Normothemic Continuous Blood Cardioplegia Improves Electrophysiologic Recovery after Open Heart Surgery

Background: Myocardial protection during open heart surgery is based on administration of oxygenated blood cardioplegia, the preferred temperature of which is still under debate. The current randomized study was designed to prospectively evaluate the quality of myocardial protection and the functional recovery of the heart with either normothermic (group N) or hypothermic (group H) oxygenated blood cardioplegia.

Methods: Under continuous electrocardiographic Holter monitoring, 42 patients were randomly scheduled to receive either normothermic (33.5 degrees C) or hypothermic (10 degrees C) cardioplegia solutions during coronary bypass grafting surgery. Blood samples for creatinine phosphokinase, creatinine phosphokinase-MB, lactate, epinephrine, and norepinephrine were withdrawn during cardiopulmonary bypass via a coronary sinus cannula.

Results: Active cooling in group H on initiation of cardio-pulmonary bypass was characterized by transition through ventricular fibrillation in 75% of patients, whereas in group N atrial fibrillation occurred in 65% of patients. On myocardial reperfusion, sinus rhythm spontaneously resumed in 95% of group N patients compared to 25% in group H (P = 0.0003). In the latter, 75% of patients developed ventricular fibrillation often followed by complete atrioventricular block, which necessitated temporary pacing for a mean duration of 168+/-32 min. Both groups showed a similar incidence of intraventricular block and ST segment changes. However, the incidence of ventricular premature beats in the first 16 h after cardiopulmonary bypass was significantly greater in group H (P < 0.05), 20 +/-26/h, compared to 3+/-5/h in group N. Blood concentrations of lactate, creatinine phosphokinase, epinephrine, and norepinephrine increased gradually during the operation, but the differences between the groups were not significant.     

磁刺激运动诱发电位在腰椎间盘突出所致的腰骶神经根病变中的应用研究

在35例有L5和／或S1神经根损害表现的腰椎间盘突出患者腰椎区进行磁刺激运动诱发电位（MEP）检查，测定、记录胫前肌、展肌和小趾展肌MEP的起始潜伏期（OL）。结果显示，35例中至少有一条总侧肌肉MEP异常33例（94．3％）。在L4－5椎间盘突出中，以胫前肌的MEP异常为主；在L5－S1椎间盘突出中，以小趾展肌的MEP异常为主。表明腰椎区MEP检查对腰椎间盘突出所致的腰骶神经根病变较为敏感，可为临床诊断提供可靠依据并有助于定位诊断。     

干性型老年黄斑变性60例随访观察

探刊干性型老年黄斑变性（age-related macular deganeration，AMD)的病变发展特征并 寻找监测AMD病情进展的较敏感指标。 方法：用眼底彩色照相和眼底荧光血管造影(FFA)、明视视网膜电囤(ERG)、FM100-hue 色彩试验及视力检查，对60例(111眼)50~80岁、视力≤1.0的干性型AMD患者进行3～74个月(平均30.2个月)的随访观察。 结果：本组68眼经FFA检查、平均25.6个月随访，其中25%的患眼病灶损害有快慢不一的发展．全部111眼视力在平均30.2个月随访中有18%患眼的视力下降2行以下，且与病灶进展相符，FM100-hue 色彩试验的被随访者中，随访2年以后，其总错误分明显的增加(P<0.01)．63眼的明视ERG在随访过程中无明显变化。 结论：大部分干性AMD患眼的病灶损害和视力可以在较长时间内维持稳定。FM100—hue的总错误分可能为监测AMD病情进展的较敏感指标． （中华眼底病杂志，1997，13：150-152）     

Destructive ocular myiasis in a noncompromised host

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.