Clinical outcomes with off-pump coronary surgery after angioplasty with stent.

INTRODUCTION AND OBJECTIVES: The aim was to determine whether prior coronary stent implantation affects postoperative outcomes in patients undergoing coronary artery bypass grafting. METHODS: Between January 2005 and April 2008, a retrospective analysis was carried out to evaluate the effect of prior coronary stent implantation in patients undergoing off-pump coronary surgery on the incidence of major cardiovascular events in the postoperative period (i.e. at 30 days or during postoperative hospitalization). RESULTS: In total, 796 consecutive patients underwent coronary artery bypass grafting. Of these, 116 (14.6%) had a coronary stent at the time of surgery. Patients with and without stents had similar levels of risk (i.e. EuroSCORE). Multivariate analysis, adjusted for the presence of confounding variables (i.e. preoperative left ventricular ejection fraction <40%, critical preoperative state, age, history of cerebrovascular accident, recent acute myocardial infarction, number of diseased coronary vessels, incomplete revascularization and on-pump conversion), showed that the presence of a stent was significantly associated with increased risks of postoperative myocardial infarction (relative risk [RR]=3.13; 95% confidence interval [CI], 1.75-5.96), in-hospital cardiac mortality (RR=4.62; 95% CI, 1.76-12.11) and in-hospital all-cause mortality (RR=3.65; 95% CI, 1.60-8.34). CONCLUSIONS: In our experience, coronary artery stent implantation prior to coronary surgery was associated with increased risks of postoperative myocardial infarction, cardiac mortality and all-cause mortality in the postoperative period.

Resultados de la cirugía coronaria sin circulación extracopórea tras angioplastia con stent / Clinical outcomes with off-pump coronary surgery after angioplasty with stent

Introducción y objetivos. Evaluar el impacto de la implantación de stents coronarios previa a la cirugía de revascularización miocárdica en los resultados postoperatorios de ésta. Métodos. Desde enero de 2005 hasta abril de 2008, se evaluó retrospectivamente el impacto de la implantación de stents coronarios previa a la cirugía coronaria sin circulación extracorpórea en la incidencia de eventos cardiovasculares mayores en el postoperatorio (30 días o ingreso hospitalario postoperatorios). Resultados. Se sometió a 796 pacientes consecutivos a revascularización miocárdica quirúrgica; 116 (14,6%) portaban algún stent coronario en el momento de la cirugía. Los grupos con stent y sin stent tenían un perfil de riesgo similar (EuroSCORE). En el análisis multivariable, ajustando el riesgo por las variables de confusión detectadas (fracción de eyección del ventrículo izquierdo preoperatoria < 40%, estado crítico preoperatorio, edad, antecedentes de accidente cerebrovascular agudo, infarto miocárdico agudo previo reciente, número de vasos coronarios enfermos, revascularización quirúrgica incompleta y conversión a circulación extracorpórea) se detectó que el ser portador de stent se asociaba de forma significativa a un mayor riesgo de infarto miocárdico postoperatorio (RR = 3,13; intervalo de confianza [IC] del 95%, 1,75-5,96), mortalidad cardiaca hospitalaria (RR = 4,62; IC del 95%, 1,76-12,11) y mortalidad hospitalaria por todas las causas (RR = 3,65; IC del 95%, 1,6-8,34). Conclusiones. En nuestra experiencia, la implantación previa de stents coronarios se asocia a un mayor riesgo de infarto miocárdico y mortalidad cardiaca y por todas las causas en el postoperatorio de la cirugía coronaria (AU)

Introduction and Objectives. The aim was to determine whether prior coronary stent implantation affects postoperative outcomes in patients undergoing coronary artery bypass grafting. Methods. Between January 2005 and April 2008, a retrospective analysis was carried out to evaluate the effect of prior coronary stent implantation in patients undergoing off-pump coronary surgery on the incidence of major cardiovascular events in the postoperative period (ie, at 30 days or during postoperative hospitalization). Results. In total, 796 consecutive patients underwent coronary artery bypass grafting. Of these, 116 (14.6%) had a coronary stent at the time of surgery. Patients with and without stents had similar levels of risk (ie, EuroSCORE). Multivariate analysis, adjusted for the presence of confounding variables (ie, preoperative left ventricular ejection fraction <40 critical preoperative state age history of cerebrovascular accident recent acute myocardial infarction number diseased coronary vessels incomplete revascularization and on-pump conversion showed that the presence a stent was significantly associated with increased risks postoperative relative risk rr="3.65;" 95 confidence interval ci 1 75-5 96 in-hospital cardiac mortality 76-12 11 all-cause 60-8 34 conclusions in our experience artery implantation prior to surgery period inhospital (AU)

[Determination of the N-acetylcysteine and methionine effects in the cerebellum of rats intoxicated with lead]. / Determinación de los efectos de la N-acetilcisteína y metionina en cerebelo de ratas intoxicadas con plomo.

