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Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: general anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone.

OBJECTIVE: This study compared general anesthesia (GA), combined GA plus thoracic epidural anesthesia (TEA), and TEA alone in patients scheduled for off-pump coronary artery bypass grafting. DESIGN: Prospective, nonrandomized clinical study SETTING: University hospital. PARTICIPANTS: Ninety consenting patients undergoing beating-heart coronary artery revascularization with comparable coronary status and left ventricular function. INTERVENTIONS: GA (n=30) was conducted with propofol, remifentanil, and cisatracurium or combined with TEA (GA+TEA, n=30) or TEA as the sole anesthetic with ropivacaine plus sufentanil (TEA, n=30). MEASUREMENTS AND MAIN RESULTS: Groups were comparable regarding the surgical approaches and the number of anastomoses. Four patients (GA, n=2; GA+TEA, n=2) who required unplanned cardiopulmonary bypass, and 4 patients in the TEA group who underwent unexpected intubation because of pneumothorax (n=2), phrenic nerve palsy, or incomplete analgesia were excluded from further analysis. Intraoperative heart rate decreased significantly with both GA+TEA and TEA. None of the patients with TEA alone was admitted to the intensive care unit, they all were monitored on average for 6 hours postoperatively in the intermediate care unit and allowed to eat and drink as desired on admission. Postoperative pain scores were lower in both groups with TEA. There were no differences among groups in patients overall satisfaction. CONCLUSION: Based on the authors data, all anesthetic techniques were equally safe from the clinicians standpoint. However, GA+TEA appeared to be most comprehensive, allowing for revascularization of any coronary artery, providing good hemodynamic stability and reliable postoperative pain relief. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated.

Aged↗

A case-control study of association between life-style, alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 genotype and idiopathic osteonecrosis of the femoral head.

A case-control study of idiopathic osteonecrosis of femoral head (ION) was carried out to investigate the association between workload intensity, smoking, drinking, ADH2 and ALDH2 genotype and other factors and development of ION by comparing 43 cases (34 males and 9 females) without history of systemic corticosteroid use with 86 matched controls (68 males and 18 females). Univariate analysis by conditional logistic regression for males showed statistically significant odds ratios (OR) for heavier workload (OR = 4.661), cumulative alcohol consumption (OR trend per drink-years = 1.015), ALDH2(1/1) (OR = 3.310), consumption of green tea less than 3 or 4 times/week (OR = 2.705), body weight over 60 kg at examination (OR = 0.413), or body mass index of over 25 at examination (OR = 0.208). Multivariate analysis based on a hierarchically well-formulated model strategy for males revealed that heavier workload (OR = 5.785, 95% confidence interval (CI): 1.211, 27.635) and cumulative alcohol consumption (OR = 1.016, 95% CI: 1.005, 1.026) remained as the significantly associated risk factors for ION after adjusting the remaining confounders. The reason for the insignificant multivariate OR of ALDH2(1/1) may be due to the strong confounding of alcohol consumption on the association between ALDH2 genotype and ION. For females, the small sample size made it impossible to produce any meaningful univariate analysis.

Adult↗

[Brick-tea type adult bone fluorosis].

To investigate health impact of brick-tea type fluorosis in adults, the total daily fluorine intake, environment fluorine level were determined, the average urinary fluorine content assay and bone X-ray examination were conducted, the clinical manifestations were observed in the brick-tea type bone fluorosis epidemiological study conducted in Naqu County, Tibet at September, 2001. One hundred and eleven adults aged at 30-78 year-old were enrolled. It was found that the fluorine level of drinking water in Naqu County was 0.10 +/- 0.03 mg/L, but the brick-tea water processed foods-zamba and buttered tea had fluorine content of 4.52 +/- 0.74 mg/kg and 3.21 +/- 0.65 mg/kg respectively. The adult daily fluorine intake reached 11.99 mg, among which 99% is originated from the brick-tea containing foods. Positive detection rate of fluorosis osteopathy was 89% and the X-ray film confirmed that the diagnosis rate was 83%. Degenerative arthropathy and ossification of the interosteal membrane, calcification of the tendon were the characteristics that indicated by both the positive signs and reogenological examination. The prevalence of osteosclerosis type (bone matrix increased) was 74%. It is suggested that there were even more severe health impact compared with those in the water type and coal combustion type fluorosis.

Adult↗

Risk factors for oesophageal cancer in northeast China.

