A Ro/SS-A auto-antibody positive mother's infant revealed congenital complete atrioventricular block,followed by insulin dependent diabetes mellitus and multiple organ failure

We experienced a congenital complete atrioventricular block infant who was born from a Ro/SS-A antibody positive mother. Ro/SS-A antibody was also found in this baby which was presumed to be mediated by the maternal placenta. Temporary cardiac pacing was required at birth and pacemaker implantation was performed at 9 months. At 11 months of age, the baby fell into shock and experienced multiple organ failure because of diabetes mellitus-induced coma. The association between congenital complete heart block and the Ro/SS-A antibody is well known. However, the accompaniment of insulin-dependent diabetes mellitus has not been reported previously. As the Ro/SS-A antigen appears in the cytoplasm of many tissues, the possibility of an association between Ro/SS-A antibody and diabetes mellitus is difficult to deny. We report this rare case to draw attention to the possibility that babies who are born from an Ro/SS-A antibody positive mother may develop diabetes mellitus as well as congenital complete heart block.     

Ultrasound biomicroscopic features of spherophakia

Background: Spherophakia is an uncommon diagnosis. This is the first case report of spherophakia evaluated by ultrasound biomicroscopy.
Methods: Ultrasound biomicroscopy is a new diagnostic technique developed by one of the authors and provides images with microscopic resolution of the anterior segment. A patient with spherophakia was evaluated by ultrasound biomicroscopy (Zeiss-Humphrey, 50MHz) before and after YAG laser iridotomy.
Results: Ultrasound biomicroscopic assessment revealed a shallow anterior chamber, a very steep anterior lens curvature, iridolenticular contact, elongated zonules, and an increased distance between the lens equator and the ciliary processes. Angle closure glaucoma was due to a pupil block mechanism. The pupil block was relieved by YAG laser iridotomy.
Conclusions: Ultrasound biomicroscopy is a useful technique to confirm the diagnosis of spherophakia. The pupil block in spherophakia is relieved by YAG laser iridotomy.     

Hydrodynamic aspects of pyelocalyceal peristalsis

This study was undertaken to determine the nature of pressure changes in manometric studies of renal pelvis and calyces. In previous studies in pigs it has been assumed that pressure increases occur in the contracting segments of the renal pelvis and calyces, but our observations suggested that these increases were actually due to distension of noncontracted segments. Pressures were recorded with two catheters introduced percutaneously into the pyelocalyceal system with simultaneous video recording of the fluoroscopic image. There was no pressure rise in the calyces or the renal pelvis when these segments contracted; however, pressure rose when the noncontracted calyces were distended by a remote contraction ring. These findings confirmed the observations at kinetic urography. They agreed with the hydrodynamic experience that the pressure in a ring-shaped contracted segment is lower than upstream and downstream of that segment. It was concluded that if the porcine pyelocalyceal system is a valid model of the human, the pressure increases, assumed to be contractions, were actually caused by the injection and distension of the noncontracted segments.     

Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy.

Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paralysis has never been documented to our knowledge. We report a patient with bilateral self-induced tourniquet paralysis of the lower extremities, whose symptoms were initially attributed to an acute demyelinating sensorimotor polyneuropathy based on clinical presentation and electrodiagnostic study. After investigations failed to reveal a cause, he was found to have placed tourniquets on his legs because of a rare obsession with limb amputation known as apotemnophilia. Significant spontaneous partial resolution of clinical symptoms was noted after 6 weeks. Electrophysiologic evidence of segmental demyelination of multiple motor nerves localized to the same region may help to distinguish this condition from other forms of acute demyelinating polyneuropathy.     

电针内关穴对窦房传导功能的影响及其意义

采用直接窦房传导时间（ＳＡＣＴｄ）为指标，对１０例窦房结功能正常者进行了针刺前、针刺及固有心率（ＩＨＲ０）期间ＳＡＣＴｄ测定，以探讨电针内关穴对窦房传导功能的影响及其意义。结果表明：电针与ＩＨＲ０期间ＳＡＣＴｄ较对照期显著缩短（Ｐ〈０．０１；Ｐ〈０．００１）。自主神经阻滞后，电针该穴不能使ＳＡＣＴｄ进一步缩短（Ｐ〉０．０５）。提示；以内关穴为主的电针刺激能改善正常窦房传导功能，其作用似与自主神经中     

