Plasma lipid peroxidation and antioxidiant nutrients in type 2 diabetic patients.

BACKGROUND AND OBJECTIVE: Observation shows diabetic patients to be more prone to oxidative stress because of hyperglycemia. The elevation of free radical production by this hyperglycemic production may exacerbate cardiovascular complication in diabetes. This study aims to investigate the oxidative stress related parameters in type 2 DM. Since the effects of glycemic control and cardiovascular complications in DM on these parameters has been not fully determined, the comparison between plasma MDA (malondialdehyde) and antioxidant nutrients with their age-matched normal healthy group may be used to determine the susceptibility of oxidative stress in this type of DM. MATERIAL AND METHOD: MDA and antioxidant nutrients (vitamin A, C, E and beta-carotene) were analyzed in plasma of 19 subjects with poorly controlled type 2 DM (fasting plasma glucose [FPG] > 180 mg/dl), 26 subjects with fairly controlled type 2 DM (FPG < or = 180 mg/dl), and 20 subjects with type 2 DM complicated coronary heart disease (CHD) who were matched for age and gender. Twenty healthy subjects with normal plasma glucose level (FPG < 110 mg/dl) and matched for age and gender served as a control group. In all groups of DM these oxidative stress parameters were compared to a normal group. RESULTS: The plasma MDA levels were significantly higher in all types of DM compared to age-matched normal control. Plasma antioxidant vitamin C and E significantly lower only in poorly controlled and CHD complicated type 2 DM, respectively. The mean of plasma vitamin E level was lowest in type 2 DM complicated with CHD. No significant differences in both plasma vitamin A and beta-carotene were noted between any types of DM and age-matched normal healthy group. The positive correlation between MDA and FPG was demonstrated in most group of patients with their normal subjects except in fairly controlled type 2 DM and negative correlation between vitamin E and FPG was also demonstrated in type 2 DM with CHD. CONCLUSION: These findings suggested that diabetic patients were susceptible to oxidative stress and higher plasma glucose level had an association with free radical-mediated lipid peroxidation. The lowest level of vitamin E in type 2 DM complicated with CHD indicated that oxidative stress played an important role in cardiovascular complication and vitamin E supplementation may be necessary for treatment and prevention in this group of diabetics.

Sudden cardiac death in athlete : A case report and review of literature.

A 21 year old man was successfully resuscitated from sudden cardiac arrest during sports training. Cardiac investigations revealed that he had pre-excitation syndrome. He was scheduled to cardiac electro physiologic study and radiofrequency ablation. The bypass tract was located at left posteroseptal site, the procedure was successful. The detailed history and investigations are reported, as well as review of the literatures.

Glutathione and glutathione peroxidase in type 2 diabetic patients.

Objectives: Hyperglycemia is claimed to cause oxidative stress in diabetic (DM) patients. The influence of free radical production by hyperglycemia may exacerbate the cardiovascular complications in diabetes. However, the effects of glycemic control and cardiovascular complications is diabetes on oxidative stress parameters have been not fully studied. This study compared the red cell glutathione (GSH) level and glutathione peroxidase (GPx) activity in fairly controlled typed 2DM(Fasting plasma glucose {EPG}-<180 mg/dl) poorly-controlled type 2 DM (FPG>180 mg/dl), and type 2 DM complicated with coronary heart disease (CHD) with that in a normal healthy group (FPG <110 mg/dl). Materials & Methods : GSH level and GPx activity were determined in the red cells of 19 subjects with poorly controlled type 2 DM, 26 subjects with fairly controlled type 2 DM, and 20 subjects with type 2 DM complicated CHD with that of 20 healthy subjects with normal plasma glucose level matched for age and gender who served as a control group. In all groups of DM these oxidative stress parameters were compared to a control group by one-way ANOVA test. The association between these parameters and FPG was to a control group by one-way ANOVA test. The association between these parameters and FPG was determined using the Pearson product moment correlation. Results : The red cell GSH levels were significantly lower in all types of diabetes compared with those of age-matched normal control subjects (p<0.05).Red cell GPx activity was significantly increased only in the poorly controlled type 2 DM and type 2DM with CHD (<0.05). The decrement of red cell GSH may be due to the higher consumption of GSH for the increasing of GPx activity or there is a reduction or the pentose phosphate pathway that stimulated by insulin resulting in lowered GSH recycling. The association between FPG and GSH or GPx activity in all subgroups of type 2 diabetic patients compared with normal healthy subjects showed no correlation. Conclusion : These findings suggested that type 2 DM patients were susceptible to oxidative stress and higher blood glucose level in poorly controlled type 2DM and type 2 DM complicated with CHD had an association with free radical-mediated lipid peroxidation. Therefore, any means that can reduce oxidative stress may be beneficial for the prevention or slowing of progression of cardiovascular complication in these types of diabetic patients.

