BACKGROUND: Both systemic inflammatory reaction and regional myocardial ischemia/reperfusion injury may elicit hypercoagulability after off-pump coronary artery bypass grafting (OPCAB). We investigated the influence of ulinastatin, which suppresses the activity of polymorphonuclear leukocyte elastase and production of pro-inflammatory cytokines, on coagulation in patients with elevated high-sensitivity C-reactive protein (hsCRP) undergoing OPCAB. METHODS: Fifty patients whose preoperative hsCRP > 3.0 mg/L were randomly allocated into the ulinastatin (600,000 U) or control group. Serum concentrations of thrombin-antithrombin complex (TAT) and prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately after surgery, and at 24 h after surgery, respectively. Secondary endpoints included platelet factor (PF)-4, amount of blood loss, and transfusion requirement. RESULTS: All baseline values of TAT, F1+2, and PF-4 were higher than the normal range in both groups. F1+2 was elevated in both groups at immediate, and at 24 h after surgery as compared to baseline value, without any significant intergroup differences. Remaining coagulation parameters, transfusion requirement and blood loss during operation and postoperative 24 h were not different between the two groups. CONCLUSIONS: Intraoperative administration of ulinastatin did not convey beneficial influence in terms of coagulation and blood loss in high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who already exhibited hypercoagulability before surgery.
Antithrombin III ; Blood Platelets ; C-Reactive Protein ; Coronary Artery Bypass, Off-Pump ; Cytokines ; Glycoproteins ; Humans ; Leukocyte Elastase ; Peptide Hydrolases ; Prothrombin ; Reference Values ; Thrombophilia ; Transplants

Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.
Aged ; Blood Pressure ; *Collateral Circulation ; Coronary Artery Bypass, Off-Pump/*methods ; Coronary Artery Disease/physiopathology/*surgery ; *Coronary Circulation ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Norepinephrine/administration & dosage ; Prospective Studies ; Stroke Volume ; Sympathomimetics/administration & dosage ; Thermodilution ; *Ventricular Function, Right

BACKGROUND: Hydroxyethyl starch (HES) effectively restores plasma volume and thereby enhances microcirculation and tissue oxygenation at the expense of coagulation impairment. These effects are related to molecular weight, substitution and C2:C6 ratio. But, most of the studies regarding coagulation impairment in cardiac surgeries were performed in patients undergoing cardiopulmonary bypass which significantly causes coagulation derangements. Therefore, we have evaluated the effects of 2 different HES solutions on tissue oxygenation and postoperative bleeding in patients undergoing off-pump coronary artery bypass surgery (OPCAB). METHODS: Forty four patients were prospectively enrolled. After the induction of anesthesia, either HES 130/0.4 (V group) or 200/0.5 (H group) were infused for fluid therapy to maintain predetermined urine output, cardiac index and filling pressure up to 16 h after the surgery. Tissue oxygenation profiles and respiratory parameters were recorded after induction of anesthesia, completion of distal anastomosis and sternum closure, upon admission at intensive care unit, and 4 h thereafter. The amounts of chest tube drainage, transfusion and fluid balance were measured up to 16 h after the surgery. RESULTS: Patients' demographic data were similar between the groups. Tissue oxygenation profiles, respiratory parameters, hemodynamics, and time to extubate were not different between the groups. However, chest tube drainage and transfusion requirements were significantly less in the V group. CONCLUSIONS: In OPCAB, 6% HES 130/0.4 causes less postoperative bleeding and transfusion requirement and has a comparable efficacy on hemodynamic stability, pulmonary function and tissue oxygenation when compared to 6% HES 200/0.5.
Anesthesia ; Cardiac Output ; Cardiopulmonary Bypass ; Chest Tubes ; Coronary Artery Bypass, Off-Pump* ; Drainage ; Fluid Therapy ; Hemodynamics ; Hemorrhage* ; Humans ; Intensive Care Units ; Microcirculation ; Molecular Weight ; Oxygen* ; Plasma Volume ; Prospective Studies ; Starch* ; Sternum ; Water-Electrolyte Balance