126例心房颤动合并长R-R间期患者的动态心电图分析

Objective To analyze the relationship between atrial fibrillation complicating long R-R interval, escape beat and escape heart rhythm and pathological atrioventricular block by dynamic electrocardiography (DCG). Methods 126 patients with atrial fibrillation were divided into group A (being related to sleep) and group B (being not related to sleep) according to the factor whether long R-R interval, escape beat and escape heart rhythm relevant to sleep. All were detected by DCG for 24 hours. Results The cases with1.5～2.0 s long R-R interval, more than 2.0s long R-R interval, escape beat and escape heart rhythm were (26.02±6.03), (7.39±1.05 ) and (6.90±1.28)in group A and (203.05±41.01), (35.48±7.52), (28.10±6.25) in group B respectively. The cases of group B were markedly more than those in group A. Conclusion Those atrial fibrillation complicating long R-R interval, escape bbeat and escape heart rhythm were related to sleep could not be deemed as pathological atrioventricular block, while those were not related to sleep could be considered pathological atrioventricular block.     

Effects of complete heart block on myocardial function, morphology, and energy metabolism in the rat.

AIMS: Severe sustained bradycardia may cause acute and possibly chronic congestive heart failure (CHF). The aim of this study was to investigate acute and chronic effects of complete heart block (CHB) on cardiac function, morphology, and creatine (Cr) metabolism. METHODS AND RESULTS: CHB was induced in male Sprague-Dawley rats (approximately 250 g, n = 11) by means of electrocautery applied to the region of AV node and were compared with controls (n = 15). The rats were investigated at 1, 3, and 12 weeks after CHB induction with transthoracic echocardiography. Invasive haemodynamic assessment of left and right ventricular pressures was performed at 12 weeks. After the sacrifice, the hearts were freeze-clamped for analysis of myocardial Cr, and high energy phosphometabolites. The efficacy of operative procedure was 54%. The peri-operative mortality rate was 20%. Heart rate (HR) decreased by approximately 50% (P < 0.01) while stroke volume (SV) increased 2.5 times (P < 0.01) in the CHB rats. Cardiac index remained unchanged. The rats with CHB grew normally and were in no apparent distress. Filling pressures in left and right ventricles were normal. The CHB rats developed marked cardiomegaly with biventricular dilatation and eccentric left ventricular hypertrophy (P < 0.01). There was no change in the myocardial content of Cr and high energy phosphometabolites. CONCLUSION: Rats with CHB are compensating for reduction in HR with increased SV without haemodynamic and biochemical characteristics of CHF. This model may be useful to study the effects of CHB and bradycardia on myocardial structure, function, electrophysiology, and metabolism as well as for studies of cell therapy for reparation of AV conductance.     

交感神经节与椎旁阻滞联合运用于改善脑中风预后的研究

目的 评价交感神经节与椎旁阻滞联合运用在脑中风康复治疗中的效果。方法 150例中风患者随机分为交感神经节与椎旁阻滞联合运用组（SGB组）和康复训练组（H组）。分别在治疗前、治疗后及随访期间，记录患者的体征、实验室检查及特殊检测结果。使用临床神经功能缺损程度评分标准及修订的巴氏指数（modified Barthel index，MBI）评测。采用t检验和卡方检验分析组间差异。结果 治疗1、3、6个月后，SGB组与H组总疗效均有改善，分别为H组：50％、60％、70％；SGB组：90％、95％、100％，SGB组疗效优于H组。两组比较，自觉症状、神经功能缺损改善程度有明显差异，生活活动能力改善程度差别不大。治疗前、后相比，SGB组收缩压、舒张压、局部皮温、血高切黏度、血低切黏度、PGA有改善，H组改变不明显；两组患者血浆黏度无明显改善。TCD显示，SGB组脑血流改善占85．3％，H组占14．3％。SGB组住院时间短于H组，住院费用不增加。结论 在脑中风康复治疗中，联合运用交感神经节与椎旁阻滞，疗效明显优于常规康复训练。     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Peripheral Foot Blockade Versus Popliteal Fossa Nerve Block: A Prospective Randomized Trial in 51 Patients

The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. The anesthesia was classified as effective if it was the sole anesthetic technique for the forefoot surgery. We found successful results in both groups: 92% in the foot block group and 96% in the popliteal block group. Analysis of time required to perform the anesthetic procedure showed a significant difference between the 2 groups, with foot block being considerably faster (14.3 minutes vs 19.2 minutes for popliteal block) (P = .0078). Foot block patients demonstrated 10.96 hours of analgesia, whereas popliteal block patients exhibited 14.32 hours (P = .132). With a mean follow-up of 5.7 months, we did not find anesthesia-related complications in any of the patients. Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.