A hospital-based case-control study of oesophageal cancer was carried out in the Heilongjiang Province, a low-risk area for oesophageal cancer in China. From May 1985 to May 1989, 196 histologically confirmed cases and 392 controls with other (non-neoplastic) diseases were personally interviewed in the wards of 5 major hospitals. Information was obtained about usual consumption in the early 1980s of 32 major contributors to the diet in the province, socio-demographic status, smoking and alcohol consumption. Odds ratios (OR) were obtained from logistic regression models, and confounding was controlled by means of multivariate models. Smoking and alcohol consumption were major risk factors for oesophageal cancer in this population. Smokers of handmade cigarettes exhibited a particularly high risk. A near multiplicative synergism was found between smoking and alcohol consumption. There was a significant inverse dose-risk trend for combined consumption of vegetables and fruits; a 300-g increase per day lowered risk by 35%. Vitamin C intake was negatively associated with risk; a 100-mg increase per day lowered risk by 39%. Our data suggest a modifying effect of vitamin C and beta-carotene on risk associated with smoking, but the power of analyses was low. Salt, salt-preserved foods and pickled vegetables were not associated with increased risk. High temperature of meals and drinks was a strong risk indicator in this population. The strength of tea and overall tea consumption were independent determinants of the risk.

Adult↗

Coffee, tea, tobacco, and cancer of the large bowel.

The impact of tobacco use and coffee and tea intake on the risk of colorectal cancer is unclear. Previous research has suggested that coffee may be protective against these cancers, and investigation regarding tea or cigarette smoking has yielded inconsistent results. To clarify these issues, we evaluated coffee and tea intake and tobacco smoking as risk factors for cancer of the colon and rectum in a population-based case-control study from Stockholm, Sweden. Cases were ascertained from the regional cancer registry, and controls identified through population registers. Subjects completed a questionnaire requesting information regarding foods and beverages consumed, exercise, tobacco use, and personal characteristics. Logistic regression modelling was used to compute odds ratios. A total of 352 cases of colon cancer, 217 cases of rectal cancer, and 512 controls took part. High coffee intake was negatively associated with the risk of colon cancer: the odds ratio for those drinking 6 or more cups per day was 0.55 (95% confidence interval, 0.31-0.96) compared to those drinking one or fewer. There was no association with rectal cancer. For tea, the associations were the opposite: there was no association with colon cancer risk, but the odds ratio for rectal cancer was 0.56 (95% confidence interval, 0.34-0.90) for those drinking 2 or more cups per day compared with those drinking none. Smokers of 11 or more cigarettes per day had a 20 to 30% reduction in the risk of colon and rectal cancer, but these findings were consistent with chance. There was no association of long-term cigarette smoking with risk.

Adenocarcinoma↗

[Fluoride in the environment and brick-tea-type fluorosis in Tibet].

To explore whether endemic fluorosis in Tibet is related to local factors, an epidemiological survey of fluorosis was conducted in 3 districts in Tibet. The survey used the WHO and FAO established "Guideline for the study of dietary intake of chemical contaminants" and the Horowitz suggested criteria for children dental fluorosis examination. The fluorine in the local environment of the 3 selected districts was studied in detail. The possible fluorine sources examined indicated that only the brick-tea carried a high content of fluoride; water, other food materials, and fuel contents were insignificant. The children daily fluorine intake was high, where Naqu was 8.03 mg, Lahsa was 6.93 mg, Dingri was 7.68 mg. All the dietary fluoride was come from the brick-tea processed foods: the buttered-tea and zamba, these two contributed 99.74%, 98.70% and 99.60% of their daily fluorine intake respectively. The dental fluorisis index indicated that Naqu and Dingri were severe epidemic and Lahsa was moderate epidemic. The endemic fluorosis that occurs in Tibet was essentially due to heavy consumption of foodstuffs prepared with brick-tea, however, the high altitude, harsh living conditions, and poor nutritional status aggravated the fluorosis. Brick-tea type fluorosis is a new type of fluorosis recently discovered in China. Compared with the drinking water type and coal combustion type of fluorosis, it covered extensive area, more covert, and difficult to control. Decrease the fluorine content of brick-tea might be the most promising measure.

Altitude↗

Nutritional benefits of drinks.

Much is known about the importance of promoting adequate nutrition, but the fluid content of a patient's diet is not always as strongly emphasised. Vicki Madden discusses the benefits of various drinks in helping to keep patients hydrated.

Dehydration↗

Subacute (90 days) oral toxicity studies of Kombucha tea.

