Plasma lidocaine concentrations after local anesthesia of the groin for cardiac catheterization.

This study aimed to investigate serum lidocaine concentrations after subcutaneous infiltration of the groin for cardiac catheterization. One hundred twenty-six patients for planned heart catheterization received five different dosages (5-25 ml) of lidocaine 2% for local anesthesia of the groin in a randomized manner. All of them received an arterial sheath and 13 received both an arterial sheath and a venous sheath for right heart catheterization. Blood samples were taken before as well as 15, 30, and 120 min after subcutaneous application of the drug. Although in 33 patients with an arterial sheath (no venous sheath) excessive doses of lidocaine 2% (20-25 ml) were used, neither symptoms of intoxication nor toxic plasma levels were observed. However, in patients receiving an additional venous sheath, toxic plasma levels were obtained in a third of the cases. One of them showed symptoms of intoxication.     

Three-dimensional coronary anatomy in contrast-enhanced multislice computed tomography

A number of three-dimensional imaging modalities, such as magnetic resonance imaging, electron beam computed tomography, ultrasonography, and multislice computed tomography have been introduced in cardiovascular medicine. One of the most recently developed techniques, multislice computed tomographic coronary angiography, allows assessment of the small coronary vessels. The entire heart is scanned within a single breathhold and contrast-enhanced images are reconstructed through retrospective electrocardiographic gating. Instead of the conventional two-dimensional projection images, multislice computed tomographic data can be displayed in a three-dimensional, volume-rendered manner. This paper presents an overview of the cardiac and coronary morphology as it is imaged with contrast-enhanced multislice computed tomography. Further imaging characteristics of computed tomographic angiography are discussed.     

Who controls the placebo? Introducing a Placebo Quality Checklist for pharmacological trials

Randomised placebo-controlled trials (RCT) are an invaluable tool for testing the efficacy of new treatment strategies. The choice of placebo in an RCT can affect not only patients' physical and psychological response to a particular intervention, but also the trial setting, the success of patient blinding to the intervention, and therefore the outcome of the study and the efficacy of treatment in general. Therefore the placebo is intrinsically tied to the trial's methodology and results. However, although placebos are an important component in randomised trials, their quality is often left unquestioned. A placebo which was not properly validated may even have specific effects that lead to false negative results. To address this deficit, we propose a measure of placebo quality using the term placebo to assess the physical aspect of a dummy treatment used in the placebo group of a randomised controlled trial (RCT). The Placebo Quality Checklist (PQC) described here may help investigators select an appropriate placebo and help both investigators and critical readers interpret the findings of studies with more care.     

Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy

Introduction

Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABP_NI) and cardiac output (CO_NI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABP_NI and CO_NI as well as the adequacy of detecting changes in ABP and CO, we compared FAP to intra-arterially measured blood pressure (ABP_IA) and transpulmonary thermodilution (CO_TD) in postcardiac surgery patients during a fluid challenge (FC).

Methods

Twenty sedated patients post cardiac surgery were included, and 28 FCs were performed. Measurements of ABP and CO were simultaneously collected before and after an FC, and we compared CO and blood pressure.

Results

Finger arterial pressure was obtainable in all patients. When comparing ABP_NI with ABP_IA, bias was 2.7 mm Hg (limits of agreement [LOA], ± 22.2), 4.9 mm Hg (LOA, ± 13.6), and 4.2 mm Hg (LOA, ± 13.7) for systolic, diastolic, and mean arterial pressure, respectively. Concordance between changes in ABP_NI and ABP_IA was 100%. Mean bias between CO_NI and CO_TD was − 0.26 (LOA, ± 2.2), with a percentage error of 38.9%. Concordance between changes in CO_NI vs CO_TD and was 100%.

Conclusion

Finger arterial pressure reliably measures ABP and adequately tracks changes in ABP. Although CO_NI is not interchangeable with CO_TD, it follows changes in CO closely.     

Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study

OBJECTIVE: Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries. The objective of this study was to investigate the efficacy of acupuncture and moxibustion in the treatment of active ulcerative colitis (UC). MATERIAL AND METHODS: In a prospective, randomized, controlled clinical trial 29 patients with mild to moderately active UC (mean age 37.8 +/- 12.0 years) were randomly assigned to receive either traditional acupuncture and moxa (TCM group, n = 15), or sham acupuncture consisting of superficial needling at non-acupuncture points (control group, CG, n = 14). All patients were treated in 10 sessions over a period of 5 weeks and followed-up for 16 weeks. The main outcome measure was the change in the Colitis Activity Index (CAI) after treatment; secondary outcome measures were changes in quality of life, general well-being and serum markers of inflammation. RESULTS: In the TCM group, the CAI decreased from 8.0 (+/- 3.7) to 4.2 (+/- 2.4) points and in the control group from 6.5 (+/- 3.4) to 4.8 (+/- 3.9) points (TCM versus CG: p = 0.048). In both groups these changes were associated with significant improvements in general well-being (TCM group: from 3.0 (+/- 1.8) to 1.8 (+/- 1.0); CG: from 3.2 (+/- 1.9) to 2.2 (+/- 1.7)) and quality of life (TCM group: from 146 (+/- 23) to 182 (+/- 18); CG: from 157 (+/- 20) to 183 (+/- 23)). No significant differences between the TCM and CG were found regarding these secondary outcome measures. CONCLUSIONS: Differences in efficacy between traditional acupuncture and sham acupuncture were small and significant only for CAI as the main outcome measure. Both traditional and sham acupuncture seem to offer an additional therapeutic benefit in patients with mild to moderately active UC.     

