Effects of hyperglycemia, hyperinsulinemia, and hyperosmolarity on neutrophil apoptosis.

Background: Hyperglycemia is an independent risk factor for increased mortality of critically ill surgical patients, but despite the recognized clinical benefits of early insulin treatment, there is a lack of understanding of the cellular and molecular mechanisms behind this phenomenon. We hypothesized that polymorphonuclear neutrophils, the first line of the innate immune defense system, suffer from altered apoptotic turnover when exposed to hyperglycemic conditions, ultimately decreasing the number of viable cells active at a site of infection.

Methods: Venous blood samples were drawn from 10 volunteers and incubated for 0.

Chronic pouchitis after ileal pouch-anal anastomosis for ulcerative colitis: effect on quality of life.

Chronic pouchitis can be observed in up to 30% of patients after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). It remains a poorly understood complication and often requires chronic antibiotic and antidiarrheal treatment. We hypothesized that its occurrence can be predicted by distinct clinical parameters and that it adversely affects quality of life.

Clinical anatomy of the atrioventricular node artery.

Background And Aim Of The Study: The study aim was to describe the topographical relationship of the atrioventricular (AV) node artery and mitral valve annulus fibrosus with regard to AV node dysfunction following mitral valve replacement or ring annuloplasty.

Methods: The anatomy of the AV node artery was analyzed in 55 human hearts without previous pathological alterations. Selective coronary angiograms were performed to identify the AV node origin.

Panicovirus accumulation is governed by two membrane-associated proteins with a newly identified conserved motif that contributes to pathogenicity.

Panicum mosaic virus (PMV) has a positive-sense, single-stranded RNA genome that serves as the mRNA for two 5'-proximal genes, p48 and p112. The p112 open reading frame (ORF) has a GDD-motif, a feature of virus RNA-dependent RNA polymerases. Replication assays in protoplasts showed that p48 and p112 are sufficient for replication of PMV and its satellite virus (SPMV).

Apoptosis and necrosis: a review for surgeons.

Background: Orderly cell death, termed apoptosis, features a morphology that is distinct from necrotic, or accidental, cell death. As the body of literature on apoptotic cell death grows, it is difficult for practicing surgeons to stay current with the involved mechanisms and their biologic significance.

Methods: A MEDLINE/PubMed literature search was conducted, followed by manual crossreferencing, to identify relevant articles published in the English language between 1972 and 2004.

Endotoxin inhibits apoptosis but induces primary necrosis in neutrophils.

Lipopolysaccharide (LPS) is known to prolong the functional lifespan of neutrophils at a site of infection by preventing apoptosis through inhibitor of apoptosis proteins (IAPs). We hypothesized that the increased neutrophil lifespan ultimately leads to a larger fraction of cells undergoing uncontrolled, primary necrosis. Diluted venous whole blood was incubated with increasing concentrations of LPS for up to 36 hr.

Interleukin-10 suppresses natural killer cell but not natural killer T cell activation during bacterial infection.

Interleukin (IL)-10 is an anti-inflammatory cytokine known to modulate the outcome of sepsis by decreasing pro-inflammatory cytokine production, including IL-12, a main activator of natural killer (NK) cells. We hypothesized that neutralization of IL-10 would increase NK and natural killer T (NKT) cell activation through increased IL-12 in a mouse model of bacterial peritonitis. NK and NKT cell activations were measured by CD69 expression on NK1.

Characterization of a potyvirus isolated from Tradescantia fluminensis in northern Italy.

We isolated a potyvirus from Tradescantia fluminensis that was causing leaf distortion and mild mosaic. We cloned and sequenced a 1500 bp cDNA obtained by RT-PCR corresponding to the 3' proximal region of the genome. We determined the host range and tested a series of potyviral antisera against our tradescantia virus isolate by immuno-enzymatic methods.

Impact of diabetes mellitus and metabolic disorders.

