Risk factors influencing the surgical outcome in 138 consecutive patients with infrarenal aortic aneurysm: experience at the Cluj-Napoca Cardiovascular Surgery Center.

UNLABELLED: Abdominal aortic aneurysms represent a common pathologic condition, with an increasing incidence in the last decades. Unfortunately, the mortality rate in ruptured abdominal aortic aneurysms has also increased. The aim of this retrospective study was to determine the risk factors that could interfere with the surgical outcome of these patients, especially with the perioperative morbidity and mortality rates. MATERIALS AND METHODS: In this study we included 138 consecutive patients with infrarenal aortic aneurysm, who underwent elective repair (for chronic aortic aneurysm) or emergency repair (for ruptured aortic aneurysm), in the Cluj-Napoca Cardiovascular Surgery Clinic between January 2003 and December 2011. We noted the most frequently associated diseases and perioperative complications among the studied population. Three types of interventions were performed:tubular graft interposition, aortobiiliac bypass and aortobifemoral bypass. RESULTS: The perioperative mortality in the elective repair group was 5.68% (5 - 88), while in the emergency repair group it was 46% (23 - 50). CONCLUSIONS: Ruptured abdominal aortic aneurysm continues to represent a condition associated with substantial risks and high mortality. Selective screening and elective repair are therefore necessary for the improvement of the survival rate for patients with infrarenal aortic aneurysm.

Glucocorticoid receptors in human epicardial adipose tissue: role of coronary status.

BACKGROUND: Epicardial adipose tissue (EAT) is in close contact with coronary vessels and therefore could alter coronary homeostasis. Glucocorticoids are pathophysiological mediators of visceral fat deposition and its associated atherogenic complications. AIM: We investigated in EAT the expression of the glucocorticoid receptor (GR) and its various (A, B, C) promoters. MATERIALS AND METHODS: Paired subcutaneous adipose tissue (SAT) and EAT biopsies were obtained from 15 patients with coronary artery disease (CAD) and 12 patients without CAD (NCAD). GR and 11ß-hydroxysteroid dehydrogenase type 1 protein (11ß-HSD-1, the enzyme which converts inactive cortisone into active cortisol) were studied by immunohistochemistry and GR and its various promoters were studied by mRNA quantitative RT-PCR. RESULTS: GR and 11ß-HSD-1 protein were expressed in adipocytes, stromal areas, isolated stromal cells close to adipocytes, and blood vessels. Total GR mRNA levels did not differ in SAT obtained from NCAD or CAD patients and were decreased in EAT, irrespectively of the coronary status, with parallel changes in promoter B- and C-, but not promoter A-associated transcripts. Total GR mRNA and adipocyte surface in EAT obtained from CAD patients were correlated negatively (p<0.035, r=0.39). CONCLUSIONS: Our findings demonstrate that in EAT, GR gene promoters could play a role in tissue- specific GR expression levels. EAT may be less sensitive to glucocorticoids than SAT, preventing the EAT mass development in CAD patients and suggesting a protective role on coronary homeostasis.

Increased mast cell density and microvessel density in the thymus of patients with myasthenia gravis.

There were investigated 15 cases with normal thymus removed during cardiac surgery and nine cases with clinical signs of myasthenia gravis. Four patients with myasthenia gravis had thymoma (three invasive, one non-invasive). Specimens were fixed in buffer formalin, embedded in paraffin and slides were stained with Hematoxylin-Eosin and Alcian blue-Safranin. Additional slides were stained for factor VIII in order to estimate microvessel density. Mast cell density was performed at magnification x400, and microvessel density at magnification x200, using the "hot spot" method. There were found intralobular mast cells in all cases, located mainly in the cortex (6.53 in the normal thymus, 21.4 in patients with myasthenia gravis, and 10 in thymoma-associated myasthenia gravis). A significant increase in the number of intralobular mast cells was noticed in patients with myasthenia gravis without thymoma (p < 0.001), and a moderate increase in patients with thymoma-associated myasthenia gravis (p < 0.023). Values of microvessel density were 10.3 for the normal thymus, 33 for myasthenia gravis without thymoma and 21.8 for myasthenia gravis with associated thymoma. A strong correlation was found between the number of mast cells and microvessel densities in all three conditions.

[Transesophageal electrophysiology study, a simple method of investigation of unexplained illness in elderly patients]. / Etude électrophysiologique par voie transoesophagienne, moyen simple d'investigation de malaises inexpliqués, chez des sujets âgés.

Cardiac arrhythmias are common causes of syncope and malaise in elderly patients, but they are sometimes difficult to demonstrate without invasive procedures. The aim of this report was to demonstrate the value of transoesophageal electrophysiological investigation in cases of negative classical non-invasive studies. The authors report 18 cases of patients, aged 70 to 88, mainly in poor general condition, who were admitted for the investigation of malaise or syncope. The ECG was normal or subnormal and Holter monitoring non-contributive to the diagnosis. Transoesophageal electrophysiological study enabled initiation of an arrhythmia, bradycardia or tachycardia, which reproduced the symptoms of spontaneous malaise. In 10 cases, paroxysmal junctional tachycardia was demonstrated, by nodal reentry in 8 cases, and in a latent Kent bundle in 2 cases. The malaise was caused by tachyarrhythmia in 3 patients and by a vagal reaction or sinus arrest after the tachycardia in the other patients. In 6 other patients, atrial fibrillation reproduced the malaise either due to the rapid rhythm, or to bradycardia after the arrhythmia in 3 cases. In another 2 patients, conduction defects were demonstrated by atrial stimulation (alternating bundle branch block in one patient, complete atrioventricular block at the end of atrial stimulation in another patient). The authors conclude that transoesophageal electrophysiological study is a simple technique which allows diagnosis of unexplained malaise in elderly patients when non-invasive methods are unable to demonstrate the causal arrhythmia. Supraventricular arrhythmias seem to be a common and probably underestimated cause of malaise or syncope in elderly patients.