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Inflammatory response and oxidative stress associated with cardiopulmonary bypass PhD Thesis By Dr. Balazs Gasz Supervisor : Prof. Erzsébet Roth University of Pécs, Department of Surgical Research and Techniques CONTENTS, Abbreviations 1. Introduction 1.1 Historical background 1.2. Pathophysiology of cardiopulmonary bypass 1.2.1 Inflammatory response to cardiopulmonary bypass 1.2.2 Role of oxidative injury in the pathomechanism of cardiopulmonary bypass 1.2.3. Inflammatory events at the organ level: Systemic inflammatory response syndrome 1.2.4 Therapeutic, anti-inflammatory strategies 1.3. “Off-pump” coronary artery bypass grafting | 1.4 Conclusion | 2. Aims and hypothesis 3. Clinical outcomes and myocardial damage | following coronary surgery:on-pump versus off-pump 3.1 Introduction 3.2 Patients and Methods 3.2.1 Anesthesia and operative technique 3.22. Preoperative data 3.2.3. Perioperative and early-postoperative outcomes, 3.2.4 Determination of myocardial injury 3.2.5. Statistical analysis, 3.3 Results | 3.3.1 Preoperative data 3.3.2. Early postoperative outcomes 3.3.3. Alteration of myocardial necrosis enzyme levels 3.4 Discussion w 26 26 26 27 27 27 28 28 28 28 30 4, Cytokine network and myocardial cytokine-produetion in patients receiving conventional or off-pump operation 34 4.1 Introduction 34 4.2 Patients and Methods 35 4.2.1 Patients 35 ‘Anaesthesia and surgical technique 35 Blood sampling 35 Measurement of cytokines 3 Statistical analysis 36 43° Results 37 43.1 Concentration of cytokines from samples of peripheral vein 37 4.3.1 Assessment of cytokine balance 38 4.3.3. Concentration of cytokines from samples of coronary sinus 41 44 Discussion 42 5, Expression of CD97 and adhesion molecules on circulating leukocytes in patients undergoing coronary artery bypass grafting with or without cardiopulmonary bypass 48. 5.1 Introduction 48 5.2 Patients and Methods 49 5.2.1 Patients 49 5.2.2 Anesthesia, operative technique 49 5.2.3 Blood sampling 49 5.2.4. White blood cell count measurement 49 5.2.5 Assessment of CD 97 expression 50 5.2.6 Measurement of adhesion molecules 50 5.2.7. Statistical analysis 50 53 Results 30 5.3.1 Alteration in leukocyte subsets 50 5.3.2. CD97 granulocytes and monocytes 52 5.3.3. Percentage of CD97 positive lymphocytes 54 5.3.4 Adhesion molecules 55 54 Discussion 37 6. Oxidative stress during coronary artery bypass grafting with or without cardiopulmonary bypass 61 6.1 Introduction 61