Long-Term Follow-Up of Corridor Operation for Lone Atrial Fibrillation:

Late Results of Surgery for AF. Introduction: Currently, surgery- and catheter-mediated ablation is applied when drug refractoriness of atrial fibrillation is evident, although little is known about the long-term incidence of new atrial arrhythmia and the preservation of sinus node function.
Methods and Results: To address this issue, 30 patients with successful corridor surgery for lone paroxysmal atrial fibrillation and normal preoperative sinus node function were followed in a single outpatient department. Five years after surgery, the actuarial proportion of patients with recurrence of atrial fibrillation arising in the corridor was 8%± 5%, with new atrial arrhythmias consisting of atrial flutter and atrial tachycardia in the corridor 27%± 8%, and with incompetent sinus node requiring pacing therapy 13%± 6%. Right atrial transport was preserved in 69% of the patients without recurrence of atrial fibrillation and normal sinus node function. Stroke was documented in two patients.
Conclusions: Corridor surgery for atrial fibrillation is a transient or palliative treatment instead of a definitive therapy for drug refractory atrial fibrillation. This observation strongly affects patient selection for this intervention and constitutes a word of caution for other, non-pharmacologic interventions for drug refractory atrial fibrillation.     

蒙药益智温肾十味丸质量标准

目的:建立蒙药益智温肾十味丸的显微、薄层、理化鉴别方法和高效液相含量测定方法,提高其质量控制水平.方法:在显微镜下观察本品粉末,以种皮厚壁细胞、石细胞群和体壁碎片为指标,鉴别本品中益智、苦石莲、冬葵果和方海;提取挥发油,点样于硅胶GF254薄层板上,环己烷-乙酸乙酯(9∶1)展开,以标准药材为对照,鉴别本品中的益智;理化方法鉴别白硇砂中氯化铵和方海中碳酸钙.对荜茇中胡椒碱进行含量监控,用ODS填充的色谱柱,甲醇-水(77∶ 23)为流动相,343 nm波长下测定.结果:方法可有效鉴别本品中益智、苦石莲、冬葵果、方海和白硇砂5味药材,高效液相含量测定方法在0.040 4～0.282 8 μg线性良好(r=0.999 9),胡椒碱的平均回收率为98.1％,RSD 0.62％,含量限度为不得少于1.4 mg·g-1.结论:该方法可有效控制本品质量.     

Effects of terlipressin as early treatment for protection of brain in a model of haemorrhagic shock

IntroductionWe investigated whether treatment with terlipressin during recovery from hypotension due to haemorrhagic shock (HS) is effective in restoring cerebral perfusion pressure (CPP) and brain tissue markers of water balance, oxidative stress and apoptosis.MethodsIn this randomised controlled study, animals undergoing HS (target mean arterial pressure (MAP) 40 mmHg for 30 minutes) were randomised to receive lactated Ringer’s solution (LR group; n =14; volume equal to three times the volume bled), terlipressin (TERLI group; n =14; 2-mg bolus), no treatment (HAEMO group; n =12) or sham (n =6). CPP, systemic haemodynamics (thermodilution technique) and blood gas analyses were registered at baseline, shock and 5, 30, 60 (T60), 90 and 120 minutes after treatment (T120). After the animals were killed, brain tissue samples were obtained to measure markers of water balance (aquaporin-4 (AQP4)), Na⁺-K⁺-2Cl⁻ co-transporter (NKCC1)), oxidative stress (thiobarbituric acid reactive substances (TBARS) and manganese superoxide dismutase (MnSOD)) and apoptotic damage (Bcl-x and Bax).ResultsDespite the HS-induced decrease in cardiac output (CO) and hyperlactataemia, resuscitation with terlipressin recovered MAP and resulted in restoration of CPP and in cerebral protection expressed by normalisation of AQP4, NKCC1, TBARS and MnSOD expression and Bcl-x/Bax ratio at T60 and T120 compared with sham animals. In the LR group, CO and blood lactate levels were recovered, but the CPP and MAP were significantly decreased and TBARS levels and AQP4, NKCC1 and MnSOD expression and Bcl-x/Bax ratio were significantly increased at T60 and T120 compared with the sham group.ConclusionsDuring recovery from HS-induced hypotension, terlipressin was effective in normalising CPP and cerebral markers of water balance, oxidative damage and apoptosis. The role of this pressor agent on brain perfusion in HS requires further investigation.     

