Myocardial changes during open heart surgery: a clinical, histopathological and ultra structural study

Crystalloid cardioplegia and induced fibrillation reduce myocardial injury and improve metabolic recovery during open heart surgery. However, there is little evidence of a benefit of either technique in clinical practice. Twenty patients ASA physical status II and III from Alexandra Main University Hospital scheduled for open heart surgery with congenital or acquired cardiac lesions using cardiopulmonary bypass were included in the study. They were divided into two groups, group I received cold crystalloid and group II in whom hypothermic fibrillatory arrest was applied using the fibrillator. The time of whole operation, total cardiopulmonary bypass time, aortic cross clamp time and time to resume heart beating in both groups were recorded. The level of CK-MP, createnin kinase and lactic dehydrogenase were determined at 1, 6, and 24 hours after cross clamp. In addition histological studies for assessment of myocardial injury were done. The results of this study revealed a significant shorter cardiopulmonary bypass time and the fibrillation time in group II, also the recovery time was shorter in group II. As regards the enzymatic studies, the CK-MB was statistically high in group II than group I at 1 and 6 hours. The light microscope shows signs of ischemic damage were detected in both groups with a greater intensity in group II as compared to group I patients: however no irreversible changes [myofibril necrosis] were observed in either group. The Electron microscopic examination shows no irreversible changes in the form of necrosis in the studied cases. The mean scores of ischaemic injury in group I patients were significantly lower [p=0.045] and more consistent than those in group II which showed a higher wider range and higher. Normothermic fibrillation and hypothermic crystalloid cardioplegia provide equal protection of the myocardium during open heart surgery and provide an optimum condition for the surgical field

Estrogen receptors in adult Egyptians with gynecomastia with or without schistosomiasis

Idiopathic gynecomastia occurs with persistence of low T/E1 and T/E2 ratios after puberty. Men with liver disease have gynecomastia, as a consequence of impaired hepatic steroid metabolism. In Egyptian patients with schistosomal hepatic fibrosis, gynecomastia is not an uncommon condition. To study the estrogen receptors in breast tissue in gynecomastia associated with schistosomal hepatic fibro sis compared to idiopathic gynecomastia. The study included 10 males with gynecomastia associated with schistosomal hepatic fibrosis [group A] and 8 patients with idiopathic gynecomastia free of liver disease. Mammary tissue, obtained via surgical excision was submitted to histopathological examination. The mean values of the plasma testosterone in the groups A and B, were 8 +/- 2.6 ng/ml and 5.7 +/- 2 ng/ml respectively. The difference was statistically insignificant [p = 0.058]. The mean values of serum estradiol were 45 +/- 24 pg/ml for group A and 24 +/- 9 pg/ml for group B. In group A there was characteristic lymphocytic and histocytic infiltration, with less fibrous reaction in the stromal tissue than it was in group B. ER status showed positivity in 67% of cases including 5/10 [50%] in group A and 7/8 [88%] in group B. It appeared in the form of reddish nuclear staining in 10 patients and cytoplasmic in two patients who were both in group B. The ER positivity was found to be significantly lower in patients of group A than it is in those of group B

Stimulation of hepatocyte regeneration by cyclosporine A [CyA]: an experimental, histopathologic and image analysis study

The effect of cyclosporine [CyA] upon liver regeneration was studied in rats after partial hepatectomy. In group I [controls], a standard two- thirds hepatectomy was performed. In group 2, CyA, at a dose of 10mg/kg body weight was given orally one day prior to, on the day of the operation and at 24 hours after the partial hepatectomy. Histologic findings and mitotic activities of remnant livers, as well as serum levels of ALT, AST, albumin and total bilirubin were examined from the day of the operation [day 0] to 10 days after hepatectomy. Treatment with CyA resulted in an increase of the mitotic activities of hepatocytes at days 2, 3 and 5 pstoperatively. This phenomenon coincided well with other histologic findings and biochemical pqarameters. Data obtained from image analysis studies demonstrated that CyA induced hepatocytes in the GO phase to enter the cell cycle and produce a reversible block at the G2 phase of the cycle. Based on these data, it may be concluded that CyA stimulates liver cell proliferation, reduces enzyme loss [ALT and AST] and improves albumin synthesis in rats after partial hepatectomy. Such actions would have important clinical implications in cases of hepatitis, hepatic resection and liver transplantation