Apoyo metabólico del corazón isquémico en cirugía cardíaca / Metabolic support of the ischemic heart during cardiac surgery

We examine [IBM1] the basic principles and clinical results of the metabolic intervention with glucose-insulin-potassium (GIK) solutions in the field of cardiovascular surgery. On the basis of many international publications concerning this subject, and the experience obtained in the operating room of the Instituto Nacional de Cardiologia [quot ]Ignacio Chávez[quot ], we conclude that the metabolic support wit GIK is a powerful system that provides very useful energy to protect the myocardium during cardiac and non-cardiac surgery. The most recent publications indicate their effects in reducing low output syndromes, due to interventions on the coronary arteries, as well as producing a significant reduction of circulating fatty acids. These effects are produced also in the field of interventional cardiology, where GIK solutions protect the myocardium against damage due to impaired microcirculation. It is evident that these solutions must be utilized in higher concentrations that the initial ones, equal to those employed in laboratory animals. On the other side, it is worthy to remember that it has been always underlined that this treatment represents only a protection for the myocardium. Therefore, its association with other drugs or treatments favoring a good myocardial performance is not contraindicated--on the contrary, it yields better results. The present review presents pharmacological approaches, such as the use of glutamato, aspartate, piruvato, trimetazidina ranolazine and taurine to optimize cardiac energy metabolism, for the management of ischemic heart disease.

The acrosomic reaction in stallion spermatozoa: inductive effect of the mare preovulatory follicular fluid

In the female genital tract, spermatozoa must undergo capacitation and acrosome reaction prior to fertilization. A number of factors may induce physiological acrosome reaction assayed in vitro. The aims of this study are to determine the inductive effect of the preovulatory follicular fluid on the sperm acrosomal status in the equine, once some characteristics of the follicular fluid during folliculogenesis had been evaluated. The spermatozoa were obtained from cauda epididymes of adult stallion. Follicular fluid was taken from mare ovarian follicles classified according to their diameter. In these fluids, total protein, progesterone, estradiol and osmolarity were determined. Afterwards, the effect of preovulatory follicular fluid (50) upon induction of the acrosomic reaction in stallion capacitated spermatozoa was assayed. Results show that during folliculogenesis the ratio progesterone/estrogen is below 1. In large preovulatory follicles, there is a sharp increase of progesterone, reaching a ratio progesterone/estrogen close to 4. Protein concentration and osmolarity increase together with follicular development, being osmolarity very high at the preovulatory stage. Follicular fluid--in vitro--increases the percentage of spermatozoa with acrosome reaction, maintaining high rates of vitality and motility. The characteristics of follicular fluid undergo dynamic changes during the folliculogenesis, such as steroid level, protein concentration and osmolarity. These events may play a role in the reproductive process in vivo, considering that in vitro the follicular fluid is a very effective inductor of the acrosome reaction, with optimum levels of vitality and motility.