Group B1 Patients Research Articles

Effect of non-surgical periodontal therapy on salivary and gingival crevicular fluid concentration of visfatin in periodontal health and disease

Background and objectiveVisfatin, a pleotropic mediator mostly produced by visceral fat, is crucial in controlling the immunological and defensive systems. It serves the roles of a cytokine, an enzyme involved in energy metabolism, and a growth factor. The objective of the present study was to assess the impact of non-surgical periodontal therapy (scaling and root planing) on visfatin concentrations in saliva and gingival crevicular fluid in individuals with Periodontitis (stage-II grade-A) Materials and methods54 individuals were divided into Group A (Periodontally Healthy) and Group B1(Periodontitis baseline) based on periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and radiographic parameters. After NSPT (SRP), Group B1 patients were recalled after 4 weeks, constituting Group B2 (post NSPT group B1). At baseline and 4 weeks after non-surgical periodontal therapy (SRP), all clinical parameters, salivary and GCF samples were recorded. An ELISA kit was used to measure the levels of visfatin. Using the paired t-test, unpaired t-test, and Pearson's correlation coefficient, data were analysed using SPSS 15. ResultsAfter non-surgical periodontal treatment (SRP), the mean salivary and gingival crevicular fluid concentration of visfatin considerably decreased to a level comparable to periodontal health. In all groups, GCF visfatin concentration was higher than salivary concentration of visfatin. In periodontitis patients, visfatin concentration in GCF was 1.5 times higher than in saliva. ConclusionThe results of this investigation suggest a direct correlation between salivary and gingival crevicular fluid visfatin concentration and periodontal tissue inflammation and disease activity.

How to Perform Intravesical Chemotherapy after Second TURBT for Non-Muscle-Invasive Bladder Cancer: A Single-Center Experience

The objective of this study aimed to explore whether the original IVC regimen should be continued after the second TURBT or whether the IVC induction phase should be restarted from the beginning. A retrospective analysis was performed on 137 patients who underwent a second TURBT at the Affiliated Hospital of Xuzhou Medical University between April 2014 and June 2022. Based on the pathological findings, patients were divided into two groups: group A patients, who did not have a residual tumor on pathological examination after the second TURBT; and group B patients, who had residual tumor. Recurrence was determined using cystoscopy and imaging every three months. The endpoint was recurrence-free survival. In the entire cohort, there was a statistically significant difference in the RFS between patients in the two IVC regimens (p = 0.029). The RFS of patients in group B1 was significantly lower than that of patients in group B2 (p = 0.009). There was no significant difference in RFS between the subgroups A1 and A2 (p = 0.560). Multivariate Cox regression analysis confirmed that the IVC regimen after a second TURBT (p = 0.012) and T stage after a second TURBT (p = 0.005) were both independent predictors for patient RFS. If the pathological findings of the second TURBT specimen is benign, patients can continue their previous treatment regimen without restarting an IVC induction phase. Unnecessary IVC can be avoided in these patients. In contrast, for patients with residual tumors in the second TURBT specimen, the need to restart the IVC induction phase should be emphasized to improve patient prognosis.

Relationship between gut microbiome diversity and hepatitis B viral load in patients with chronic hepatitis B

BackgroundHepatitis B virus (HBV) infection is associated with a reduced risk of developing dyslipidemia and non-alcoholic fatty liver diseases. Given that the gut microbiota plays a significant role in cholesterol metabolism, we compared the differences in gut microbial diversity and composition between HBV-infected and uninfected subjects.ResultsA prospective case–control study was designed comprising healthy controls (group A) and HBV-infected individuals (group B) in a 1:1 ratio (57 participants each; total = 114). The patients in group B were divided into two subgroups according to their HBV DNA loads: B1 < 2000 IU/mL (N = 40) and B2 ≥ 2000 IU/mL (N = 17). In a pairwise comparison of HBV-infected individuals and controls, higher alpha diversity was noted in group B, and the difference was significant only in patients in group B1. Alloprevotella and Eubacterium coprostanoligenes were predominant in group B1 compared to the control, whereas the abundance of Bacteroides fragilis and Prevotella 2 was lower.ConclusionsThe gut microbiome in HBV-infected individuals with a low viral load is highly diverse and is dominated by specific taxa involved in fatty acid and lipid metabolism. To our knowledge, this is the first demonstration of a correlation between the presence of certain bacterial taxa and chronic HBV infection depending on the load of HBV DNA.

