Publications by authors named "Erling Aarsaether"

17 Publications

  • Page 1 of 1

Improvement in early continence after introduction of periurethral suspension stitch in robotic prostatectomy.

J Robot Surg 2021 Oct 14;15(5):679-686. Epub 2020 Oct 14.

Department of Urology, University Hospital of North Norway, 9038, Tromsø, Norway.

Early urinary incontinence remains a major source of morbidity for patients undergoing robotic prostatectomy. The purpose of the study was to determine whether the introduction of a suspension stitch would improve early urinary continence rates in patients undergoing robotic prostatectomy for localized prostate cancer at our department. We retrospectively reviewed patients undergoing robotic prostatectomy with either suspension (n = 119) or figure-of-eight (n = 48) stitching of the dorsal venous complex. The patients submitted EPIC-26 questionnaires before surgery and after 3 and 18 months, respectively. Logistic regression analysis was run to determine the effect of the suspension stitch, nerve-sparing, posterior reconstruction, prostate volume, age and body mass index on early continence rate. The odds ratio of experiencing urinary leaks was 2.1 times higher (95% CI 1.0-4.3) in the figure-of-eight stitch group compared to the suspension stitch group 3 months after surgery (p < 0.05). The early urinary continence rate was 61.3% in the suspension stitch group compared to 35.4% in the figure-of-eight stitch group (p < 0.005). There were no differences between the groups 18 months post-prostatectomy (90.7% in the suspension stitch group versus 81.4% in the non-suspension stitch group, p = 0.1). Ordinal regression analysis identified the suspension stitch, bilateral nerve-sparing and body mass index as independent predictors of urinary continence at 3 months. The association between urinary continence and either unilateral nerve-sparing, posterior reconstruction, prostate volume or age did not reach statistical significance. Our results suggest that the suspension stitch improved early urinary continence following robotic prostatectomy.
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http://dx.doi.org/10.1007/s11701-020-01156-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423698PMC
October 2021

Hoffmann's syndrome necessitating forearm fasciotomy: a case report.

J Med Case Rep 2020 Mar 2;14(1):38. Epub 2020 Mar 2.

Department of Urology and Endocrine Surgery, University Hospital of North Norway, Tromsø, Norway.

Background: Hoffmann's syndrome is a rare form of hypothyroid myopathy. Only a few cases of fasciotomy in this setting have previously been reported.

Case Presentation: A 41-year-old Caucasian man under treatment for hypothyroidism presented with acute-onset severe pain in his forearm for no obvious reason and was admitted to our emergency room. He eventually developed compartment syndrome which necessitated surgical decompression. Soon after surgery he complained of similar symptoms in his calves. By the time his hypothyroid status was confirmed, conservative treatment and orally administered levothyroxine gradually made the pain from his calves disappear, without further surgical treatment.

Conclusion: Hoffmann's syndrome may precipitate a compartment syndrome in the absence of trauma.
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http://dx.doi.org/10.1186/s13256-020-2351-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050128PMC
March 2020

Isoflurane Increases Tolerance to Renal Ischemia Reperfusion Injury Compared to Propofol: An Experimental Study in Pigs.

J Invest Surg 2021 Apr 9;34(4):359-365. Epub 2019 Jul 9.

Department of Urology, University Hospital of North Norway, Tromso, Norway.

To compare two clinically relevant anesthetic agents, i.e., isoflurane versus propofol with respect to protection of the kidney in a porcine renal ischemia reperfusion model. 14 hybrid pigs were randomized to anesthesia with either isoflurane or propofol prior to laparoscopic surgery. Following anesthesia, the left kidney hilum was clamped for 60 min and the right kidney removed. After 48 h of reperfusion, urine was sampled for analysis of neutrophil gelatinase-associated lipocalin (NGAL), albumin, and creatinine. The left kidney was harvested for histologic scoring of injury. Histologic examination of renal injury revealed a statistically significant difference in favor of isoflurane on denuded basement membrane score (isoflurane group 1.58 ± 0.38 vs. propofol 2.42 ± 0.80,  = .026). Median (25-75 percentile) urinary albumin 3.4 g/L (2.25-7.48) vs. 8.9 g/L (3.73-13.8), ( = .041) and urinary albumin/creatinine ratio 1.17 (0.76-1.82) vs. 1.76 (1.63-5.99), ( = .026) were both significantly lower in the isoflurane group. Median (25-75 percentile) urinary NGAL was 167 (51-215) pg/ml in the isoflurane group compared with 362 (149-508) pg/ml in the propofol group ( = .093). Isoflurane increases tolerance to renal ischemia reperfusion injury compared to propofol in this model.
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http://dx.doi.org/10.1080/08941939.2019.1637038DOI Listing
April 2021

The influence of frame rate on two-dimensional speckle-tracking strain measurements: a study on silico-simulated models and images recorded in patients.

