Significance of coupling intervals of spontaneous ventricular arrhythmias in long-term ECG in patients with coronary heart disease

Coupling intervals of premature ventricular beats and complex arrhythmias were studied by 24-h ambulatory electrocardiographic recordings in 76 patients (35 sudden death patients and 41 survivors) with coronary artery disease. A first Holter (HM 1) was recorded at the time of left ventricular angiography and a second Holter (HM 2) after a mean interval of 34.4 +/- 11.2 months (range 2-61 months). All patients were only treated medically. The mean heart rate was significantly faster in patients who died suddenly than in survivors in both HM 1 and HM 2 (p less than 0.01). In HM 1, there were no significant differences in mean coupling intervals between patients who died suddenly and survivors, whereas in HM 2, coupling intervals of premature ventricular beats and couplets were significantly shorter in patients who died suddenly than in survivors (p less than 0.05). Patients with coupling intervals for couplets less than 500 ms died significantly earlier than those patients with coupling intervals greater than 500 ms (p less than 0.05). Our data show that there is a relationship between heart rate, coupling intervals and sudden death. Patients with fast heart rates and coupling intervals for couplets less than 500 ms represent a group at high risk of sudden death.     

Anulus fibrosus in bulging intervertebral disks

In this investigation the association of radial tears of the anulus fibrosus and bulging of the intervertebral disk was studied. An index of disk bulging was measured in sagittal anatomic sections in 149 lumbar disks from 31 cadavers. The indexes of disk bulging were correlated with stages of disk development and the presence of an annular tear. The largest disk-bulging indexes were always associated with radial tears of the anulus. Eighty-four percent of the disks with radial tears had disk-bulging indexes greater than 2.5 mm. Most normal adult disks had an index of less than 2.5 mm. The results challenge the concept that the anulus fibrosus is intact in bulging disks, although ruptured in herniated disks.     

痛

黑暗!黑暗!!黑暗!!!这样的世界看不到半点光明。孤独的舞者终究还是孤独地倒下,然后又孤独地消失。黑暗呀,为什么老是缠绕着我?一声“妈妈”划破了天际,却也突不出黑暗的包围。谁来应我一声呀,妈妈,你在哪里呀?我的心在不停地挣扎,告诉自己:“不怕,不怕。”可这是在黑暗里呀,周     

Implantation and follow-up of a third-generation cardioverter defibrillator: comparison of epicardial and nonthoracotomy defibrillation lead system

OBJECTIVE: The intraoperative and follow-up results were compared in 67 patients with ventricular tachyarrhythmias who underwent implantation of the Ventritex Cadence defibrillator with either epicardial patch (EPI, 25 patients) or nonthoracotomy CPI Endotak (ENDO, 42 patients) defibrillation lead systems. RESULTS: There was no significant difference between groups in age, sex, structural heart disease, ejection fraction, arrhythmia history, or drug therapy. Successful implantation was accomplished in all patients using either lead system. In the ENDO group, 35 patients (83%) had a defibrillation threshold < or = 550 V and did not require a subcutaneous patch. Intraoperatively, the defibrillation threshold was 453 +/- 139 V (13 +/- 9 J) for EPI and 490 +/- 113 V (15 +/- 8 J) for ENDO (P = NS). There were no perioperative deaths in either group. At predischarge testing, the defibrillation threshold was 445 +/- 183 V (14 +/- 12 J) for EPI and 439 +/- 133 V (13 +/- 7 J) for ENDO (P = NS). During a mean follow-up of 16 +/- 8 months, there were no sudden deaths, and four patients died from congestive heart failure (3 EPI, 1 ENDO). During follow-up, 916 spontaneous arrhythmia episodes occurred in 16 of 25 EPI patients (64%) and 967 episodes occurred in 31 of 42 ENDO patients (74%) (P = NS). The number of episodes detected as ventricular fibrillation were 192 for EPI (21%) and 232 for ENDO (24%), with first shock success in 76% and 75%, respectively; all episodes were successfully terminated by the device. In the remaining episodes detected as ventricular tachycardia, antitachycardia pacing was attempted and was successful in 672 of 724 episodes (93%) with EPI and 666 of 735 episodes (91%) with ENDO lead systems (P = NS). Acceleration of ventricular tachycardia with antitachycardia pacing occurred in 21 episodes (3%) with EPI and in 37 episodes (5%) with ENDO leads (P = NS). CONCLUSIONS: A nonthoracotomy approach using the third generation cardioverter defibrillator Cadence V-100 is safe and effective and has clinical results that are not significantly different from epicardial defibrillation lead systems.     

Effects of precooling on thermoregulation during subsequent exercise

PURPOSE: The purpose of this study was to examine the effect of a decreased body core temperature before a simulated portion of a triathlon (swim,15 min; bike, 45 min) and examine whether precooling could attenuate thermal strain and increase subjective exercise tolerance in a warm environment (26.6 degrees C/60% relative humidity (rh)). METHODS: Six endurance trained triathletes (28+/-2 yr, 8.2+/-1.7% body fat) completed two randomly assigned trials 1 wk apart. The precooling trial (PC) involved lowering body core temperature (-0.5 degrees C rectal temperature, Tre) in water before swimming. The control trial (CON) was identical except no precooling was performed. Water temperature and environmental conditions were maintained at 25.6 degrees C and 26.6 degrees C/60% rh, respectively, throughout all testing. RESULTS: Mean time to precool was 31+/-8 min and average time to reach baseline Tre during cycling was 9+/-7 min. Oxygen uptake (VO2), HR, skin temperature (Tsk), Tre, RPE, and thermal sensation (TS) were recorded following the swim segment and throughout cycling. No significant differences in mean body (Tb) or Tsk were noted between PC and CON, but a significant difference (P < 0.05) in Tre between treatments was noted through the early phases of cycling. No significant differences were reported in HR, VO2, RPE, TS, or sweat rate (SR) between treatments. Body heat storage (S) was negative following swimming in both PC (-92+/-6 W x m2) and CON (-66+/-9 W x m2). A greater S occurred in PC (109+/-6 W x m2) vs CON (79+/-4 W x m2) during cycling (P < 0.05). CONCLUSIONS: Precooling attenuated the rise in Tre, but this effect was transient. Therefore, precooling is not recommended before a triathlon under similar environmental conditions.     

Ependymoma of the thoracic spine. Cervico-brachialgia as the first symptom--a case report

Most frequently the ependymomas of the central nervous system affect the Conus medullaris and Filum terminale. Ependymomas of the thoracic spine with association of a tumor-caused syringomyelia are extremely rare. The reported 50 years old patient with a thoracic ependymoma realized first symptoms as a shoulder-arm pain caused by the tumor-syrinx. The case report indicates that MRI is the superior imaging modality for primary tumors of the central nervous system. All relevant diagnostic and therapeutic informations derived from the MRI. The article describes the clinical manifestations, the diagnostic way and therapeutic procedure in the problem region thoracic spine.