Impact of preoperative body mass index on perioperative outcomes is optimized by enhanced recovery protocols in laparoscopic radical cystectomy with intracorporeal urinary diversion.

BackgroundWe aimed to examine whether body mass index (BMI) had an impact on clinical outcomes of laparoscopic radical cystectomy with intracorporeal urinary diversion. Furthermore, we analyzed the optimization of enhanced recovery protocols (ERPs) on the impact of BMI on clinical outcomes.MethodsBy searching our database, data of 83 consecutive patients were retrospectively collected, including 37 patients with a BMI <24 kg/m2 (group A) and 46 patients with a BMI ≥24 kg/m2 (group B). The baseline and peri-operative variables of the two groups were compared. Subgroup analysis was conducted for ERPs (11 patients in group A1, 18 patients in group B1) and conventional recovery protocols (CRPs; 26 patients in group A2, 28 patients in group B2). The primary outcomes were 30-day overall complication rate and ΔALBmin (reduction proportion of minimum albumin). The secondary outcomes were operative time and length of stay.ResultsThe baseline variables were similar between the two groups (P>0.05). The 30-day overall complication rate, operative time, and length of stay were similar between the two groups (P>0.05). But post-operative nausea and vomiting (PONV) was higher in group A than in group B (32.4% vs. 8.7%, P=0.014). Group A was associated with lower serum albumin level pre-operatively and on post-operative days 1–3. ΔALBmin was higher in group A than in group B (33.08%±9.88% vs. 27.92%±8.52%, P<0.05). In the subgroup analysis, the CRPs group presented similar results, with group A2 showing higher PONV rate, lower albumin level pre- and post-operatively, and higher level of reduction proportion (P<0.05). For the ERPs group, the PONV rate, pre-operative albumin level, and reduction proportion were similar between group A1 and B1 (P>0.05). Multivariable analysis showed that PONV and CRPs were independently associated with ΔALBmin ≥34% (P<0.05).ConclusionsBMI had no impact on the 30-day overall complication rate, operative time, and length of stay of patients who underwent laparoscopic radical cystectomy with intracorporeal urinary diversion. BMI <24 kg/m2 was associated with higher PONV rate and more albumin loss, both of which could be optimized by ERPs.

Influence of periodontal treatment on blood microbiotas: a clinical trial.

ObjectiveTo investigate the effects of periodontal treatment on the abundance and diversity of blood microbiota.Methods and MaterialsTwenty-seven periodontitis patients were randomly allocated to a control group (A) and two test groups (B1 and B2). Group A patients received full-mouth scaling and root planing (SRP), group B1 patients received subgingival glycine air polishing (GAP) right after SRP, and group B2 patients received subgingival glycine air polishing right before SRP. Peripheral blood samples were obtained at the baseline, the day after periodontal treatment, and 6 weeks after treatment and evaluated using nested polymerase chain reaction and 16SrRNA Gene Sequencing (Miseq platform).ResultsAll participants exhibited significant improvements in the clinical parameters evaluated at the 6-week follow-up visit compared to the values at the baseline, but no significant differences were observed between the three groups. The total bacterial count was lowest in group B2. The bacterial species diversity (α-diversity) in group B1 was significantly higher (Chao-1 index, P = 0.03) and Porphyromonas and Pantoea were the dominant genera (linear discriminant analysis (LDA > 2)) in this group the day after treatment compared to the baseline. No significant difference was detected in the relative abundance and α-diversity of blood microbiota between the baseline and 6 weeks after treatment.ConclusionLocal periodontal treatment merely disrupts the stability of blood microbiota in the short term. Periodontitis treatment using full-mouth SRP followed by adjunctive GAP is a promising approach to reduce the introduction of bacteria into the bloodstream during the procedure.