Metabolic and endocrine disorders are common in the perioperative surgical patient. During surgical stress and critical illness, each hormonal system reveals characteristic changes that can be of diagnostic and prognostic significance. A number of endocrinopathies,electrolyte problems, or metabolic derangements may either preexist or develop during the course of surgical treatment.

Respiratory dependent compression of a venous bypass: therapy by stenting.

Although coronary artery bypass surgery has provided major advances in the treatment of coronary artery disease, narrowing of bypass vessels still constitutes a drawback of this therapy. Although this event is most frequently caused by intraluminal processes, obstruction from external structures is extremely rare. We report such a case in which external bypass compression was provoked by deep inspiration causing typical anginal symptoms.

Slow transit colon constipation is not related to the number of interstitial cells of Cajal.

Background And Aims: Recent studies have demonstrated decreased numbers of interstitial cells of Cajal in patients suffering from severe chronic constipation as measured by c-Kit (CD117) and CD34 immunohistology. In this study, we wished to determine whether there were abnormalities in the number of neurons of the Auerbach's plexus, their CD117 and CD34 immunoreactivity, or the thickness of colon wall sections in patients with refractory slow transit colonic constipation as compared with control subjects.

Patients And Methods: Specimens from 13 patients who had undergone subtotal colectomy for severe chronic constipation refractory to medical treatment were compared with normal controls.

Infection and organ failure in the surgical patient: a tribute to seminal contributions by Hiram C. Polk, Jr, M.D.

Despite intensive research over past decades, infections and organ failure remain the most common severe complications in the critically ill surgical patient. Multiple-organ dysfunction syndrome represents the clinical endpoint of a cascade of mainly immunologic and cardiovascular events, ultimately leading to progressive patient deterioration and high mortality. Few clinicians have contributed as vigorously as Hiram C.

Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects.

Objective: To extract from the biomedical literature the reported effects of acute hyperglycemia on the major components of the innate immune system and to describe the clinical benefits of strict blood glucose control in certain patients.

Data Source And Selection: A Medline/PubMed search (1966 to July 2004) with manual cross-referencing was conducted, including all relevant articles investigating the effects of acutely elevated glucose levels on innate immunity. All publication types, languages, or subsets were searched.

Aortic dissection with potential origin from a mechanical bypass anastomosis.

Ascending aortic dissection is a known complication of cardiac surgery. Off-pump coronary artery bypass surgery seems to be associated with a higher risk for this event as compared with on-pump bypass surgery. This increased risk may result from aortic side-clamping under pulsatile flow as opposed to continuous flow in conventional bypass surgery.

A Hydrophobin of the chestnut blight fungus, Cryphonectria parasitica, is required for stromal pustule eruption.

Hydrophobins are abundant small hydrophobic proteins that are present on the surfaces of many filamentous fungi. The chestnut blight pathogen Cryphonectria parasitica was shown to produce a class II hydrophobin, cryparin. Cryparin is the most abundant protein produced by this fungus when grown in liquid culture.

Living patches engineered from human umbilical cord derived fibroblasts and endothelial progenitor cells.

Objective: A major shortcoming in contemporary congenital heart surgery is the lack of viable replacement materials with the capacity of growth and regeneration. Here we focused on living autologous patches engineered from human umbilical cord derived fibroblasts and endothelial progenitor cells (EPCs) as a ready-to-use cell source for paediatric cardiovascular tissue engineering.

Methods: EPCs were isolated from 20 ml fresh umbilical cord blood by density gradient centrifugation and myofibroblasts were harvested from umbilical cord tissue.

The CentriMag: a new optimized centrifugal blood pump with levitating impeller.

Purpose: Blood pumps are routinely used for circulatory and pulmonary support. However, blood trauma and pump failure remain severe drawbacks of currently available pump models. This study evaluated the first clinical application of a new, totally bearingless centrifugal blood pump (CentriMag).

Inferior partial sternotomy for surgical closure of isolated ventricular septal defects in children.

