34th annual congress abstracts

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<ul><li><p>34th R S RACTS </p><p>EFFECTS OF ALPROSTADIL INFU~ON cr A ~n~OREA L CIRCULATION ON PLATELET COUNT AND POSTOPERATIVE BLOOD LOSS WITH REFERENCE TO BLOOD RHEOLOGY: Abdusalam EI-Gatit, MD, FICA i Najib Al-Kaja, PhD, FICA; Ali Belboul, MD; Goran Radberg, MD, Donald Roberts, PhD, FICA; Department of Thoracic and Cardiovascular Surgery, Sahlgrens Hospital, Goteborg University, Goteborg, Sweden. </p><p>The blood protective effects of Alprostadil (synthetic prostaglandin El) were tested in 24 male patients undergoing coronary artery bypass graft surgery (CABG) with the use of cardiopulmonary bypass (CPB), 12 were given intravenous infusion of Alprostadil during surgery (20 nanograms/kg/minute) and the rest were controls. Blood rheology was assessed by measuring red and white cell filterability. The rheological loss and the reduction of the platelet count during and following surgery were significantly less in the Alprostadil group, p</p></li><li><p>Abstracts 153 </p><p>EFFECTS OF VITAMIN E ON THE STATUS OF ()XYGEN FREE RADICAL ACTIVITY IN PATIENTS UNDERGOING AORTOCORONARY BYPASS SURGERY: Taras Mycyk, MDI Dorothy J. Thomson, MD; Jawahar Kalra, MD, Phi), FICA; Marion Prasad, BA; Subrahmanyam V. Mantha, Phi); Kailash Prasad, MD, PhD, FICA, Professor of Physiology; Officer and Vice President, Scientific Council, International College of Angiology; Departments of Surgery, Pathology, Physiology, College of Medicine, University of Saskatchewan and Royal University Hospital, Saskatoon, Saskatchewan, Canada. </p><p>We have previously show that oxygen free radicals (OFRs) depress cardiac function and contractility. Oxygen free radicals exert their cytotoxic effects by lipid peroxidation of cellular membrane resulting in the production of malondialdehyde (MDA). It is possible that postoperative cardiac dysfunction using CPB may be due to increased levels of OFR. Vitamin E, an antioxidant, should be able to reduce the lipid peroxidation and cardiac dysfunction in aortocoronary bypass surgery. To evaluate the possible role of OFR in post-pump cardiac dysfunction, OFR producing activity of polymorphonuclear (PMN) leukocytes and blood MDA were measured at induction of anesthesia, before cross clamping of aorta, after closure of the chest and 24 hours postoperatively in 27 patients undergoing aortoeoronary bypass surgery. The patients were divided into two groups: Group I, warm blood eardioplegia with Vit. E, n= 15; Group II, cold blood cardioplegia, n= 12. Oxygen free radical producing activity of PMN leukocytes increased significantly during aortocoronary bypass in both groups. Malondialdehyde levels of blood increased during aortocoronary bypass surgery and 24 hours postoperatively in Group I. However, the MDA levels of blood did not change significantly throughout the procedure in patients of Group II. These results suggest that (i) OFR might be responsible for cardiac dysfunction after CPB (ii) Vitamin E might be helpful in preventirig cardiac dysfunction during aortoeoronary bypass surgery. </p><p>AMIODARONE LUNG TOXICITY AND MAJOR SURGERY: Pertti Aarnio, MD, FICA, Co-Chairman, Scientific Program Committee, 34th Annual Congress; Officer and Vice President, Scientific Council, International College of Angiology; Jay H. Ryu, MD; Richard J. Rodeheffer, MD; Christopher GA McGregor, MB, FRCS; Mayo Clinic, Rochester, Minnesota, USA. </p><p>During a six-year period, 12 patients with a previous diagnosis of lung toxicity underwent major cardiac, pulmonary, or abdominal surgery. The diagnosis was based on new lung infiltrates in a patient receiving long-term amiodarone therapy and in whom other causes of line infiltration were excluded. Eight patients underwent bronchoalveolar lavage and transbronchial or open lung