Kombucha tea (KT) is a popular health beverage and is used as an alternative therapy. KT is prepared by placing the kombucha culture in solution of tea and sugar and allowing to ferment. The inoculum is a fungus consisting of symbiotic colony of yeast and bacteria. KT is consumed in several countries and is believed to have prophylactic and therapeutic benefits in a wide variety of ailments, viz., intestinal disorders, arthritis, ageing and stimulation of immunological system. Though KT is used in several parts of the world its beneficial effects and adverse effects have not been scientifically evaluated. Since there are no animal toxicological data on KT, subacute oral toxicity study was carried out. Five groups of rats were maintained: (a) control group given tap water orally, (b) KT given 2 ml/kg orally, (c) plain tea (PT) given 2 ml/kg orally, (d) KT given in drinking water, 1% (v/v) and (e) PT given in drinking water, 1% (v/v). The rats were given this treatment daily for a period of 90 days. Weekly records of weight, feed intake, water intake and general behaviour were monitored. There was no significant difference in the growth of the animals as evidenced by the progressive body weight change. The organ to body weight ratio and histological evaluation did not show any toxic signs. The haematological and biochemical variables were within the clinical limits. The study indicates that rats fed KT for 90 days showed no toxic effects.

Administration, Oral↗

Drinking water consumption patterns in Sweden.

Estimates on drinking water consumption are necessary in risk assessments on microbial hazards in drinking water. Large differences in consumption habits between countries have been reported. In order to establish estimates for the Swedish population, water consumption data from a waterborne outbreak investigation (157 people), a small water consumption study (75 people) and a large study on health and environmental factors (10,957 people) were analysed. A lognormal distribution for the daily direct/cold water intake in litres with mu = - 0.299 and sigma = 0.570 was fitted to the quantitative data, representing the general population. The average daily consumption of tap water as plain drinking water and as heated tap water, e.g. in coffee and tea, was 0.86 +/- 0.48 l and 0.94 +/- 0.69 l, respectively. Women consumed more cold tap water than did men, while men appeared to have a higher consumption of heated tap water. Cold tap water intake was highest in the oldest age group, (> or =70 years). The consumption of bottled water was very low (mean 0.06 l/d) when compared to other countries.

Adult↗

Epithelial ovarian cancer and coffee drinking.

A recent report from a case-control study in Greece suggested that coffee consumption is related to an increase in the risk of ovarian cancer. This hypothesis was examined in a hospital-based case-control study in the US. Information on coffee drinking and other factors was obtained from 290 incident cases of epithelial ovarian cancer and compared with that of 580 controls with non-malignant conditions of acute onset and 476 controls with cancer of other sites. Adjustment was made for the potential confounding effects of several factors, including the major known risk factors for ovarian cancer. The estimated relative risk for drinking five or more cups of coffee per day, relative to none, was 1.1 (95% confidence interval, 0.6-2.0) using the controls with non-malignant conditions and 1.0 (0.5-1.8) using the controls with cancer. The estimates for drinking less than five cups per day were greater than 1.0, but this could have been due to chance. The consumption of decaffeinated coffee and tea also appeared to have no influence on risk. The evidence from this study suggests that, if coffee drinking increases the risk of ovarian cancer, the effect is small.

Adult↗

Determination of the total concentration and speciation of Al(III) in tea infusions.

The aluminium species in different tea infusions were investigated, by determining their stability constants and concentration. This was done for some particular samples using a simple experimental method based on the sorption of aluminium on the strongly sorbing resin Chelex 100, by a batch procedure. From the thermodynamic information obtained it is possible to calculate the concentration of the different species, and in particular that of the free metal ion, which is very important for evaluating the adsorption of aluminium on biological membranes. It was found that aluminium in the tea infusions here considered is present at high total concentration, approximately 0.1 mM, but mainly linked to strong complexes, for instance with side reaction coefficient higher than 10(5.11) at pH 3.95 in one case (tea 1). This could be the reason for the low toxicity of aluminium in tea. These strong complexes were not dissociated even in the presence of Chelex 100. In this case only a limiting value of the reaction coefficient could be evaluated. The presence of the very strong complexes was found in all the tea sample here considered. In two of the considered samples (one black and one green tea) a part of Al(III) was linked to less strong complexes, for example with a reaction coefficient 10(4.14) (tea 2, pH 4.20). The presence in the considered tea infusions of other substances able to complex aluminium was also detected, by the well known ligand titration procedure, at concentration ranging from 0.65 to 3.37 mM in three tea infusions, and at somewhat higher concentration in the case of the ready drink, which was also considered for comparison.