Timing day-3 vitrification for PGT-M embryos: pre- or post-blastomere biopsy?

To assess the efficacy and clinical outcomes of preimplantation genetic testing for monogenic diseases (PGT-M), following blastomere biopsy prior or following vitrification. A cohort-historical study of all consecutive patients admitted to IVF in a large tertiary center for PGT-M and PCR cycle from September 2016 to March 2020. Patients were divided into 4 groups: Group A1 consisted of patients undergoing day-3 embryos biopsy followed by a fresh transfer of unaffected embryos. Group A2 consisted of Group A1 patients that their surplus unaffected embryos were vitrified, thawed, and transferred in a subsequent FET cycle. Group B1 consisted of patients that their day-3 embryos were vitrified intact (without biopsy) for a subsequent FET cycle. Later embryos were thawed and underwent blastomere biopsies, and the unaffected embryos were transferred, while the surplus unaffected embryos were re-vitrified for a subsequent FET cycle. Group B2 consisted of Group B1 patients that their surplus unaffected embryos were re-vitrified, thawed, and transferred in a subsequent FET cycle. The laboratory data and clinical results were collected and compared between groups. A total of 368 patients underwent 529 PGT-M cycles in our center: 347 with day-3 embryos biopsied before undergoing vitrification (Group A1) and 182 following vitrification and thawing (Group B1). There were no between group differences in embryo survival rate post-thawing, nor the ongoing implantation and pregnancy rates. In PGT-M cycles, the timing of embryos vitrification, whether prior or following blastomere biopsy, has no detrimental effect on post-thawing embryo survival rate, nor their potential ongoing implantation and pregnancy rates.

Effect of the wide-spread use of endovenous laser ablation on the treatment of varicose veins in Japan: a large-scale, single institute study.

Background and aims: In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Subjects and methods: Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density [LEED], and the incidence of surgical site infections [SSI]) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Results: Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm2, respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ±7 minutes, which was statistically significant (p<0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. Conclusions: This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is >20 mm or in patients with highly tortuous veins.

Dynamic measurement of patello-femoral joint alignment using weight-bearing magnetic resonance imaging (WB-MRI)

ObjectiveAim of our work was to compare standard and weight-bearing WB-MRI to define their contribution in unmasking patello-femoral (PF) maltracking and to define what measurement of patellar alignment is the most reliable. MethodsWe prospectively collected 95 non consecutive patients, clinically divided into 2 groups: group A (the control group), including 20 patients (negative for patellar maltracking), and group B including 75 patients (positive for patellar maltracking). The patients underwent a dedicated 0.25T MRI, in supine and WB position, with knee flexion of 12–15°. The following measurements were performed: Insall-Salvati index (IS), lateral patellar displacement (LPD), lateral patello-femoral angle (LPA) and lateral patellar tilt (LPT). Quantitative and qualitative statistical analyses were performed to compare the results obtained before and after WB-MRI. Measurements were subsequently performed on both groups. ResultsGroup A patients showed no statistically significant variations at all measurements both on standard and WB-MRI. On the basis of measurements made on standard MRI, group B patients were divided into group B1 (23 patients) (negative or positive at 1 measurement) and group B2 (52 patients) (positive at 2 or more measurements). After WB-MRI, group B1 patients were divided into group B1a (6 patients), in case they remained positive at 0/1 measurement, and group B1b (17 patients), in case they became positive at 2 or more measurements. All group B2 patients confirmed to be positive at 2 or more measurements at WB-MRI. Quantitative statistical analysis showed that LPT and LPA were the most reproducible and clinically useful measurements. Qualitative statistical analysis performed on standard and WB-MRI demonstrated that LPT was the best predictive measurement. ConclusionsThis study demonstrates both the high diagnostic value of WB-MRI in unmasking PF-maltracking and the best predictive value of LPT measurement.

