comparison of the demographic characteristics of the two groups showed that age (P = .036), frequency of renal failure (P = .007), and frequency of DM (P = .001) were higher in the PoAF (+) group. An examination of the laboratory data revealed a negative correlation between Hct (P = .001) and albumin (P = .000) levels and presence of PoAF. Also, the MPV (P = .02), BUN (P = .007), and Cr (P = .043) values were higher in the PoAF (+) group.

CONCLUSION

The present study, whose focus was on the effects of albumin levels on the occurrence of PoAF, found that low levels of pre-procedural albumin, as one of the major proteins in the blood, is a risk factor for the development of PoAF.

Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. A single center experience

This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results.

A rare complication of carotid artery stenting: displacement of marker ring causing locking of stent and incomplete stent expansion

We present a rare case of a complication of placement of a carotid artery stent represented by partial opening of a carotid Wallstent caused by displacement of its metal ring marker, which thus hindered complete expansion of the stent. An intraluminally locked carotid stent necessitated referral of the patient for urgent carotid endarterectomy. A possible reason of this unusual complication can be a manufacturing defect, which, to our knowledge, was not documented previously in open public data bases or on the Internet.

Early and late arrhythmogenic effects of doxorubicin

18587

Background: To determine the early and late arrhythmogenic effects of doxorubicin-containing chemotherapy regimens, and to identify associated risk. Methods: A prospective study including 29 patients who were treated with doxorubicin-containing regimens between September 2002 and September 2003. Cardiac evaluation was based on 24-hour electrocardiographic monitorization (Holter), which was performed during the first cycle of doxorubicin-containing regimens as well as after the last cycle of chemotherapy. Results: The mean age of the patients was 45.8 ± 15.1 (range 18–69) and the average dose of doxorubicin was 280.03 ± 113.50 mg/m2 (range 50–480). Holter records obtained during the first cycle of treatment revealed varying arrhythmias in 19 patients (65.5%). The most common arrhythmia was supraventricular extrasystole (n = 11, 37%). Holter records obtained after completion of therapy revealed a variety of rhythm abnormalities in 18 (62.1%) patients, with supraventricular extrasystole again being the most common arrhythmia (n = 13, 44.8%). Only 13 (44.8%) patients had arrhythmias documented in both Holter records. One patient presented with syncope during the first course of doxorubicin therapy and Mobitz type 2 atrioventricular block along with complete atrioventricular block lasting for 12 seconds were demonstrated after examination of Holter records. The patient subsequently underwent permanent pacemaker implantation. There was no correlation between the development of arrhythmia in the early and late period and sex, diagnosis, age, and previous radiotherapy history. Conclusion: Doxorubicin may result in arrhythmias both in early and late periods of treatment. These arrhythmias are rarely life threatening.

No significant financial relationships to disclose.

Determining the level of the dural sac tip: magnetic resonance imaging in an adult population

PURPOSE

To determine the variation in the location of the dural sac (DS) in a living adult population and to correlate this position with age and sex.

MATERIAL AND METHODS

T2-weighted, midline, sagittal, spin-echo magnetic resonance imaging (MRI) studies of 743 patients were assessed to identify the tip of the DS. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disk.

RESULTS

Frequency distribution for levels of termination of the DS on MRI demonstrated that the end of the DS was usually located at the upper one-third of S2 (25.2%). The mean level in females was also the upper one-third of S2 (26.5%) and in males the lower one-third of S2 (24.1%). The overall mean DS position was mostly at the upper one-third of S2. No significant differences in DS position were seen between male and female patients or with increasing age.

CONCLUSION

It is important to know the possible range for the termination level of the DS when performing caudal anesthesia and craniospinal irradiation in some clinical situations. The distribution of DS location in a large adult population was shown to range from the L5-S1 intervertebral disk to the upper third of S3 vertebrae.

cTnT can be a useful marker for early detection of anthracycline cardiotoxicity

BACKGROUND

The level of serum cardiac troponin-T (cTnT) increases with myocardial damage. We sought to assess whether cTnT level could be a useful marker for the early detection of anthracycline cardiotoxicity.

