Suppression of myocardial injury markers following percutaneous coronary interventions by pre-treatment with carvedilol

Retrospective studies and clinical trials have indicated that beta -receptor blockers have an influential role in improving survival and reducing risk of recurrent infarction in patients with myocardial infarction. However, there is still controversy regarding the effects of beta -receptor blockers on the markers of myocardial infarction following percutaneous coronary interventions [PCI]. The aim of this study was to evaluate the pre-treatment effect of Carvedilol on markers of myocardial injury in patients undergoing elective PCI. In this clinical trial patients undergoing elective PCI were categorized randomly in the Carvedilol group including 100 patients who received two doses of 12.5 mg, 6 and 12 hours prior to PCI, and the control group [105 patients]. Blood samples were obtained to analyse cardiac biomarker, 12 and 24 hours after PCI. The clinical features were not significantly different between the two groups. A increase in the level of Troponin I was observed in the control group 24 hours following PCI [P=0.042], whereas this rise in troponin I was slight and insignificant in the Carvedilol group [P>0.05]. some difference was observed between the two groups in regard to the level of CPK-MB after PCI [P=0.041]. The findings of our study indicate that pre-treatment with Carvedilol confers cardio-protection by limiting the rise of markers of myocardial injury following PCI

Locked-in syndrome and blue toe syndrome caused by cardiopulmonary bypass

Severe inflammation after cardiopulmonary bypass with the vasculitis of the acral extremity and vertebro-basilar arterial system leads to the locked-in syndrome and blue toe syndrome. In broad terms, systemic, idiopathic, and environmental factors provoke syndromes that present with digital discoloration or the blue toe syndrome. Painful digital discoloration, accompanied by ulceration, suggests vasculitis, involving small blood vessels. Definitive diagnosis usually requires histological documentation because vasculitic syndromes have no pathognomonic clinical features or laboratory test results. The case introduced herein is that of a woman who developed the locked-in syndrome in conjunction with quadriplegia, loss of facial movement, speech loss, and loss of horizontal eye movements. She had initially presented with severe mitral stenosis and left atrial clot and undergone mitral valve replacement and clot extraction. The patient expired from multiple organ failure despite prolonged ventilatory support, including tracheotomy, and meticulous nursing care and antibiotic prophylaxis. Given the previously reported partial recovery from this syndrome with the use of steroids, we would advocate the use of such pharmacological agents

Predictive Factors for ICU and Ward Stay After CABG

To determine factors that predicts ICU and ward stay during hospitalization for coronary artery surgery. Data were collected retrospectively from 200 patients. ICU and ward stay time was divided into two groups and compared by X2 and t test and variables with a p value of less than 0.1 were included in logistic regression model. Specificity and sensitivity of tests were examined by ROC curve. Mean time of ICU and ward stay [day] was 3.89 and 11.07 days respectively. The mean volume of transfused blood in group 1 [ICU stay 3 day] was 1231 ml where the difference was significant [p<0/05] and this correlation between stay time and transfusion was not seen in ward stay. In univariate analysis, factors such as transfused volume, maximum flow, Chronic obstructive pulmonary disease [COPD], Ejection fraction [EF], Intra aorta pump [IABP] and drainage volume were different between two groups of ICU stay times and such factors in ward stay were transfused volume, minimum flow, COPD, reoperation due to bleeding, and amount of 24 hours bleeding. In logistic regression model variables such as age, pump time, transfused volume and COPD were predictors of ICU stay and only drainage volume was predictor of ward stay. Transfusion of blood is associated with long ICU stay time. Mechanism of this increased time is depression of immune system and increased rate of infection. Volume of bleeding from chest tube in 24 hours is associated with long hospital stay, because chest tube dose not pull out until drainage volume reduced to 50 ml in 24h