Differences Between Atrial Single Chamber Pacing (AAI) and Ventricular Single Chamber Pacing (VVI) with Respect to Prognosis and Antiarrhythmic Effect in Patients with Sick Sinus Syndrome

STANGL, K., ET AL.: Differences Between Atrial Single Chamber Pacing (AAI) and Ventricular Single Chamber Pacing (VVI) with Respect to Prognosis and Antiarrhythmic Effect in Patients with Sick Sinus Syndrome. Several studies suggest different effects of atrial (AAI) and ventricular single chamber pacing (VVI) for sick sinus syndrome with respect to the suppression of atrial tachycardias and to the prognosis. With this aspect in mind, we studied 222 patients with sick sinus syndrome, 110 of whom had been supplied with AAI systems, and 112 with VVI systems, in the period from January 1978to December 1986. The mean observation period was 53 ± 28 months. The cumulative 5-year survival rate was not significantly different in the two groups. After subgroups with comparable underlying diseases had been differentiated, patients with coronary heart disease showed a significantly higher survival rate (p < 0.05) under AAI pacing, and the same was shown for patients with no underlying heart disease (p < 0.02). The incidence of chronic atrial fibrillation was 6% in the AAI group and 19% in the VVI group. Patients with preexisting atrial tachyarrhythmias showed the lowest incidence of chronic atrial fibrillation under AAI pacing. Under VVI pacing this incidence was a function of the basic rate of the pacemaker systems. In conclusion, the pacing mode seems to have a prognostic importance in spite of all methodological difficulties. A suppressive effect of AAI pacing on atrial dysrhythmias can also be assumed.     

Two Cases with Persistent Falcine Sinus as Congenital Variation

The falcine sinus is an abnormal anatomic structure located in the falx cerebri that is closed after birth and is rarely observed. We describe two cases of persistent falcine sinus. A 60-year-old woman presented with headache. An 11-year-old girl presented with intermittent headache and a palpable scalp mass in the middle of the high parietal area. The straight sinuses were absent in both patients. In both patients, drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. Suspicious dysplastic tentorium cerebelli was observed in one patient. It can be concluded that a mesenchymal disorder can be the primary cause for a persistent falcine sinus.     

Balloon sinuplasty — the first Indian experience

The surgical management of sinusitis was revolutionized worldwide with the advent of the rigid Hopkins rod nasal endoscopes three decades ago. The traditional Messerklinger technique, was thus propagated worldwide by Prof. Stammberger, from the University of Graz in Austria and has come into vogue as functional endoscopic sinus surgery (FESS). The principal aim behind this procedure was the maximal preservation of the nasal mucosal integrity, while providing optimal disease clearance. Today, the introduction of a new technological innovation called ‘balloon sinuplasty’, has taken the field of sinus surgery a step further. This new technology is very similar to the principles of balloon angioplasty and today, this system has added an efficient, non-invasive tool in the armamentarium of the innovative endoscopic rhinologist. This FDA approved technique, in recent times has provided excellent results in various centers across the western world. We share our first surgical experience with the introduction of this cutting-edge technology in India.     

Influence of residual alveolar bone height on osseointegration of implants in the maxilla: a pilot study

