Combined anti-bradycardia/anti-tachycardia pacemaker-cardioverter-defibrillator systems in patients with recurrent ventricular tachyarrhythmias]

In 41 patients with recurrent sustained ventricular tachycardia and/or ventricular fibrillation an integrated pacemaker-defibrillator-system (PCD, Medtronic, model 7216 A or 7217 B) was implanted. In 21 out of 24 (88%) patients a new transvenous implantation technique in combination with a subcutaneous patch electrode was used. The implanted devices comprise antibradycardiac pacemaker functions, two different forms of antitachycardiac pacemaker functions (ramp and burst pacing), and internal cardioversion or defibrillation capabilities. During a mean follow-up of 8 months 147 episodes of ventricular tachycardia were detected, 131 of them were terminated successfully by antitachycardiac pacing; in 13 episodes internal cardioversion was applied to revert ventricular tachycardia. Twenty-seven episodes of ventricular fibrillation or rapid ventricular tachycardia (greater than 200/min) were detected and successfully terminated by internal defibrillation. In six patients with intermittent rapid atrial fibrillation, change of antiarrhythmic therapy was required to avoid activation of the device. The new integrated pacemaker-defibrillator systems improve therapy in patients with life-threatening tachyarrhythmias by reducing the number of internal cardioversions/defibrillations; the non-thoracotomy approach reduces the post operative risk.     

The percutaneous anterior approach to the celiac plexus using CT guidance

This paper describes a new approach to the neurolytic block of the celiac plexus through the anterior abdominal wall using CT guidance. In 5 patients, CT guidance was used for needle placement and visualization of the spread of the injection. Once the pain has been relieved on completion of the neurolytic block, the radiologist proceeds with the biopsy. Pain relief was obtained in 80% of the cases after 2 weeks and in 60% after 6 months. No serious complications were observed. The anterior approach is simple and is useful in those patients with upper chronic abdominal pain scheduled for biopsy of the pancreas, and in those terminally ill patients who cannot tolerate the prone position.     

Movement disorders in patients with peripheral facial palsy.

Acute unilateral facial paralysis is usually a benign neurological condition that resolves in a few weeks. However, it can also be the source of a transient or long-lasting severe motor dysfunction, featuring disorders of automatic and voluntary movement. This review is organized according to the two most easily recognizable phases in the evolution of facial paralysis: (1). Just after presentation of facial palsy, patients may exhibit an increase in their spontaneous blinking rate as well as a sustained low-level contraction of the muscles of the nonparalyzed side, occasionally leading to blepharospasm-like muscle activity. This finding may be due to an increase in the excitability of facial motoneurons and brainstem interneurons mediating trigeminofacial reflexes. (2). If axonal damage has occurred, axonal regeneration beginning at approximately 3 months after the lesion leads inevitably to clinically evident or subclinical hyperactivity of the previously paralyzed hemifacial muscles. The full-blown postparalytic facial syndrome consists of synkinesis, myokymia, and unwanted hemifacial mass contractions accompanying normal facial movements. The syndrome has probably multiple pathophysiological mechanisms, including abnormal axonal branching after aberrant axonal regeneration and enhanced facial motoneuronal excitability. Although the syndrome is relieved with local injections of botulinum toxin, fear of such uncomfortable contractions may lead the patients to avoid certain facial movements, with the implications that this behavior might have on their emotional expressions.     

Surgery for left ventricular free wall rupture: patch glue repair without extracorporeal circulation.

Left ventricular free wall rupture is a dramatic complication after myocardial infarction. We present our experience with the simple, expedient technique of patch glue repair without extracorporeal circulation. Access is obtained via median sternotomy. Evacuation of blood and haematoma is undertaken and a Goretex patch exceeding the size of infarct is fashioned. The patch is applied to the epicardium using enbrucrilate surgical glue instilled with gentle pressure against the beating heart. We performed this technique on 17 patients from 1993 to 2001, with a operative (30-day) mortality of 23.5% with a post-discharge survival of 85% at 2.2 years.     

