BACKGROUND:To evaluate the myocardial protective effect of nicorandil when used as an adjuvant to cold hyperkalaemic cardioplegia in open-heart surgery. METHODS:Patients who underwent surgery under cardiopulmonary bypass (CPB) for mitral valve replacement (MVR, 23 patients) or coronary artery bypass grafting (CABG, 24 patients) were entered in a double-blind study. The patients were randomized to a nicorandil Group (N) or placebo Group (P). Nicorandil 0.1 mg kg-1 (Group N), or normal saline (Group P), were administered at three time points: (1) after aortic cannulation, but prior to going on CPB, (2) 5 min before aortic cross-clamping and (3) 5 min before reperfusion. The following variables were studied: (a) time until electromechanical arrest after cardioplegia administration (Tarrest), (b) time until return of electromechanical activity after aortic cross-clamp removal (Trecovery), (c) incidence of postoperative myocardial infarction or low output syndromes (d) dysrhythmias requiring intervention after aortic cross-clamp removal and (e) haemodynamic changes after nicorandil administration. RESULTS:The Tarrest after cardioplegia administration was significantly faster in nicorandil group in both MVR and CABG patients (P 75 IU L-1 in MVR patients was significantly lower in the Group N than in placebo patients (P < 0.05). However, in CABG patients there was no such significant difference. The incidence of dysrhythmias requiring intervention after aortic cross-clamp removal was also less in Group N. Administration of 0.1 mg kg-1 boluses of nicorandil did not cause significant haemodynamic changes or precipitate dysrhythmias in any patient. CONCLUSION:Nicorandil enhances the myocardial protective effect of cold hyperkalaemic cardioplegia in cardiac surgery patients.

OBJECTIVE:The purpose of this study was to assess the cardioprotective effects of nicorandil in patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). DESIGN:A prospective, double-blind, randomized clinical study. SETTING:A university hospital. PARTICIPANTS:Thirty-two patients undergoing elective CABG surgery. INTERVENTIONS:Patients were randomized into 2 groups: the nicorandil and placebo groups. In the nicorandil group, intravenous nicorandil infusion was started after the induction of anesthesia by a loading dose of 0.1 mg/kg, followed by a continuous infusion of 0.1 mg/kg/h until 2 hours after CPB, then decreased to 0.05 mg/kg/h, and discontinued at the end of surgery. The placebo group received the same volume of saline. Arterial blood was sampled, and serum troponin T (TnT) and CK-MB were measured at the following 4 stages: after the induction of anesthesia (baseline), 2 hours after CPB, the first postoperative day (POD), and the third POD. MEASUREMENTS AND MAIN RESULTS:TnT concentrations were similar at baseline and increased with a peak on the first POD in both groups. In the nicorandil group, TnT concentration returned to the baseline value at the third POD, and the time course of TnT showed significantly lower levels (p = 0.012). CK-MB concentrations were similar at baseline, increased and peaked at 2 hours after CPB, and returned to the baseline on the third POD in both groups. There were no significant differences between the groups with respect to the changes in CK-MB concentrations. CONCLUSIONS:The nicorandil group showed lower concentrations of TnT, suggesting that intraoperative administration of nicorandil may provide a degree of myocardial protection in CABG surgery.

Cutaneous inflammatory myofibroblastic tumors (IMT) constitute a rare entity, generating a diagnostic pitfall when diagnosing spindle cell proliferation within the dermis. Raising awareness of this tumor among dermatopathologists remains vital in differentiating it from common cutaneous tumors such as fibrous histiocytoma, atypical fibroxanthoma, melanoma, poorly differentiated carcinoma, and other more aggressive tumors. Accurate diagnosis of IMT aids in ensuring appropriate management and follow-up for patients while preventing unnecessary harm and overtreatment. Here we report a case of a 38-year-old female with a painless, slow-growing nodule of the left posterior scalp initially diagnosed as a dermatofibroma. The histopathological examination revealed an ill-defined dermal nodule of spindled cells without connection or infiltration of the epidermis. At high power, the cells were arranged in fascicles with a prominent background of lymphocytic infiltrate. Immunohistochemical analysis showed strong diffuse immunoreactivity for anaplastic lymphoma kinase (ALK), and targeted RNA sequencing identified a CARS-ALK fusion ultimately confirming the accurate diagnosis of a cutaneous IMT.