BACKGROUND: We tried to assess whether the presence of warning symptoms and age could be useful indicators for performing endoscopy in patients who suffer from various organic gastrointestinal diseases. METHODS: Between May 2005 to August 2005, 827 subjects who visited the health care center were studied via questionnaires and performing upper endoscopy. The questionnaires evaluated the presence and pattern of dyspepsia and the warning symptoms. RESULTS: A total of 808 patients were enrolled. The mean age of patients was 44.6+/-8.9 years (mean+/-SD) with a male to female ratio of 1.2:1. 153 patients (18.9%) were diagnosed with confirmed organic diseases and 52 patients (6.4%) were diagnosed with definite organic diseases. The total number of organic diseases and definite organic diseases (gastroduodenal ulcer, reflux esophagitis and advanced gastric cancer) was statistically higher in the male population (p=0.001 in both). The relative risk of dyspepsia, the presence of warning symptoms and each warning symptom for the organic disease and definite organic diseases were not consistently higher for the males or females. The males over fifty years and the males over sixty years age had a relative risk of 2.046 (95% CI: 1.27~3.30) and 3.105 (95% CI: 1.39~6.95) for organic disease and 1.913 (95% CI: 0.97~3.77) and 5.333 (95% CI: 2.15~13.22) for definite organic disease, respectively. For the male patients over fifty or sixty years old with dyspepsia or warning symptoms, there were tendencies to increase the relative risk of definite organic disease rather than organic disease. CONCLUSIONS: The relative risk of organic diseases in the presence of warning symptoms in males of over fifty years or sixty years age was not sufficiently significant for differentiating organic diseases. Thus, warning symptoms, old age and presence of dyspepsia alone can not be used as a predictor to guide endoscopic examination.
Delivery of Health Care ; Dyspepsia* ; Endoscopy ; Esophagitis, Peptic ; Female ; Gastrointestinal Diseases ; Humans ; Male ; Ulcer ; Surveys and Questionnaires

Intraoperative transesophageal echocardiography (TEE) during cardiac surgery is an invaluable procedure, which aids hemodynamic management as well as surgical directions. TEE adds valuable information to the assessment of cardiac structures and in contrast to transthoracic echocardiography (TTE), due to its proximity to left atrium (LA), it is especially useful in detection of mass lesions in the LA. The following case describes a patient undergoing aortic valve replacement under cardiopulmonary bypass with low risk of thrombi formation and undetected thrombi in the LA appendage by preoperative TTE. These thrombi could be detected by intraoperative TEE and removed at the same operation, thus avoiding thromboembolic complication and second operation.
Aortic Valve* ; Cardiopulmonary Bypass* ; Echocardiography ; Echocardiography, Transesophageal* ; Heart Atria ; Hemodynamics ; Humans ; Thoracic Surgery ; Thrombosis ; Weaning*

BACKGROUND: Although female gender is associated with higher prevalence of perioperative morbidity and mortality than male gender in conventional coronary artery bypass surgery (CABG) using cardiopulmonary bypass, the impact of gender as an independent risk factor for morbidity and mortality following off-pump CABG (OPCAB) is controversial. Therefore, we prospectively investigated the impact of gender on intraoperative variables and postoperative outcome and complications in OPCAB. METHODS: One hundred patients (69 males and 31 females) undergoing OPCAB by a single cardiac surgeon during 5 months period were prospectively enrolled. Preoperative patient's characteristics, intraoperative hemodynamics and medications and postoperative outcome and complications were recorded during hospital stay. RESULTS: There were no significant differences in preoperative characteristics including age, NYHA class and incidence of concomitant diseases between the male and female groups, except body surface area which was less in the female group. There were no significant differences in intraoperative hemodynamics and use of cardiotonic drugs between the groups. Frequency and amount of blood transfusion were greater, and length of ventilatory care and stay in intensive care unit were longer in female group. Other postoperative outcomes were similar between the groups. CONCLUSIONS: Gender did not significantly affect postoperative outcome, except use of blood products, length of ventilatory care and stay in intensive care unit in OPCAB. These results may be attributable to comparable preoperative patient's characteristics between the groups.
Blood Transfusion ; Body Surface Area ; Cardiopulmonary Bypass ; Cardiotonic Agents ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Female ; Hemodynamics ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Male ; Mortality ; Prevalence ; Prospective Studies ; Risk Factors