A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation.

The limited efficacy and proarrhythmic risks of antiarrhythmia agents have resulted in alternative therapeutic approaches. Radiofrequency ablation has been reported to be an effective treatment of patients with atrial fibrillation. However, there is no randomized clinical trial comparing drug and radiofrequency ablation. The authors randomized 30 patients with chronic atrial fibrillation refractory to medication into amiodarone and radiofrequency ablation. The primary objective of this study was to compare the efficacy of amiodarone and radiofrequency ablation in the maintenance of sinus rhythm at 1 year after randomization. Pulmonary vein isolation and linear ablation of right atrium was the technique used for radiofrequency ablation. There were no significant differences in baseline patient characteristics between the 2 groups. The results of this study showed that the probability of free from atrial fibrillation was better in the radiofrequency ablation group compared to amiodarone (78.6% in the ablation group and 40% in the amiodarone group, p = 0.018). Radiofrequency ablation results in a significant reduction in symptoms relating to atrial fibrillation and a significant improvement in quality of life, whereas amiodarone had no significant effect on symptoms and quality of life. There was an ischemic stroke as a major complication related to radiofrequency ablation. Amiodarone was associated with adverse effects in 46.7 per cent of patients and needed discontinuation in 1 patient. In conclusion, radiofrequency ablation is an effective alternative treatment in patients with atrial fibrillation refractory to medication.

Successful implantation of transveneous biventricular permanent pacemaker for refractory congestive heart failure: the first case-report in Thailand.

Biventricular pacemaker is a pacemaker that can pace both the right and left ventricle at the same time. There have been progression in the development of biventricular pacemaker from thoracotomy system to fully transveneous system. The benefit in improving quality of life in selected medical refractory congestive heart failure patients of this device had been shown in randomized controlled trials. The authors reported successful implantation fully transveneous biventricular pacemaker in Thailand.

Radiofrequency catheter ablation of ventricular tachycardia from right ventricular outflow tract.

From January 1996 to May 2002, 61 patients with ventricular tachycardia from right ventricular outflow tract were referred to Siriraj hospital. All patients underwent clinical examination, Doppler echocardiography and electrophysiologic study. Mapping of ventricular tachycardia was performed by activation mapping and pacemapping. There were 44 females and 17 males with an average age of 41.7 +/- 9.9 years. Presenting symptoms were palpitation (95.1%), presyncope (39.3%), and syncope (26.2%). Six patients were found to have underlying cardiac disease. Radiofrequency catheter ablation was successful in 56 patients (91.8%). There were no major complications. Seven patients (12.5%) had recurrent ventricular tachycardia. Five of them were successfully reablated. The authors concluded that radiofrequency ablation is an effective treatment in patients with ventricular tachycardia from right ventricular outflow tract.

Radiofrequency ablation for atrial fibrillation.

There have been a lot of progression in the treatment of atrial fibrillation during the last 10 years. Atrial fibrillation treatment is not only focus on prevention of thromboembolic comlications of this tachyarrhythmia but also on heart rate control which can be obtained in many ways. Recently, more information of atrial fibrillation mechanism led to new treatment modalities including surgery and the use of radiofrequency ablation. However, most of these new treatment forms are still investigational, evolving and reserved to atrial fibrillation patients who are refractory to standard treatment.

Radiofrequency catheter ablation for various tachyarrhythmias: experience in the Bangkok Heart Institute.

Radiofrequency catheter ablation (RFCA) is the first-line therapy for various tachyarrhythmias. The authors reports experience of RFCA for various types of tachyarrhythmia in 80 consecutive patients, 85 tracts of ablation, from May 2001 to October 2002. The mean age was 40 years, range 6-81 years. Seventy four and 13 tracts of ablation were supraventricular and ventricular arrhythmia, respectively. The results are shown below. [table: see text] Conclusion: RFCA is an effective method to cure various types tachyarrhythmia. Long-term follow-up should be evaluated in patients with paroxysmal atrial fibrillation.

A multidisciplinary approach to atrial fibrillation.

We report a case with mitral regurgitation and atrial fibrillation and discuss the management of atrial fibrillation. The successful result of combining of mitral valve repair and simple pulmonary vein isolation in a single procedure is presented.