Effect of Intracoronary Shunt on Right Ventricular Function During Off-pump Grafting of Dominant Right Coronary Artery with Poor Collateral

Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.

A Case of Anaphylaxis to Chlorhexidine during Digital Rectal Examination

Chlorhexidine is widely used as an antiseptic and disinfectant in medical and nonmedical environments. Although the sensitization rate seems to be low, its ubiquitous use raises the possibility of sensitization in many patients and medical care workers. We describe a patient with anaphylaxis during digital rectal examination with chlorhexidine jelly. Urticaria, angioedema, dyspnea, and hypotension developed within a few minutes of the rectal examination. The patient fully recovered after treatment with epinephrine and corticosteroids. Skin tests for chlorhexidine were undertaken 5 weeks later, showing positive prick and intradermal skin tests. Within 30 min of the skin test, the patient complained of febrile sensation, chest tightness, angioedema, and urticaria on the face and trunk. An enzyme allergosorbent test for latex was negative. We present this case to alert clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. We suggest that chlorhexidine should be recognized as a causative agent of anaphylaxis during procedural interventions.

Successful management of stuttering priapism using home self-injections of the alpha-agonist metaraminol

Low-flow priapism can result in impotence if treatment is delayed, yet patients with recurrent priapism often suffer delay before therapy. We describe management of recurrent priapism using self-administered injections of intracavernosal metaraminol (AramineÖ, Merck), a long-acting vasoconstricting amine that is considered safer than epinephrine. The patient injects as often as once daily using 5-10 mg of drug. Our patient reports rapid detumescence and has not required emergency room visits since starting injections. He denies complications. Treatment of priapism using metaraminol has been suggested in the hospital setting; however, this is the first report of successful home self-administration of the drug.

Central noradrenergic & dopaminergic modulation of brewer's yeast-induced inflammation & nociception in rats.

The possibility of central noradrenergic and dopaminergic modulation of Brewer's yeast-induced peripheral inflammation was investigated in rats. Centrally administered noradrenaline (NA), amphetamine, which liberates NA and dopamine in the central nervous system and L-dopa, the precursor of dopamine significantly suppressed paw oedema. Conversely, the beta-adrenoceptor blocker, propranolol, catecholaminergic neuron degenerator, 6-hydroxydopamine (6-OHDA), dopaminergic antagonist, haloperidol and dopamine synthesis inhibitor, alpha-methyl para tyrosine (AMPT) augmented paw oedema. In addition, 6-OHDA and haloperidol produced significant reduction in pain threshold. The results of this study indicate that central NA and dopamine exert inhibitory effects on Brewer's yeast-induced peripheral inflammation.

Effect of salbutamol on oxygen saturation in COPD.

The effect of nebulized salbutamol on oxygen saturation in COPD was evaluated in this study. Twenty patients aged 56-75 years with stable COPD were recruited to the study. All patients received 5 mg of salbutamol nebulizer driven by oxygen at 8 L/min. The SaO2 was then measured continuously and readings were taken before and every minute after salbutamol inhalation by face mask. Following treatment, mean SaO2 was significantly lower than preinhalation values. The desaturation occurred from 3 minutes and reached the maximum desaturation at 15 minutes postinhalation. At 30 minutes, SaO2 had returned to baseline values. The findings suggest that salbutamol nebulization induced prolonged desaturation in COPD.

Estudio retrospectivo multicentrico del asma bronquial en la infancia / Multicentric retrospective study of bronquial asthma in infants

Trabajo Retropectivos multicentrico. Fueron estudiados un total de 2.544 pacientes atendidos en los 4 hospitales mas grandes de Santa cruz de la Sierra en 1992. Encontrandose 1.267 pacientes en consulta externa y 1.140 en emergencia. La proporcion de consultas por asma Bronquial en estos Hospitales fue de 2.34 por ciento con un indice de internacion de 5.77 por ciento (147 pacientes internados). Se encontro una leve predominancia del sexo masculino 58.8por ciento sobre el femenino (41.2 por ciento). El grupo etereo mas acometido fueron los mayores de 5 anos. En mas de 60 por ciento de los pacientes internados los principales sintomas fueron Disnea. Sibilancia, Tos y Tiraje. La droga mas utilizada fue la Aminofilina en 93.2 por ciento, seguida de los B2 adrenergicos en 76.9 y los corticoides en 59.2. La mortlidad fue del 1.2 por ciento. La gran mayoria de los pacientes recibio alta con un tiempo medio de internacion de 2,86 dias. Conclusiones que el Asma Bronquial prevalente en Santa Cruz de la Sierra con indice de Internacion y de mortalidad bajos indicando que la mayoria de los ninos responden adecuadamente al tratamiento de la crisis asmatica.