Transesophageal echocardiography: a screening method for pulmonary vein stenosis after catheter ablation of atrial fibrillation.

AIMS: Pulmonary vein (PV) stenosis has been described as a complication after catheter ablation of atrial fibrillation. The aim of the study was to investigate the diagnostic role of transesophageal echocardiography (TEE) in the assessment of PV stenosis. METHODS: Ninety-one patients (71 men, mean age 57+/-16years), initially treated by catheter ablation of atrial fibrillation, underwent re-ablation because of arrhythmia recurrences. PV angiograms and TEE were performed before the first and second ablation. PVs were analysed in an intraindividual comparison by measurements of mean and peak flow velocity and of velocity time integrals and diameters. PV angiograms served as standard for assessment of PV stenosis. RESULTS: Sixteen of 91 patients developed PV stenoses as a consequence of the first ablation (13 mild PV stenoses, 4 moderate PV stenoses). All patients with PV stenosis were asymptomatic. In moderate PV stenosis (50-70%) a significant increase of blood flow parameters, reduction of vessel diameter, inhomogeneous blood flow and aliasing were demonstrated by TEE. Using quantitative TEE criteria moderate PV stenosis could be identified with a sensitivity of 84% and specificity of 98%. Detection of mild PV stenosis (30-50%) is challenging (sensitivity of 48% and specificity of 75%). CONCLUSIONS: TEE identifies significant PV stenosis by assessment of flow characteristics and vessel diameter and can thereby be used as a follow-up tool after catheter ablation of atrial fibrillation.     

Das myofasziale Schmerzsyndrom

Background

Pain and/or functional disorders, such as weakness or movement control disorders, often have a myofascial origin. The pathophysiological substrates of myofascial problems are myofascial trigger points (mTrP) and reactive connective tissue alterations. Typical for myofascial pain is that the site of the origin of pain and the site of pain perception often do not lie in the same place (referred pain). Myofascial disorders can have a primary or a secondary cause and often make a substantial contribution to stimulus summation problems. In the process of clinical reasoning it needs to be investigated what value mTrP and fascial alterations have for the current problem in question (e.g. primary, secondary and contribution to stimulus summation).

Methods

The causal and sustained therapy of myofascial disorders considers the contractile part of muscle (contracture knots) as well as the noncontractile parts (reactive connective tissue alterations). Predisposition and maintaining factors have to be recognized and if possible included in the therapy, depending on the necessity. The trigger point therapy IMTT® (“Interessengemeinschaft für Myofasziale Triggerpunkt-Therapie”) encompasses manual techniques and if necessary dry needling for deactivation of the disruption potential of mTrP, stretching/detonization and functional training/ergonomics.     

Circulating endothelial cells: life, death, detachment and repair of the endothelial cell layer.

Introduction Circulating endothelial cells (CECs) were first detected inthe 1970s although convenient techniques to isolate them haveonly recently become available [1]. These cells have now beenshown to be present in a variety of vascular disorders but onlya few reports have appeared since the mid-1990s. Very recentlywe were able to demonstrate grossly elevated numbers of CECsas a novel marker of disease activity in patients with ANCA-associatedvasculitis [2]. It appears that this approach to vascular injuryhas not been appreciated so far and that its use should be evaluatedin other vascular disorders as well. Circulating endothelial cells Early on, CECs were detected     

双柱双pH固相萃取和毛细管气相色谱法同时快速测定血浆中酸性和碱性药物

报道了一种能同时快速测定血浆中酸性和碱性药物的固相萃取毛细管气相色谱法。在自制的并联双柱萃取装置上,两柱可在不同的pH下操作,分别提取酸性和碱性药物。通过对6类8种酸性和碱性药物的定性和定量实验表明,该法快速、灵敏。     

苯氧烷胺类化合物的合成及其抗高血压活性

前以2,6-二甲基苯氧乙叉为母体合成了一系列化合物,其中1-(2,6-二甲基苯氧基-2-(3,4-二甲氧基苯乙胺)-丙烷盐酸盐(Ⅰ)有较强而特久的降压作用。进一步研究又表明它具有阻断α-肾上腺素受体并兼有钙拮抗作用。     

Effectiveness of individualized neurodevelopmental care in the newborn intensive care unit (NICU)

The individual infant's neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infant's survival and quality of outcome. The infant's neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infant's current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infant's strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infant's strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neuro developmental approach to NICU care will be presented, and suggest implications for staff education and nursery-wide implementation.     

