A new dosage regimen for topical application of ciprofloxacin in the management of chronic suppurative otitis media

The clinical and bacteriologic efficacy of topically applied ciprofloxacin was studied in 60 patients with chronic suppurative otitis media. Two hundred fifty and 125 μg/ml concentrations of ciprofloxacin solutions were given to two groups of patients. The duration of therapy was determined according to the clinical cure at follow-up. More than 21 days of therapy was not needed in any patient. The clinical cure rate with 250 μg/ml ciprofloxacin was 78.1% at 14 days and with 125 μg/ml it was 83.3%. However, a 100% clinical cure rate and complete bacteriologic eradication was obtained in 21 days in both groups. In each group only one patient had otomycosis by the fourteenth day of therapy, although ear discharge had ceased. It was concluded that 125 μg/ml ciprofloxacin could be applied as successfully as 250 μg/ml, and the duration of therapy had to be at least 14 days. This new dosage regimen can be adopted as an optimal dosage for ototopical application of ciprofloxacin in chronic suppurative otitis media. It will also obviously decrease the expense of therapy. (Otolaryngol Head Neck Surg 1998;118:883-5.)     

Bilateral ureteral fibroepithelial polyps and review of the literature

Despite being the most common forms of benign ureteral neoplasms, ureteral fibroepithelial polyps are rare and their etiology is still unknown. To our knowledge, we report the fourth case of bilateral fibroepithelial polyps in the English literature with a discussion of clinical features and etiology.     

Interrelations Between QRS Morphology, Duration, and HV Interval Changes Following Right Bundle Branch Radiofrequency Catheter Ablation

Interrelations between QRS morphology, duration, and HV interval changes in a model of “complete” bundle branch block following right bundle branch radiofrequency ablation have not been subjected to systematic study. This article describes these interrelations in patients who underwent right bundle ablation. Over a period of 42 months, 16 patients underwent radiofrequency ablation of the right bundle for treatment of bundle branch reentrant tachycardia. AH 16 patients had prolonged HV interval at baseline (minimum = 60 ms; mean = 68 ± 8 ms). After ablation, one patient developed complete heart block; the remaining 15 patients developed complete right bundle branch block (RBBB) and further prolongation of the HV interval (increment = 24 ± 16 ms). In 14 of these 15 patients, QRS duration was 138 ± 26 ms before ablation and increased to 168 ± 13 ms after ablation. In the remaining patient, the QRS duration was 160 ms before ablation and shortened to 144 ms following ablation despite further HV prolongation. Larger increases of HV interval after ablation were associated with smaller or negative changes in QRS duration (r = -0.77). There was a direct relationship between QRS duration at baseline and the increment in HV interval after ablation (r = 0.70), and an inverse relationship between QRS duration before and after ablation (r = -0.84). Radiofrequency ablation of right bundle may he associated with an increase in HV interval and QRS duration. However, HV interval prolongation is not necessarily associated with QRS duration widening. A large change in HV interval is more likely to be associated with an already prolonged QRS duration before ablation and a lesser increase or even decrease in QRS duration after ablation. A shorter QRS duration before ablation is associated with a smaller HV interval increase following ablation but a greater increment in QRS duration. These findings are consistent with the concept that narrowness of QRS duration is due to synchronized activation of ventricular endocardium; whereas, QRS duration widening seen with His Purkinje damage is due to reduced synchronization of endocardial activation.     

CLINICAL PHARMACOLOGY OF MIVACURIUM CHLORIDE (BW B1090U) INFUSION: COMPARISON WITH VECURONIUM AND ATRACURIUM

Mivacurium chloride (BWB1090U) is a new, short-acting non-depolarizingneuromuscular blocking agent. It is a synthetic bis-benzylisoquinoliniumdiester, which is hydrolysed rapidly by plasma cholinesterase.This study compares mivacurium, atracurium and vecuronium bycontinuous i.v. infusion. The duration of mivacurium infusionranged from 29.5 to 286 min. The steady state infusion ratesnecessary to maintain 95 (SEM 4)% twitch suppression were: mivacurium8.3 (0.7) µg kg^–1 min^–1; atracurium 7.9 (0.4)µg kg^–1 min^–1; vecuronium 1.2 (0.3) µgkg^–1 min^–1. Following infusions of mivacurium, variousrecovery times (for example: 25–75%, 6.9 (0.3) min; 25–95%,11.0 (0.4) min; 5–95% 14.5 (0.4) min) did not differ significantlyfrom those following single bolus doses. Recovery times followingcessation of mivacarium infusions were approximately 50% ofthose for equivalent durations of infusion of atracurium (10.9(0.3) min for 25–75% recovery and 26.6 (0.4) min for 5–95%recovery). For vecuronium, corresponding recovery times were13.8 (0.9) and 32.0 (1.2) min, respectively. Comparative recoverytimes for mivacurium were 40–50% of those for vecuronium.There was a significant correlation between the infusion rateof mivacurium required to maintain 95% twitch depression andthe plasma cholinesterase activity of individual subjects. Presented in part in Abstract form at the Annual Meeting, AmericanSociety of Anesthesiologist, Las Vegas, Nevada, 1986.     

