Role of emergency coronary artery bypass grafting in the era of percutaneous interventions

Background: In acute coronary syndrome, prompt restoration of myocardial blood flow is essential to optimize myocardial salvage and decrease mortality. Coronary artery reperfusion, if performed in a timely manner improves clinical outcomes compared to no reperfusion. Fibrinolysis and percutaneous interventions can restore blood flow in an acutely occluded coronary artery in most of the patients; but in a few subset of patients coronary artery bypass grafting (CABG) is needed to effectively restore blood flow.Methods: A retrospective study was conducted among all CABGs performed during March 2016 - February 2018. During this period, 366 CABGs were performed and 57 patients underwent emergency CABG as per the inclusion criterias. Pre-operative, intra-operative and post-operative data was analysed of these patients. Patients were divided into four groups based on the time of surgery from the time of onset of myocardial infarction.  Results: 57 patients underwent emergency CABG with males constituting 94.7% of the study population. 78.9% of them had an ejection fraction less than 35%. 52% presented with low cardiac output status, 10% needed intra-aortic balloon pump support and 15% required mechanical ventilation prior to surgery. All patients received an average of 2.8 grafts. Mortality was 5%Conclusions: Immediate surgical revascularisation of patients presenting with acute MI is feasible. Emergency CABG not only treats the culprit lesion but also achieves complete revascularization and offers a clear advantage for patients. The optimal timing of CABG for patients with acute MI remains difficult to establish.

Solubility enhancement of oral hypoglycemic agent by solid dispersion technique.

The present study was aimed to increase the solubility of the poorly water soluble drug (Gliclazide) by using hydrophilic polymers (PVP K-30 and HPMC E4). Solid dispersions were prepared by kneading method. Phase solubility study, in-vitro dissolution of pure drug, physical mixtures and solid dispersions were carried out. PVP and HPMC were found to be effective in increasing the dissolution of Gliclazide in solid dispersions when compared to pure drug. FT-IR spectroscopy, differential scanning calorimetry and X-ray diffractometry studies were carried out in order to characterize the drug and solid dispersion.

A Novel Technique for Retrieval of a Drug-Eluting Stent After Catheter Break and Stent Loss

Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.

Incorporation and biodegradation of hydroxyapatite-tricalcium phosphate implanted in large metaphyseal defects--an animal study.

Incorporation and biodegradation of hydroxyapatite(HA)-tricalcium phosphate(TCP) granules implanted in 5 x 5 x 5 mm distal femoral metaphyseal defects created in 18 adult rabbits were studied. In two rabbits, the defects were left to heal spontaneously without any implant. Roentgenographic and histological study by light microscopy was done on silver nitrate stained undecalcified sections as well as haematoxylin-eosin stained decalcified sections. The synthetic HA-TCP was biocompatible and produced no adverse reactions. The implant was osteoconductive and allowed good new bone formation to occur, mainly from periphery to center, but mature trabeculae could be delineated only at 4-6 months. The HA-TCP biomaterial had very low biodegradability with marked amount of intact implant still present at final follow up. Bonding between implant and bone, though a close biological bond, was not uniformly strong. Rate of bone ingrowth was very slow and large areas of implant at center did not show new bone formation at 12 months.

Devicyprin induced gonadal impairment in a freshwater food fish, Channa punctatus (Bloch).

Synthetic pyrethroids are the recent major class of broad spectrum, photostable, organic insecticides used in agricultural, domestic and veterinary applications and now account for more than 30% of global insecticide use. Cypermethrin is metabolized and eliminated significantly more slowly by fish than by mammals or birds, which may explain this compound's high toxicity in fish compared to other organisms. The present communication deals with histoanatomical alterations in the gonads of a local fresh water food fish, Channa punctatus exposed to 0.033 ppm (96 hr LC50 X 1/10) concentration of a synthetic pyrethroid, devicyprin (cypermethrin 25%) in aquatic medium of aged tap water for 15, 30 and 45 days respectively. In testis, exposure dependent histological damage has been observed in terms of vacuolization, condensation of spermatogonic cells, distortion of tubular epithelium, shrinkage of interstitial cells and general inflammatory responses. Longest exposure of 45 days has resulted in peculiar starry-sky appearance of the testicular tissue. Gross histo-anatomy of ovarian tissue reveals epithelial lesions, inflammatory responses, stromal hemorrhage, increased interstitium and shrinkage of yolk vesicles towards periphery These findings are quite suggestive of reproductive impairments leading to delayed gonadal maturity and adversely affecting processes of sperm production and ovulation and thus, the fish production.

Impact of Smoking and Smoking-Related Parameters on Acetylcholine-Induced Coronary Artery Spasm

BACKGROUND AND OBJECTIVES: Smoking has been known to be an independent risk factor of the coronary morbidity induced by coronary artery endothelial dysfunction, but its detailed impact, including the duration and amount of smoking on coronary artery spasm, has not been clarified yet. We investigated the incidence of acetylcholine (Ach)-induced coronary artery spasm according to smoking and the smoking-related parameters. SUBJECTS AND METHODS: The study consisted of 306 patients (163 males, age: 56.1+/-11.2 years), without significant coronary artery disease underwent Ach provocation testing by injecting incremental doses of 20, 50 and 100 ug Ach into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>75%) with/without chest pain or ST-T change of the EKG. The impact of conventional risk factors, including smoking and the smoking-related parameters, on coronary artery spasm was analyzed. RESULTS: The conventional risk factors of coronary atherosclerosis, including hypertension, DM and hyperlipidemia, were numerically higher in the provocation (+) group, but the differences were not statistically different between the two groups. Only smoking itself was significantly higher in the provocation (+) group whereas the smoking duration, amount and the duration of quitting smoking were not different between the two groups. CONCLUSION: Smoking is known to be an independent risk factor of coronary artery spasm, but smoking-related parameters such as the smoking duration, the amount and the duration of quitting smoking were not associated with coronary artery spasm.