Comparative Functional Effects of Chronic Ventricular Demand and Atrial Synchronous Ventricular Inhibited Pacing

We compared the effects of chronic ventricular inhibited (VVI) and atrial synchronous ventricular inhibited (VDD) pacing on functional capacity in 8 patients with complete atrioventricular heart block. Permanent VDD (Medtronic #2409, ASVIP) pacemakers were implanted in four men and four women (age range 27-76 years, mean 58.9 +/- 18.4 years), and randomly assigned to a three-month period of VDD or VVI pacing in this single blinded, crossover study. Functional capacity was assessed by questionnaire, graded treadmill exercise testing and radionuclide angiocardiography prior to pacemaker implant and following each pacing period. Following 3 months of pacing in each of VVI and VDD pacing modes, maximum heart rate (83.4 +/- 14 vs 134.9 +/- 16.4 beats/min, p less than 0.001) and double product (147.5 +/- 58.3 vs 218.9 +/- 52.7, p less than .001) were greater with VDD pacing. Although exercise duration on treadmill exercise testing (5.3 +/- 2.9 vs 6.9 +/- 3.1 minutes, p less than 0.1) was greater in the VDD mode, the difference was not significant. Similarly, there was no significant difference in functional capacity as measured by questionnaire scores (50.1 +/- 8.4 vs 46.9 +/- 8.9, p less than 0.1) or in left ventricular ejection fraction for the two pacing modes (.54 vs .55, p less than .5). Only one patient reported a subjective improvement with physiologic (VDD) pacing, whereas the remaining patients stated no preference. We conclude that VDD pacing offers improved maximal cardiac work during exercise compared to VVI pacing.(ABSTRACT TRUNCATED AT 250 WORDS)     

Erectile dysfunction following nerve-sparing radical retropubic prostatectomy and its treatment with sildenafil

BACKGROUND: We retrospectively evaluated the erectile function after nerve-sparing radical retropubic prostatectomy (RRP) and the efficacy of sildenafil for erectile dysfunction (ED) following RRP according to the preoperative erectile function. METHODS: We evaluated 48 Japanese patients who underwent nerve-sparing RRP at the Sapporo Medical University School of Medicine, Sapporo, Japan, between January 1996 and December 2001. Erectile function following nerve-sparing RRP was assessed by a simple mailed questionnaire that was constructed for the study. RESULTS: Of the 48 patients, 36 had normal erectile function preoperatively, but for 12, function was not sufficient to penetrate. The overall estimated recovery rates of any degree of erection were 50.6% at 36 months and 94.3% at 60 months. However, that of erection sufficient to penetrate was only 17.7% at 36 months and was only seen in bilateral nerve-sparing patients. Sildenafil was effective in 9 of 13 ED patients (69.2%) in both nerve-sparing groups. When patients were divided according to preoperative erectile function, no difference was found in the efficacy rate between patients with normal function and those with ED. CONCLUSIONS: Even bilateral nerve-sparing RRP can not always guarantee a sufficient erection. However, sildenafil is effective for ED following nerve-sparing RRP regardless of the nerve-sparing procedure or preoperative erectile function. Thus, preoperative function alone, although depending on its severity, may not necessarily be a reason for exclusion from receiving nerve-sparing RRP if patients want to have the operation.     

Stereoselectivity of Butylidenephthalide on Voltage-dependent Calcium Channels in Guinea-pig Isolated Ileum

Two geometric isomers, the Z- and the E- forms, can be separated from synthetic mixtures of butylidenephthalide (Bdph). Z-Bdph (50–100 μm ) non-competitively inhibited Ca²⁺-induced contractions in depolarized (K⁺, 60 mm ) guinea-pig ileum longitudinal smooth muscle, with a pD₂' value of 3.88 ± 0.20 (n = 5). However, E-Bdph (20–100 μm ) competitively inhibited these contractions with a pA₂ value of 4.56 ± 0.18 (n = 5) which was significantly (P < 0.05) greater than the pD₂' value of Z-Bdph. In contrast, the two isomers had no stereoselective inhibitory action on Ca²⁺ influx through pre- or post-junctional membranes of cholinergic nerve endings from which the transmitter acetylcholine is released or on Ca²⁺ release from intracellular stores. Therefore, the trans-Z and cis-E forms of Bdph might have geometric stereoselectivity for voltage-dependent calcium channels (VDC) in guinea-pig longitudinal smooth muscle. Both isomers might inhibit more selectively the contractile twitch responses evoked by electrical stimulation than by cumulative acetylcholine-or carbachol-induced transient contractions in guinea-pig ileum longitudinal smooth muscle.     

Efficacy of 308-nm excimer light for Japanese patients with psoriasis

Ultraviolet irradiation therapy, including psoralen and ultraviolet A therapy and narrow-band ultraviolet B (310–312 nm) therapy, is a widely used and highly efficient treatment modality for psoriasis. Therapy with 308-nm excimer light has been reported to be effective for the treatment of psoriasis vulgaris. To evaluate the efficacy of 308-nm excimer light therapy for Japanese psoriasis patients, seven patients (six men and one woman) with plaque-type psoriasis were treated with 308-nm excimer light at 7–14-day intervals. The Psoriasis Severity Index (PSI) was calculated for individual plaques in order to assess the effectiveness of the therapy. A 74.9% mean improvement in the PSI was observed after 10 treatment sessions. These results suggested that targeted irradiation with 308-nm excimer light leads to rapid and selective improvement in plaque-type psoriatic lesions without unnecessary radiation exposure to the surrounding unaffected skin.     

增生性瘢痕无创性评估策略及方法

增生性瘢痕是皮肤遭遇创伤后,因细胞外基质异常沉积、过度纤维化造成的皮肤病理现象。对于瘢痕诊断、临床疗效判定及比较研究,临床上使用的客观且可靠的瘢痕评判方法具有关键作用。我们就增生性瘢痕的评估、测量方式及工具的研究进展进行综述。     

经口经胃腹部手术

一、简介 随着内镜治疗技术的发展．传统外科手术处理疾病的方式发生了变革。由于具有低侵袭性的特点，内镜治疗已成为某些疾病，如胆总管结石和早期胃癌的标准治疗手段。内镜治疗的范围已扩展至腹膜腔。操作时发生穿孔有引发腹膜炎的危险，是内镜操作最严重的并发症：因此，如何安全地通过胃壁行可曲式内镜操作是我们面临的主要挑战。自2000年首次报道内镜经胃腹腔镜检查获成功以来，研究者们对这一问题十分关注，并进行了大量探索和研究。本文对经胃腔外手术或天然入口穿腔内镜手术（NOTES）概念的发展和现状作一讨论。