Digoxin dosing in the aged: new pharmacokinetic system versus Jellife and Koup methods

To evaluate three methods for digoxin dose adjustment in aged patients, we determined the plasma digoxin levels that would be attained in 87 aged patients with doses adjusted to the kidney function by means of three separate procedures. Mean patient age was: 79.0 +/- 6.3 years; creatinine clearance (Clc): 0.70 +/- 0.23 mL/Kg of lean body weight and minute; digoxinemia/dose ratio (RCpD): 0.421 +/- 0.237 Kg/L. The dose that would attain a digoxinemia of 1.2 ng/mL, calculating the elimination constant (K) and the volume of distribution (V) as linear functions of the Clc, so that K ranges between 0.173 and 0.462 days-1 and V between 4 and 10 L/Kg of lean body weight when the Clc varies from 0 to 110 mL/minute, was 2947 ng/Kg of lean body weight, coefficient of variation (CV): 25.2%. The digoxinemia that patients would have with this D, taking into account the individual RCpD, was 1.1 ng/mL, CV: 38.0%; with figures between 0.8 y 2.0 ng/mL and above 2.0 ng/mL in the 81.6% and the 0.0% of the patients (95% confidence intervals (95% CI): 72.2% to 88.4 and 0.0% to 4.6%), respectively. The precision and the bias were 0.43 and -0.06 ng/mL (95% CI: 0.38 to 0.48 and -0.16 to 0.03 ng/mL), respectively, and with this method the digoxinemia was not associated with the Clc. We concluded that the described method would lead to good results if digoxin has not been prescribed in order to control the cardiac frequency in the setting of auricular fibrilation.     

Differential diagnosis of Taenia saginata and Taenia solium infection by PCR

We have designed species-specific oligonucleotides which permit the differential detection of two species of cestodes, Taenia saginata and Taenia solium. The oligonucleotides contain sequences established for two previously reported, noncoding DNA fragments cloned from a genomic library of T. saginata. The first, which is T. saginata specific (fragment HDP1), is a repetitive sequence with a 53-bp monomeric unit repeated 24 times in direct tandem along the 1, 272-bp fragment. From this sequence the two oligonucleotides that were selected (oligonucleotides PTs4F1 and PTs4R1) specifically amplified genomic DNA (gDNA) from T. saginata but not T. solium or other related cestodes and had a sensitivity down to 10 pg of T. saginata gDNA. The second DNA fragment (fragment HDP2; 3,954 bp) hybridized to both T. saginata and T. solium DNAs and was not a repetitive sequence. Three oligonucleotides (oligonucleotides PTs7S35F1, PTs7S35F2, and PTs7S35R1) designed from the sequence of HDP2 allowed the differential amplification of gDNAs from T. saginata, T. solium, and Echinococcus granulosus in a multiplex PCR, which exhibits a sensitivity of 10 pg.     

Metabolic polymorphisms and the micronucleus frequency in buccal epithelium of adolescents living in an urban environment

Micronuclei and other biomarkers were evaluated in oral cells from 11- to 16-year-old girls living in a foster home in the central area of México City. Variables analyzed for possible association with these biomarkers include smoking habits, body mass index, metabolic polymorphisms for NAT1 and GSTM1 and whether the cells were obtained from the cheek or pharynx. The results indicated that individuals having the NAT1*10 homozygous genotype showed a significant increase in chromatin buds and binucleated cells. When the damage in the cheek was compared with damage in the pharynx, a significant increase in micronuclei and binucleated cells was found for the latter tissue in all the individuals analyzed.     

Localization of gamma-aminobutyric acid (GABA) in type 3 cells and demonstration of their source to F2 terminals in the cat lateral geniculate nucleus: a Golgi-electron-microscopic GABA-immunocytochemical study

Postembedding immunocytochemistry with a gamma-aminobutyric acid (GABA) antiserum was done on semithin sections of cat lateral geniculate nucleus (LGN) previously processed with the rapid-Golgi and gold-toning procedures, to determine which of the three main morphological types (1, 2,3) of neurons in the A-laminae show immunoreactivity and are, therefore, presumably GABAergic. Only type 3 cells were found to be GABA positive. These cells were characterized by small somata and few, scarcely branched dendrites bearing almost exclusively appendages with long slender stalks. Some of these cells have extensive filiform "axonlike" processes originating from different regions of dendrites and having appendages similar to those originating directly from dendrites. Many of these Golgi gold-toned impregnated dendritic appendages of type 3 cells were analyzed in the electron microscope and were identified as typical F2 terminals by their content of pleomorphic synaptic vesicles; by being postsynaptic to retinal (RLP), cortical (RSD), and perigeniculate (F1) terminals; and by being presynaptic to dendrites. In addition, since it was previously demonstrated that glutamic acid decarboxylase (GAD) and GABA-positive cells are not retrogradely labeled with horseradish peroxidase (HRP) from the visual cortex, the present results, by showing that GABA-positive cells have type 3 morphology, provide supporting evidence for the interneuronal nature of type 3 cells in cat LGN.