biopsy. Amiodarone maintenance dose was either 200 or 400 mglday with a cumulative mean dose of 2274 mg/kg (range 177 to 6761 mg/kg). The interval between the diagnosis of toxicity and surgery was a mean of 3.2 months (range 12 days to 12 months). The preoperative drug-free interval was a mean of 2 months (range 0 to 7 months). One of these 12 patients developed postoperative recurrence of lung toxicity. During the same time period, three additional patients were diagnosed with amiodarone lung toxicity developing following surgery: one after heart transplantation, another after left ventricular resection and coronary artery bypass graft, and the third after knee synovectomy. Amiodarone maintenance dose was 200 rag/day with a cumulative dose of 1409 mg/kg (range 829 to 2000 mg/kg). All three patients survived although intubation times, intensive care stays and time in hospital were all markedly prolonged. In this study, preoperative amiodarone lung toxicity did not appear to be a risk factor for the development of life-threatening postoperative pulmonary complications. In addition, postoperative lung toxicity could not be predicted by preoperative amiodarone dose and occurred with low-dose therapy. </p></li><li><p>154 IJA Summer 1992 </p><p>NEW ASPECTS IN THE DIAGNOSIS AND MANAGEMENT OF ACUTE MESENTERIC INFARCTION: Philippe G. Bull, MD, FICA; G.W. Hagmuller, MD; W. Kreuzer, MD; Department of Surgery, Wilhelminenspital, Vienna, Austria. </p><p>A retrospective analysis of 121 patients suffering from mesenteric ischemia was carried out to compare the current diagnostic and therapeutic modalities. The average age was 72.9 years and 76 of the patients reviewed were female (63 %). The overall mortality was 76 %. In 45 patients (37 %) only exploratory laparotomy was performed with none surviving, and 11 patients (9 %) died before any form of therapy could be undertaken. Thirty-four patients (28%) had bowel resection alone with a perioperative mortality of 56 %, 21 patients (17 %) had bowel resection combined with a revascularization procedure with a mortality of 48%, and in 10 patients (8%) with revascularization alone a mortality of 70 % was observed. Significant findings for mortality in this group was duration of symptoms over 10 hours, central mesenterie occlusion with extensive intestinal infarction, stage of hypovolemie shock and age. Mean serum lactate concentration was 8.6+_.2.8 mmol/l (normal 1.5+1.0 mmol/l), and its return to normal following surgery was significant of an uncomplicated recovery (p 0.1). </p><p>The authors conclude that high serum lactate concentration combined with abdominal symptoms and leucocytosis in the absence of shock are high indicators of bowel ischemia and warrants surgery without delay. Surgery should combine revascularization with extensive bowel resection. Postoperative monitoring of serum lactate seems to obviate routine second-look operations in those with primary anastomosis. </p><p>APPROACH TO MICROANGIOLOPATHIC ULCERATIONS: DIAGNOSIS AND THERAPY: Patricia Cristodor, MDI F.C. Rada, MD; M. Hancu, MD; Medical University of Timisoara, Timisoara, Romania. </p><p>Microangiolopathie ulcerations represent a particular sort of ulceration and, though not rare, are still not well enough known and not well enough treated, their treatment implying a long-term and deceiving therapy. </p><p>We have followed 52 patients with microangiolopathie ulcerations secondary to metabolic disorders (diabetes mellitus), vascular disorders (thromboangiitis obliterans, arteriosclerosis obliterans, livedo reticularis, hypertension, chronic pemio), and vasculitis. </p><p>We have followed some biological data, such as serum electrolytes, lipids, electrophoresis, blood ceils, as well as blood pressure, and other investigations: Doppler, arteriography, radiographies of soft tissues surrounding