Acute Myocarditis

ABSTRACT In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a “routine” serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p < 0.05).     

CUTANEOUS MYIASIS: REVIEW OF 13 CASES IN TRAVELERS RETURNING FROM TROPICAL COUNTRIES

Background. Cutaneous myiasis is frequently reported in patients from tropical countries. Most commonly infestation is due to Cordylobia anthropophaga and Dermatobia hominis, whereas Hypoderma lineatum is less likely to affect humans. Methods. The clinical and parasitologic aspects in a series of 13 patients with cutaneous myiasis seen in a German travel clinic are reviewed. Results. Six patients were infected with larvae of the tumbu fly, Cordylobia anthropophaga, six with larvae of the botfly, Dermatobia hominis, and one patient presented with an infection with Hypoderma lineatum. Dermatobia hominis was exclusively acquired in the American tropics and Cordylobia anthropophaga exclusively in Africa, whereas infection with Hypoderma lineatum was acquired in Nepal. The number of larvae removed from the skin was markedly higher in patients infected with the tumbu fly (average of five larvae) compared to the botfly (average of 1.7 larvae), whereas pain was more frequently reported from patients with botfly infestation. Treatment consisted in the removal of the larvae by forceps or surgical incision in tumbu or botfly infection and oral application of infection in infection with Hypoderma lineatum. This led to complete recovery in all patients. Conclusions. In patients presenting with cutaneous lesions after return from tropical countries, myiasis has to be considered as a differential diagnosis. Simple and effective therapy is available through removal of the maggots.     

Effects of intraoperative blood loss during liver resection on patients’ outcome: a single-center experience

Background/aim Operative bleeding is one of the major determinants of outcome in liver surgery. This study aimed to describe the impact of intraoperative blood loss on the postoperative course of liver resection (LR). Materials and methods The data of 257 patients who were treated with LR between January 2007 and October 2018 were retrospectively analyzed. LRs were performed via intermittent portal triad clamping (PTC) under low central venous pressure. Results LRs were performed for 67.7% of patients with a malignant disease and 32.3% of patients with a benign disease. Major LR was performed in 89 patients (34.6%). The mean PTC period was 20.32 min (±13.7). The median intraoperative bleeding amount was 200 mL (5–3500 mL), the 30-day mortality rate was 4.3%, and the morbidity rate was 31.9%. The hospital stay (p = 0.002), morbidity (p = 0.009), and 30-day mortality (p = 0.041) of patients with a bleeding amount of more than 500 mL significantly increased. Conclusion Surgeons should consider the adverse effects of intraoperative bleeding during liver resection on patients’ outcome. Favorable outcomes would be obtained with diligent postoperative care.     

Diagnostic Value of Synchronized Transesophageal Atrial Pacing

Synchronized transesophageal atrial pacing (single and double extrastimuli) was used in 137 patients with various tachycardias inducible by atrial pacing during transesophageal electrophysiological study (EPS). This pacing mode in five patients initiated atrioventricular tachycardias with ipsilateral bundle branch block not seen when using other pacing modes. During the tachycardia, single or double extrastimuli caused ipsilateral bundle branch block disappearance in two patients with atrioventricular tachycardia, and changed AV activation ratio in one patient with atrioventricular junctional reentrant tachycardia. This pacing mode causes very little discomfort, what is important in children, and enhances diagnostic abilities of transesophageal EPS. So, this pacing mode should be used routinely as one of the steps of transesophageal EPS.     

On the VIP-ergic innervation of the uterotubal junction

Chronic ACTH treatment (3 IU/kg daily for 8 days) caused an increase in wet weight of the interscapular brown adipose tissue (ISBAT) in the rat without affecting the enzyme activities of the cardiac or skeletal muscles or of ISBAT. On the other hand, chronic β-blockade (alprenolol 10 mg/kg daily for 8 days) induced elevated activities in the oxidative enzymes of the ISBAT but not of the muscle tissues measured. Combined ACTH and alprenolol treatment also increased significantly the citrate synthase and malate dehydrogenase activities and protein concentration, but decreased the weight of ISBAT to normal. The results suggest that, although a direct antagonism between the β-blockers and ACTH has not been demonstrated, β-blockers can abolish the ACTH-induced weight gain of the ISBAT.     

Implantable Cardioverter Defibrillator Clinic Casualties: Inadvertent Reprogramming During Routine Implantable Cardioverter Defibrillator Follow-Up

On one occasion during a busy ICD follow-up clinic, the preceding patient's parameters for rate, PDF, and delay were inadvertently programmed into the subsequent patient's generator using the CPIProgrammer Model 2035. This occurred after capacitor reformation, without pressing the "Program" button. The source of this reprogramming error was failure to clear the programmer memory of the previous patient's data, usually achieved by turning the programmer off between patients (or selecting "New Patient" from the menu). At our next ICD follow-up clinic, we purposely did not turn off the programmer between two sets of patients. On both occasions the above finding was repeated and confirmed. These observations indicate the potential for serious reprogramming errors that can occur simply by not clearing the programmer's memory between clinic patients.     

Comparative electromyographic study of bite plates and stabilization splints

Abstract – The object was to study any influence on the integrated clectromyographie activity in the masseter and temporal muscles of two types of occlusal appliances. Seventeen healthy subjects wore a bite plate with a frontal plateau and a full coverage stabilization splint at night, each for 1 wk. The EMG activity was recorded without appliances in situ, in the rest position, and during gentle and maximum biting before and after use of the different appliances. After use of the bite plate, the EMG activity was not significantly different at any tested level. After use of the splint, the activity in the rest position was significantly lower in the anterior and posterior parts of the temporal muscles. The EMG activity was significantly lower in the rest position in both parts of the temporal muscle after use of the splint than after use of the bite place. In a control group of eight subjects in whom no appliances were used, the EMG activity did not change significantly between the initial and 1- or 5-wk recordings. Thus, the occlusal design of the appliances seems to be of importance for the influence on the EMG activity in the masticatory muscles, at least in healthy subjects.     

Clinico-Pathological Investigation on Patients With "Early Gastric Cancer" and "Intermediate Gastric Cancer" in Chile

We reported the final results obtained in a group of 30 patientswith gastric cancer confined to the mucosa or submucosa (earlygastric cancer) and in 29 cases with cancer infiltration upto the muscularis propria (intermediate gastric cancer). The clinical findings and postoperative course were presented.The five-year survival rate was 84% in early gastric cancercases and 44% in intermediate gastric cancer patients.