Eur Heart J Cardiovasc Imaging 2015 Oct 9;16(10):1137-47. Epub 2015 Mar 9.

Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.

Aims: Ultrasound-derived myocardial strain can render valuable diagnostic and prognostic information. However, acquisition settings can have an important impact on the measurements. Frame rate (i.e. temporal resolution) seems to be of particular importance. The aim of this study was to find the optimal range of frame rates needed for most accurate and reproducible 2D strain measurements using a 2D speckle-tracking software package.

Methods And Results: Synthetic two dimensional (2D) ultrasound grey-scale images of the left ventricle (LV) were generated in which the strain in longitudinal, circumferential, and radial direction were precisely known from the underlying kinematic LV model. Four different models were generated at frame rates between 20 and 110 Hz. The resulting images were repeatedly analysed. Results of the synthetic data were validated in 66 patients, where long- and short-axis recordings at different frame rates were analysed. In simulated data, accurate strain estimates could be achieved at >30 frames per cycle (FpC) for longitudinal and circumferential strains. Lower FpC underestimated strain systematically. Radial strain estimates were less accurate and less reproducible. Patient strain displayed the same plateaus as in the synthetic models. Higher noise and the presence of artefacts in patient data were followed by higher measurement variability.

Conclusion: Standard machine settings with a FR of 50-60 Hz allow correct assessment of peak global longitudinal and circumferential strain. Correct definition of the region of interest within the myocardium as well as the reduction of noise and artefacts seem to be of highest importance for accurate 2D strain estimation.
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http://dx.doi.org/10.1093/ehjci/jev058DOI Listing
October 2015

Strategies to improve quality of life in bladder cancer patients.

Expert Rev Pharmacoecon Outcomes Res 2014 Aug 12;14(4):537-44. Epub 2014 May 12.

Department of Urology and Endocrine Surgery, University Hospital of North Norway, N-9038 Tromsø, Norway.

Bladder cancer is a heterogeneous disease that includes both tumors with low risk of dissemination as well as highly malignant tumors with a considerable potential to metastasize. The patient's quality of life is closely related to the management of the disease. The challenge for the urologist is to acknowledge the malignant potential of the cancer and to adjust the approach to the patient accordingly. Patients with low-risk bladder cancer should avoid an exaggerated follow-up, but on the other hand high-risk patients must be sufficiently surveyed to secure that definitive surgical treatment is performed before it's too late. When the decision to perform a cystectomy has been made, it is crucial that the patient understands the consequences of the surgery as well as the possible options for urinary reconstruction. This review focuses on aspects of bladder cancer management that we believe are vital for the quality of life of these patients.
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http://dx.doi.org/10.1586/14737167.2014.917967DOI Listing
August 2014

Enhanced recovery after surgery: are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy?

Eur Urol 2014 Feb 22;65(2):263-6. Epub 2013 Oct 22.

Academic Urology Unit, University of Sheffield, Sheffield, UK.

Enhanced recovery after surgery (ERAS) for radical cystectomy seems logical, but our study has shown a paucity in the level of clinical evidence. As part of the ERAS Society, we welcome global collaboration to collect evidence that will improve patient outcomes.
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http://dx.doi.org/10.1016/j.eururo.2013.10.011DOI Listing
February 2014

Telemedical technologies in urological cancer care: past, present and future applications.

Expert Rev Anticancer Ther 2013 Jul;13(7):795-809

Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway.

