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Abstract Background: It is unclear whether asthma is over-diagnosed in developed countries, particularly among obese individuals, who may be more likely than nonobese people to experience dyspnea. Methods: We conducted [...]

Byline: Andrew J. Lodge, Paul J. Chai, C.William Daggett, Ross M. Ungerleider, James Jaggers Abstract: Introduction: Cardiopulmonary bypass produces an inflammatory response that can cause significant postoperative pulmonary dysfunction and total body edema. This study evaluates the efficacy of preoperative methylprednisolone administration in limiting this injury in neonates and compares the effect of giving methylprednisolone 8 hours before an operation to the common practice of adding methylprednisolone to the cardiopulmonary bypass circuit prime. Methods: A control group of neonatal pigs (control; n = 6) received no preoperative medication. One experimental group (n = 6) received methylprednisolone sodium succinate (30 mg/kg) both 8 and 1.5 hours before the operation. A second experimental group received no preoperative treatment, but methylprednisolone (30 mg/kg) was added to the cardiopulmonary bypass circuit prime. All animals underwent cardiopulmonary bypass and 45 minutes of deep hypothermic circulatory arrest. Hemodynamic and pulmonary function data were acquired before cardiopulmonary bypass and at 30 and 60 minutes after bypass. Results: In the control group, pulmonary compliance, alveolar-arterial gradient, and pulmonary vascular resistance were significantly impaired after bypass (P < .01 for each by analysis of variance). In the group that received methylprednisolone, compliance (P = .02), alveolar-arterial gradient (P = .0003), pulmonary vascular resistance (P = .007), and extracellular fluid accumulation (P = .003) were significantly better after bypass when compared with the control group. Results for the group that received no preoperative treatment fell between the control group and the group that received methylprednisolone. Conclusions: When given 8 hours and immediately before the operation, methylprednisolone improves pulmonary compliance after bypass, alveolar-arterial gradient, and pulmonary vascular resistance compared with no treatment. The addition of methylprednisolone to the cardiopulmonary bypass circuit prime is beneficial but inferior to preoperative administration. (J Thorac Cardiovasc Surg 1999;117:515-22) Author Affiliation: Department of Surgery, Duke University Medical Center, Durham, NC. Article History: Received 6 April 1998; Revised 9 July 1998; Revised 7 October 1998; Accepted 6 November 1998 Article Note: (footnote) [star] Address for reprints: James Jaggers, MD, Division of Thoracic Surgery, Department of Surgery, Box 3474, Duke University Medical Center, Durham, NC 27710., [star][star] 12/6/95759

Byline: Gary E. Hill, Anselmo Alonso, John R. Spurzem, Alfred H. Stammers, Richard A. Robbins Abstract: Cardiopulmonary bypass induces an inflammatory state characterized by tumor necrosis factor-[alpha] release. Integrin CD11b is a neutrophil surface adhesive glycoprotein integrin that is rapidly and permanently unregulated by tumor necrosis factor-[alpha] exposure. The CD11b integrin is known to be the primary neutrophil integrin responsible for neutrophil lung and myocardial entrapment after cardiopulmonary bypass and subsequent reperfusion injury. Twenty-four adults admitted to the hospital for myocardial revascularization were equally randomized to one of three groups: group A (control), group B (methylprednisolone before cardiopulmonary bypass), and group C (low-dose aprotinin protocol). Blood was collected at three times: (1) baseline, (2) 50 minutes of cardiopulmonary bypass duration, and (3) 30 minutes after cardiopulmonary bypass termination. Neutrophil CD11b integrin expression was measured by fluorescence-activated cell sorter analysis and plasma tumor necrosis factor-[alpha]levels measured by enzyme-linked immunosorbent assay. Group A demonstrated significant (p < 0.05) increases in CD11b expression at times 2 and 3 when results were compared with those of the same group baseline and with those of groups B and C at similar times. No significant changes were noted between groups B and C at any time. Group A demonstrated a significant (p < 0.05) increase in levels of tumor necrosis factor-[alpha] at time 3 when results were compared with those of the same group baseline and of groups B and C at the same time. No significant changes were noted between groups B and C at any time. These results demonstrate low-dose aprotinin has a similar antiinflammatory effect to that of methylprednisolone in blunting cardiopulmonary bypass-induced systemic tumor necrosis factor-[alpha] release and neutrophil integrin CD11b upregulation. (J THORAC CARDIOVASC SURG 1995;110:1658-62) Author Affiliation: Omaha, Neb Article History: Received 28 February 1995; Accepted 6 April 1995 Article Note: (footnote) [star] From the Departments of Internal Medicine,b Anesthesiology, a Surgery, c and Perfusion Sciences Education, d University of Nebraska Medical Center, Omaha, Neb., [star][star] Address for reprints: Gary E. Hill, MD, FCCM, Department of Anesthesiology and Internal Medicine, University of Nebraska Medical Center, 600 S. 42 St., Box 984455, Omaha, NE 68198-4455., a 0022-5223/95 $5.00 + 0, aa 12/1/65323

By a News Reporter-Staff News Editor at Women's Health Weekly -- A new study on Cardiovascular Diseases is now available. According to news reporting originating from Boston, Massachusetts, by NewsRx [...]