Single Stage Repair of Aortic Coarctation and Coronary Artery Bypass Grafting in a 55-Year- Old-Man Presenting with Pulmonary Edema.

Coarctation of the aorta, virtually always a congenital malformation, is characterized by localized aortic narrowing, usually in the arch opposite to the ductus arteriosus and just distal to the left subclavian artery. The condition occasionally goes undiagnosed until adulthood. We report a case of a 55-year-old man who presented with uncontrolled hypertension, pulmonary edema, and non-ST-segment elevation myocardial infarction due to multi-vessel coronary artery disease. He underwent successful simultaneous coronary artery bypass grafting and coarctation repair using an ascending-to-descending aortic bypass graft.

Recovery from sedation with remifentanil and propofol, compared with morphine and midazolam, for reduction in anterior shoulder dislocation.

OBJECTIVE: To compare recovery from sedation using remifentanil and propofol with our standard regimen of morphine and midazolam for closed reduction in shoulder dislocation in an ED. METHODS: We randomised 40 patients for closed shoulder reduction to receive either remifentanil and propofol (R&P) (20 patients) or morphine and midazolam (M&M) (20 patients). A suitably trained ED doctor gave the sedation. R&P patients received oxygen from a tight-fitting facemask and Mapleson C circuit to prevent hypocapnia and thus reduce the risk of apnoea. Shoulder reduction was performed by another doctor with an ED nurse also present. We noted recovery times, pain and sedation scores, operative conditions, additional medication and adverse events. RESULTS: All patients given remifentanil and propofol had recovered within 30 min in contrast to the morphine and midazolam group where 17 of 20 patients had recovered after 60 min, the remainder requiring a total of 90 min. Median recovery times were 15 min (95% CI 15 to 20) for the remifentanil and propofol group, and 45 min (95% CI 29 to 48) for the morphine and midazolam group. Reduction conditions and scores for pain/distress did not differ between the groups. Seven patients required additional sedation (four R&P, three M&M) to enable shoulder reduction. Five patients (three R&P, two M&M) had received analgesia prior to the procedure from the ambulance service (one R&P, one M&M) and ED (two R&P). Two patients given morphine and midazolam required flumazenil to counter oversedation. CONCLUSIONS: Remifentanil and propofol reduces patient recovery time and provides equivalent operating conditions compared with morphine and midazolam for the reduction of anterior glenohumeral dislocation.

Omega-3 polyunsaturated fatty acids inhibit the accumulation of PAS-positive material in the myocardium of STZ-diabetic wistar rats.

This study was conducted to investigate the effect of Omega-3 PUFA on streptozotocin (STZ)-induced diabetic cardiomyopathy in wistar rats. After 4 weeks of STZ (60 mg/kg, i.v.) administration, the diabetic animals were randomly divided into two groups: Diabetic control and Omega-3 PUFA treated diabetic rats. Omega-3 PUFA (0.5 ml/kg) was administered to the latter group for 10 weeks. Age matched normal rats served as Normal controls. During the study, plasma glucose, glycosylated hemoglobin, plasma cholesterol, LDL and HDL cholesterol, triglyerides were evaluated in all the groups. Omega-3 PUFA treatment did not normalise but instead blunted the effect of diabetes with regards to the above parameters significantly (P<0.01). At the end of the experiment, morphometric and histochemical studies were performed on heart and myocardial enzyme markers were studied. In the diabetic control group, diabetic cardiomyopathy was characerised by elevated CPK (DC 110+/-8.85 vs. NC 39+/-5.83) and morphological changes in heart. Gravimetric ratios showed increased heart-to-body weight ratio in diabetic control over normal control group. (DC 3.38+/-0.05 vs. NC 2.48+/-0.03). Histochemical evidence showed increased accumulation of PAS-positive material in myocardial interstitium (++++). The Omega-3 PUFA treatment blunted all these adverse effects of diabetes on heart significantly (P<0.001). However, further studies are warranted to elucidate the mechanism by which Omega-3 PUFA decreases the accumulation of PAS-positive material in diabetic myocardium.