Pulmonary endarterectomy combined with cardiac surgery: A 7-year retrospective analysis

BackgroundPulmonary artery endarterectomy (PEA) is established as a successful method for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). A significant fraction of patients indicated for the pulmonary endarterectomy has other severe comorbidities that generally increase the risk of cardiac surgery. The aim of our study is to analyze the process of indications and therapeutic procedures at our Cardio-Centre, as well as comparing hemodynamic parameters and long-term results in order to determine the continuation of the treatment. MethodFrom September 2004 to August 2012, 192 patients underwent PEA for CTEPH. We carried out a retrospective analysis of patients’ data. Patients were divided into two groups: A and B. The group A included patients with PEA only (128 patients), group B consisted of patients with PEA and other cardiac procedure (64 patients, i.e. 33.3% of which 72 cardiac procedures were carried out). Group B was further subdivided into group B1-patients with PEA+CABG, which included 25 patients, and group B2-PEA+suture of PFO, which consisted of 29 patients for more detailed analysis. ResultsFive-year survival rate is 83% in group A, 79.3% in group B, and 63.1% in group B1. Group B1 is statistically significantly different from group A (P=0.031). The cumulative survival rate is comparable for groups A and B2. Cumulative survival rate is very good with annual survival in group A – 94%, group B2 – 90% and group B1 – 82.6%. ConclusionResults of combined interventions are comparable with isolated pulmonary endarterectomy. We did not find any differences in hemodynamic effects. All patients indicated for the PEA should be screened for the most common comorbidities regardless of their age. We recommend implementation CryoMAZE for the treatment of atrial fibrillation or atrial flutter.

38 * Effectiveness of ECG-based triage in older patients with TLoC attending a rapid access blackouts triage clinic: conduction tissue abnormalities predict a higher mortality, recurrent TLoC and a good response to cardiac pacing

Introduction: Transient loss of consciousness (TLOC) is common and increasing rapidly with a rising burden on health care expenditure. It often leads to hospitalisation in the elderly population. In the elderly, electrocardiographic (ECG) findings suggesting conduction tissue disease are frequently found, but it is not always clear if they accurately represent the underlying cause of TLOC. We therefore compared outcomes in elderly patients attending the rapid access blackout clinic (RABTC) with conduction tissue abnormalities (ECG-CTA) with patients attending with a normal ECG. Methods: Our twice-weekly RABTC is staffed by specialist nurses and a cardiologist. Detailed clinical assessment is given using a secure web-based 13 page RABTC Assessment Tool. Risk is assessed with 8 “Red Flags”, which include an abnormal ECG. We sequentially selected 85 patients with normal ECG, Group A, and 65 patients with ECG-CTA, Group B, >65 years of age, presenting to RABTC between 1st January 2007 till 1st January 2013 where all had 3 years of follow-up. Group B patients had ECG-CTA (38 had first degree AV block, 15 had left axis deviation, 8 had Right Bundle branch block, 14 had Left bundle branch block,). Results: 2586 patients were assessed in the RABTC during the period. Mean age 56±10 yrs, 51% female (F). Group A, Age 75±7sd, 62% F, Group B Age 77±8sd, 51% F. The rate of recurrent TLOC was higher in Group B, (73% v 81%, P<0.004), significant injury/fracture was similar, (45% v 51%), use of implantable ECG recorders was similar, (26 v 24%), and annual rate of hospital admission was similar, (1.77 v 2.25 /patient/year). 12 Group A patients received pacemakers, and 31 Group B patients (Group B1). Amongst Group B1 patients, pacing relieved symptoms and prevented re-admission in 20 (64%). Three-year all cause mortality overall in Group A was 6% and in Group B 15% (p<0.03), but pacing did not seem to alter mortality risk (Group B1=14%, Group B2=16%, ns) Conclusion: Amongst TLOC patients referred to an RABTC for clinical and ECG assessment, baseline characteristics are similar, but the finding of ECG-CTA confers a poor outcome. Pacing appears to reduce admission and relieve symptoms but not mortality.

Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome

No consensus has been formed on the optimal treatment strategy for the prognosis of patients with inguinal lymph node (ILN) metastasis from lower rectal adenocarcinoma. We, therefore, retrospectively analyzed outcomes of patients with ILN metastasis from lower rectal adenocarcinoma. Of 323 patients with lower rectal adenocarcinoma treated at a single institution between November 1993 and March 2010, 10 had synchronous or metachronous ILN metastasis, as confirmed by curative resection (R0) of the primary lesion. Outcomes of these 10 patients were assessed. The 10 patients with ILN metastasis were divided into two groups: group A (two patients who did not undergo ILN resection surgery because of metastases at other sites) and group B (eight patients with no other metastases who underwent surgery). Both patients in group A, with median overall survival of 5.2 months, died due to the other metastases, whereas five out of eight patients in group B survived (P = 0.001). Group B patients were further subclassified into synchronous (group B1) and metachronous (group B2) metastasis (n = 4 each) groups. Two patients in group B1 died of other metastases, which was diagnosed later, whereas three patients in group B2 survived. Some patients with isolated inguinal lymph node metastasis show a good prognosis after lymph node excision and, therefore, should be treated surgically. Patients with metachronous metastases have a better prognosis than patients with synchronous ILN metastases. Nevertheless, assessment of additional patients for prognosis and treatment strategy is warranted.

The prognostic role of serum uric acid level in patients with acute ST elevation myocardial infarction

ObjectivesThe role of uric acid as a prognostic factor in patients with acute ST elevation myocardial infarction is controversial. The purpose of this study was to demonstrate the relationship between serum uric acid level and mortality during admission period and 30-day period after admission. MethodsWe assessed the relation between serum uric acid level and in-hospital and short-term mortality rates in 184 patients admitted with acute ST elevation myocardial infarction. We divided the patients according to their gender and uric acid level measured on admission into four groups: group A1: men with uric acid ⩽7mg/dl versus group B1: men with uric acid >7mg/dl and group A2: women with uric acid ⩽5.6mg/dl versus group B2: women with uric acid >5.6mg/dl. The patients were followed for 30days after admission. ResultsIn-hospital mortality rate in group B1 was higher than group A1 [P value: 0.011, Relative risk: 13.33 (95% confidence interval: 1.55–114.7)]. Short-term all-cause mortality was significantly higher in group B1 patients [P value: 0.037, Relative risk: 3.3 (95% confidence interval: 1.02–10.64)]. Multivariate logistic regression analysis of data showed an odds ratio of 15.23 for in-hospital mortality and odds ratio of 3.76 for short-term mortality in male hyperuricemic patients. ConclusionsOur data suggest that in the acute phase of ST elevation myocardial infarction, uric acid has a prognostic role for in-hospital and short-term (30-day) mortality in men.

Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma

To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function, postoperative complications and cancer prognosis. We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993, Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006, Group B), and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)]. Additionally, only in limited patients in Group B1 and Group B2 with intraoperative blood loss ≥ 2000 mL (Group B1(≥ 2000 mL) and Group B2(≥ 2000 mL)), postoperative complications, liver function tests, and cancer prognosis were compared. No mortality was registered in Group B, compared to 8 patients (3.9%) of Group A. The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)]. The incidence of complications and postoperative liver function tests were comparable between Group B1(≥ 2000 mL) vs Group B2(≥ 2000 mL). Postoperative prognosis did not correlate with administration of FFP, but with tumor-related factors. The outcome of hepatectomy for HCC is not influenced by FFP transfusion. We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.

