Problems of cold agglutinins in cardiac surgery: how to manage cardiopulmonary bypass and myocardial protection

Cold agglutinins are of unique relevance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass [CPB]. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins [usually IgM or IgA antibodies] that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease. Immunoglobulin M autoantibodies to red blood cells, which activate at varying levels of hypothermia, can cause catastrophic hemagglutination, microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB and myocardial protection requires individualized planning. We describe a case of MV repair and CABG in a patient with high titer cold agglutinins and high thermal amplitude for antibody activation. Normothermic CPB and continuous warm blood cardioplegia were successfully used

[Effects of resistance and endurance exercises on androgens, cortisol and lactate in elderly women]

The basal levels of androgens in women decline gradually with age. These changes may reduce muscle strength and bone density leading to fatigue and psychological problems. Thus, the aim of this study was to compare the effects of resistance and endurance exercises on androgens, cortisol and lactate concentrations in elderly women. In this study, 10 elderly women with a mean age of 54.3 +/- 3.74 years and a BMI of 24.88 +/- 2.07 kg/m[2] completed an endurance exercise session [ES], a resistance exercise session [RS], and a control session [CS] in a randomized, cross-balanced design. The RS consisted of three sets of 10 repetitions of eight exercises with 80% 1RM [one repetition maximum] over of 45 minutes and the ES consisted of cycling at 60%-70% of maximum oxygen consumption for 45 minutes. During the CS, subjects performed no exercise. Before and immediately after exercises, and after 15 minutes of recovery, and also during CS blood samples were obtained an analyzed for serum testosterone, dehydroepiandrosterone sulfate, cortisol and lactate. There was a significant increase in testosterone levels following resistance and endurance exercise sessions [P<0.05]. Dehydroepiandrosterone sulfate demonstrated a significant increase after resistance exercise [P<0.05]. While differences in cortisol levels were not significant within groups, but they were significant [P<0.05] between groups. A session of resistance exercise in elderly women can increase concentrations of androgens that are essential for their health and well-being

Immunohistochemical detection of p53 protein expression as a prognostic factor in wilms tumor

Histological typing, especially the evidence of anaplasia and stage of the tumor are two major prognostic indicators in Wilms tumor, but some genetic factors have recently been noted. Mutations in TP53, which is a tumor suppressor gene, have been demonstrated to be associated with poor prognosis in some malignancies. There are also few studies which have confirmed the correlation between p53 protein overexpression and advanced course in Wilms tumor. This study was conducted to determine the correlation p53 immunoexpression and prognosis and outcome of Wilms tumor. The overexpression of p53 in 44 specimens of children [26 boys and 18 girls] with Wilms tumor [median age, 36 months; range, 4 to 96 months] was assessed in Mofid Children's Hospital, Tehran, Iran. The overexpression of p53 was determined by immunohistochemistry with antihuman p53 antibody. A positive immunostaining for p53 was detected in 24 of the 44 cases [54.7%]. The grade of the tumor and anaplasia were associated with p53 positivity, but there was no association of p53 with the tumor stage. In comparison to p53 negatives, week-moderate and high p53-expressing tumors had significantly decreased the overall survival [hazard ratio, 3.75 and 8.61; P=.05 and P=.01, respectively]. Overexpression of p53 protein in Wilms tumor is an indicator of poor pro gnosis, because it is correlated with unfavorable histology tumors and a shorter survival period