Identification of omentin mRNA in human epicardial adipose tissue: comparison to omentin in subcutaneous, internal mammary artery periadventitial and visceral abdominal depots.

OBJECTIVE: The purpose of this study was to determine the relative distribution of omentin and visfatin mRNA in human epicardial, peri-internal mammary, upper thoracic, upper abdominal and leg vein subcutaneous adipose tissue as well as the distribution of omentin in the nonfat cells and adipocytes of human omental adipose tissue. BACKGROUND: Omentin is found in human omentum but not subcutaneous fat. Omentin and visfatin are considered markers of visceral abdominal fat. RESEARCH DESIGN AND METHODS: The mRNA content of omentin and visfatin was measured by qRT-PCR analysis of fat samples removed from humans undergoing cardiac or bariatric surgery. RESULTS: Omentin mRNA in internal mammary fat was 3.5%, that in the upper thoracic subcutaneous fat was 4.7% while that in the other subcutaneous fat depots was less than 1% of omentin in epicardial fat. The distribution of visfatin mRNA did not vary between the five depots. Omentin mRNA was preferentially expressed in the nonfat cells of omental adipose tissue since the omentin mRNA content of isolated adipocytes was 9% of that in nonfat cells, and similar results were seen for visfatin. The amount of omentin mRNA in differentiated adipocytes was 0.3% and that of visfatin 4% of that in nonfat cells. The amount of omentin mRNA in preadipocytes was virtually undetectable while that of visfatin was 3% of that in freshly isolated nonfat cells from omental adipose tissue. CONCLUSION: Omentin mRNA is predominantly found in epicardial and omental human fat whereas visfatin mRNA is found to the same extent in epicardial, subcutaneous and omental fat.

Coronary artery bypass after recent myocardial infarction.

During a five-year period, 280 patients underwent myocardial revascularization within 60 days of having suffered an acute myocardial infarction. Eighty-six percent of them had angina. Twelve patients had calculated ejection fractions of less than 20%; 79, 21% to 40%; and 105, from 41% to 60%. Ten patients had one graft; 33, two; 74, three; and 163, four or more. Twenty-four patients had concomitant ventricular aneurysm repair. The intra-aortic balloon pump was used in only seven patients. There was one postoperative death secondary to respiratory insufficiency and sepsis, resulting in a hospital mortality of 0.4%. Myocardial revascularization is a safe procedure following recent myocardial infarction, with results comparable to elective revascularization. Our long-term results suggest that revascularization may decrease the incidence of recurrent myocardial infarction.

Removal of axillofemoral graft.

Axillofemoral grafts which develop late occlusion often can be salvaged with a second operation, which frequently involves placement of a new graft. Velour Dacron grafts which have been in place for several years usually are bound tightly to adjacent tissues. We describe a simple method for removal of these grafts.

[Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis]. / Kombinationseingriffe bei koronarer Herzerkrankung bzw. Klappenfehlern und Karotisstenose.

This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

Implantation of an endocardial tined lead to prevent early dislodgment.

Early electrode dislodgment from the ventricular apex is a major complication associated with transvenous cardiac pacing. A new lead with flexible tines proximal to the tip electrode has been developed to minimize acute dislodgment incidence. The bipolar tined lead was implanted in 79 patients. This experience was compared to 48 implants of a standard bipolar endocardial lead. Stimulation threshold, sensing, and resistance measurements from both leads were comparable. Although the cephalic vein was the preferred venous route, the jugular vein was needed more often for tined lead insertion than for standard lead insertion. The incidence of early dislodgment with the tined lead was 2.5 percent compared to 8 percent with the standard lead (no significant difference). This preliminary experience can only suggest that the addition of flexible tined leads may reduce early electrode dislodgment.

Femoral tibial bypass grafts.

The results of 53 femoral to tibial artery bypass grafts have been reviewed. All were carried out in an attempt to salvage severely ischemic extremities which resulted from arteriosclerotic occlusive disease involving the femoral, popliteal, and tibial arterial systems as demonstrated by arteriography. Most grafts were done with autogenous vein; however, composite grafts comprised of a Dacron prosthesis and an autogenous vein and homologous veins were used in several patients. The initial salvage rate in these pregangrenous extremities was 74%. Fifty-two percent of the grafts remain patent at this writing, a period of 56 months in some instances. This study indicates that most patients with a severely ischemic extremity are candidates for revascularization and should have angiographic studies before amputation is considered.