OBJECTIVE: To assess adrenal function in patients undergoing coronary artery bypass grafting (CABG) by means of the low-dose (1 microg) ACTH test, and to correlate the adrenal function with clinical outcome. METHODS: During a 5-Month period we prospectively included 45 patients undergoing elective CABG with cardiopulmonary bypass and without symptoms of endocrine disease. Low-dose (1 microg) ACTH tests were performed on the day before surgery (day -1), immediately after the operation (day 0), on the two subsequent days in the intensive care unit (day 1 and day 2), and on the day of discharge from the hospital. A number of clinical, hemodynamic and laboratory parameters were monitored throughout. RESULTS: On day -1, 75% of the study patients had normal stimulated plasma cortisol concentrations. Eleven patients (25%) had an impaired adrenal response to 1 microg ACTH. The stimulated plasma cortisol concentrations in patients who had an inadequate adrenal response on day -1 remained significantly reduced on day 1 (756+/-205 vs 949+/-259 nmol/l, P=0.03) (mean+/-s.d.), day 2 (644 (580-793) vs 885 (713-1087), P=0.03) (median (interquartile range)), and on the day of discharge (698+/-201 vs 854+/-186, P=0.05). In patients with a normal adrenal response in the preoperative setting peak cortisol concentrations were reached on day 1, in patients with a blunted adrenal response they were reached on day 2. There were significant correlations between the stimulated plasma cortisol concentrations and the blood loss (r=-0.50, P=0.002) and Volume balance (r=0.41, P=0.015). CONCLUSIONS: Occult (partial) adrenal insufficiency is common in patients undergoing CABG who are otherwise asymptomatic as regards endocrine disease. The adrenal function in these patients differs both in the magnitude of cortisol response to ACTH and in the time course, with significantly delayed peak cortisol concentrations. Adequate regulation of Volume balance and the amount of blood loss seem to correlate with adequacy of adrenal function.

Purpose: Cryopreserved human blood vessels are important tools in bypass surgery. However, several in vitro studies have demonstrated diminished postthaw functional activity. Therefore the aim of this study was to investigate the consequences of various freezing/thawing protocols and the role of protein kinase C in the postthaw functional activity of cryopreserved human arteries.Methods: In vitro responses of frozen/thawed human internal mammary arteries (IMA) were used to investigate the functional activity after thawing at 15 degrees, 30 degrees, and 100 degrees C/min and after different prefreezing equilibration times (10, 60, 120, 240 minutes) with the cryomedium (Krebs-Henseleit solution containing 1.8 mol/L dimethyl sulfoxide and 0.1 mol/L sucrose) at room temperature followed by cryostorage at -196 degrees C.Results: Prefreezing equilibration for 10 to 120 minutes diminished maximal a-adrenoceptor-mediated responses to noradrenaline to approximately 60%, and equilibration for 240 minutes attenuated noradrenaline effects to less than 25% of that produced by unfrozen controls. Contractile responses were slightly better when thawing was performed at 15 degrees C/min compared with 100 degrees C/min. The postthaw sensitivity to direct activation of protein kinase C by phorbol 12,13-dibutyrate was enhanced. Compared with unfrozen tissues (pD(2) = 7.36 +/- 0.07, n = 32) maximal sensitization to phorbol 12,13-dibutyrate was observed in IMA that had been frozen after 60 minutes of equilibration with the cryomedium (pD(2) = 8.31 +/- 0.09, n = 30). Responses to phorbol 12,13-dibutyrate of cryopreserved IMA were highly susceptible to blockade of calcium influx by nifedipine, whereas those of unfrozen IMA were resistant to nifedipine. Against noradrenaline nifedipine was equipotent in cryopreserved (pD'(2) = 7.75 +/- 0.15, n = 8) and unfrozen IMA (pD'(2) = 7.70 +/- 0.10, n = 6). Endothelium-dependent relaxant responses to acetylcholine were significantly attenuated after cryopreservation (E-max = 26% +/- 5%, n = 4) compared with unfrozen IMA. (E-max = 71% +/- 4%, n = 4, p < 0.001); endothelium-independent relaxant responses to sodium nitroprusside were unchanged.Conclusions: Cryopreservation of human IMA under the conditions applied in this study (1) attenuated endothelial cell function and (2) induced an activation of protein kinase C, thereby increasing calcium influx through dihydropyridine-sensitive calcium channels. These experimental data suggest that postoperative administration of calcium channel blockers alone or combined with long-acting nitrates should effectively prevent the development of spasms in arterial grafts.