Nierenfunktion nach Infusionspyelographie

Zusammenfassung Glomeruläre Filtrationsrate (GFR=Inulin-Clearance), effektiver Nierenplasmastrom (RPF=PAH-Clearance), Diurese, osmolare Clearance und Natriumausscheidung wurden bei 25 Patienten mit normaler und unterschiedlich eingeschränkter Nierenfunktion infolge beidseitiger parenchymatöser Nierenerkrankungen nach Infusionspyelographie (Methylglucamin-Iothalamat) untersucht. Die Patienten wurden nach der Größe der GFR vor der Kontrastmittel (KM-) Infusion in Gruppen mit normaler (113,8±18,9 ml/min/1,73 m²), eingeschränkter (36,9±5,9 ml/min/1,73 m²) und stark eingeschränkter (11,1±4,2 ml/min/1,73 m²) Nierenfunktion eingeteilt.Die GFR änderte sich innerhalb von 2 Std nach Kontrastmittelinfusion bei den einzelnen Gruppen zwischen +2,4% und –12,4% des Kontrollwertes, wobei nur der Abfall bei eingeschränkter Nierenfunktion signifikant war. Der RPF fiel nicht signifikant zwischen 13,2% und 20,5%. Das Verhalten von GFR und RPF der einzelnen Gruppen wich statistisch nicht vom gemeinsamen Verlauf nach KM-Infusion ab. Die beobachteten Änderungen lagen in der methodischen und physiologischen Streubreite.Diurese, osmolare Clearance und Natriumausscheidung stiegen nach KM-Infusion bei normaler und eingeschränkter Nierenfunktion signifikant an. Das Ausmaß des Anstiegs war abhängig von der GFR. Es handelte sich um eine osmotische Diurese mit einer signifikanten Korrelation zwischen Urinfluß und osmolarer Clearance. Die Natriumausscheidung stieg infolge Abnahme der Natriumrückresorption signifikant an. Bei stark eingeschränkter Nierenfunktion kam es nicht mehr zu einer signifikanten osmotischen Diurese und Zunahme der Natriumausscheidung.

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Renal function after infusion pyelography

Summary The effect of infusion pyelography (meglumine iothalamate) on glomerular filtration rate (GFR), effective renal plasma flow (RPF), diuresis, osmolar clearance and sodium excretion was investigated in 25 patients with normal and reduced renal function. GFR was normal in 11 patients (113.8±18.9 ml/min/1.73 m²), moderately reduced (36.9±5.9 ml/min/1.73 m²) and severely reduced (11.1±4.2 ml/min/1.73 m²) in 7 patients, respectively.GFR was between mean +2.4% and –12.4% of control within 2 hours after infusion pyelography. The fall became significant only in patients with moderately reduced renal function. The decrease of RPF in the three groups was not significant between 13.2 and 20.5% of control. Changes of GFR and RPF in single groups did not differ statistically from the overall trend. The changes observed were within physiological variation range.Diuresis, osmolar clearance and sodium excretion increased significantly after infusion pyelography in patients with normal and moderately reduced renal function. The increase was in correlation with the GFR. The diuresis was osmotic, characterized by a significant correlation between urine flow and osmolar clearance. Tubular sodium rejection and urinary sodium excretion increased significantly. After infusion pyelography no significant osmotic diuresis and increase of sodium excretion occured in severely reduced GFR.