PATIENTS AND METHODS

Forty-one patients who had been scheduled to receive anthracycline-containing combination chemotherapy were included in the study. Serum cTnT levels were measured before (baseline) and after the first cycle of chemotherapy, and again, after the last cycle of chemotherapy. In all patients, the left ventricular ejection fraction (LVEF), fractional shortening (FS), early peak flow/atrial flow velocity (E/A) ratio, and the isovolemic relaxation time (IRT) were measured echocardiographically, both before and after the completion of chemotherapy.

RESULTS

LVEF and FS did not change in any patients. In 21 patients (49%), the E/A ratio decreased after therapy as compared to the pre-treatment values. The decrease in E/A ratio was more prominent in patients who were older than the mean age of our study group, which was 44 years. The post-treatment IRT was prolonged compared with the pretreatment IRT (94.0 +/- 2.0 versus 85.6 +/- 10.5 ms, respectively). cTnT levels after completion of therapy were elevated in 14 (34%) patients, and exceeded the upper limit of the normal range (>0.1 ng/ml) in only one patient. cTnT levels measured after completion of therapy were significantly higher, compared with those measured at baseline and after the first cycle of therapy. In the younger age group (< or =44 years old), there was a two-fold decrease in the E/A ratio in those patients whose cTnT levels increased during the therapy, when compared with those whose cTnT levels did not change (21% versus 43%, respectively).

CONCLUSION

Increased serum cTnT level can be detected in the early stages of anthracycline therapy and it is associated with diastolic dysfunction of the left ventricle. Therefore, serum cTnT level could be a useful measure for early detection of anthracycline-induced cardiotoxicity.

Portal venous variations. Prevalence with contrast-enhanced helical CT

PURPOSE

To review the distribution of intrahepatic portal venous branching in order to determine the prevalence of variations.

MATERIAL AND METHODS

We made a retrospective review of 655 contrast-enhanced helical CT (CECT) images of patients referred to our department for upper abdominal CT examination during an 8-month period. Of the 655 patients, 70 were eliminated from the study because of improper opacification of the portal venous system. Variations of portal venous branching in the remaining 585 patients were classified.

RESULTS

Of 585 patients, 504 (86.2%) had classical bifurcation of the main portal vein (MPV); 72 (12.3%) had a trifurcation of the MPV, 5 (0.9%) had a right anterior segmental branch originating from the left portal vein (LPV), 2 (0.3%) had an LPV originating from the right anterior segmental branch and 2 (0.3%) had a right posterior segmental branch arising from the MPV.

CONCLUSION

Variations of portal venous branching are common and helical CT is efficacious in identifying these variations.

Portal venous variations. Prevalence with contrast-enhanced helical CT

PURPOSE

To review the distribution of intrahepatic portal venous branching in order to determine the prevalence of variations.

MATERIAL AND METHODS

We made a retrospective review of 655 contrast-enhanced helical CT (CECT) images of patients referred to our department for upper abdominal CT examination during an 8-month period. Of the 655 patients, 70 were eliminated from the study because of improper opacification of the portal venous system. Variations of portal venous branching in the remaining 585 patients were classified.

RESULTS

Of 585 patients, 504 (86.2%) had classical bifurcation of the main portal vein (MPV); 72 (12.3%) had a trifurcation of the MPV, 5 (0.9%) had a right anterior segmental branch originating from the left portal vein (LPV), 2 (0.3%) had an LPV originating from the right anterior segmental branch and 2 (0.3%) had a right posterior segmental branch arising from the MPV.

CONCLUSION

Variations of portal venous branching are common and helical CT is efficacious in identifying these variations.

Hormone replacement therapy to improve left ventricular diastolic functions in healthy postmenopausal women

OBJECTIVES

To investigate the effects of estrogen and estrogen plus progesterone replacement therapy on left ventricular systolic and diastolic function parameters in healthy postmenopausal women.

METHODS

Forty-six healthy consecutive postmenopausal women were prospectively enrolled. Hormone replacement therapy (HRT), which was either 0.625 mg/day conjugated equine estrogen (CEE) alone, or with 2.5 mg/day medroxyprogesterone acetate (MPA) was administered depending on the hysterectomy status. Left ventricular systolic and diastolic function parameters were evaluated with echocardiography before and after 6 months of HRT. The paired t-test was used for statistical analysis.

