Factors Associated with the Development of Atrial Fibrillation in COPD Patients: The Role of P‐Wave Dispersion

Background: Supraventricular tachyarrhythmia is a common problem in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study is to analyze the factors associated with paroxysmal atrial fibrillation (AF) in COPD patients. Methods: Forty COPD patients (38 male, 2 female, mean age 60 ± 9 years) and 33 healthy controls (29 male, 4 female, mean age: 58 ± 10 years) were included in this study. Echocardiography, 24‐hour ambulatory and 12‐lead ECG, pulmonary function tests, arterial blood gases, and serum electrolytes were measured. On ECG, maximum (P_max) and minimum (P_min) duration of P wave and its difference, P‐wave dispersion (PWd), were measured. Results: On echocardiography, diastolic dysfunction was found in 14 of the 40 (35%) COPD patients. Heart rate variability analysis revealed that COPD patients had decreased SDANN, SDNN, SDNNIDX in time‐domain, and decreased LF in frequency domain parameters. Fourteen of the 40 COPD patients (35%) had AF. Patients with AF were older (57 ± 10 vs 64 ± 5 years, P = 0.03) and had lower SDANN, SDNN, and LF/HF ratio as compared to patients without AF in univariate analysis. All P‐wave intervals (P_max P_min and PWd) were increased in COPD patients compared to controls. P‐wave dispersion was significantly increased in COPD patients with AF, as compared to patients without AF (57 ± 11 vs 44 ± 7 ms, P = 0.001). In logistic regression analysis PWd was found to be the only factor associated with the development of AF (P = 0.04). Conclusions: The presence of AF was significantly related to the prolongation of PWd, but not with pulmonary function, arterial blood gasses, and left and right atrial function. A.N.E. 2002;7(3):222–227     

Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

Objective

This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.

Methods

Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn''t receive diltiazem infusion.

Results

Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.

Conclusion

We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.     

Multimeric composition of endothelial cell-derived von Willebrand factor

The multimeric composition of human endothelial cell (EC)-derived von Willebrand factor (vWF) was studied using SDS-agarose gel electrophoresis and autoradiography. Two multimers were found in lysates prepared from confluent cultures of human umbilical vein endothelial cells. The smaller multimer had a molecular weight (mol wt) of approximately 950 Kd, while the second was larger than those seen in plasma. When electrophoresis was performed using the discontinuous buffer system of Ruggeri and Zimmerman, the small multimer consisted of a single band migrating with the slowest-moving component of the corresponding plasma triplet. The large EC-vWF multimer was detected in culture media conditioned with EC monolayers for ten minutes. It remained the only multimer in media conditioned for up to three days. Calcium ionophore A23187 increased the amount of the large vWF multimer released into the culture media, but did not change its multimeric composition. The small multimer was never detected in the EC- conditioned media. These findings suggest that (1) a large, fully polymerized multimer of vWF is released from the ECs, while the small multimer probably represents a major intermediate component in the process of multimerization, and (2) plasma vWF multimers are probably generated from the large endothelial vWF after it is released into the circulation.     

Evaluation of Aerosol and Water Contamination and Control of Cross Infection in Dental Clinics

Background

The oral cavity is an unique environment which provides an ideal medium for bacterial growth. As a result of repeated exposure to the microorganisms present in blood and saliva, the dental health professionals and the patients are at a higher risk for developing many infectious diseases. A pilot study was carried out in the Dept of Dental Surgery, Armed Forces Medical College to assess the risk of cross infection in dental clinics.

Methods

Samples were collected from different dental surgeries of the Dept of Dental Surgery, Armed Forces Medical College and sent for microbiological culture and identification to the Dept of Microbiology, Armed Forces Medical College. The sampling was carried out in two stages, before and after implementing a set protocol.

Result

All dental unit waterlines were coated with a well established biofilm made up of filamentous and bacillus-like microorganisms in first stage of study. There was marked reduction in the number of colonies from the samples collected during second stage. Same findings were observed in the samples of aerosol produced by ultrasonic scalers.

Conclusion

The present study concluded that the new set protocol followed is significantly effective in reducing the microbial load in the water tubing, container and aerosol production. It is an effective measure for reducing the chances of cross infection in the dental surgeryKey Words: Aerosol, Biofilm, Cross infection, Colony forming units     

Effectiveness of a new inflatable balloon device for gluing dissected layers in an experimental model of aortic dissection

OBJECTIVES:

In the surgical treatment of acute aortic dissection, tissue glues are widely used to reinforce the adhesion between the dissected aortic layers. A new inflatable balloon device was developed to compress the dissected aortic wall during gluing to increase adhesion between the dissected layers. The present study used an ex vivo experimental animal model to test the hypothesis that this device is effective when gluing the true and false channels of dissected aortas.

METHODS:

In the ex vivo experimental model, aortic dissection was simulated surgically on 12 fresh bovine aorta samples. In six samples (group I), the inflatable balloon device was inserted into the aorta to reinforce and fuse the dissected layers during gluing. The other six fresh bovine aortic samples (group II) were compressed between the surgeon’s fingers during gluing. Aortic samples were evaluated and compared macroscopically and histologically.

RESULTS:

In group I, adhesion between the dissected layers was easily achieved during gluing. All false cavities were perfectly closed, with no deleterious effects related to the device. In group II, the adhesion between the dissected layers was not complete and some false cavities remained patent.

CONCLUSIONS:

The inflatable balloon device can increase the adhesive effect of tissue glues via homogenous compression of the dissected aortic layers. In addition, the balloon can prevent distal embolization of the glue.     

