Chrome congestive heart failure: Complete sinus arrest during diltiazem therapy; clinical correlates and efficacy of intravenous calcium

The occurrence of severe sinus node dysfunction in 10 patients(three males and seven females; mean age 78·5±3·4,range 57–92 years) receiving oral diltiazem therapy (mean190±20 mgl24 h, range 90–300) is described Sixof them were concomitantly taking amiodarone andlor beta-blockingagents. On admission, seven patients exhibited systemic hypotensionand nine complained of asthenia and/or dizziness or drowsiness.ECG findings showed in all a persistent sinus arrest with atrial,junctional or ventricular escape, leading to a mean heart rateof 40·2±3 beats. min^–1 (range 257ndash;56).All patients had chronic renal failure on biological tests,with a mean endogenou.s creatinine clearance of 25±3ml. min^–1 (range 12–36). Intravenous calcium hydrochloride(mean 1·4±0·2 g, range 1–2), givenin nine patients, rapidly restored stable sinus activity inseven. We suggest that diltiazem should be given cautiouslyto ageing patients with chronic renalfailure, and confirm theefficacy of intravenous calcium in reversing calcium channelblocker toxicity on sinus node.     

Inferior sinus venosus defect associated with incomplete cor triatriatum dexter and patent foramen ovale.

Sinus venosus atrial septal defect (SVD) is a rare cardiac abnormality in adults. Particularly, the inferior type is difficult to depict by transthoracic echocardiography because of its infero-posterior location to the fossa ovalis. We describe the case of a 33-year-old woman whose chest X-ray taken during bronchopneumonia revealed a cardiomegaly. Further echocardiographic investigations showed an underlying inferior SVD, an incomplete cor triatriatum dexter and a large patent foramen ovale (PFO). The diagnosis was confirmed by cardiac magnetic resonance imaging (CMR) and during surgical repair.     

Effect of histamine in sinus node arrested with reserpine

Summary Histamine restored spontaneous activity in the isolated rabbit sinus node arrested with reserpine. This fact suggests that catecholamines are not the unique activators of adenylate cyclase required for cardiac pacemaking, and may be replaced by histamine.     

右心房上部心律的确诊

为探讨右心房上部心律的诊断方法，通过动物实验自身对照，同步记录１５只犬心电图Ⅱ、ａＶＲ导联、心腔内窦房结电图、高位右心房电图。结果发现在窦房结局部注入维拉帕米、石碳酸及电刺激右侧颈迷走神经情况下，窦房结功能被抑制后出现房性逸搏心律时，心电图有时仍为窦性心律（ＰⅡ直立、ＰａＶＲ倒置）；而窦房结电图上则记录不到窦房结电位，心率亦有明显降低（ｔ＝２．４２０，Ｐ〈０．０５）。提示窦房结附近的右心房上部心律     

Unusual ``Midseptal' Sinus Venosus Defect

An unusual case of an interatrial communication similar to a sinus venosus defect associated with an overriding pulmonary venous chamber is reported. There was no direct connection of the pulmonary venous system with either the superior vena cava or the low right atrium, as is usual with sinus venosus defects. This defect may represent the result of a sinus venosus defect associated with cor triatriatum.     

Reactive hyperplasia of paracortex and germinal centers of the regional lymph nodes in gastric carcinoma cases as a favorable prognostic indicator

The prognosis of 141 patients subjected to curative resection for gastric carcinoma was analyzed with special reference to the paracortex, germinal centers and sinus histiocytes in the regional lymph nodes. Five year survival rates of the patients with paracortical and/or germinal center hyperplasia (PH and/or GH) was definitely superior to those without such hyperplasia. This difference was most pronouced in those with moderately advanced stage. The incidence of lymph node metastasis was lower in the patients with PH or GH. The presence of sinus histiocytosis (SH) seemed to be correlated neither with a longer survival nor with lower incidence of lymph node metastasis. No close correlation was found between Ph, GH and SH on one hand and histological types of the primary gastric carcinomas on the other. These results suggest that cell mediated and/or humoral immune response may play an important role in host resistance against gastric carcinoma.     

Effect of paced cycle length on sinus node effective refractory period before and after autonomic blockade in patients with sick syndrome

Effect of basic paced cycle length on sinus node effective refractoryperiod was studied in 22 patients with sick sinus syndrome.Sinus node effective refractory period was measured using threedifferent paced cycle lengths before and after pharmacologicautonomic blockade. Sinus node effective refractory period couldbe measured at one cycle length, at least, in 59% of the patientsbefore blockade, however, it could be measured at two or morecycle lengths in only 18% of patients because of the chaoticresponse of sinus node against premature stimuli. It could bemeasured after pharmacologic autonomic blockade in 68% of thepatients at two or more paced cycle lengths. On the other hand,the rest of the patients showed no measurable sinus node effectiverefractory period at any cycle length, for their sinus nodeeffective refractory periods were shorter than their right atrialeffective refractory periods. The comparison of sinus node effectiverefractory period at different paced cycle lengths was unsuccessfulbefore pharmacologic autonomic blockade, while the refractoryperiod was significantly prolonged as cycle length was shortenedafter blockade. We concluded that (1) sinus node effective refractoryperiod in humans is prolonged as paced cycle length decreases,(2) the autonomic reflex is the major disturbing factor in measuringsinus node effective refractory period, and pharmacologic autonomicblockade can be usefully employed to eliminate a chaotic sinusnodal response, (3) when sinus node effective refractory periodis shorter than right atrial effective refractory period, ashorter paced cycle length should be used for definite measurementof the former.     

主动脉窦动脉瘤破裂10例临床分析

本文分析10例主动脉窦动脉瘤破裂的临床表现,提出早期诊断要点。多数患者为突起胸痛、心悸、气促、相继出现心力衰竭,并在胸骨左缘3～4肋间可闻及连续性机器样杂音。超声心动图、X线、心电图等检查异常,必要时心导管或心脏造影检查,便能确诊。且应与动脉导管未闭、主动脉肺动脉间隔缺损,空间隔缺损并主动脉瓣闭锁不全相鉴别。     

鼻窦肿瘤的CT诊断与临床对照分析

由于鼻窦解剖部位隐蔽，鼻窦良恶性肿瘤早期临床表现较少，除一般炎症症状外少特异性，但它们的治疗方法尤其是手术方式却截然不同。CT检查具有密度分辨力高、解剖关系明确等特点，能早期对鼻窦肿瘤作定位诊断。本文报告的42例鼻窦肿瘤病者，定位正确者为38例，占90.48％。在肿瘤定性方面，CT对肿瘤良恶性的鉴别力也较高。但是由于各种肿瘤CT表现无明显特点，故定性诊断仍较困难。且对于体积小肿瘤及微小的骨质破坏，CT也有局限性。因此CT检查要结合临床特点，体格检查及其他辅助检查，以提高CT的诊断准确率。