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Background and Objectives: The risk of sudden death and cardiac arrhythmia increases in morbidly obese patients. We aimed to evaluate the marker of arrhythmias such as Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios in extreme obesity.Methods: The study included 41 extremely obese patients and 41 control subjects. QTmax, QTmin, QRS, JT and Tp-e intervals were measured od 12‑lead electrocardiographies. In addition, Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc rates and QTc, cQTd and JTc intervals were calculated.Results: Tp-e interval (79.2 ± 9.7 ms (milisecond) vs. 68.6 ± 8.1, p < 0.001), QTc interval (395.9 ± 18.8 vs. 377.9 ± 19.3 ms, p < 0.001), JTc interval (317.1 ± 27.0 vs. 297.4 ± 23.2 ms, p = 0.001), Tp-e/QT ratio (0.22 ± 0.03vs. 0.19 ± 0.02, p < 0.001), Tp-e/QTc ratio (0.20 ± 0.26vs. 0.18 ± 0.02, p = 0.001), Tp-e/JT ratio (0.29 ± 0.04 vs. 0.25 ± 0.03, p < 0.001), TPe/JTc ratio (0.25 ± 0.04 vs. 0.23 ± 0.03, p = 0.018), QTd (32.8 ± 10 vs.15 ± 6.4 ms, p < 0.001) and cQTd (70.0 ± 30.1 vs. 31.3 ± 22.4 ms, p < 0.001) were significantly higher in obese patients.Conclusion: Compared to healthy subjects potential ECG repolarization predictors were significantly increased in extremely obese patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis. AIM: To assess endothelial function in patients with CSF and the correlation of AVP with FMD. MATERIALS AND METHODS: FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography. RESULTS: Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1±8.4 vs. 53.7±12.7 cm/s, p < 0.001) and FMD (5.6±3.2 vs. 17.6±4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001). CONCLUSIONS: Transthoracic echocardiographic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function. [ABSTRACT FROM AUTHOR]

The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs. We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications. Coronary angiography was performed through the femoral route via 6-Fr catheters. Homeostasis was achieved by manual compression and maintained with a compressive bandage. A total of 1,446 patients were ambulated at the second hour and 1,226 of them were discharged without complication. A total of 220 patients required further follow-up due to blood oozing; 154 patients were conventionally ambulated due to difficult arterial access, longer (>15 minutes) compression time, hematoma formation within 2 hours, or hypertensive state (blood pressure >180/100 mm Hg). Twenty-five (16%) of those patients developed minor bleeding after ambulation. No major bleeding or large hematoma was observed during in-hospital observation. Ecchymosis (10% [2-hour group] vs 21% [4-5 hour group]) and small hematomas (22% vs 9%) were the most frequent complications after discharge. Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates. [ABSTRACT FROM AUTHOR]

Background: In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia. Methods: Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg-1 of S(+) ketamine (1.0 mL) in Group K (n=30) or 25 μg (1.0 mL) of fentanyl in Group F (n=30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia. Results: The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001). Conclusion: In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg -1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia [ABSTRACT FROM AUTHOR]

Background and objective; To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV). Methods: Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea sczepinsores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M l, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O. Results: Four patients (13.3%) in Group P, 13 patients (43.3%) in Group Ml, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and proposal lasted tor a much shorter time than the antiemetic effects of these drugs, Conclusions: Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects. [ABSTRACT FROM AUTHOR]

Background and objective: To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV). Methods: Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O. Results: Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs. Conclusions: Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects. [ABSTRACT FROM AUTHOR]