Ultimo Aggiornamento: Gennaio 2004

1: Am J Emerg Med. 2003 Nov;21(7):549-51.

Spontaneous coronary artery dissection causing acute coronary syndrome: an early
diagnosis implies a good prognosis.

Roig S, Gomez JA, Fiol M, Guindo J, Perez J, Carrillo A, Esplugas E, Bayes de
Luna A.

Coronary and Intensive Care Unit, Hospital Son Dureta, C/Andrea Doria 55, 07014
Palma de Mallorca, Spain.

Spontaneous coronary artery dissection is an unusual cause of acute coronary
syndrome. We describe a series of cases that with an early diagnosis and
aggressive treatment, which includes percutaneous angioplasty with stent
implantation and cardiac surgery, had a good outcome. The objective was to study
the demographic characteristics, clinical settings, treatments, and inhospital
course of patients with spontaneous coronary artery dissection. We studied a
retrospective case series in 3 coronary care units in third-level university
hospitals. The spontaneous coronary artery dissection diagnosis was made by
coronary angiography. Seven cases of spontaneous coronary artery dissections
were recorded. They were 5 women and 2 men. The age range was 28 to 64 years.
Two of them took oral contraceptives and one case occurred in the postpartum
period. An acute anterior wall myocardial infarction was the most frequent
clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior
descending artery was involved in 6 cases. An urgent coronary angiogram was
performed in all cases. Definitive treatment included percutaneous angioplasty
and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and
cardiac transplantation in another case. One patient was treated medically. None
of the patients died in the hospital. Spontaneous coronary artery dissection
remains an unusual cause of acute coronary syndrome. It should be included in
the differential diagnosis of acute myocardial infarction, especially when it
affects young, healthy females. An early clinical suspicion and diagnosis with
urgent coronary angiography and aggressive treatment that includes percutaneous
angioplasty with stent implantation and cardiac surgery could improve the
prognosis of these patients.

PMID: 14655234 [PubMed - indexed for MEDLINE]

2: Anesth Analg. 2004 Jan;98(1):185-92, table of contents.

Reduction in [D-Ala2, NMePhe4, Gly-ol5]enkephalin-induced peripheral
antinociception in diabetic rats: the role of the L-arginine/nitric oxide/cyclic
guanosine monophosphate pathway.

Tasatargil A, Sadan G.

Department of Pharmacology, Faculty of Medicine, Akdeniz University, 07070
Antalya, Turkey. arda@med.akdeniz.edu.tr

To test our hypothesis that the abnormally small efficacy of mu-opioid agonists
in diabetic rats may be due to functional changes in the L-arginine/nitric oxide
(NO)/cyclic guanosine monophosphate (cGMP) pathway, we evaluated the effects of
N-iminoethyl-L-ornithine, methylene blue, and 3-morpholino-sydnonimine on
[D-Ala(2), NMePhe(4), Gly-ol(5)]enkephalin (DAMGO)-induced antinociception in
both streptozotocin (STZ)-diabetic and nondiabetic rats. Animals were rendered
diabetic by an injection of STZ (60 mg/kg intraperitoneally). Antinociception
was evaluated by the formalin test. The mu-opioid receptor agonist DAMGO (1
microg per paw) suppressed the agitation response in the second phase. The
antinociceptive effect of DAMGO in STZ-diabetic rats was significantly less than
in nondiabetic rats. N-Iminoethyl-L-ornithine (100 microg per paw), an NO
synthase inhibitor, or methylene blue (500 microg per paw), a guanylyl cyclase
inhibitor, significantly decreased DAMGO-induced antinociception in both
diabetic and nondiabetic rats. Furthermore, 3-morpholino-sydnonimine (200 microg
per paw), an NO donor, enhanced the antinociceptive effect of DAMGO in
nondiabetic rats but did not change in diabetic rats. These results suggest that
the peripheral antinociceptive effect of DAMGO may result from activation of the
L-arginine/NO/cGMP pathway and dysfunction of this pathway; also, events that
are followed by cGMP activation may have contributed to the demonstrated poor
antinociceptive response of diabetic rats to mu-opioid agonists. IMPLICATIONS:
This is the first study on the role of the nitric oxide (NO)/cyclic guanosine
monophosphate pathway on [D-Ala(2), NMePhe(4), Gly-ol(5)]enkephalin
(DAMGO)-induced peripheral antinociception and the effect of diabetes on this
pathway. The study suggests a possible role of DAMGO as a peripherally-acting
analgesic drug.

PMID: 14693616 [PubMed - indexed for MEDLINE]