- Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats. [Journal Article]
- Plast Surg (Oakv) 2016; 24(2):99-102.
A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive.To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model.The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline.BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45).BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
- Ghrelin attenuates hyperalgesia and light aversion-induced by nitroglycerin in male rats. [JOURNAL ARTICLE]
- Neurosci Lett 2016 Jul 16.
Systemic administration of nitroglycerin (NTG) consistently provokes spontaneous-like migraine attacks in migraine sufferers, and in rat it induces hyperalgesia and allodynia. In the present study we modeled migraine headache by intraperitoneal (i.p.) injection of a single dose of NTG, which produced widespread thermal allodynia and mechanical hyperalgesia, photophobia, and increased anxiety-like behaviors and serum concentration of cortisol. Results suggest that the effects of NTG can be largely reversed by administration of ghrelin, which mimics the effects of sumatriptan used as relevant positive therapeutic control in this study. These findings suggest that ghrelin may alleviate some of the negative emotional states associated with migraine and may hold therapeutic potential in treating migraine headache.
- Impact of epicardial adipose tissue volume quantified by non-contrast electrocardiogram-gated computed tomography on ergonovine-induced epicardial coronary artery spasm. [JOURNAL ARTICLE]
- Int J Cardiol 2016 Jul 9.:877-880.
Endothelial dysfunction of the coronary artery is thought to lead to the development of coronary spasms. Epicardial adipose tissue may be a marker of coronary atherosclerosis. This study investigated the diagnostic impact of epicardial fat volume (EFV), quantified with non-contrast electrocardiogram (ECG)-gated computed tomography (CT), on ergonovine-induced coronary spasms.We included 97 patients with suspected coronary spastic angina who underwent ECG-gated CT and an ergonovine provocation test. The EFV was measured with CT data sets using dedicated software. Coronary spasm was defined as total or subtotal occlusion (compared with the relaxed state after nitroglycerin) that was associated with ischemic ECG changes and concurrent chest pain.Coronary spasms were observed in 27 patients (28%). The EFV was significantly higher in patients with spasms compared with those without spasms (175.0±57.8cm(3) vs. 129.7±57.8cm(3), p<0.01). Univariate logistic regression analyses indicated significant relationships between coronary spasms and EFV (per 10cm(3), odds ratio (OR): 1.13; p<0.01), male gender (OR: 3.34; p<0.01), and smoking (OR: 3.42; p<0.01). In the multivariate model, EFV (per 10cm(3), OR: 1.10; p=0.03) and male gender (OR: 5.94; p=0.02) remained significant predictors of coronary spasm. The optimal EFV threshold for predicting coronary spasm was 149.4cm(3), identified with a receiver operating characteristic curve.Increased EFV was associated with ergonovine-induced epicardial coronary artery spasms.
- Corrected flow time: a noninvasive ultrasound measure to detect preload reduction by nitroglycerin. [JOURNAL ARTICLE]
- Am J Emerg Med 2016 Jun 24.
Monitoring of patient's intravascular volume status without invasive measures remains challenging and unreliable. Our objective was to determine if corrected flow time (FTc) measurement could detect preload reduction with administration of nitroglycerin (NTG) as a surrogate for volume loss.Post hoc FTc analysis was performed for a prospective cohort study of pulsed wave spectral Doppler measurements before and after administration of NTG. Patients enrolled were eligible for inclusion if they were admitted to a chest pain center for cardiac evaluation. Descriptive statistics, t tests, bivariate regression, and intraclass correlation coefficient were performed as appropriate.Fifty-four patients had Doppler measurements available for review. Mean FTc decreased from 339 milliseconds (95% confidence interval, 332-346) to 325 milliseconds (95% confidence interval, 318-331) with administration of 0.3 mg of sublingual NTG (P=.0001). Mean heart rate increased 5 beats/min with administration of NTG (P<.0001); however, there was no significant change in systolic or diastolic blood pressure.Corrected flow time was able to detect a significant difference in preload reduction with 0.3 mg of NTG. The FTc may be an early reliable noninvasive measure to detect changes in intravascular volume status.
- Chronic Anal Fissure: A Comparative Study of Medical Treatment Versus Surgical Sphincterotomy. [Journal Article]
- Acta Med Iran 2016 Jul; 54(7):437-40.
