Atropine-facilitated electrical cardioversion of persistent atrial fibrillation

Conventional electrical cardioversion failed to restore normal sinus rhythm (NSR) in 49 of 364 patients (13.5%) with persistent atrial fibrillation. After receiving up to 2 mg of atropine, 40 (81%) of these 49 "electrical-refractory" patients were successfully cardioverted to NSR by subsequent attempts of electrical cardioversion.     

Incidence and characteristics of myelodysplastic syndromes in Ourense (Spain) between 1994-1998

The very few reference epidemiological studies on myelodysplastic syndromes (MDS) have been carried out in Europe: Germany, France, UK and Sweden. We present the first Spanish study on the incidence and characteristics of MDS. The incidence rates, distribution by FAB subtypes, sex and age groups are within the ranges established by the reference studies with minimal differences which we point out and attempt to explain.     

Acute normovolemic hemodilution: physiology, limitations, and clinical use

Acute normovolemic hemodilution before major surgery is a relatively simple, cheap, and effective tool to avoid or reduce allogeneic blood transfusions. The anesthesiologist, however, must be familiar with the practical aspects of ANH. In addition, knowledge of the physiologic compensatory mechanisms that occur during ANH and their limits are mandatory for the safe use of this blood-saving technique.The decision whether or not to perform ANH and to what level and the concomitant use of other blood-saving techniques must be made on an individual basis, based on the locally present knowledge and training of the involved anesthesia personnel and tailored to the patient’s needs to suit and serve him best.     

Integrins in Mammary Gland Development and Differentiation of Mammary Epithelium

Integrins are major extracellular matrix (ECM) receptors that can also serve for some cell-cell interactions. They have been identified as important regulators of mammary epithelial cell growth and differentiation. Their ability to promote cell anchorage, proliferation, survival, migration, and the induction of active ECM-degrading enzymes suggests that they play an essential role in normal mammary morphogenesis, but, on the other hand, reveals their potential to promote tumor progression.     

The effectiveness and safety of spinal anaesthesia in the pyloromyotomy procedure

BACKGROUND: Hypertrophic pyloric stenosis is a relatively common disorder of the gastrointestinal tract in infancy, causing projectile vomiting and metabolic abnormalities. Surgical management in the form of pyloromyotomy under general anaesthesia has been reported as safe for relieving the obstructed bowel. A number of studies have demonstrated the advantages of spinal anaesthesia over general anaesthesia in high risk infants undergoing minor infraumbilical surgery. The purpose of this study was to evaluate spinal anaesthesia as an alternative option to general anaesthesia in infants undergoing pyloromyotomy. METHODS: Twenty-five infants undergoing pyloromyotomy under spinal anaesthesia were studied. Haemodynamic and respiratory parameters were noted before performing the spinal block, 5 min after the spinal block, and every 10 min after performing the spinal block; for a total period of 30 min. The spinal block was performed using spinal isobaric bupivacaine 0.5%, 0.8 mg.kg-1. Blood pressure, heart rate, respiratory rate and oxygen saturation values were recorded. RESULTS: The sensory levels achieved ranged between T3-T5 thoracic segments within 6-8 min and were sufficient to perform surgery in 23 cases. There were no statistically significant differences in the oxygen saturation, systolic blood pressure and respiratory rate compared with before the spinal block and after 5, 10, 20 and 30 min. CONCLUSIONS: This study proposes that spinal anaesthesia is an alternative option to general anaesthesia in infants undergoing pyloromyotomy, and should be considered in infants undergoing pyloromyotomy.     

Pericardial patch repair of an extensive longitudinal iatrogenic rupture of the intrathoracic membranous trachea

An iatrogenic, longitudinal rupture of the membranous trachea, which extended from the thoracic inlet to 2.0 cm above the carina, was found intra-operatively, during the thoracic stage of a three-stage esophagectomy, in a female, 80-year-old patient. Tracheal rupture was the result of tracheal intubation with a 35-F double-lumen endotracheal tube. Tracheal rupture was successfully repaired by suturing a free pericardial patch at the edges of tracheal rupture, by application of BioGlue on the external patch surface and by covering tracheal repair with a pedicled serratus anterior muscle flap. The patient had a 25-day intensive care unit stay and video-bronchoscopy performed at the 25th postoperative day showed absence of granulation tissue formation and an acceptable tracheal lumen. The overall hospital stay was 83 days because of abdominal complications; no problems concerning the tracheal repair were observed during the prolonged postoperative period.