Since the initial development of telegraphy by Sir Charles Wheatstone in 1837 and the telephone by Alexander Graham Bell in 1875, doctors have been able to convey medical information across great distances. The exchange and sharing of medical information has evolved and adapted to suit the vast array of today's medicine. Early adopters of telemedicine within clinical practice have gained significant health economic benefits. The arrival of wireless connections has further enhanced the possibilities for all clinical work with focus on diagnosis, treatment and management of urological cancers, as highlighted in this article.
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http://dx.doi.org/10.1586/14737140.2013.811036DOI Listing
July 2013

Peak longitudinal strain most accurately reflects myocardial segmental viability following acute myocardial infarction - an experimental study in open-chest pigs.

Cardiovasc Ultrasound 2012 May 29;10:23. Epub 2012 May 29.

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway.

Background: The extension and the transmurality of the myocardial infarction are of high predictive value for clinical outcome. The aim of the study was to characterize the ability of longitudinal, circumferential and radial strain measured by 2-dimensional speckle tracking echocardiography (2D-STE) to predict the extent of necrosis in myocardial segments following acute myocardial infarction and to separate transmural necrotic segments from non-transmural necrotic segments in a full 18-segment porcine model.

Methods: 2D-STE strain was assessed in long- and short-axis following myocardial infarction in ten open-chest anesthetized pigs. Strain was defined according to systolic peak values. In segments displaying both negative and positive peaks, only the peak with the highest absolute value was utilized. Necrosis was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining and expressed as percent of each myocardial segment.

Results: Significant correlations were found between the extension of necrosis and all measured parameters of myocardial deformation (p < 0.001), but was stronger for longitudinal strain (r(2) = 0.52) than circumferential strain (r(2) = 0.38) and radial strain (r(2) = 0.23). The area under the receiver operator characteristic curve (AUC) for separating transmural necrotic segments (>50% necrosis) from predominantly viable segments (0-50% necrosis) was significantly larger for longitudinal strain (AUC = 0.98, CI = 0.97-1.00) when compared with circumferential strain (AUC = 0.91, CI = 0.84-0.97, p < 0.05) and radial strain (AUC = 0.90, CI = 0.83 - 0.96, p < 0.01), indicating a stronger ability of longitudinal strain to identify segments with transmural necrosis.

Conclusion: Peak strain values derived from 2D-STE correlate well with the extent of necrosis in myocardial segments following acute myocardial infarction. Longitudinal strain most accurately reflects myocardial segmental viability in this setting.
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http://dx.doi.org/10.1186/1476-7120-10-23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404936PMC
May 2012

Oral β-glucan reduces infarction size and improves regional contractile function in a porcine ischaemia/reperfusion model.

Eur J Cardiothorac Surg 2012 Apr 6;41(4):919-25. Epub 2012 Jan 6.

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway.

Objectives: We previously reported a cardioprotective effect of oral β-glucan in patients who underwent coronary artery bypass grafting. The present study was conducted to determine whether oral β-glucan could reduce myocardial infarction size and whether these changes would be reflected by better preservation of contractile indices measured by speckle tracking echocardiography (STE).

Methods: Fourteen pigs were randomized to receive oral β-glucan 50 mg/kg (n = 7) or placebo (control, n = 7) 10 days before they were anaesthetized and subjected to 1 h clamping of the left anterior descending coronary artery followed by reperfusion for 3 h. Longitudinal strain, circumferential strain and radial strain were assessed by STE after 3 h of reperfusion. Infarction size and area at risk were determined by Evans blue and 2,3,5-triphenyltetrazolium chloride staining.

Results: Pretreatment with β-glucan reduced the infarct area/area at risk ratio by 36% (P < 0.05) and the total necrotic area of the left ventricle by 37% (P < 0.05) compared with controls. Viable myocardium at risk was 30% higher in the β-glucan vs. control group (P < 0.05). Anterior apical strain values for β-glucan vs. control were -4.7 ± 9.4 vs. 5.9 ± 6.1% (P < 0.05) for longitudinal strain, -14.7 ± 6.6 vs. -7.7 ± 4.3 (P < 0.05) for circumferential strain, 15.1 ± 7.7 vs. 7.1 ± 11.8 (ns) for radial strain.

Conclusions: Oral β-glucan pretreatment reduces infarction size and improves regional contractile function in a porcine ischaemia/reperfusion model.
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http://dx.doi.org/10.1093/ejcts/ezr125DOI Listing
April 2012

Inhibition of NF-κB activation by β-glucan is not associated with protection from global ischemia-reperfusion injury in pigs.