L-arginine reduces heart rate and improves hemodynamics in severe congestive heart failure

BACKGROUND: Stimulated endothelium-derived relaxing factor-mediated vasodilation and conduit artery distensibility are impaired in congestive heart failure (CHF). L-arginine could have a potentially beneficial role in CHF, acting through the nitric oxide (NO)-L-arginine pathway or by growth hormone increment. HYPOTHESIS: This study was undertaken to investigate the effects of L-arginine on heart rate, hemodynamics, and left ventricular (LV) function in CHF. METHODS: In seven patients (aged 39 +/- 8 years) with CHF, we obtained the following parameters using echocardiography and an LV Millar Mikro-Tip catheter simultaneously under four conditions: basal, during NO inhalation (40 ppm), in basal condition before L-arginine infusion, and after L-arginine intravenous infusion (mean dose 30.4 +/- 1.9 g). RESULTS: Nitric oxide inhalation increased pulmonary capillary wedge pressure from 25 +/- 9 to 31 +/- 7 mmHg (p < 0.05), but did not change echocardiographic variables or LV contractility by elastance determination. L-arginine decreased heart rate (from 88 +/- 15 to 80 +/- 16 beats/min, p<0.005), mean systemic arterial pressure (from 84 +/- 17 to 70 +/- 18 mmHg, p < 0.007), and systemic vascular resistance (from 24 +/- 8 to 15 +/- 6 Wood units, p<0.003). L-arginine increased right atrial pressure (from 7 +/- 2 to 10 +/- 3 mmHg, p<0.04), cardiac output (from 3.4 +/- 0.7 to 4.1 +/- 0.8 l/min, p < 0.009), and stroke volume (from 40 +/- 9 to 54 +/- 14 ml, p < 0.008). The ratios of pulmonary vascular resistance to systemic vascular resistance at baseline and during NO inhalation were 0.09 and 0.075, respectively, and with L-arginine this increased from 0.09 to 0.12. CONCLUSION: L-arginine exerted no effect on contractility; however, by acting on systemic vascular resistance it improved cardiac performance. L-arginine showed a negative chronotropic effect. The possible beneficial effect of L-arginine on reversing endothelial dysfunction in CHF without changing LV contractility should be the subject of further investigations.     

Intermediate lymphocytic lymphoma: immunophenotypic and cytogenetic findings

A detailed immunohistologic and cytogenetic analysis of 12 cases of intermediate lymphocytic lymphoma was performed. The characteristic immunophenotype of intermediate lymphocytic lymphoma was: surface IgM and IgD+, BA1+, B1+, BA2-, B2-, B4+, Leu 14+, Leu 1+, HLA-DR+, and common acute lymphocytic leukemia associated (CALLA) antigen negative. Clonal chromosome abnormalities were identified in ten cases, with structural or numerical abnormalities of chromosomes 11 or 12 in nine cases. Five cases had structural abnormalities involving the long arm of chromosome 11; three of these had translocations with chromosome 14 at band q32. Three cases had trisomy 12, and one case had a translocation involving the long arm of chromosome 12. The tenth case had a translocation involving the long arms of chromosomes 7 and 9. These characteristic immunophenotypic and cytogenetic findings suggest a close lineage relationship between intermediate lymphocytic lymphoma and small lymphocytic (well differentiated) lymphoma/chronic lymphocytic leukemia. Their differing clinical, cytologic, and architectural features suggest, however, that intermediate lymphocytic lymphoma should be considered a separate category of lymphocytic lymphoma in the International Working Formulation.     

Pre- and postoperative inspiratory mechanics in ischemic and valvular heart disease

In 12 mechanically-ventilated, anesthetized, paralyzed patients undergoing cardiac surgery for either coronary bypass (six subjects) or to correct valvular disfunctions, volume, airflow, tracheal, esophageal, and transpulmonary pressures were measured. Respiratory system elastance and resistance were partitioned into lung and chest wall components. Resistances were further split into homogeneous and uneven elements. Measurements were performed prior to thoracotomy and just after rib cage closure. Before surgery, valvular patients had significantly higher elastances and uneven resistances of the respiratory system and lung than those with ischemic heart disease. Postoperatively, the patients presented with an increase in respiratory system and lung elastances, a decrease in pulmonary resistance, and a rise in chest wall resistance. Surgically induced mechanical changes were similar in ischemic and valvular patients.