BACKGROUND: It is important to assess cardiac preload for management of patients undergoing off pump coronary artery bypass surgery (OPCAB). Recently, several studies have documented the good correlation between right ventricular end-diastolic volume index (RVEDVI) and stroke volume index (SVI), compared with cardiac filling pressures. However, none of these studies have evaluated relationship between predictors of preload and SVI measured with volumetric pulmonary artery catheter during OPCAB. The correlation of continuous RVEDVI and SVI measured with volumetric pulmonary artery catheter during OPCAB was evaluated in this study. METHODS: Fifty three patients undergoing OPCAB were included. Hemodynamic parameters were measured 10 min after induction (T1), 10 min after Y-graft formation started (T2) and 10 min after sternum closure (T3). The correlation of parameters were assessed by simple linear regression. RESULTS: Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) did not correlate with SVI during OPCAB. On the other hand, a statistically significant result was found between RVEDVI and SVI at T2 (r(2)=0.133, P=0.007) and T3 (r(2)=0.380, P < 0.000). But RVEDVI and SVI were weakly correlated. And at T1, RVEDVI and SVI did not correlate. CONCLUSIONS: RVEDVI is a more reliable predictor of preload compared to CVP and PAOP during OPCAB. But in post-induction period (T2), RVEDVI did not correlate with SVI.
Catheters* ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump* ; Hand ; Hemodynamics ; Humans ; Linear Models ; Pulmonary Artery* ; Sternum ; Stroke Volume* ; Stroke*

BACKGROUND: Femoral to radial arterial pressure gradient (deltaP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ?P after CPB in patients undergoing valvular heart surgery. METHODS: Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. RESULTS: After CPB, systolic deltaP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic deltaP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. CONCLUSIONS: Preoperative treatment with RAS-A resulted in clinically significant deltaP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients.
Anesthesia ; Arterial Pressure* ; Body Temperature ; Cardiopulmonary Bypass* ; Heart* ; Hematocrit ; Hemodynamics ; Humans ; Perfusion ; Radial Artery ; Renin-Angiotensin System* ; Sternum ; Thoracic Surgery* ; Vascular Resistance ; Vasodilation

The germination rate and longevity of seeds of Gastrodia elata Blume have been observed for 48 weeks using Mycena osmundicola strain H-21, one of fungi stimulating seed germination. Storage condition of post-harvest seeds was observed in the different temperature ranges of -30degrees C, -5degrees C, 5degrees C and 30degrees C for 48 weeks. After storage period of 48 weeks, the germination rate of G. elata was 65.7% at 5degrees C and 71.6% at -5degrees C, respectively. Although the germination rate of G. elata was 77.3% for 11 weeks at 25degrees C, the germination rate had been decreased gradually to 49.3% at 13 weeks, 0.3% at 23 weeks and then 0% at 25 weeks. The germination rate was reached to the level of 10% for 2 weeks at -30degrees C and then decreased to 0%.
Fungi* ; Gastrodia* ; Germination* ; Longevity

To produce an artificial fruiting body of Armillaria mellea on the oak sawdust medium, seven strains of A. mellea were used. The top surface of oak sawdust medium covered with ground raw carrot was inoculated with each of 7 strains and cultured for 30 days at 25degrees C in the dark condition until the mycelia of A. mellea completely colonized the medium from top to bottom. Then, the mycelia which were fully covered on the top surface of the medium were scratched slightly with a spatula and filled with tap water for 3 hours. To induce the primordial formation, the 7 strains of A. mellea were transferred to the growth chamber under the illumination (350 lux) of 12 hours and relative humidity of 85 +/- 5% in a day and then cultured at 16 +/- 1degrees C. Only A. mellea IUM 949 could form primordia on the sawdust medium, but the other strains did not make primordia at the same condition. The primordia of A. mellea IUM 949 were formed 10 days after complete colonization of the medium and the fruiting bodies were produced 7 days after a primordial formation. The experimental results suggested that IUM 949 strain might be a good candidate for mass production of fruiting bodies of A. mellea.
Armillaria* ; Colon ; Daucus carota* ; Fruit* ; Humidity ; Lighting ; Water