Acupuncture in Severe,Stable Angina Pectoris: a Randomized Trial

ABSTRACT Twenty-six patients with stable angina pectoris, resistant to medical treatment, were randomized to either active or sham acupuncture in a single-blind design. Sham acupuncture was defined as the insertion of needles in a point within the same spinal segments as the active acupuncture, but outside the Chinese meridian system. The effect was evaluated from anginal attack rate, nitroglycerin consumption and exercise tests. Compared to patients receiving sham acupuncture the patients receiving active acupuncture increased cardiac work capacity significantly, expressed as dPRP (difference in pressure-rate-product between rest and maximum exercise) and maximal PRP during exercise (p<0.001). None of the other variables showed any significant difference between the two groups. Concerning exercise tolerance the median difference was 138 Wmin (95% confidence limits -12.5 to 325 Wmin), concerning anginal attack rate the median difference was 29.5% (95% confidence limits 55% to -11%) and with regard to nitroglycerin consumption the median difference was 5% (95% confidence limits +67% to -44%). No significant effect of sham treatment was observed, no adverse effect was observed. We suggest that acupuncture may improve cardiac work capacity in patients with angina pectoris, refractory to medical treatment.     

Cerebral Blood Flow, PaCO2 Changes, and Visual Evoked Potentials in Mechanically Ventilated, Preterm Infants

ABSTRACT. Two estimations of global cerebral blood flow (CBF) using 133-Xenon clearance were done with an interval of about one hour in 16 mechanically ventilated, newborn infants, of less than 33 weeks gestational age. In eight infants CBF was estimated just before a change in ventilator settings, and again when the Pa_co2 was stable. In the remaining eight infants small spontaneous changes in Pa_co2 occurred. The CBF-CO₂ reactivity was similar in the two groups (+67%/kPa (95% confidence interval 13–146) and 52%/kPa (24–86)) and considerably higher than the CBF-CO₂ reactivity estimated from the interindividual variation of flow and Pa_co2 (+19%/kPa (4–36)). There were no significant relations between CBF and arterial blood pressure. Flash evoked potentials (VEP) were recorded during the 133-Xenon clearances in 8 of the infants. VEP showed no relation to changes in CBF, even when the blood flow rose from the lowest levels. CBF and VEP were obtained once in 9 other infants. Among the 17 infants, the latency of the first negative wave of the VEP was not related to the CBF level. Mean CBF in the 25 infants was 12.3 ml/100 g/min (range 4.3 to 18.9), mean Pa_co2 was 4.2 kPa (range 2.3 to 6.4). Thus, CBF-CO₂ reactivity appeared to be normal in these clinically stable, mechanically ventilated, preterm infants, suggesting that their low cerebral blood flow was well regulated. The absence of a relation of CBF with VEP suggested that cerebral blood flow was not critically decreased.