the ulcerations, and morphopathological exams of skin samples in the area of the lesions and from other parts of the body. </p><p>As a means of treatment we have used antibiotics, correlating them with variant pH values, as well as benzol peroxide and hydrophyllie wound dressings, together with other classical means of treatment. </p></li><li><p>Abstracts 155 </p><p>LYMPHATIC OVERLOAD AND VENOUS DISEASES: F.C. Rada, MD; Patricia Cristodor, MD; I.O. Rada, MD, FICA; Medical University of Timisoara, Timisoara, Romania. </p><p>The main circulatory function of the lymphatic system consists of bringing in macromolecules back into blood circulation from interstice space of the sustaining lax connective tissue. </p><p>We have observed aspects of the lymphatic system in inferior limb injuries in 25 patients with post-thrombophlebitie syndrome (PTS) by means of: lymphangiochromy, lymphangiography with ultra fluid lipiodol, lymphographies with radioactive labeled macromolecules (RLM), histological exams of lymph vessels and lymph nodes, and protein and lipidic composition of the edema liquid. </p><p>We did not observe any obstacle in lymph circulation. RLM resorption was diminished in cellulitis areas and absent in ulcus and hypotrophie </p><p>sclerosing dermatitis areas. In edema liquid, proteins were below 0.77 g%. In the presence of PTS, the skin grows thinner and it lessens. Comparatively, from the clinical </p><p>point of view, in patients with lymphoedema, the skin of the calves becomes hypertrophic and the hair grows thicker and dense. </p><p>In some stages of PTS, lymphatic flow may increase. This increase generates the hypothesis of a false lymphatic overload syndrome. The aspect remains a pseudosyndrome in the absence of perceptible histological and functional alterations. This optional overload is generated by an increase in the extravascular liquid exodus following the alteration of venous circulation in the calves. The reaction to an increased load cannot be considered a disease of the structure responding to overload. </p><p>ERGOMETRIC TEST IN SUBJECTS OCCUPATIONALLY EXPOSED TO NOISE: Bruno Papaleo, MD, FICA; F. Tomei, MD, FICA, Associate Professor; E. Tomao, MD; T.P. Baccolo, MD, FICA; P. Alfi, MD; Occupational Medicine, University of Rome- "La Sapienza', Rome, Italy. </p><p>Three comparable groups of subjects were studied. The first two did the same type of work but were exposed to different levels of noise, and the third was not exposed to noise. </p><p>An ergometric test was done, gradually increasing effort in steps of 30 Watts/3 min., until heart rate reached 200 minus the subject's age. The responses of the three groups were assessed in relation to blood pressure and resting electrocardiographic anomalies. </p><p>The differences in response to the ergometrie test between subjects exposed to noise and the others suggest two variables are worth identifying in baseline conditions: diastolic BP 95 mmHg or more, and ECG anomalies. These can be considered as predictive - though not specifically - of cardiovascular susceptibility to chronic noise. These are easy to detect and could be employed for screening purposes. </p></li><li><p>156 IJA Summer 1992 </p><p>ACTIONS OF TETRAMETHYLPYRAZINE, A NON-SULFONYLUREA K+ ATP-CHANNEL BLOCKER, UPON ISCHEMIA- INDUCED CORONARY D ILAT ION IN ISOLATED LANGENDORFF-PERFUSED GUINEA PIG HEARTS: M. Grisold, MD; M. Wallner, MD; J. Dusleag, MD, FICA; C. Furian, MD; W. Klein, MD; Robert Gasser, MD, Phi), FICA, Co-Chairman, Scientifc Program Committee, 34th Annual Congress; Officer and Vice President, Scientific Council, International College of Angiology; Department of Medicine, University of Graz, Graz, Austria. </p><p>The compound 2,3,5,6-Tetramethylpyrazine (TMP, Ligustrazin), a flavoring component (Fr. Demande 2, 128:744, 1972) and sweetness enhancer for