A therapeutic essay was done to determine the effects of N-Acetylcysteine (NAC), Methionine (MET) and the NAC + MET combination on the lead (Pb) blood levels, the malondialdehide (MDA) and catalase activity (CAT) in cerebellum of rats treated with 0.5 and 2 microg/g of Pb acetate. One hundred ninety eight male Wistar rats with an average weight of 240 g were subjected to a test, divided into five groups. Group 1 was the control group where basal levels were determined; Group 2 was the treated group; the rest of the groups once treated received the following: Group 3 NAC, Group 4 MET, Group 5 NAC + MET. The results showed that NAC lowers blood lead levels by 35% and 38% with intoxication doses of 0.5 microg/g and 2 microg/g of Pb acetate respectively. This decrease was not statistically significant; however, there was a 56% decrease of MDA in the cerebellum with a dose of 0.5 microg/g of Pb and of 75% with 2 microg/g; CAT activity increased in the cerebellum by 62% and 71% with the studied Pb doses, making this a statistically significant difference (p < 0.0001) in relation to the intoxication group. MET has a similar effect to NAC, even though it was less strong; anyhow, when NAC + MET are combined a quelant effect is shown, with a statistically significant 45% and 51% reduction in the Pb levels with the doses administered (p < 0.001); MDA decreased and CAT activity increased in the cerebellum. In this research we can conclude that NAC+MET when combined, have a beneficial effect on the studied parameters during acute Pb treatment.

Determinación de los efectos de la N-acetilcisteína y metionina en cerebelo de ratas intoxicadas con plomo / Determination of the acetylcysteine and methionine effects in the cerebellum of rats intoxicated with lead

Se realizó un ensayo terapéutico para determinar los efectos de la N-Acetilcisteína (NAC), Metionina (MET) y la combinación NAC + MET sobre los niveles sanguíneos de Plomo (Pb), los niveles de malondialdehido(MDA) y actividad de catalasas (CAT) en el cerebelo de ratas intoxicadas con 0,5 y 2 µg/g de acetato de Pb. Se sometieron a prueba 198 ratas Wistar macho con peso promedio de 240 g divididas en cinco grupos. En el Grupo 1 Control, se determinaron niveles basales, el Grupo 2 corresponde a las ratas intoxicadas, los grupos restantes una vez intoxicados recibieron tratamiento de la forma siguiente Grupo 3 NAC, Grupo 4 MET, Grupo 5 NAC + MET. Los resultados mostraron que la NAC disminuye los niveles de plomo en sangre en un 35 por ciento y 38 por ciento con dosis de intoxicación de 0,5 µg/g y 2 µg/g de acetato de Pb respectivamente. Esta disminución no fue estadísticamente significativa; sin embargo, hubo una disminución del MDA en cerebelo en 56 por ciento con la dosis de 0, 5µg/g de Pb y de 75 por ciento con la dosis de 2µg/g. La CAT en cerebelo aumentó su actividad en 62 por ciento y 71 por ciento con las dosis de Pb estudiadas, siendo esta diferencia estadísticamente significativa (p < 0,0001) en relación al grupo intoxicado. La MET tuvo un efecto similar a la NAC aunque fue menor, no obstante cuando se combinan la NAC + MET mostraron un efecto quelante significativo observándose 45 por ciento y 51 por ciento de disminución de los niveles de Pb con las dosis de intoxicación administradas (p < 0,001) así como disminución del MDA y aumento de la actividad de CAT en el cerebelo de ratas expuestas al Pb. En esta investigación se puede concluir que la combinación de NAC + MET tiene efectos beneficiosos sobre los parámetros aquí estudiados en intoxicación aguda por Pb.

Toxicological effects of alpha-solamargine in experimental animals.

Alpha-solamargine isolated from the fresh fruits of Solanum americanum Miller was studied for its toxicity. Lethality studies in rats showed a dose-mortality relationship with a LD(50) of 42 mg/kg body weight intraperitoneally. The chronic and subchronic toxicity investigations indicated that the size of the glycoalkaloid dose was more important than the total glycoalkaloid intake. No appreciable toxic effects were observed at doses below 35 mg/kg body weight as indicated by blood parameters, enzyme levels and histological sections of kidney, liver and cardiac muscle. Alpha-solamargine did not affect the weight of the testes and epididymis or the number of spermatozoa but produced a slight irritation and congestion in the epididymis and testis at doses up to 50 mg/kg body weight.