Interleukin-23 serum levels in patients affected by peripheral arterial disease.

OBJECTIVES: To clarify whether interleukin (IL)-23 is involved in peripheral arterial disease (PAD). DESIGN AND METHODS: We evaluated IL-23 serum levels, in 29 patients suffering from lower extremity PAD and in 30 healthy subjects. RESULTS: IL-23 serum levels were higher during the three times (T0, T1 and T2) compared to the control group, although only statistically significant for T0 and T2: T0 (15.83 ± 22.08 vs. 8.08 ± 8.62 pg ml, p=0.026), T1 (16.10 ± 23.71 vs. 8.08 ± 8.62 pg/ml, p=0.101), T2 (15.06 ± 16.72 vs. 8.08 ± 8.62 pg/ml, p=0.005). CONCLUSION: For the first time, our data gives us reason to believe there is an involvement of IL-23 in PAD.

[Cardiac tamponade: a modified video-assisted thoracoscopic approach]. / Tamponamento cardiaco: approccio modificato in videotoracoscopia.

Pericardial effusion may lead to cardiac tamponade sometimes requiring surgical treatment. The aim of the study was to retrospectively analyse a group of patients with cardiac tamponade treated with a modified video-assisted thoracoscopy technique. We treated 15 patients (8 males and 7 females; mean age 63 years; range 24-80 years) with cardiac tamponade. All patients were treated by a modified video-assisted thorascopic approach on the right hemithorax, with the use of two trocars: a 15-mm trocar on the 4th right intercostal space on the anterior axillary, and a 10-mm trocar on the 7th right intercostal space on the median axillary line. We used a 5-mm optic, the size of which permitted the simultaneous use of two instruments through a single trocar (both for the optic and the endoscopic forceps), leaving the second trocar for the dissecting scissors. In all patients we obtained a pericardial resection equivalent to the one obtainable in an anterolateral thoracotomy. There was no intraoperative mortality or perioperative morbidity. Drainage of the pericardial effusion was effective in all cases. The modified video-assisted thoracoscopic technique on the right chest using two trocars seems a feasible surgical technique for patients suffering from cardiac tamponade.

A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery.

Cardiac surgery performed with cardiopulmonary bypass (CPB) may be complicated by hypotension due to low systemic vascular resistance (SVR). Often in those cases, hypotension is resistant to pressor catecholamines. We report six cases of norepinephrine-resistant postcardiotomy hypotension, treated by terlipressin (TP), a potent vasopressor agent. Between May 2007 and May 2008, we treated six patients with TP administration (1 mg bolus) for post CPB refractory vasodilatory hypotension. Analyzed parameters were: mean arterial pressure (m-AP), SVR, cardiac output index (CI), mean pulmonary pressure (m-PP), and lactate, at baseline (before TP bolus) and 3 h after injection. Before TP bolus, the average m-AP was 53.32+/-8.86 mmHg, the CI was 3.45+/-0.24 l/min/m(2), the SVR was 650+/-62.03 dyne*s/cm(5) and the arterial lactate level was 4.6+/-0.95 mmol/l. Three hours after the TP bolus, the m-AP increased to 81.83+/-9.71 mmHg (P=0.002), the CI decreased to 2.88+/-0.14 l/min/m(2) (P=0.002), the SVR increased to 1154+/-116 dyne*s/cm(5) (P=0.002), and arterial lactates decreased to 3.13+/-0.78 mmol/l (P=0.015), without significant modification of m-PP and CVP. We treated postoperative refractory low SVR hypotension by TP administration in bolus. Exogenous administration of TP normalized SVR and increased the systemic arterial pressure with a minimum effect on pulmonary pressure. Subsequently, the effect on systemic blood pressure enhanced urine output. No major collateral effects were observed. The administration of TP in bolus may result as a useful alternative for treating refractory low SVR hypotension post CPB.