Adsorption↗

Effects of peppermint teas on plasma testosterone, follicle-stimulating hormone, and luteinizing hormone levels and testicular tissue in rats.

OBJECTIVES: To justify the effects of Mentha piperita labiatae and Mentha spicata labiatae herbal teas on plasma total testosterone, luteinizing hormone, and follicle-stimulating hormone levels and testicular histologic features. We performed this study because of major complaints in our area from men about the adverse effects of these herbs on male reproductive function. METHODS: The experimental study included 48 male Wistar albino rats (body weight 200 to 250 g). The rats were randomized into four groups of 12 rats each. The control group was given commercial drinking water, and the experimental groups were given 20 g/L M. piperita tea, 20 g/L M. spicata tea, or 40 g/L M. spicata tea. RESULTS: The follicle-stimulating hormone and luteinizing hormone levels had increased and total testosterone levels had decreased in the experimental groups compared with the control group; the differences were statistically significant. Also, the Johnsen testicular biopsy scores were significantly different statistically between the experimental groups and the control group. Although the mean seminiferous tubular diameter of the experimental groups was relatively greater than in the control group, the difference was not statistically significant. The only effects of M. piperita on testicular tissue was segmental maturation arrest in the seminiferous tubules; however, the effects of M. spicata extended from maturation arrest to diffuse germ cell aplasia in relation to the dose. CONCLUSIONS: Despite the beneficial effects of M. piperita and M. spicata in digestion, we should also be aware of the toxic effects when the herbs are not used in the recommended fashion or at the recommended dose.

Animals↗

Factor structure of common drug usage.

The correlated usage of commonly employed, legal drugs was examined in a sample of 377 American and 908 Swedish adults. Measures of alcohol, tranquilizer, sleeping pill, and coffee or tea consumption were submitted to a principal components factor analysis with Varimax rotation. The resultant three factors were characterized by (1) heavy drinking in general and beer consumption specifically (ALCFAC), (2) the use of tranquilizers and sleeping medications (TSFAC) and (3) the consumption of coffee and tea (CTFAC). Factor structure profiles for ALCFAC and TSFAC were more stable than CTFAC across nationalities, sexes, and cohorts. Profiles for Swedish smokers and never-smokers were very similar; for Americans, however, profiles for never-smokers were more similar to Swedish profiles than to those of American smokers. Factor scores were computed to examine the relationship between tobacco use and levels of the factors by means of analysis of variance. In Swedes, ALCFAC and CTFAC levels varied with smoking status, whereas ALCFAC and TSFAC levels with smoking status in Americans.

Alcohol Drinking↗

Natural history of peptic ulcer disease in Poland. Part IV. Dietary habits, mode of eating, coffee, tea, tobacco and alcohol, addiction's.

In the "Ulcer" research programme 5813 male and female patients with peptic ulcer of the upper gastrointestinal tract were analysed paying attention to the quality of their diet and mode of meal taking. Weight loss was found to occur in these patients and information was gathered concerning alcohol, tobacco, coffee, tea consumption and addictions.

Adolescent↗

Effects of green tea and black tea on 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone bioactivation, DNA methylation, and lung tumorigenesis in A/J mice.

Previous studies in our laboratory showed that decaffeinated green tea and black tea extracts inhibited 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced tumorigenicity in A/J female mice. In order to understand the mechanism of the inhibitory action, we examined the effects of decaffeinated green tea, black tea, and tea components on the metabolic activation of NNK in vitro and in vivo in this animal model. When added to incubation mixtures containing mouse lung microsomes, decaffeinated green tea and black tea extracts and their fractions, at concentrations up to 0.4 mg/ml, inhibited NNK oxidation and NNK-induced DNA methylation. Among the tea components examined, (-)-epigallocatechin-3-gallate was the most potent inhibitor with 50% inhibitory concentrations of about 0.12 mM for both NNK oxidation and DNA methylation. At these concentrations, (-)-epigallocatechin-3-gallate inhibited the catalytic activities of several P450 enzymes and was more potent against P450 1A and 2B1 than 2E1. When decaffeinated green or black tea extracts were given to female A/J mice as the sole source of drinking fluid before an i.p. injection of NNK (100 mg/kg body weight), a statistically significant inhibition of lung DNA methylation, however, was not observed, although a significant reduction in lung tumor multiplicity was observed. The results suggest that, although inhibition of the metabolic activation of NNK and the subsequent DNA alkylation by tea extracts can be demonstrated in vitro, this mechanism may not be important for the inhibitory action of tea against lung tumorigenesis.

Animals↗