Ablation of Atrial Fibrillation at the Time of Cavotricuspid Isthmus Ablation in Patients With Atrial Flutter Without Documented Atrial Fibrillation Derives a Better Long‐Term Benefit

AF Ablation in Patients With Only Documentation of Atrial Flutter. Objectives: The aim of the study was to evaluate whether isolation of the pulmonary veins (PVs) at the time of cavotricuspid isthmus (CTI) ablation is beneficial in patients with lone atrial flutter (AFL). Background: A high proportion of patients with lone persistent AFL have recurrent episodes of atrial fibrillation (AF) after CTI ablation. However, the benefit of AF ablation in patients with only documentation of AFL has not been determined. Methods: Forty‐eight patients with typical lone persistent AFL (age 56 ± 6; 90% male) were randomized to CTI ablation (Group A; n = 25) or to CTI + PV isolation (PVI) (Group B; n = 23). In addition to PVI, some patients in group B underwent ablation of complex fractionated electrograms and/or creation of left atrial roof and mitral isthmus ablation line in a stepwise approach when AF was induced and sustained for more than 2 minutes. Mean follow‐up was 16 ± 4 months with a 48‐hour ambulatory monitor every 2 months. Results: There were no recurrences of AFL in either group. Six patients in group B (22%) underwent a stepwise ablation protocol. AF organized and terminated in 5 patients during ablation (83%). Complication rate was not significantly different among the groups. Twenty patients in group B (87%) and 11 patients in group A (44%) were free of arrhythmias on no medications at the end of follow‐up (P < 0.05). Conclusions: Ablation of AF at the time of CTI ablation results in a significantly better long‐term freedom from arrhythmias. (J Cardiovasc Electrophysiol, Vol. 22, pp. 34‐38, January 2011)     

A Distinct Type of Palmoplantar Keratoderma

Abstract:   Palmoplantar keratodermas (PPK) are a diverse group of disorders. We report a boy with PPK, grayish-blue hyperkeratotic lesions on the lips and peri-oral area, opacities on the lower portions of the corneas, mutilation of his right auricle and many other skin lesions.     

Reduced Fluoroscopy During Atrial Fibrillation Ablation: Benefits of Robotic Guided Navigation

Reduced Fluoroscopy in PVI Using RN.   Background: Recently, a nonmagnetic robotic navigation system (RN, Hansen-Sensei™) has been introduced for remote catheter manipulation.
Objective: To investigate the influence of RN combined with intuitive 3-dimensional mapping on the fluoroscopy exposure to operator and patient during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial.
Methods: Sixty patients were randomly assigned to undergo PVI either using a RN guided (group 1; n = 30, 20 male, 62 ± 7.7 years) or conventional ablation approach (group 2; n = 30, 14 male, 61 ± 7.6 years). A 3-dimensional mapping system (NavX™) was used in both groups.
Results: Electrical disconnection of the ipsilateral pulmonary veins (PVs) was achieved in all patients. Use of RN significantly lowered the overall fluoroscopy time (9 ± 3.4 vs 22 ± 6.5 minutes; P < 0.001) and reduced the operator's fluoroscopy exposure (7 ± 2.1 vs 22 ± 6.5 minutes; P < 0.001). The difference in fluoroscopy duration between both groups was most pronounced during the ablation part of the procedure (3 ± 2.4 vs 17 ± 6.3 minutes; P < 0.001). The overall procedure duration tended to be prolonged using RN without reaching statistical significance (156 ± 44.4 vs 134 ± 12 minutes, P = 0.099). No difference regarding outcome was found during a midterm follow-up of 6 months (AF freedom group 1 = 73% vs 77% in group 2 [P = 0.345]).
Conclusion: The use of RN for PVI seems to be effective and significantly reduces overall fluoroscopy time and operator's fluoroscopy exposure without affecting mid-term outcome after 6-month follow-up. (J Cardiovasc Electrophysiol, Vol. 21, pp. 6–12, January 2010)