This study aimed to assess the involvement of bilirubin and its oxidative metabolite biopyrrin in patients with acute myocardial infarction (AMI) and to determine the responsible organs that overproduce these molecules. One hundred thirteen consecutive patients hospitalized for AMI were analyzed. Levels of serum bilirubin, plasma and urinary biopyrrins were measured on the day of admission, day 2, 3, 7 and 14. Expressions of biopyrrins and heme oxygenase-1 (HO-1), a stress-responsive bilirubin-producing enzyme, in heart, aorta, kidney, liver and lung were immunostained with autopsied specimens. Serum bilirubin, plasma and urinary biopyrrins were increased within 24 hr, formed a peak on day 3 and then decreased by day 14. These three parameters were well correlated to each other. The maximum biopyrrin elevation was higher in death cases and associated with impaired left ventricular function. Immunohistochemical analyses revealed biopyrrin accumulation and HO-1 expression in the infracted myocardium. Immunoreactive HO-1 and biopyrrins were also observed in renal tubular cells, aortic wall and lung. Serum bilirubin and its metabolite biopyrrins were elevated in patients with AMI. Plasma and urinary biopyrr in elevation were associated with mortality and morbidity. Induction of anti-oxidative enzyme HO-1 seemed to be involved in the activation of bilirubin/biopyrrin pathway.
Objective: Simultaneous aortic arch repair and coronary artery bypass are associated with considerable morbidity and mortality. We retrospectively analyzed our experience with on-and off-pump coronary artery bypass (CAB) combined with aortic arch repair. Methods: Before aortic arch repair, distal coronary artery anastomosis was constructed on the arrested heart under CAB (ONCAB: n=14), or on the beating heart before CAB (OPCAB: n=18). We also analyzed data from patients after isolated total arch replacement (TAR: n=20). Results: Compared with ON CAB, OPCAB was associated with shorter periods of myocardial ischemia (133±24 vs. 180±48 min, P=0.017) and cardiopulmonary bypass (239±35 vs. 306±61 min, P=0.002), less prolonged postoperative ventilation (33% vs. 79%, P=0.027) and lower postoperative peak CK-MB levels (35±19 vs. 99±124 U/L, P=0.012). One (6%) patient after OPCAB and 3 (21%) after ONCAB (P=0.210) died in hospital. Compared with the TAR group, the myocardial ischemic periods after OPCAB (125±30 vs. 133±24min, P=0.401) and postoperative outcomes were similar. Conclusions : Aortic arch repair with OPCAB offers an option for treating aortic arch aneurysm accompanied by atherosclerotic coronary artery disease.
We investigated the differences between males and females in the reversal effect of neostigmine on neuromuscular blockade. Thirty male and 30 female patients undergoing elective general anesthesia were studied. Vecuronium was given in all patients anesthetized with nitrous oxide, oxygen, and sevoflurane. After the surgical procedure, when Tl (1st response in train-of-four (TOF))/control returned to 0.25, neostigmine 40 μg/kg in combination with atropine 20 μg/kg was given to antagonize residual neuromuscular blockade. Three, six, nine, 12, and 15 minutes after neostigmine reversal, Tl/control or TOF ratio (T4/Tl) did not significantly differ between the sexes. Also, 15 minutes after neostigmine administration, the number of patients in whom recovery from neuromuscular blockade was sufficient to guarantee good respiratory function, i.e., TOF ratio >0.74, did not significantly differ between the sexes. In contrast, 15 minutes after neostigmine, the number of patients in whom recovery from neuromuscular blockade was adequate to ensure satisfactory recovery from neuromuscular blockade including the return of the faculty of sight, i.e., TOF ratio >0.9, was significantly less in the males than in females (6 vs 14, P=0.028). In conclusion, 15 min after neostigmine, TOF ratio less often returns to a value of more than 0.9 in males than in females.