RESULTS

Estrogen or estrogen plus progesterone did not significantly alter the left ventricular dimensions and systolic function parameters. However, significant improvements were noted in several diastolic function parameters including late diastolic mitral flow velocity, ratio of early to late mitral flow velocity and isovolumic relaxation time (P=0.003, P=0.001 and P=0.005, respectively, for the CEE group; all P<0.001 for the CEE+MPA group).

CONCLUSIONS

Estrogen or estrogen plus progesterone replacement therapy may significantly improve left ventricular diastolic functions in healthy postmenopausal women.

Effects of hormone replacement therapy on heart rate variability in postmenopausal women

BACKGROUND

Hormone replacement therapy (HRT) is associated with reduced cardiovascular risk, but the underlying mechanism(s) are not fully understood. This study investigated the effects of a 6-month course of HRT on cardiac autonomic function parameters assessed by heart rate variability (HRV) in postmenopausal women.

METHODS

Forty-six healthy postmenopausal women (age 48 +/- 5, range 40-60) with normal baseline electrocardiogram and negative exercise testing were enrolled. HRT, which was either 0.625 mg/day conjugated equine estrogen (CEE) plus 2.5 mg/day medroxyprogesterone acetate or 0.625 mg/day CEE alone were administered depending on hysterectomy status. Power spectral analysis of HRV was performed to calculate the low frequency component in absolute (LF) and normalized units (LF nu), high frequency component in absolute (HF), and normalized units (HF nu), and the LF/HF ratio. The standard deviation of RR intervals (SDNN) was calculated from the time series of RR intervals.

RESULTS

A 6-month course of HRT did not significantly alter resting heart rate (P > 0.05). The LF/HF ratio and LF nu significantly decreased after HRT (P = 0.022 and P = 0.032), whereas a significant increase was noted in the HF component of HRV (P = 0.043), indicating an improvement in cardiac autonomic function. The SDNN value, which was 28.8 +/- 11.8 ms before HRT significantly increased to 35.4 +/- 16.7 ms after 6 months (P = 0.011).

CONCLUSION

Our results indicate that a 6-month course of HRT may significantly improve cardiac autonomic function parameters, a finding that could at least partly explain the potential cardioprotective effect(s) of HRT.

Hormone replacement therapy shortens QT dispersion in healthy postmenopausal women

BACKGROUND

The aim of the study was to investigate the effects of hormone replacement therapy (HRT) on myocardial repolarization characteristics in postmenopausal women without coronary artery disease.

METHODS

Fifty-one consecutive healthy postmenopausal women (age 48 +/- 5) with negative exercise stress testing were prospectively enrolled into the study. Standard 12-lead electrocardiograms were obtained to evaluate the effects of 6 months of HRT on QT intervals, corrected QT intervals (QTcmax and QTcmin), QT dispersion (QTd), and corrected QTd (QTcd). Hormone regimens were continuous 0.625 mg/day conjugated equine estrogen (CEE) plus 2.5 mg/day medroxyprogesterone acetate (MPA) or 0.625 mg/day CEE alone depending on the hysterectomy status.

RESULTS

Although not statistically significant, CEE alone or in combination with MPA increased QTmax and QTmin values. However, the increase in QTmin was greater than the increase in QTmax, which resulted in statistically significant shortening of QTd (P = 0.007 in CEE and P < 0.001 in CEE + MPA groups). There was a significant prolongation of QTcmin values after 6 months in patients assigned to the CEE group (P = 0.001). The QTcd values were significantly shortened by HRT with both regimens (for CEE group 49 +/- 13 ms vs 38 +/- 13 ms, P = 0.01; for CEE + MPA group 49 +/- 14 ms vs 36 +/- 13, P < 0.001).

CONCLUSION

HRT significantly decreased the QTd and QTcd in postmenopausal women without coronary artery disease, independent of the addition of MPA to the regimen. This improvement in myocardial repolarization may be one of the mechanisms of the favorable effects of HRT on cardiovascular system. However, the clinical implications of the shortening of QTd in postmenopausal women with HRT must be clarified.