Beating heart versus conventional coronary bypass surgery : Our experience

Background: Off-pump Coronary Artery Bypass (OPCAB) has become the standard surgical treatment of Coronary Artery Disease in most centres in India. It is clear from the current evidence that, in certain patients, OPCAB offers advantages over conventional Coronary Artery Bypass Grafting (CABG). Experience of this procedure in the Armed Forces is highlighted.     

Body weight reduction in rats by oral treatment with zinc plus cyclo-(His-Pro)

Background and purpose:

We have previously shown that treatment with zinc plus cyclo-(His-Pro) (CHP) significantly stimulated synthesis of the insulin degrading enzyme and lowered plasma insulin and blood glucose levels, alongside improving oral glucose tolerance in genetically type 2 diabetic Goto-Kakizaki (G-K) rats and in aged obese Sprague-Dawley (S-D) rats. Thus, we postulated that zinc plus CHP (ZC) treatment might also improve body weight control in these rats. We therefore determined the effects of ZC treatment on body weights in both genetically diabetic, mature G-K rats and non-diabetic, obese S-D rats.

Experimental approach:

G-K rats aged 1.5–10 months and non-diabetic overweight or obese S-D rats aged 6–18 months were treated with 0–6 mg CHP plus 0–10 mg zinc·L⁻¹ drinking water for 2–4 weeks, and changes in weight, serum leptin and adiponectin levels, food and water intakes were measured.

Key results:

The optimal dose of CHP (in combination with zinc) to reduce weight and plasma leptin levels and to increase plasma adiponectin levels was close to 0.1 mg·kg⁻¹·day⁻¹, in either mature G-K rats and aged overweight or obese S-D rats. Food and water intake significantly decreased in ZC treated rats in both aged S-D rats and mature G-K rats, but not in young S-D and G-K rats.

Conclusions and implications:

ZC treatment improved weight control and may be a possible treatment for overweight and obesity.     

Aktivierter Faktor VII stillt Blutung rasch und zuverl?ssig Erworbene H?mophilie

„ Jede Blutung unbekannter Ursache kann eine erworbene H?mophilie sein“, erkl?rte Dr. Andreas Tiede, Hannover.     

Calprotectin as a marker of inflammation in cystic fibrosis

Calprotectin is an abundant neutrophil cytosolic protein released during neutrophil activation or death. The use of plasma calprotectin concentration as a marker of pulmonary inflammation was tested in 31 children with cystic fibrosis, none of whom was acutely unwell or pyrexic. Twenty three were receiving antibiotics, 21 had positive sputum cultures, but none of the traditional tests clearly diagnosed ongoing infection. Plasma calprotectin was significantly higher in the cystic fibrosis group than in matched controls. Sixteen children with cystic fibrosis had values above the control range (320-1570 micrograms/l). Their chest radiograph Northern score, an index of accumulated pulmonary involvement, and their plasma copper, an index of acute phase response, both correlated with plasma calprotectin. Plasma gamma-glutamyltransferase also correlated weakly with plasma calprotectin: thus, hepatic pathology may be a confounding variable. However, the data still suggested that plasma calprotectin is a better index of inflammation than the traditional indices in general use.     

Growth Hormone and Prolactin Secretion after External Cranial Irradiation for Extrasellar Tumours

Background

Deficiency of one or more anterior pituitary hormones may follow treatment with external radiation when hypothalamo-pituitary axis lies within the field of radiation. Patients with brain tumours who are treated with radiation frequently have growth hormone (GH) deficiency, other neuro-endocrine abnormalities are presumed to be uncommon. The present study has been undertaken with the aim to study GH and prolactin secretion, their relationship with dose of radiotherapy and duration after radiotherapy in patients who have received extracranial radiation for extrasellar tumours.

Method

In this study, 96 patients who underwent cranial radiation before 12 months, were evaluated. Basal 8 a.m. venous blood samples were taken for estimation of prolactin and GH. Insulin tolerance test was performed for stimulated GH levels.

Result

GH deficiency was present in 59% patients. Isolated GH deficiency was present in 12 (21%) cases, whereas others had associated hormone deficiency. Height percentiles of prepubertal and pubertal patients were 10^th to 25^th (-1.5 to -0.5SD). Patients with isolated GH deficiency had received significantly higher radiation dose than normal pituitary function (5795 ± 24 vs 4908 ± 71, p=0.001). Proportion of patients with GH deficiency increased with increasing dose of radiation (p=0.12), fractional dose of radiation (p=0.08) and increasing duration after radiotherapy (p=0.038). GH levels among all decreased significantly with increasing dose of radiation (p=0.02). Hyperprolactinemia was present in 21% of cases. GH deficiency is more common with lower (<5ng/ml) and higher (>15ng/ml) prolactin levels.

Conclusion

GH deficiency is common after extracranial radiation for extrasellar tumours. GH deficiency is related to dose of radiation, fraction of radiation, and duration after radiotherapy. All prepubertal and pubertal patients with GH deficiency had their height percentile within normal range. Relation of prolactin and GH deficiency indicates that radiation affects both hypothalamus and pituitary.Key Words: Cranial radiation, Growth hormone deficiency, Hyperprolactinemia     

Target Gland Dysfunction Following External Cranial Radiation for Extrasellar Tumours

Background

Diseases of the pituitary gland manifest as increased or decreased production of one or more of these hormones that in turn trigger a series of secondary hormonal changes in target glands (Thyroid, Adrenal and Gonad). Dysfunction of target glands may follow treatment with external radiation when hypothalamo-pituitary axis lies within the field of radiation. The present study has been undertaken with the aim to study target gland dysfunction and their relationship with dose of radiotherapy and duration after radiotherapy in patients who have received extracranial radiation for extrasellar tumours.

Methods

In this study, 96 patients who underwent cranial radiation 12 months ago were evaluated. Basal 8 am venous blood samples were taken for estimation of triiodothyronine (T₃), thyroxin (T₄), thyrotropin stimulating hormone (TSH) and basal cortisol estimation. Pooled samples (three samples taken 20 minutes apart and pooled together) were taken for LH, FSH and testosterone (TE) estimation. Insulin tolerance test was performed for stimulated cortisol levels.

Results

Target gland dysfunction was present in 72 (75%) patients. Hypogonadism was present in 48 (53%) of post-pubertal patients. 36% of male patients had hypogonadism whereas 100% of female patients had hypogonadism. Patients with hypogonadism were older, received higher doses of radiation and evaluated earlier after radiotherapy than without hypogonadism. Serum testosterone level declined significantly with increasing doses of radiation. Hypoadrenalism was present in 44 patients (46%). There was no significant difference of age, radiation dose and radiation fraction among patients with or without adrenal insufficiency. Proportion of patients with hypoadrenalism increased with increasing duration after radiotherapy. Hypothyroidism was present in 12 patients (13%). Proportion of patients with hypothyroidism doubled with increasing dose of radiation. Serum T₃ level declined significantly with increasing doses of radiation. Patients with hypothyroidism had significantly low T₃ and T₄ level, but significantly higher TSH and basal and peak cortisol levels than patients without hypothyroidism.

Conclusion

Target gland dysfunction is common after extracranial radiation for extrasellar tumours. Hypogonadism was the commonest followed by hypoadrenalism and hypothyroidism. Target gland dysfunction was related to age, radiation dose and duration after radiotherapy, but not with fraction of radiation.Key Words: Adrenal insufficiency, Cranial radiation, Hypogonadism, Hypothyroidism