The Effect of Mitomycin-C in Reducing Pericardial Adhesion After Cardiac Surgery in Rabbits

Background

Mitomycin-C has been in clinical use primarily as a chemotherapeutic agent and is well known for antifibrotic properties. It has been widely used to prevent postoperative fibroblast proliferation and reduce scar adhesion in ophthalmologic and otolaryngologic operations. We investigated the efficacy of mitomycin-C in reducing postoperative pericardial adhesions in a rabbit model.

Methods

New Zealand white rabbits were used and categorized into 2 groups, study (use of mitomycin-C) and control. Group 1 (n = 8) was treated with a sponge impregnated with mitomycin-C solution that was applied over the abraded epicardium. In group 2 (control group), the sponge was impregnated with 0.9% isotonic NaCl solution and was applied with the same protocol as the mitomycin-C–impregnated sponge in group 1 (n = 8). Rabbits were humanely killed at a mean of 2 weeks. The scores of adhesion were graded by macroscopic examination, and the pericardial tissues were analyzed microscopically in terms of inflammation and fibrosis.

Results

In group 1, the adhesion scores were significantly lower than the control group's. No significant difference was found between the groups in terms of the severity of inflammation. There was a difference between groups in terms of the degree of fibrosis.

Conclusions

The use of mitomycin-C to prevent postoperative pericardial adhesions reduced adhesion and fibrosis scores in an experimental rabbit model. However, efficacy in reducing inflammation was not demonstrated.     

Osteochondritis dissecans

Osteochondritis dissecans (OCD) is a disease of unknown etiology, characterized by separation of necrotic bone from its bony bed. While the juvenile form seen in patients with open physes has a 60-90% rate of spontaneous resolution, the adult form has virtually no chance of spontaneous healing. Plain X-rays are sufficient for the diagnosis, and magnetic resonance imaging (MRI) is essential for evaluation of disease progression and/or healing. The clinical correlation of MRI criteria defined in recent years to determine stability of the lesion is high. Juvenile OCD can be treated conservatively if there are no signs of instability on magnetic resonance images. Adult patients or unstable lesions in children should be treated surgically. For stable lesions, arthroscopic antegrade perforation is indicated to increase vascularity and stimulate healing. Unstable or displaced lesions should be treated with debridement, internal fixation, and cancellous bone grafting. Although cannulated metal screws are the most widely used implants for internal fixation, biodegradable implants have also been utilized in recent years. Loose fragments that are too deformed to be internally fixed should be removed and cartilage reconstruction techniques should be employed for the remaining crater. Long-term results of loose body removal alone are unsatisfactory. Modern cartilage restoration techniques are technically demanding due to the large, deep, and unconfined nature of the defect in the femoral condyle.     

Bilateral staged total knee arthroplasty in obese patients

Introduction The purpose of this study was to compare the clinical and functional results and complications associated with staged bilateral total knee arthroplasty (TKA) performed 4–11 days apart during a single hospitalization in patients who were obese and patients who were not obese. Methods We retrospectively evaluated 48 (96 knees) patients who were obese and divided into two groups based on their body mass indices (BMI). Morbidly obese patients (group A1, BMI ≥ 40 kg/m²) consisted of 21 patients (42 knees), and obese patients (group A2, BMI ≥ 30 kg/m²) consisted of 27 patients (54 knees). The control group (group B, BMI < 30 kg/m²) consisted of 20 non-obese patients (40 knees), who were undergoing staged bilateral procedure within the same time frame. All patients had cemented TKAs with use of posterior cruciate sparing prosthesis without patellar resurfacing. If medically stable after the first arthroplasty the patients then underwent the second arthroplasty 4–11 days later. The data on major complications and minor complications were evaluated. Results Although, there was no statistically significant difference in overall complication rates in any of the groups, the non-obese group had fewer wound complications than the other groups (P > 0.05). No significant differences in preoperative or postoperative Knee Society score, and functional score could be demonstrated between the three groups (P > 0.05). Both obese and nonobese patients showed improvements in pain and function from pre-surgery to a minimum 2 years follow-up. Conclusion Results of bilateral staged TKAs in obese patients have low complication and high success rates and increased BMI has no negative effect on the early outcome. Bilateral staged TKA might be a good treatment alternative for the improvement of the patient’s quality of life and functional and clinical outcomes.     

Pathological yawning in a patient with anxiety and chronic disease anaemia

Yawning, frequent in daily life, is accepted as a complex arousal reflex. Excessive yawning may be due to neurological, psychiatric, infectious, gastrointestinal or metabolic diseases. This reflex has also been associated with different selective serotonin reuptake inhibitors. We report a female patient, with excessive yawning, who was on selective serotonin reuptake inhibitor treatment with the diagnosis of generalised anxiety disorder. She was then found to have endometrial carcinoma. Her complaints of palpitation, shortness of breath and loss of energy might be explained by a psychiatric disease and/or anaemia. Previous anaemic periods and partial response of her psychiatric symptoms during last 3 years alerted us to think about an organic cause. Investigations for chronic disease anaemia resulted in diagnosis of endometrial carcinoma. This case is a good example showing misdiagnosis caused by medical stigmatisation.     

The potential relationship between QTc interval prolongation and ziprasidone treatment: three cases

QTc interval prolongation may appear as a consequence of both typical and atypical antipsychotic treatments. Ziprasidone, which is effective in treating schizophrenia, is associated with QTc prolongation. Although the prolongation of QTc with ziprasidone treatment is often pronounced, there is a scarce number of cases reported about the relationship between ziprasidone and QTc prolongation. Of the three cases presented in this case series, two cases showed values exceeding 0.50 s with ziprasidone treatment.