Cardiomyoplasty and implantable cardioverter defibrillator: efficacy and safety of concomitant device implantation: sudden death and cardiomyoplasty

Sudden death represents a common event in the natural history of patients affected by chronic heart failure. Such an outcome also has been shown to characterize the follow-up of the cardiomyoplasty procedure. We report two cases of patients who had cardiomyoplasty and experienced witnessed episodes of ventricular arrhythmia at variable times after surgery (2 years and 2 months, respectively). In the first case, an implantable cardioverter defibrillator (ICD) was implanted subsequent to the arrhythmic episode, whereas the second patient had a combined cardiomyoplasty and ICD implantation procedure. In particular, this patient underwent a modified wrapping technique, herein described, because of a large left ventricular dilatation. In both cases, ventricular defibrillation did not affect the correct functioning of the implanted cardiomyostimulator. Our article confirms that ventricular arrhythmia is common in cardiomyoplasty patients. The combined use of a skeletal muscle stimulator and implantable defibrillator may therefore be effective in preventing arrhythmia-related sudden death without any concurrent effect on the correct functioning of the wrapped muscle/heart circuit, with likely benefit on long-term cardiomyoplasty patient survival.     

EEG profile of intravenous zolpidem in healthy volunteers

Zolpidem is an imidazopyridine which binds specifically to the ₁ receptor. Zolpidem demonstrated potent hypnotic activity at a dose of 10 mg. Pharmacodynamics and pharmacokinetics of zolpidem were studied after daytime administration in a randomised, double-blind, placebo-controlled, cross-over trial. Single doses of zolpidem (10 mg IV as a 3-min infusion and 20 mg orally) and placebo were firstly tested in 12 healthy young male volunteers. Two other doses (5 mg IV and orally) were then evaluated in 6 out of these 12 subjects. EEG (4 leads = Fp2-T4, Fp1-T3, T4-02 and T3-01), and Stanford Sleepiness Scale (SSS) were measured up to 5 h post-dosing. Blood samples were also collected up to 24 h. The time course of the hypnotic activity of zolpidem, assessed by the score obtained on SSS, showed a similar profile whatever the route or the dose administered: slightly earlier onset after IV but sedative scores were reached at 30 min and the effect peaked between 1 and 1.5 h and lasted 4 h in both conditions. The EEG profile of zolpidem was characterised by a decrease of alpha activity and an increase in delta and in beta activity. The effect on beta activity was marked within the first hour and then disappeared. The time course of delta and alpha activities indicated a rapid onset (10 min after IV, 30 min after oral route) and a duration of 3–4 h. The amplitude of these relative EEG changes and their duration were independent of the route of administration and the dose administered. AUC and C_max increased proportionally to the administered dose and elimination half life (2 h), clearance and volume of distribution did not change according to the dose or the route of administration. T_max was 1 h after the oral administration. The absolute bioavailability was about 70%. In conclusion, EEG induced changes and score of SSS were in good correlation with what has been observed with insomniac patients: zolpidem has a rapid onset and a short duration of action.     

银杏叶提取物对体外循环细胞因子的干预作用

目的：探讨体外循环脑损伤的发生机制及银杏叶提取物的干预作用．方法：选择44例心脏病需体外循环手术的风湿性心脏瓣膜病患者，随机分为观察组和对照组，每组22例．观察组在体外循环予充液中加入银杏叶提取物2mg／kg体质量，对照组应用常规予充液．分别在术前、主动脉阻断后1h，术后6，12，24和48h抽取静脉血标本，检测血清IL-1β，IL-18和S100蛋白水平．结果：对照组自CPB结束即刻开始，血清IL-1β显著升高，观察组血清IL-1β自主动脉阻断1h开始升高，持续至术后48h，自主动脉阻断1h开始，对照组显著低于观察组．对照组自术后6h开始，血清IL-18持续升高至术后48h，观察组血清IL-18主动脉阻断1h开始，血清IL-18持续升高至术后48h，主动脉阻断1h，对照组血清IL-18低于观察组，但术后6，12，24，48h显著高于观察组．对照组S100蛋白自CPB结束开始升高，持续至实验结束，自主动脉阻断1h开始至术后48h血清S100蛋白水平对照组均显著高于观察组．结论：体外循环心脏直视手术细胞因子IL-18参与脑组织损伤过程，GBE可调节细胞因子，使血清S100蛋白显著降低．     

计算机辅助角膜分析系统在主动眼球跟踪近视准分子激光原位角膜磨镶术后光学切削区偏中心应用中的意义

目的:分析主动眼球跟踪近视准分子激光原位角膜磨镶术后光学切削区偏中心程度,评价这一系统的精确性及临床意义。方法:①选取2005-11/12在青岛大学医学院附属医院眼科准分子激光治疗中心行准分子激光原位角膜磨镶术,术前近视透镜焦度不超过-10.00m-1的近视患者进行回顾性分析,共纳入100例(200眼),其中男52例(104眼),女48例(96眼);年龄18～45岁,平均(22.5±2.68)岁;术前近视透镜焦度:球镜-0.75～-10.00m-1,散光-0.50～-3.50m-1。②将患者分为两组,低中度近视组56例(112眼),透镜焦度<-6.00m-1;高度近视组44例(88眼),透镜焦度-6.00～-10.00m-1。③所有患者术前及术后1个月采用附设瞳孔中心定位软件的计算机辅助角膜地形图分析系统(Wavelight Allegretto,德国)对患眼进行检查,在手术前后差异图上,测定光学切削区偏中心数值及方位。④术后随访1年,了解手术的安全性、有效性。结果:100例(200眼)全部进入结果分析。①术后光学切削偏中心数值:低中度近视组0.06～0.38mm,平均(0.22±0.16)mm,高度近视组0.07～0.41mm,平均(0.24±0.17)mm,两组均无>0.50mm者,两组间比较差异不显著(P>0.1)。②偏中心方位两组间比较无明显差异,多数位于鼻上象限。③术后随访1年,裸眼视力均达到或超过术前最佳矫正视力,无视力下降及眩光、光晕等手术并发症,患者对手术结果满意。结论:主动眼球跟踪系统能减少光学切削区偏中心,提高手术的安全性、有效性。