International Journal of CancerVolume 71, Issue 6 p. 1119-1121 Letter to the EditorFree Access High expression of MAGE-3 protein in squamous-cell lung carcinoma Claude Fischer, Claude Fischer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorFred Gudat, Fred Gudat Department of Pathology, University of Basel, Basel, SwitzerlandSearch for more papers by this authorPeter Stulz, Peter Stulz Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorChristoph Noppen, Christoph Noppen Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorChristoph Schaefer, Christoph Schaefer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorPaul Zajac, Paul Zajac Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMarkus Trutmann, Markus Trutmann Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorThomas Kocher, Thomas Kocher Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMarkus Zuber, Markus Zuber Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorFelix Harder, Felix Harder Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMichael Heberer, Michael Heberer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorGiulio C. Spagnoli, Corresponding Author Giulio C. Spagnoli Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSurgical Research Laboratory, Z.L.F., 20, Hebelstrasse, 4031, Basel, Switzerland. Fax:—41 61 265 3990.Search for more papers by this author Claude Fischer, Claude Fischer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorFred Gudat, Fred Gudat Department of Pathology, University of Basel, Basel, SwitzerlandSearch for more papers by this authorPeter Stulz, Peter Stulz Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorChristoph Noppen, Christoph Noppen Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorChristoph Schaefer, Christoph Schaefer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorPaul Zajac, Paul Zajac Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMarkus Trutmann, Markus Trutmann Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorThomas Kocher, Thomas Kocher Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMarkus Zuber, Markus Zuber Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorFelix Harder, Felix Harder Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorMichael Heberer, Michael Heberer Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSearch for more papers by this authorGiulio C. Spagnoli, Corresponding Author Giulio C. Spagnoli Departments of Surgery and Research, University of Basel, Basel, SwitzerlandSurgical Research Laboratory, Z.L.F., 20, Hebelstrasse, 4031, Basel, Switzerland. Fax:—41 61 265 3990.Search for more papers by this author First published: 06 December 1998 https://doi.org/10.1002/(SICI)1097-0215(19970611)71:6<1119::AID-IJC34>3.0.CO;2-5Citations: 26AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume71, Issue611 June 1997Pages 1119-1121 ReferencesRelatedInformation

Inactivation of the p53 gene plays a key role in tumour biology, probably through a disturbed cell cycle control and an increased genetic instability in p53-inactivated tumours. To learn more about the relationship between p53 alterations, proliferation and genetic instability (DNA aneuploidy) in lung cancer patients, specimens of 220 surgically resected lung carcinomas with clinical follow-up information were examined by immunohistochemistry (p53; CM1) and flow cytometry. Nuclear p53 positivity – found in 49.5% of the tumours – was associated with both high S-phase fraction (SPF) and DNA ploidy aberrations. SPF was higher in p53-positive tumours (15.9 ± 10.2) than in p53-negative tumours (10.3 ± 8.7; P = 0.03). The rate of p53 positivity was higher in 101 DNA-aneuploid and DNA-multiploid tumours (55%) than in 27 diploid and peridiploid carcinomas (33%; P = 0.0512). These results are consistent with an in vivo role of p53 inactivation for increased proliferative activity and development of genomic instability in lung cancer. There was no association between SPF and prognosis. Although prognosis was worse in DNA-aneuploid and multiploid tumours than in diploid, peridiploid and tetraploid carcinomas (P = 0.029), DNA ploidy was not an independent predictor of poor prognosis in multivariate analysis. These data show that DNA-flow cytometry has little prognostic value for patients with resected non-small-cell lung carcinoma.