J Surg Res 2011 Nov 13;171(1):58-65. Epub 2010 Jan 13.

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway.

Background: Pretreatment with β-glucan has been shown to protect against regional ischemia-reperfusion injury, through inhibition of myocardial NF-κB activation. The aim was to examine whether β-glucan pretreatment could protect against the global ischemia-reperfusion injury, which is encountered in the clinical setting during open heart surgery.

Materials And Methods: Twenty-one pigs were randomized to pretreatment with oral β-glucan (SBGo, n = 7), pretreatment with i.p. β-glucan (SBGip, n = 7), and untreated controls (n = 7). The pigs were subjected to cardiopulmonary bypass (CPB) with 1 h of global cardioplegic ischemia followed by wean from CPB and reperfusion for 4 h. Cardiac function was determined by a conductance catheter, and troponin T was sampled from the coronary sinus. Atrial biopsies obtained at baseline, following 30 min, and 3 h of reperfusion were analyzed for phosphorylated NF-κB by Western blot.

Results: Following reperfusion, phosphorylated NF-κB increased by 210% in the control group, 197% in the SBGo group, but was reduced by 5% in the SBGip group (P < 0.01 versus control). After 4 h of reperfusion, preload recruitable stroke work dropped by 19% in the control group and 25% in the SBGo group compared with 60% in the SBGip group (P < 0.01 versus control). The area under the curve for troponin T was larger in the SBGip group compared with the control group (P < 0.05) and the SBGo group (P < 0.01).

Conclusion: Inhibition of NF-κB activation by i.p. β-glucan does not protect against ischemia-reperfusion injury in pigs subjected to global ischemia and reperfusion, and may be associated with aggravation of ischemia-reperfusion injury.
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http://dx.doi.org/10.1016/j.jss.2009.12.015DOI Listing
November 2011

High resolution speckle tracking dobutamine stress echocardiography reveals heterogeneous responses in different myocardial layers: implication for viability assessments.

J Am Soc Echocardiogr 2010 Apr;23(4):439-47

University Hospital North Norway, Tromsø, Norway.

Background: Speckle-tracking echocardiography (STE) can be used to quantify wall strain in 3 dimensions and thus has the potential to improve the identification of hypokinetic but viable myocardium on dobutamine stress echocardiography (DSE). However, if different myocardial layers respond heterogeneously, STE-DSE will have to be standardized according to strain dimension and the positioning of the region of interest. Therefore, the aim of this study was to create a high-resolution model for ejection time (ET) strain and tissue flow in 4 myocardial layers at rest, during hypoperfusion, and during dobutamine challenge to assess the ability of STE-DSE to detect deformation and functional improvement in various layers of the myocardium.

Methods: In 10 open chest pigs, the left anterior descending coronary artery was constricted to a constant stenosis, resulting in 35% initial flow reduction. Fluorescent microspheres were used to measure tissue flow. High-resolution echocardiography was performed epicardially to calculate ET strain in 4 myocardial layers in the radial, longitudinal, and circumferential directions using speckle-tracking software. Images were obtained at rest, during left anterior descending coronary artery constriction (hypoperfusion), and during a subsequent dobutamine stress period.

Results: Dobutamine stress at constant coronary stenosis increased flow in all layers. ET strain increased predominantly in the midmyocardial layers in the longitudinal and circumferential directions, whereas subendocardial strain did not improve in either direction.

Conclusion: Dobutamine stress influences ET strain differently in the various axes and layers of the myocardium and only partially in correspondence to tissue flow. Longitudinal and circumferential functional reserve opens the potential for the specific detection of midsubendocardial viable tissue by high-resolution STE.
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http://dx.doi.org/10.1016/j.echo.2009.12.023DOI Listing
April 2010

Mechanoenergetic function and troponin T release following cardioplegic arrest induced by St Thomas' and histidine-tryptophan-ketoglutarate cardioplegia--an experimental comparative study in pigs.

Interact Cardiovasc Thorac Surg 2009 Oct 23;9(4):635-9. Epub 2009 Jul 23.

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, N-9038 Tromsø, Norway.