Cutting balloon for in-stent restenosis: acute and long-term results

INTRODUCTION: Conventional percutaneous coronary intervention for the treatment of in-stent restenosis (ISR) has shown a high rate of ISR (30-55%). Considering the need for both extrusion of hyperplastic intima and additional stent expansion, a cutting balloon might be more effective for the treatment of ISR. METHODS: We prospectively assessed the immediate and 8-month outcome of balloon angioplasty using the Barath Cutting Balloon in 100 consecutive patients (mean age: 60.5 +/- 10.8 years, 71% male). RESULTS: In 73 lesions (73%), a good result was reached with the cutting balloon only. In 21 lesions (21%) postdilatation and in 6 lesions (6%) predilatation with a conventional balloon was necessary. The mean inflation pressure was 8.7 +/- 2.0 (range: 6.0-18.0) atm. Before the procedure the mean minimal luminal diameter (MLD) was 0.95 +/- 0.45 mm. Quantitative coronary analysis showed a mean diameter stenosis of 65%+/- 16%. Immediately after the procedure the mean MLD was 2.42 +/- 0.54 mm with a mean diameter stenosis of 19%+/- 13%. Two patients died during the follow-up period (1 stroke, 1 nonvascular). At 8-month follow-up 26 patients (26%) reported to have anginal complaints CCS class II-IV of whom 16 (16%) needed target lesion revascularization. CONCLUSION: Treatment of ISR using the Barath Cutting Balloon can be performed safely with good immediate results and a relatively low need for repeated target lesion revascularization at 8-month follow-up.     

Apelin, a potent diuretic neuropeptide counteracting vasopressin actions through inhibition of vasopressin neuron activity and vasopressin release

Apelin, a recently isolated neuropeptide that is expressed in the supraoptic and the paraventricular nuclei, acts on specific receptors located on vasopressinergic neurons. The increased phasic pattern of these neurons facilitates sustained antidiuresis during dehydration or lactation. Here, we investigated whether apelin interacts with arginine vasopressin (AVP) to maintain body fluid homeostasis. We first characterized the predominant molecular forms of endogenous hypothalamic and plasma apelin as corresponding to apelin 13 and, to a lesser extent, to apelin 17. We then demonstrated that, in lactating rats, apelin was colocalized with AVP in supraoptic nucleus magnocellular neurons and given intracerebroventricularly inhibited the phasic electrical activity of AVP neurons. In lactating mice, intracerebroventricular administration of apelin 17 reduced plasma AVP levels and increased diuresis. Moreover, water deprivation, which increases systemic AVP release and causes depletion of hypothalamic AVP stores, decreased plasma apelin concentrations and induced hypothalamic accumulation of the peptide, indicating that AVP and apelin are conversely regulated to facilitate systemic AVP release and suppress diuresis. Opposite effects of AVP and apelin are likely to occur at the hypothalamic level through autocrine modulation of the phasic electrical activity of AVP neurons. Altogether, these data demonstrate that apelin acts as a potent diuretic neuropeptide counteracting AVP actions through inhibition of AVP neuron activity and AVP release. The coexistence of apelin and AVP in magnocellular neurons, their opposite biological effects, and regulation are likely to play a key role for maintaining body fluid homeostasis.     

Intravenous coronary angiography using electron beam computed tomography

Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the noninvasive visualisation of coronary arteries. With dedicated computer hardware and software, three-dimensional renderings of the coronary arteries, veins, and other cardiac structures can be constructed from the individual transaxial tomograms. Interest in this technique is growing, and recently a number of clinical studies have been published comparing EBCT coronary angiography with conventional cine-coronary angiography. In this article, image acquisition, postprocessing techniques, and the results of recently published clinical studies are discussed. EBCT coronary angiography is a promising imaging technique of coronary arteries. Currently, it is a reasonably robust technique for the visualization and assessment of the left main and left anterior descending coronary artery. However, at the moment a relatively high proportion of the right and circumflex coronary angiograms are noninterpretable. Improvements in image acquisition and postprocessing techniques are expected to improve visualization and diagnostic accuracy of the technique.