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Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high.

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitusCoronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus Abstract Objective: We sought to describe the use of both internal thoracic arteries (ITA) in patients with diabetes mellitus (DM) submitted to a coronary artery bypass grafting (CABG).Method: Between January 1995 to August 2005, 4,569 patients received isolated CABG in our institution. Of the initial population, 1,298 had DM. The median age of the patients was 62 years and total mortality rate was 2.18% (100 patients). Both internal thoracic arteries were used in 700 patients. Patients were divided into two groups: with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double ITA grafting was based on coronary artery anatomy and on the quality of sternum. The later was evaluated during the sternal transsection. When these two factors were considered favorable, we have both ITAs dissected, regardless whether the patient had DM. During the dissection of both internal thoracic arteries, one must take care not to open the pleural spaces.Results: There was a small difference between the two groups in terms of morbidity and mortality.Conclusion: Our data suggests that patients with DM can benefit with the efficient use of both internal thoracic arteries with a small increase in the risk of complications, if its application is carefully indicated.

Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration. MethodsWe included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the same team under a standard technique except for the addition of methylprednisolone (15 mg/kg) to the CPB priming solution for patients from group MP (n = 37), but not for the remaining patients -group NS (n = 37). MIF circulating levels were assayed at the anesthesia induction, 3, 6, and 24 hours after CPB. A standard weaning protocol with fast track strategy was adopted, and indicators of organ dysfunction and therapeutic intervention were registered during the first 72 hours postoperative.Results Levels of MIF assayed 6 hours post CPB correlated directly to the postoperative duration of mechanical ventilation (P = 0.014, rho = 0.282) and inversely to PaO 2 /FiO 2 ratio (P = 0.0021, rho = -0.265). No difference in MIF levels was noted between the groups. The duration of mechanical ventilation was higher (P = 0.005) in the group MP (7.92 ± 6.0 hours), compared with the group NS (4.92 ± 3.6 hours). ConclusionCirculating levels of MIF assayed 6 hours post CPB are correlated to postoperative pulmonary performance. Immunosuppressive doses of methylprednisolone did not affect circulating levels of MIF and may be related to prolonged mechanical ventilation. P2Immediate and short-term safety of catheter-based autologous bone marrow-derived mononuclear cell transplantation into myocardium of patients with severe ischemic heart failure Background Bone marrow-derived mononuclear cell (BM-MNC) transplantation into the myocardium has been proposed as a new therapy for ischemic heart failure (HF). Successful cellular therapy for HF using myoblast transplantation has been reported previously but malignant arrhythmias (MA) were an issue. We investigated the safety of BM-MNC transplantation into the myocardium for MA.Methods A prospective study to evaluate the safety of autologous BM-MNC transplantation in patients with severe ischemic HF not amenable to myocardial revascularization was conducted. Bone marrow was harvested from the iliac crest and BM-MNCs were selected by Ficoll gradient. Hibernating myocardium areas were targeted using electromechanical mapping in catheter-based subendocardial injections (MyoStar, Cordis, Miami Lakes, FL, USA). All patien...