The study compares the single dose histidine-tryptophan-ketoglutarate (HTK) cardioplegia to the repeatedly delivered St Thomas' Hospital Solution (STHS) with respect to preservation of left ventricular mechanoenergetics and leakage of troponin T in a porcine experimental model. Fourteen pigs were randomized to a single infusion of 30 ml/kg HTK cardioplegia (n=7) or 500 ml STHS (n=7) followed by 200 ml after 20 and 40 min. After 1 h of aortic cross-clamping on cardiopulmonary bypass (CPB), the pigs were weaned and the hearts reperfused for 4 h. Stroke work (SW) was determined by a conductance catheter in the left ventricle. Myocardial oxygen consumption (MvO(2)) was measured as a function of coronary blood flow and arterial-to-coronary sinus oxygen saturation difference. Troponin T was sampled from the coronary sinus. The slope of the SW-MvO(2) relationship increased by 1.09 (+/-0.53) in the HTK group compared with 0.33 (+/-0.70) in the STHS group following ischemia and 4 h of reperfusion (P=0.04). Troponin T was significantly higher in the HTK group compared with the STHS group (P=0.04). Repeatedly delivered STHS gives better preservation of postischemic mechanoenergetic function and lower troponin T release compared with single dose HTK cardioplegia, indicating improved cardioprotection with STHS.
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http://dx.doi.org/10.1510/icvts.2009.208231DOI Listing
October 2009

Left ventricular size determines tissue Doppler-derived longitudinal strain and strain rate.

Eur J Echocardiogr 2009 Mar 30;10(2):271-7. Epub 2008 Sep 30.

Institute of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway.

Aims: Tissue Doppler-derived indices of strain (epsilon) and strain rate (SR) have been developed to assess regional cardiac function. However, the effect of left ventricular (LV) size on epsilon and SR has not been studied in depth. The aim of this study was to assess to what extent heart size influence epsilon or SR.

Methods And Results: In 21 anaesthetized pigs ranging from 12.5 to 70.0 kg, tissue Doppler-derived epsilon and SR, and haemodynamic parameters, were assessed during controlled heart rates and different loading conditions. dP/dt did not correlate to pig weight, suggesting constant contractility during growth. Longitudinal epsilon and SR were significantly higher in smaller compared with larger hearts. The hyperbolic correlation between pigs weight and epsilon and SR was r(2)=0.621 and 0.372, respectively, both P<0.0001. Afterload elevation induced a reduction in longitudinal epsilon (from -24.2+/-3.2 to -12.1+/-5.5%, P=0.001) and SR (from -2.3+/-0.8 to -1.3+/-2.4 s(-1), P=0.034), whereas increasing preload increased epsilon (from -26.4+/-10.3 to -38.1+/-14.3%, P=0.006) and SR (from -2.3+/-0.9 to -4.22+/-1.8 s(-1), P=0.002).

Conclusion: Longitudinal epsilon and SR decrease with increasing LV dimensions in spite of an unaltered contractility. These results show and confirm that heart size influences epsilon and SR, which are highly load-dependent parameters.
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http://dx.doi.org/10.1093/ejechocard/jen230DOI Listing
March 2009

Adenosine instead of supranormal potassium in cardioplegic solution improves cardioprotection.

Eur J Cardiothorac Surg 2007 Sep 5;32(3):493-500. Epub 2007 Jul 5.

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.

Objective: To determine whether adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest and improved cardioprotection. Cold crystalloid cardioplegia with adenosine, procaine and magnesium (A) was compared with standard cold crystalloid hyperkalemic cardioplegia (K).

Methods: Sixteen pigs were randomized to receive either cold K (n=8) or A (n=8), where hyperkalemia was substituted with 1.2 mM adenosine. The cold (6 degrees C) cardioplegia was given intermittently and antegradely, with an aortic cross-clamp time of 1 h. Hemodynamic data was continuously measured and pressure-volume conductance catheters were used to determine global left ventricular systolic and diastolic function. Coronary flow and O2 content differences allowed determination of left ventricular energetics. Blood samples, and left ventricular microdialysis were used to measure parameters of ischemia. Measurements were done at 1 and 2 h after cross-clamp release.

