Comparison between the effects of bretschneiders htk solution and cold blood cardioplegia on systemic endothelial functions in patients who undergo coronary artery bypass surgery: a prospective randomized and controlled trial

Abstract Objective: To investigate the effects of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. Methods: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider's HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. Results: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). Conclusion: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider's HTK solution causes less severe endothelial injury than cold blood cardioplegia.

Gradual treatment of arteriovenous fistula in femoral vessels as a complication of coronary angiography

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Weight reduction for a better visual outcome in idiopathic intracranial hypertension / Redução de peso para a melhora do resultado visual na hipertensão intracraniana idiopática

ABSTRACT Purpose: To evaluate the correlation between weight reduction and visual outcome in overweight patients with idiopathic intracranial hypertension. Methods: Thirty-nine newly diagnosed, overweight (body mass index >25 kg/m2) patients with idiopathic intracranial hypertension were studied retrospectively. All patients underwent medical treatment with acetazolamide, and a weight reduction program was also offered. Patients were grouped according to their compliance with this weight reduction program into the diet-success (Group 1) and diet-failure groups (Group 2). Body mass index, papilledema, visual acuity, and perimetric mean deviation were compared at the end of the 6-month study period. Results: Groups 1 and 2 did not differ regarding the baseline mean body mass index (32.63 ± 5.61, 32.35 ± 5.06 kg/m2), visual acuity (0.080 ± 0.13, 0.130 ± 0.24 logMAR), perimetric mean deviation (-9.978 ± 0.68, -12.86 ± 8.91), or papilledema grade (2.94 ± 0.22, 2.90 ± 0.30), respectively (p>0.05). During the 6 months' follow-up, Group 1 patients, who complied with both medical and diet therapy, improved significantly in all parameters, including body mass index (p<0.001), visual acuity (p=0.001), perimetric mean deviation (p=0.016), and papilledema grade (p<0.001). Conversely, Group 2 patients, who only underwent medical therapy, improved only in papilledema grade (p<0.001). However, coincident development of optic disc pallor was observed in three patients. Further, they also had significant loss in visual acuity (p=0.047) during the study period. Conclusion: Weight reduction combined with medical treatment is associated with significantly better improvement in visual acuity, visual field, and papilledema in idiopathic intracranial hypertension patients. Compliance with an efficient diet program should be encouraged in overweight patients with idiopathic intracranial hypertension.

RESUMO Objetivo: Avaliar a correlação entre a redução de peso e o resultado visual em pacientes com hipertensão intracraniana idiopática e sobrepeso. Métodos: Trinta e nove pacientes, recém-diagnosticados com hipertensão intracraniana idiopática e sobrepeso (índice de massa corporal >25 kg/m2), foram estudados retrospectivamente. Todos os pacientes foram submetidos a tratamento médico com acetazolamida e receberam um programa para redução de peso. Os pacientes foram classificados de acordo com o cumprimento do programa de redução de peso em: sucesso da dieta (Grupo 1) e falha da dieta (Grupo 2). Os índices de massa corporal, a papiledema, a acuidade visual e desvios médios perimétricos foram comparados no final de 6 meses. Resultados: Os grupos não apresentaram diferenças em relação às médias da linha de base de índice de massa corporal (32,63 ± 5,61/32,35 ± 5,06 kg/m2), acuidade visual (0,080 ± 0,13/0,130 ± 0,24 logMAR), desvios médios perimétricos (-9,978 ± 0,68/-12,86 ± 8,91) e níveis de papiledema (2,94 ± 0,22/2,90 ± 0,30) (p>0,05). Durante o período de acompanhamento de 6 meses, os pacientes do grupo 1, que obedeceram as terapias médicas e dietéticas, melhoraram significativamente em todos os parâmetros, incluindo o índice de massa corporal (p<0,001), a acuidade visual (p=0,001), o desvio médio perimétrico (p=0,016) e o nível de papiledema (p<0,001). Por outro lado, os pacientes do grupo 2, que receberam apenas terapia médica, apresentaram melhoras somente no nível de papiledema (p<0,001). No entanto, observou-se o desenvolvimento coincidente de palidez de disco óptico em três pacientes. Além disso, esses pacientes também apresentaram perda significativa de acuidade visual (p=0,047) durante o período de estudo. Conclusão: A redução de peso combinada ao tratamento médico está associada à melhora significativa das acuidades visuais, dos campos visuais e de papiledema em pacientes com hipertensão intracraniana idiopática. O cumprimento de programas de dietas eficientes deve ser encorajado em pacientes obesos com hipertensão intracraniana idiopática.