Aims/Background: For sinus floor augmentation and simultaneous implant placement, a minimum of 5 mm of residual bone height has been recommended empirically. This study was designed to test this assumption in an experimental animal trial. Material and methods: In eight mini pigs, three premolars and two molars were removed on one side of the maxilla. Three months later, the animals were assigned to four groups of two animals each. A cavity was created at the base of the alveolar process so that the residual bone height was reduced to 2, 4, 6 and 8 mm, respectively. Six implants were installed and an inlay augmentation procedure was carried out using a particulated iliac bone graft. Implants were loaded with fixed provisional restorations after a healing period of 6 months. The animals were sacrificed after 6 months of functional loading. Histologic specimens were prepared and histomorphometric analysis was performed [bone‐to‐implant contact (BIC) ratio, interthread bone area, peri‐implant bone area, crestal bone resorption (CBR)]. Results: Two implants were lost during follow‐up and fibrous encapsulation was detected in one additional implant. All failures occurred in one animal with a residual alveolar height of 2 mm. On the buccal aspect, BIC turned out to be significantly higher for 6 mm when compared with 2/4 mm (75.8 ± 26.1 vs. 58 ± 23.2/53.9 ± 22.8; P<0.05), while on the palatal aspect, BIC was significantly higher for 6/8 mm when compared with 2/4 mm (80 ± 17.8/78.9 ± 10.3 vs. 55.8 ± 26.5/55.6 ± 21.3; P<0.05). For an alveolar height of 8 mm, CBR tended to be significantly lower than for bone heights of 2/4 mm (3.8 ± 2.3 vs. 5.3 ± 2.6/5.8 ± 3.9; P<0.05). Correlation analysis revealed a significant association of BIC and interthread bone area as well as a negative association to CBR on the palatal aspect. Conclusion: The results of the present study show that the combination of maxillary inlay grafting and simultaneous implant placement does not hinder osseous integration even though the alveolar crest has been reduced to a residual height of 4 mm and below. However, according to histomorphometry, the highest predictability is gained in sites with residual bone heights of 6 and 8 mm.     

额叶肿瘤患者认知功能和事件相关电位P300的研究

目的 探讨额叶肿瘤患者认知功能的损害和事件相关电位P300有关参数的变化特点,了解额叶在认知功能及P300产生中的作用.方法 对31例额叶肿瘤患者(左侧15例、右侧16例)及30例健康对照者分别进行Stroop字色干扰等多项认知神经心理学测试和P300检查.结果 与健康对照组相比,额叶肿瘤组认知功能各项测试指标评分均显著降低(P＜0.05),P300的N2、P3波潜伏期显著延长(P＜0.05),P3波幅显著降低(P＜0.05).进一步研究发现,右额叶肿瘤组患者的各项认知测试指标评分均显著低于健康对照组(P＜0.05),而左额叶肿瘤组只有词语流畅性指标评分显著低于健康对照组(P＜0.05);与健康对照组相比,左、右额叶肿瘤组P300的N2、P3波潜伏期均显著延长(P＜0.05),P3波幅均显著降低(P＜0.05);左、右额叶肿瘤组患者之间的P300比较则无统计学差异(p＞0.05).结论 额叶肿瘤患者认知功能有明显损害,右侧肿瘤患者的认知功能损害更严重:额叶可能与P300发生或传导有关,且左右额叶无明显的差异.     

额颞联合入路治疗颅脑损伤86例手术体会

目的探讨颅脑损伤不影响术后恢复和便于二期手术的术中处理方式。方法回顾性分析额颞联合颅脑手术86例,其中额部骨瓣保留、颞侧去骨瓣减压54例(A组),额颞骨瓣去除32例(B组)。比较2组术后脱水剂使用时长和拆线时长。结果2组术后脱水剂使用时长和拆线时长比较无显著性差异。结论额颞联合伤,术中内外充分减压后骨瓣复位不影响患者术后的正常恢复,能够保持患者术后的面部正常形态,减少面部畸形给患者带来的心理问题,方便了二期手术(颅骨修补)的实施,能够有效减少骨缺损面积,减少颅骨修补巨额耗材费用。     

额颞颧入路海绵窦眶尖肿瘤切除及脑神经保护

目的探讨海绵窦眶尖肿瘤显微手术及脑神经保护的方法。方法回顾性分析8例海绵窦眶尖肿瘤临床资料,均采用额颞颧入路显微神经外科手术切除肿瘤及神经电生理检测保护脑神经,术后定期随访。结果肿瘤全切除4例,次全切2例,大部分切除1例,活检1例。脑神经继发损伤症状出现率22%,脑脊液漏1例,无脑内感染及死亡病例。结论掌握海绵窦眶尖区解剖及熟练的显微神经外科技术,再加上神经电生理检测保护脑神经,可提高肿瘤切除程度,减少脑神经继发损伤。     