Results: Mean arterial pressure was reduced with 55 mmHg (standard deviation, SD: 19) in the K group versus 30 mmHg (SD: 14) in the A group 2 h after cross-clamp release (p=0.030). Left ventricular contractility expressed as slope of the preload recruitable stroke work index (Mw) was reduced to 53% (SD: 14) in the K group versus 78% (SD: 23) in the A group 2h after cross-clamp release (p=0.046). Reduction of maximum of first derivate of pressure with respect to time (dP/dtmax) was 804 mmHg/s (SD: 189) in the K group versus 538 mmHg/s (SD: 184) in the A group (p=0.033). The slope of the myocardial oxygen consumption-pressure volume area was at 2 h reperfusion increased from 1.37 (SD: 0.64) to 2.86 (SD: 1.27) in the K group, whereas no shift was detected in the A group (p=0.019). Cardiac troponin T measured in the coronary sinus 1 h after cross-clamp release was 1.25 microg/l (SD: 0.64) in the K group versus 0.73 microg/l (SD: 0.31) in the A group (p=0.046).

Conclusion: Adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest, improves post cardioplegic left ventricular systolic function and efficiency, and attenuates myocardial cell damage.
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http://dx.doi.org/10.1016/j.ejcts.2007.05.020DOI Listing
September 2007

Cardioprotective effect of pretreatment with beta-glucan in coronary artery bypass grafting.

Scand Cardiovasc J 2006 Oct;40(5):298-304

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, 9038, Tromsø, N-Norway.

Background: Beta-glucan pretreatment has been shown to attenuate inflammatory response and to protect against ischemia-reperfusion injury in animal studies. The aims of the present study were to examine the safety of pretreatment with beta-1,3/1,6-glucan in patients scheduled for coronary artery bypass grafting (CABG), and to investigate whether beta-1,3/1,6-glucan pretreatment could suppress inflammatory response and protect against ischemia-reperfusion injury following CABG.

Methods: Twenty one patients scheduled for CABG were assigned to oral beta-1,3/1,6-glucan 700 mg (Group 1) or 1 400 mg (Group 2) five consecutive days before surgery and were compared with a control group (Group 3). Blood samples were drawn preoperatively and on the first, third and fifth postoperative day for analysis of acute-phase reactants, hematology, cytokines and myocardial enzymes.

Results: The study drug was well tolerated. Creatine kinase isoenzyme MB was significantly lower in Group 2 compared with controls on the first postoperative day (p = 0.028). Mean change in cardiac troponin T was lower in Group 2 compared with controls (p = 0.028).

Conclusions: Beta-1,3/1,6-glucan pretreatment is safe in patients undergoing CABG and may protect against ischemia reperfusion injury following CABG.
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http://dx.doi.org/10.1080/14017430600868567DOI Listing
October 2006

[Carotid endarterectomy in patients with coronary heart disease].

Tidsskr Nor Laegeforen 2005 Nov;125(21):2946-8

Avdeling for hjerte-/lunge- og karkirurgi, Universitetssykehuset Nord-Norge, 9038 Tromsø.

Background: Patients with coexistent coronary and carotid artery disease are at high risk of developing stroke following coronary artery bypass grafting (CABG) and at the same time at increased risk of myocardial infarction when subjected to carotid endarterectomy (CEA). In patients with pronounced symptoms from both vascular territories, some institutions advocate a combined approach, with both CABG and CEA performed during the same period of anaesthesia.

Material And Methods: We reviewed the medical records of patients who underwent the combined procedure between 1986 and 2004 (n = 37; group 1) and compared them to patients with coronary artery disease who underwent isolated CEA over the same period of time (n = 118; group 2).

Results: The ASA score, NYHA class, prevalence of peripheral artery disease, atrial fibrillation and contralateral carotid occlusion were significantly higher in group 1. Two patients (5.4%) in group 1 and five patients (4.2%) in group 2 suffered a stroke. Five of these were ipsilateral to the CEA. Six patients had a perioperative myocardial infarction, one in group 1 (2.7%) and five (4.2%) in group 2 (ns). There were no deaths in group 1 and three deaths (2.5%) in group 2 during the first 30 days after surgery. The cumulative risk of death, stroke and myocardial infarction within 30 days was 8.1% in group 1 and 11.0% in group 2.

Interpretation: Patients with coexistent atherosclerosis of the coronary and carotid arteries who underwent the combined procedure seem to have the same perioperative risk as patients with coronary artery disease who underwent isolated CEA, in spite of the fact that the former had a more generalised atherosclerotic disease.
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November 2005
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