Background: Surgical closure of isolated ventricular septal defect (VSD) through partial inferior sternotomy offers the advantages of a much shorter, cosmetically superior skin incision, potentially improved sternal stability, a lower rate of infection, and less postoperative pain. We report our technique and results of use of inferior partial sternotomy for closure of isolated VSD in children.

Patients And Methods: From July 2002 to July 2003, 24 consecutive patients with a median age of 4.

In the footsteps of senning: lessons learned from atrial repair of transposition of the great arteries.

The Senning operation has evolved from being the initial surgical correction that allowed survival in complete transposition of the great arteries to an integral part of the anatomic repair of congenitally corrected transposition. In patients with complete transposition, the Senning operation has given satisfactory initial and long-term surgical results, but the potential for right ventricular failure and atrial arrhythmias have drastically reduced its indications in the current era. The long-term follow-up and pertinent postoperative issues of the Senning operation will be reviewed, along with its newfound role in the anatomic repair of congenitally corrected transposition.

Geometrical model of the pulmonary root.

Background And Aim Of The Study: The renaissance of the Ross procedure has attracted much attention to the clinical anatomy of the pulmonary valve. Within the reviewed literature which emphasizes the morphology of the pulmonary root, no detailed anatomy has been reported. The study aim was to describe the cardiosurgical-orientated anatomy of the pulmonary valve.

Future of heart valve surgery.

In highly developed nations, valve surgery will be increasing applied in older people, with more co-morbidities and a higher incidence of concomitant coronary artery disease. Valve surgeons will be facing increased competition from the catheter-based procedures, both for valve repair and replacement; these are already applied clinically, and their numbers will rise in near future. Early mortality in double valve procedures and in combined CABG and valve operations remains substantial, and there is ample room for improvement of surgical results.

Guidant Heartstring: initial experience in OPCAB surgery.

Purpose: The aim of this study was to evaluate the feasibility of the Heartstring hemostatic seal system for proximal anastomoses without the need for aortic side clamping in off-pump coronary artery bypass surgery .

Material And Methods: Between May and November 2003, 50 proximal bypass anastomoses were performed with the Heartstring device in 29 consecutive patients (21 men, 8 women) with calcified aorta (assessed by transesophageal echocardiography/digital palpation). Mean patient age was 68 +/- 7 years.

Normalization of high pulmonary vascular resistance with LVAD support in heart transplantation candidates.

Objective: Pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) lead to poor outcome after heart transplantation due to postoperative failure of the non-conditioned right ventricle. The role of continuous flow left ventricular assist device (LVAD) support in the reduction of elevated PVR was evaluated in a series of clinical implants.

Methods: Among 17 patients with terminal heart failure receiving a MicroMed DeBakey LVAD as bridge to transplant, there were six patients with pulmonary hypertension (mean systolic PAP 47 mmHg) and high PVR (398 dynes/cm5), previously not considered suitable for heart transplantation, who underwent serial right heart catheters during their LVAD support period.

Supra-annular aortic valve replacement with a mechanical prosthesis.

Supra-annular placement of the aortic valve prosthesis is primarily used in small aortic annulus to prevent a patient-prosthesis mismatch. The most important surgical steps are: careful removal of the diseased valve including annular decalcification; assessment of the prosthesis seating to guarantee free movement of leaflets and to prevent obstruction of coronary orifices; implantation with interrupted stitches placed infra-annularly, with the prosthesis being seated in a supra-annular position. If necessary, a sub-annular resection of asymmetric septal hypertrophy should be carried out prior to placement of the prosthesis.

Clinical challenges and unmet needs in the management of complicated skin and skin structure, and soft tissue infections.

Background: Skin and soft tissue infections remain among the most frequently encountered infections in surgery, and their severity ranges from mild cellulitis to severe, necrotizing infections with high incidences of morbidity and mortality. Most commonly, these disorders result from skin lesions in a susceptible host, but sometimes develop following hematogenous spread from a previously unknown focus.

Methods: The current literature was reviewed to provide an up-to-date summary of the microbiology, diagnosis, pathogenesis, and therapy of complicated skin and soft tissue infections.