Clinical Score and Transcript Abundance Patterns Identify Kawasaki Disease Patients Who May Benefit From Addition of Methylprednisolone

Intravenous immunoglobulin (IVIG) treatment-resistant patients are high risk of developing coronary artery lesions with Kawasaki disease. The IVIG-responsive (Group A; n = 6) and IVIG-resistant patients (Group B) were predicted before starting the initial treatment using the Egami scoring system and randomly allocated as a single-IVIG treatment group (group B1; n = 6) or as a IVIG-plus-methylprednisolone (IVMP) combined therapy group (group B2; n = 5). We investigated the transcript abundance in the leukocytes of those patients using a microarray analysis. Five patients in group A and one patient in group B1 responded to initial IVIG treatment. All group B2 patients responded to IVIG-plus-IVMP combined therapy. Before performing these treatments, those transcripts related to IVIG resistance and to the development of coronary artery lesions, such as IL1R, IL18R, oncostatin M, suppressor of cytokine signaling-3, S100A12 protein, carcinoembryonic antigen-related cell adhesion molecule-1, matrix metallopeptidase-9, and polycythemia rubra vera-1, were more abundant in group B patients in comparison with group A patients. Moreover, those transcripts in group B2 patients were more profoundly and broadly suppressed than group B1 patients after treatment. This study elucidated the molecular mechanism of the effectiveness of IVIG-plus-IVMP combined therapy.

Impact of Risk Organ Involvement on Outcome in Langerhans Cell Histiocytosis (LCH)

Objectives: To compare the outcome in children with low risk vs. risk LCH and to evaluate the impact of individual risk organ on outcome.Material and Methods: Medical records of 52 patients were reviewed retrospectively (1992 to 2007). Patients were classified into 2 groups: A-low risk (bone, skin and lymph node involvement), B-risk patients (lungs, liver, spleen and bone marrow involvement). Group B further subdivided in B1-isolated lung involvement, B2-liver, bone marrow or both without lung, B3-lung involvement with liver and/or bone marrow. Patients were treated as per histiocytosis society protocols.Results: There were 31 Males and 21 Females. Mean age at presentation was 4.8 yrs (range 1 month to 15.5 yrs). There were 21 patients in Group A and 31 in Group B with 0 (0%) and 6 (19%) deaths respectively. Overall mortality was 6/52 (11.5%). In group A, 6 patients had skin and lymph node involvement, 6 had unifocal bony involvement and 9 multifocal. Out of these 15 (bony involvement) patients 4 had otitis media and 5 diabetes insipidus. There were 9 patients in Group B1, 18 in Group B2 and 4 in Group B3 with mortality of 0 (0%), 4 (22.2%) and 2 (50%) respectively. Comparison of mortality in risk patients vs. low risk patients approached statistical significance (19.4% vs. 0%, p=0.069). Mortality difference within the 3-subgroups of risk patients was not statistically significant (p=0.097).Conclusion: Outcome is worse if risk organs are involved. However, isolated lung involvement had trend towards better outcome.

A Comparison of the Use of Several Concentrations of Bupivacaine with Epidural Volume Extension during Combined Spinal-epidural Anesthesia in Total Knee Replacement

Background: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. Methods: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Results: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. Conclusions: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement. (Korean J Anesthesiol 2007; 53: 593～7)

Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization

Background. The impact of aortic manipulation on incidence of cerebrovascular accidents (CVAs) was evaluated in patients who underwent myocardial revascularization. Methods. From January 1988 to December 2000, 4,875 patients had coronary operations; 33 who survived less than 24 hours and 19 who had aortic cannulation without cross-clamping were excluded. According to the degree of aortic manipulation, patients were divided into two groups: group A, aortic cannulation, cross-clamping, with (A1, n = 597) or without (A2, n = 2,233) side-clamping, and group B, with (B1, n = 460) or without (B2, n = 1,533) side-clamping. Patients in group A (n = 2,830) were operated on with and patients in group B (n = 1,993) were operated on without cardiopulmonary bypass (CPB). Univariate and multivariate analyses were applied to identify independent predictors of higher incidence of CVAs. Results. Forty-nine patients (1.0%) had a postoperative CVA, 24 early and 25 delayed, with a 30-day mortality of 34.7%. Independent CVA predictors were low output syndrome, presence of extracoronary vasculopathy, conversion from off to on pump, and any aortic manipulation. This latter risk factor was significant in patients with extracoronary vasculopathy, but not in patients without. Side-clamping was not a risk factor in patients operated on with CPB, but it was in no-CPB cases. Patients in group B1 had the same CVA incidence as patients in group A2. Therefore CPB, per se, was not a risk factor for higher CVA incidence. Conclusions. Aortic manipulation must be avoided in patients with extracoronary vasculopathy. Maintenance of a good hemodynamic status is crucial for any patient to reduce CVA incidence. Patients with extracoronary vasculopathy are at higher risk, and a correct surgical strategy should be tailored for each case. In no-CPB cases use of side-clamping provides the same CVA risk as in patients in whom CPB, aortic cannulation, and cross-clamping were used.

Effects of a short-term suspension of hormone replacement therapy on mammographic density

Objective: To evaluate the effects of hormone replacement therapy (HRT) and of a short-term suspension of HRT on mammographic density. Design: Prospective clinical study. Setting: Outpatient menopausal clinic of the Second University of Naples. Patient(s): Ninety-seven healthy postmenopausal women. Intervention(s): Thirty-nine menopausal women with intact uterus (group A) were treated with continuous transdermal E 2 plus acetate nomegestrolo sequentially added, 37 women in surgical menopause (group B) were treated with transdermal E 2 continuously administered, and 21 menopausal women did not receive any medication (group C). At the entry and after 12 months, a mammography was performed without suspension of HRT (group A1: 19 women; group B1: 19 women) or after a short-term suspension (group A2: 20 women; group B2: 18 women). Main Outcome Measure(s): Mammographic density evaluated according to a quantitative method. Result(s): At the second mammography, seven patients in group A1, four patients in group B1, and one patient in both groups A2 and B2 showed an increase in mammographic density, whereas no mammographic density increase was observed in patients in group C. A statistically significant difference in the mammographic density increase was found between group A1 and group A2; no difference was found between group B1 and B2. Conclusion(s): Suspension of HRT for about 3 weeks may reverse mammographic density increase associated with its use.

Comparison of zidovudine and zidovudine-thymostimulin in the long-term treatment of patients with asymptomatic human immunodeficiency virus infection and persistent generalized lymphadenopathy