To determine whether the medical Treatment of anal fissure can be an effective alternative for surgery
Methods:Retrospectively, we randomly selected 190 Patients being treated for anal fissure between the years 2005-2010 in 3 equal groups: group A: Patients who received medical treatment with topical nitroglycerin, group B: Patient treated with topical diltiazem, and group C: Patients underwent surgery. The results were then correlated with the statistical program SPSS using chi-square test. Main complaints of the patients were first anal pain and then bleeding. The response to treatments for relieving pain was: 77% in A, 83% in B, and 98% in group C. Response of treatments for fissure healing, in order of groups A, B and C was: 74%, 83%, and 94%. Despite good response to medical treatment, surgical treatment was more effective and medical treatment of choice in patients who are willing to have surgery.
- [The modification of structural and functional properties of human hemoglobin induced by nitroglycerin under different oxygen regime conditions]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Biomed Khim 2016 Mar; 62(3):251-258.
Human oxyhemoglobin exhibits high resistance to nitroglycerin during incubation of the protein with this compound for 0.3-3 h. Prolonged exposure (24 h) leads to activation of methemoglobin production. In the presence of nitroglycerin hemoglobin molecules undergo rapid oxidation during deoxygenation with formation of methemoglobin as the terminal product of human oxyhemoglobin interaction with nitroglycerin. The scheme of interaction processes of oxyhemoglobin with nitroglycerin in different conditions of oxygen regime is proposed. Partially deliganded hemoglobin plays the leading role in the initiation of hemoglobin oxidation processes.
- The Association Between Nitroglycerin Use and Adverse Outcomes in Women Undergoing Cesarean Delivery in the Second Stage of Labor. [JOURNAL ARTICLE]
- J Matern Fetal Neonatal Med 2016 Jul 12.:1-17.
To identify predictors of hysterotomy extension in women undergoing cesarean delivery (CD) in the second stage of labor, and whether use of nitroglycerin (NTG) during CD has a protective effect.We conducted a retrospective cohort study of women undergoing CD in the second stage of labor from 2012-2015. Some women received NTG at the obstetrician's request. Logistic regression was used to examine the relationship between second stage duration and NTG administration on maternal and neonatal outcomes.Of the 391 women in the sample, 27% had an extension and 12% received NTG. Second stage ≥4h was associated with a 2.14-fold higher risk of extension (95% CI 1.22-3.75), a 2.00-fold higher risk of hemorrhage (95% CI: 1.20-3.33) and 2.42-fold higher risk of blood transfusion during delivery hospitalization (95% CI: 0.99-5.91). Intravenous (IV) and sublingual-spray (SL) NTG administration were not associated with an increased risk of hemorrhage or extension. SL-NTG was associated with 4.68-fold increased odds of 5-minute Apgar <7 (95% CI 1.42-15.41), and 3.36-fold greater odds of NICU admission (95% CI 1.20-9.41).We found no evidence that NTG protects against extension, and SL-NTG use was associated with adverse neonatal outcomes. Clinical trials should be conducted to evaluate risk and benefits of NTG use.
- Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm. [JOURNAL ARTICLE]
- Dermatol Surg 2016 Jul 8.
Chondrodermatitis nodularis helicis (CNH) is an idiopathic benign inflammatory painful condition of the ear. Still, to date, no study has yet evaluated nor compared treatments regarding their safety and efficacy.The objective of this study is to review all available treatment modalities of CNH that were described in the literature, compare their efficacy and propose a treatment algorithm.A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles studying the management of CNH that reported data on the cure rates were included in this review.A total of 29 studies were included in the review. The 3 most commonly reported treatments for CNH are surgery, pressure relief, and topical nitroglycerin. Surgery has higher cure rate (82%) compared with pressure relief treatment (37%) or nitroglycerin (51%) (p < .0001). Surgery should be considered as the first-line treatment for CNH. Second-line treatments include nonsurgical therapies, particularly nitroglycerin and pressure relief techniques, alone or in combination. Third-line treatments include newer or less studied methods.Among the treatment modalities, surgery showed the highest cure rates. Adequately designed randomized controlled trials are warranted to compare newer therapeutic methods.