beverages (Japan. Kokai 73:17, 073), constitutes a commonly used food additive. </p><p>Now we studied the effect of TMP on coronary artery dilation during ischemia. In our experiments we used isolated Langendorff-perfused guinea pig hearts, arrested with K+-rich normal Tyrode solution (in MM: NaCI 129.5, KCI 15, MgCI 2 0.8, CaC12 1.0, glucose 10), buffered with 10 mM HEPES to pH 7.4 at 37 ~ C, equilibrated with 100% 02. Ischemia was simulated by equimolar replacement of glucose by 2-deoxyglucose (DOG), an inhibitor of oxydative phosphorylation. </p><p>We found that coronary perfusion pressure (CPP) decreased by 20__+1.2 cm H20 (from initially 90 cm H20; n=6,+SEM) within 15 minutes from the onset of DOG. In the presence of 1 mM TMP the decrease in CPP was largely attenuated and CPP declined by 1.4__+1.0 cm H20 (n=6, + SEM; P</p></li><li><p>Abstracts 157 </p><p>ASSOCIATION OF ANTI-TRYPANOSOMA CRUZI, ANTI-SCIATIC NERVE, AND ANTI-GANGLIOSIDE ANTIBODIES IN CHAGAS DISEASE: S. Gea, PhDi P. Ordonez, PhD; Daniel Iosa, MD, Phi), FICA, Officer and Vice President, Scientific Council, International College of Angiology; F. Cerban, PhD; C. Chizzolini, MD; E. Votero-Cima, Phi); Dpto. Bioq. Clinic Fat., C. Quimicas, Univ. Nac. Cordoba, Cordoba, Argentina; Centro Priv. Med., Cordoba, Argentina; Fidia S.p.A., Abano Terme, Italy. </p><p>We have demonstrated that a Trypanosoma cruzi cytosol acidic fraction named F IV is target of substantial antibody response in patients with chronic Chagas' disease (ClaP). It has been reported in the presence of antibodies and T cells reactive with 7". cruzi that recognized nervous tissue antigens. In this work, we have studied the anti F IV and autoreactive immune responses by ELISA. ClaP with positive serology were classified in: group (G) I (n= 12) with normal ECG, G II (n= 12) with abnormal ECG and G III (n= 12) with cardiomegaly. Sera from G II ChP showed the highest reactivity against F IV, 8/9 had titres &gt; 8.6. The autoreactive response was studied against human sciatic nerve saline extract (SNS), a lipid extract of it (SNL) and gangliosides from bovine brain (Ga) (FIDIA). The binding oflgG to SNS was positive in G I (58%), G II (66%) and G III (75%) of the patients. The reactivity against SNL was revealed in a high proportion of all groups of patients. The treatment of SNS with periodate eliminated the ability of antigens to fix IgG from ChP suggesting the carbohydrate nature of SNS epitopes. The reactivity against Ga was detected in 33% ofG I patients, 66% of G II and 50% of G III. We also detected cross reactivity between SNS and F IV. In fact, F IV was able to inhibit the ELISA reactivity of ChP sera by 31-54% when the SNS was used as antigen. Overall these results suggest that Z cruzi and sciatic nerve components possess at least one epitope, possibly of carbohydrate nature, in common. </p><p>LOW MOLECULAR WEIGHT HEPARIN (LOGIPARIN TM) COMPARED WITH LESS INTENSE WARFARIN PROPHYLAXIS AGAINST VENOUS THROMBOEMBOLISM FOLLOWING MAJOR ELECTIVE HIP SURGERY: Russell Hull, MBBS; Gary Raskob, MSc; Graham Pineo, MD, FICA~ Frank Smith, MD; William Evans, MD; Thomas Mallory, MD; David Rosenbloom, PharmD; C. Gregory Elliot, MD; American-Canadian Orthopedic Clinical Trials Group, University of Calgary, Calgary, Alberta, Canada. </p><p>The promise of experimental findings that low molecular weight (LMW) heparin may be less hemorrhagic remains to be fulfilled unequivocally in man. The relative effectiveness and safety of LMW heparin compared with less intense warfarin sodium prophylaxis remains uncertain. We have performed a double-blind randomized trial using a single daily injection of LMW heparin (75 F XaI U/kg) compared with less intense warfarin sodium adjusted to maintain the INR between 2.0 and 3.0;...</p></li></ul>

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