Given the positive results of the TP1-AZT Multicenter Study (TAMS), a second stage of the study was undertaken. The goal of this second study was to confirm the therapeutic efficacy and clinical and immunologic effects of the combination of low-dose zidovudine (AZT) and thymostimulin (TP1) in a larger number of patients infected with human immunodeficiency virus (HIV) belonging to Centers for Disease Control and Prevention (CDC) group 2 (patients with asymptomatic HIV infection) and group 3 (patients with persistent generalized lymphadenopathy). A total of 248 HIV-positive patients were divided into two groups. Group A consisted of 123 CDC group 2 patients and group B consisted of 125 CDC group 3 patients. Each group was divided into two subgroups according to pharmacologic therapy. Subgroups A1 (n = 62) and B1 (n = 61) were treated with AZT (500 mg/d); subgroups A2 (n = 61) and B2 (n = 64) were treated with AZT (500 mg/d) + TP1 (70 mg/d intramuscularly for 1 week and then 70 mg intramuscularly three times per week). Clinical evaluations and routine hematochemical tests were checked every 15 days during the first month, every month during the following 2 months, and then every 3 months up to the end of the follow-up period (17 ± 3 months). In group A, a significant increase in T cells, subset CD4+, was observed in the group treated with AZT + TP1: this difference was statistically significant compared with both the pretreatment values (+7.6%, P < 0.001) and the AZT-treated group (+13.5%, P < 0.001). At the end of the follow-up period, a significant difference in the white blood cell (WBC) count between groups A1 and A2 was noted (+15% in group A2 [P < 0.001 vs baseline values], and −28% in group A1 [ P < 0.001 vs baseline values and P < 0.001 vs group A2]). Oral candidiasis was the only opportunistic infection observed in the group A patients. None of the patients in the two group A subgroups progressed to acquired immunodeficiency syndrome (AIDS). In group B, a significant increase in T cells, subset CD4+, was observed in patients treated with AZT + TP1; the difference was statistically significant compared with both the pretreatment values (+9.3%, P < 0.001) and the AZT-treated group (+13.7%, P < 0.001). In the AZT-treated group, a significant myelodepression was observed. At the end of the follow-up period, a difference was noted between groups B1 and B2 in blood cell counts, with a significant increase seen in the AZT + TP1-treated group (red blood cells, +8.1%, P < 0.001; WBC, +15%, P < 0.001; and platelets, +30%, P < 0.001). Opportunistic infections were observed in 14 (22.9%) patients in group B1 and 9 (14.1%) patients in group B2 (relative risk ratio, 0.64; 95% confidence interval, 0.27–0.82; P < 0.001). Progression to AIDS was observed in five (8.2%) patients in group B1 and two (3.1%) patients in group B2 (relative risk ratio, 0.40; 95% confidence interval, 0.22–0.70; P < 0.05). These results suggest that the combination of AZT and TP1 may be useful in the early stages of HIV infection, particularly in HIV-positive patients with levels of CD4+ T cells ⩾400/mm 3 and <600/mm 3. AZT + TP1 significantly improved cell-mediated immunity parameters and decreased the incidence of opportunistic infections. In the more advanced stages of HIV infection, AZT + TP1 may have a positive effect on immunologic and hematologic parameters and reduce the myelodepressive effect of long-term treatment with AZT.

Assessment of relationship between the pattern of hypertrophy and the function of left ventricle in patients with chronic aortic regurgitation.

Pre- and postoperative echocardiograms of 64 patients with chronic aortic regurgitation who had undergone isolated aortic valvular replacement (AVR) were studied. These patients were divided into 3 groups as follows: (1) Group A patients who had preoperative end-diastolic radius to wall thickness ratio (R/Thd) less than or equal to 3. (2) Group B1 patients who had preoperative R/Thd greater than 3 and end-systolic radius to wall thickness ratio (R/Ths) less than 2. (3) Group B2 patients who had preoperative R/Thd greater than 3 and R/Ths greater than or equal to 2. Using this classification we assessed the relation between the pattern of hypertrophy and left ventricular (LV) function and the reversibility of LV dysfunction following AVR. Preoperatively, ejection fraction (EF) during handgrip exercise was unchanged in Group A (% delta EF: -2.8 +/- 7.1%) and significantly decreased in Groups B1 (-17.0 +/- 5.8%) and B2 (-20.2 +/- 4.6%). In the late postoperative period, however, it was, -1.2 +/- 3.3%, -2.0 +/- 4.6%, and -17.7 +/- 8.6% in Groups A, B1, B2, respectively. Preoperatively the slope of end-systolic wall stress/volume (ESWS-ESV relation was 1.96 +/- 0.43 in Group A (p less than 0.01 vs Group B2, NS vs Group B1), 1.54 +/- 0.38 in Group B1 (NS vs Group B2) and 1.17 +/- 0.47 in Group B2. It was stressed that a good relationship existed between the pattern of hypertrophy and function as well as the reversibility of LV dysfunction following AVR.