Forty‐eight samples of primary non‐small‐cell lung cancer (nsclc) and normal tissue from the same patients were analyzed for allelic deletions on chromosome 11p. five polymorphic loci were assessed to determine the incidence of 11 p sequence deletions and to define hot‐spots of deletions. information was obtained from all patients in at least one locus. our data show that the deletions observed were not randomly scattered over the short arm of chromosome i i. rather, 2 hot‐spots of deletions were observed: one in the area of the genes for catalase and β‐fsh corresponding to band ii p13, the other close to the igf‐ii locus corresponding to band ii p15. a high incidence of loss of heterozygosity (loh) was found with the probe for catalase (21/29), a locus flanking the centromeric region of the wilms' tumor locus. most of the samples exhibiting loh of one or more of the alleles analyzed remained heterozygous for at least one other chromosome iip allele. furthermore, duplication of the intensity of the remaining allele was rarely observed. our results indicate that loh on the short arm of chromosome ii is a common event in nsclc and that the chromosomal region containing the wilms' tumor locus is most commonly involved.

BACKGROUND:In patients with coronary artery disease, continuation of aspirin may reduce the incidence of unstable angina and preoperative myocardial infarction before surgery, but the risk of perioperative bleeding may be increased.METHODS:The efficacy of aprotinin and tranexamic acid (TXA) was examined in a prospective, randomized, double-blind trial involving 56 patients scheduled for coronary artery bypass grafting and who received aspirin 100 mg/day until the day of the operation. Group I received high-dose aprotinin whereas group II received 10 g of tranexamic acid (TXA) over 20 minutes before sternotomy. Heparinization during cardiopulmonary bypass was controlled with HDTT (high-dose thrombin time) to eliminate interference of aprotinin on ACT (celite activated clotting time). Postoperative blood loss and transfusion requirements were registered during the first 24 hours.RESULTS:The demographics, coagulation, and intraoperative parameters were similar in both groups. Postoperative blood loss (aprotinin 840 mL /24 hours, TXA 880 mL/24 hours, p = 0.481), and transfusion requirements (2.18 units/patient in the aprotinin group, 2.11 units/patient in the TXA group) were not remarkably different between the two regimen protocols. No perioperative myocardial infarction, pulmonary embolism, cerebrovascular event, or other thrombotic events were observed.CONCLUSIONS:In this trial, we were not able to demonstrate any difference in postoperative bleeding in patients pretreated with aspirin after high-dose aprotinin or TXA. From a practical point of view, TXA is safe, less expensive than aprotinin, and easy to handle, and can be recommended in patients pretreated with aspirin to improve postoperative hemostasis.

Präludium: Die vorliegende Publikation enthält einen Auszug aus einer Diplomarbeit nach einem dreijährigen berufsbegleitenden Nachdiplomstudium "Philosophie und Management" - ein Angebot der Universität Luzern. Das Paradigma der "Evidence based Medicine" dominiert die heutige verkopfte Medizin. Die nachfolgenden Gedanken wollen eine andere Seite der Medizin beleuchten: "Die Kunst der Medizin". Mit harten Daten lässt sich diese "Kunst" nicht belegen. Der Ausdruck entbehrt auch einer genauen Definition. Die Ausführungen gliedern sich in zwei Hauptteile: Der kursorische Überblick über den wissenschaftstheoretischen Status der Medizin im Laufe der Zeit und ein historischer Rückblick auf das Spannungsfeld des Begriffpaares Medizin als "ars" und "scientia" bieten Grundlage und Voraussetzung für die Behandlung des zweiten Teiles (erscheint in der Juni Ausgabe des LAZ). Dieser widmet sich der Ontologie der Kunst der Chirurgie. Der Begriff der "Kunst" entzieht sich hierbei einer präzisen Definition und Eingrenzung. Man kommt folglich nicht umhin, Teilaspekte herauszugreifen, welche die Kunst der Chirurgie repräsentieren , ohne den Begriff jedoch erschöpfend und definitorisch zu beschreiben.