Presse Med
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Four consecutive patients underwent resection and graft replacement of ascending aorta or aortic arch for acute dissection. Retrograde cerebral perfusion (RCP) was used during circulatory arrest. RCP at 15 degrees C was administered through the superior vena cava. ⋯ Minor neurological disturbance was found in 1 patient, he was discharged from hospital at day 11 without any detectable neurological deficit. This technique was attractive because it provided a dry operative field unencumbered by perfusion cannulas or clamps, facilitated construction of a more secure distal anastomosis, and avoided the risk of further injury resulting from the aortic cross clamp. It seems that RCP allows longer circulatory arrest time.
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Recent studies have confirmed that the mean blood pressure levels recorded during ambulatory monitoring are lower than the levels measured by the standard cuff method, possibly due to the "white coat" effect which involves as many as 25 to 30% of the total hypertensive population. In addition, ambulatory blood pressure monitoring is particularly useful to evaluate the day/night cycle. Loss of the normal decrease in blood pressure at night occurs in certain types of secondary hypertension and can be revealed by ambulatory monitoring. ⋯ Ambulatory monitoring can also modify management decisions as found in a recent survey conducted in the United States demonstrating the impact on the treatment of hypertension. For 30 to 40% of the hypertensive patients, therapeutic management was different after ambulatory monitoring than after conventional cuff measurement. Standardization will be the next step in the widespread use of ambulatory blood pressure monitoring.
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Zinc metabolism is frequently abnormal in renal allograft recipients. These abnormalities may be immune mediated because zinc metabolism is affected by inflammation. ⋯ Our results suggest that enhanced urinary zinc excretion in allograft recipients is due to immune activation. The data indicate that cytokines play a role in zinc metabolism.