Anesthetic management of patients with dilated cardiomyopathy for noncardiac surgery.

Anesthetic management of patients with dilated cardiomyopathy (DCM) is a challenge to the anesthesiologist, due to poor left systolic function, ventricular enlargement, risk of malignant arrhythmias and sudden cardiac death. Therefore, preoperative assessment and appropriate anesthetic management are important in patients with DCM. This review describes the preoperative evaluation and anesthesia considerations of patients with DCM undergoing non-cardiac surgery. Patient pathophysiology and clinical status, such as ventricular function, degree of myocardial fibrosis, resting heart rate and high-sensitivity C-reactive protein can affect survival rates. Advanced monitoring devices, such as transesophageal echocardiography and cardiac resynchronization therapy can be used to assess ventricular function and myocardial fibrosis. Thoracic epidural blockade can improve ventricular function. In summary, the optimal anesthetic management of patients with dilated cardiomyopathy requires good preoperative assessment, close perioperative monitoring, suitable anesthetic, optimization fluid management, and stable hemodynamic status.

Intra- and extracranial atherosclerotic stenosis in China: epidemiology, diagnosis, treatment and risk factors.

OBJECTIVE: Data regarding the cerebral atherosclerotic stenosis (CAS) and incidence of stroke are conflicting. The number of stroke patients is more than three times that from coronary heart disease in China. The main aim of this report is to review the current status of intracranial and extracranial atherosclerotic stenosis including epidemiology, diagnosis, treatment and risk factors in China. METHODS: Data was identified by searches of MEDLINE (January 1966 to December 2008), China Biological Medicine Database (CBM-disc 1979 to 2008), China National Knowledge Infrastructure (CNKI 1994 to December 2008). RESULTS: The occurrence of intracranial artery stenosis was more frequent than that of extracranial artery in the Chinese population. TCD, Doppler ultrasound, CTA, MRA and DSA techniques are established to examine intracranial and extracranial atherosclerotic stenosis in China. Evidence-based treatments and CAS are more commonly applied in patients with cerebrovascular stenosis in China. However, the development of carotid endoarterectomy (CEA) is limited in Chinese communities. The risks of cerebral atherosclerotic stenosis include age, hypertension, diabetes mellitus, dyslipidemia, smoking and metabolic syndrome. CONCLUSIONS: Further studies are needed to focus on the intracranial atherosclerotic stenosis.

Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.

BACKGROUND: Although surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications. Botulinum toxin injection and lateral internal sphincterotomy are technical options for patients suffering from chronic anal fissure. However, little is known about the efficacy of these two techniques. The aim of this meta-analysis was to compare the outcomes of botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure. METHODS: Original studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials that compared botulinum toxin injection with lateral internal sphincterotomy were identified. Data were independently extracted for each study, and a meta-analysis was performed using fixed and random effects models. RESULTS: Four hundred and eighty-nine patients from seven trials met the inclusion criteria. Patients undergoing lateral internal sphincterotomy had a higher-healing and incontinence rate. No statistically significant differences were noted in total complications between botulinum toxin injection and lateral internal sphincterotomy. Patients treated with lateral internal sphincterotomy had a significantly lower recurrence rate than the patients treated with botulinum toxin injection. CONCLUSIONS: Our meta-analysis shows that lateral internal sphincterotomy was superior to botulinum toxin injection in terms of healing rate and lower recurrence rate. Botox, however, is safe associated with a lower rate of incontinence and could be used in certain situations. Further studies with a long-term follow-up are required to confirm our observations.

Administration of probiotics reduces bacterial translocation after intestinal transplantation in rats.

Bacterial translocation (BT) has been suggested to be responsible for the high incidence of infections after intestinal transplantation (IT). The purpose of this study was to examine whether a probiotic supplement after orthotopic IT ameliorated ischemia-reperfusion injury and reduced BT at 4 or 6 days postoperative (sham or IT), as mesenteric lymph nodes (MLNs), liver, and splenic tissue samples from the six groups were assessed for BT by bacterial culture, measurement of tumor necrosis factor-α (TNF-α) in MLNs by competitive reverse transcription-polymerase chain reaction, and histological evaluation by Park's classification. Oral administration of probiotics after IT did not improve short-term survival rates compared with the transplant-only groups (P > .05). However, the BT rates and levels of TNF-α in MLNs in groups with IT only were higher than the probiotic cohorts (P < .05). Histological injuries were significantly ameliorated in the group with six days of probiotic treatment compared with that in the nontreated hosts (P < .05). These data indicated that administration of probiotics after IT improved graft histology and reduced BT in rats.