内镜下经鼻蝶窦入路至鞍上区的解剖与临床初步应用

目的研究内镜下扩大经鼻蝶窦入路至鞍区、鞍上区的显露范围，及手术入路中重要的解剖标志与其相互位置关系。结合该入路切除鞍结节脑膜瘤的临床应用体会，探讨内镜在此区域手术中面临的主要问题和解决办法。方法选择10例灌注尸头标本，采用显微镜解剖2例，其中冠状位和矢状位切开各1例；另8例标本模拟经鼻蝶窦入路。在内镜和显微镜下扩展显露鞍前及鞍上区的主要解剖标志，并研究其相互位置关系。对2例女性鞍结节脑膜瘤病人，采用神经导航经鼻蝶窦入路手术，肿瘤切除过程中和切除后分别应用成角内镜观察肿瘤周围结构及切除情况，肿瘤切除后以脂肪、人工硬膜及明胶海绵重建鞍底。结果内镜下在颅前窝向外侧显露的主要限制是两侧的眶内侧壁和视神经管；选择三个平面测量向侧方的显露范围，分别为筛骨鸡冠后缘平面（19．1±2．65）mm，鞍结节前方10mm的蝶骨平台平面（23．2±2．35）mm，两侧视神经管内口平面（13．1±2．18）mm。内镜下可清晰显示双侧视神经、视交叉、垂体柄、前交通动脉复合体等颅内结构。2例鞍结节脑膜瘤病人均达到肿瘤全切除，视力部分改善，术后均出现脑脊液漏，再次经原入路手术修补后痊愈。结论采用单纯内镜或内镜辅助的经鼻蝶窦入路可更直接达到鞍前及鞍上区病变，避免了经过重要的神经血管结构及对脑组织的牵拉。颅底骨质磨除位置和范围以及颅底的修补和重建是采用该入路需要解决的主要问题。     

经面静脉-眼静脉途径栓塞海绵窦区硬脑膜动静脉瘘

目的探讨经面静脉-眼静脉途径栓塞治疗海绵窦区硬脑膜动静脉瘘（CSDAVFs）的方法和疗效。方法自2001年4月至2005年9月采用经股静脉-面静脉-眼静脉途径插管，以弹簧圈栓塞治疗CSDAVFs病人9例。结果7例病人导管均成功插入海绵窦，其中6例病人栓塞后完全治愈，另1例病人不全栓塞，但病人突眼、球结膜充血等症状完全好转。1例病人由于术中眼静脉痉挛导致插管失败，术后症状加重，但2个月后眼部症状完全恢复正常。1例病人由于插管失败，改行眼静脉切开穿刺插管成功栓塞。随访4～51个月，9例病人均未复发。结论对于岩下窦插管困难、面静脉和眼静脉扩张明显而无明显迂曲的CSDAVFs病人采取经面静脉-眼静脉栓塞治疗,其疗效较满意。     

Apoptosis seems to be the major process while surface and neural ectodermal layers detach during neurulation

Objective The aim of this study is to demonstrate the process of detaching neural and surface ectodermal layers soon after the neurulation completes. Materials and methods Specific pathogen-free chicken egg embryos were used to investigate the neurulation procedure. Ten eggs were saved as controls. The other ten eggs were opened at the 30th hour of embryo development and cultured with Z-VAD-FMK (peptide caspase inhibitor) to investigate the results of the apoptosis inhibition. Embryos were placed and developed up to 48 h in the culture medium. To detect apoptotic cells between neural and surface dermal layers, immunoreactivity of p53 and terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were used. Results While the control group shows positive immunoreactivity of p53 and TUNEL-positive apoptotic cells at the site where the neural folds detach from the surface ectoderm, no TUNEL activity and no detachment were detected in the apoptosis-inhibited group. Conclusion As inhibition of apoptosis prevented the detachment of the neural and surface ectodermal layers from each other at the end of the neurulation, inhibition of apoptosis seemed to cause a considerable embryological error accounted for congenital dermal sinus tractus maldevelopment. This paper was presented at the 35th annual meeting of International Society of Paediatric Neurosurgery, 9–14 September 2007, Liverpool, England.