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We propose to arrange the randomised study, comparing results of open and endoscopic vein graft harvesting technique during the coronary bypass surgery. One hundred patients will be enrolled in the study. The histological examination of harvested graftswill be performed focusing on extent of endothelial impairment. The limb-morbidity, wound healing complications rate, length of hospitalization and cardiovascular complications will be observed postoperatively. The vein grafts quality will be evaluated through the use of CT scan two years after the operation, focused on quantification of degree of eventual stenosis and on determination of calcium content in the vein bypasses wall. We want to document or to suspend, that endoscopic technique will be followed by the decrease in limb-morbidity and it will result in the same or higher endothelium preservation and the same or better mid-term patency rate with slower wall degeneration and slower formation of stenosis, what would lead to reduced postoperati

Projekt předpokládá provedení randomizované studie, srovnávající výsledky otevřené a endoskopické techniky odběru žilního štěpu ke koronárnímu bypassu. Zařazeno bude 100 pacientů, u kterých bude provedeno histologické vyšetření odebraných žilních štěpů se zaměřením na míru poškození endotelu. Pooperačně bude sledována končetinová morbidita, četnost ranných komplikací, délka hospitalizace a kardiovaskulární komplikace. Za 2 roky od výkonu bude pomocí CT hodnocena kvalita žilních štěpů se zaměřením na kvantifikaci eventuálních stenóz a stanovení podílu kalcia ve stěnách žilních štěpů. Chceme prokázat nebo vyloučit, že endoskopický odběr bude pro pacienty znamenat pokles končetinové morbidity, pro žilní štěp stejnou nebo větší šetrnost a pro našitý bypassstejnou nebo lepší střednědobou průchodnost s pomalejší degenerací stěny a vznikem stenóz bypassu, což by vedlo k redukci pooperační kardiovaskulární morbidity.

Konspekt
Patologie. Klinická medicína
NLK Obory
kardiologie
angiologie
chirurgie
NLK Publikační typ
závěrečné zprávy o řešení grantu IGA MZ ČR

Článek

Miotic action of tramadol is determined by CYP2D6 genotype

Physiological research. 2007 ; 56 (1) : 129-136.

ISSN 0862-8408
Medvik
Zdroj

Polymorphic CYP2D6 is the enzyme that activates the opioid analgesic tramadol by O-demethylation to its active metabolite O-demethyltramadol (M1). Our objective was to determine the opioid effects measured by pupillary response to tramadol of CYP2D6 genotyped volunteers in relation to the disposition of tramadol and M1 in plasma. Tramadol displayed phenotypic pharmacokinetics and it was possible to identify poor metabolizers (PM) with >99 % confidence from the metabolic ratio (MR) in a single blood sample taken between 2.5 and 24 h post-dose. Homozygous extensive metabolizers (EM) differed from PM subjects by an almost threefold greater (P=0.0014) maximal pupillary constriction (Emax). Significant correlations between the AUC and Cmax values of M1 versus pupillary constriction were found. The corresponding correlations of pharmacokinetic parameters for tramadol itself were weaker and negative. The strongest correlations were for the single-point metabolic ratios at all sampling intervals versus the effects, with rs ranging from 0.85 to 0.89 (p‹0.01). It is concluded that the concept of dual opioid/non-opioid action of the drug, though considerably stronger in EMs, is valid for both EM and PM subjects. This is the theoretical basis for the frequent use and satisfactory efficacy of tramadol in clinical practice when given to genetically non-selected population.