Clinical Experience with Expanded Polytetrafluoroethylene Gore-Tex® Surgical Membrane for Pericardial Closure: A Study of 110 Cases

Complete closure of the pericardium after cardiac operations has the advantage of avoiding injury of the heart and great vessels during reoperation. Between 1985 and 1987, the pericardium was closed with Gore-Tex Surgical Membrane (SM) in a selected series of 110 patients 1 month to 76 years of age. Fifty-three patients had congenital heart lesions and 57 patients had acquired heart disease. Overall hospital mortality was 3/110 cases. In no instance was there a relationship between occurrence of death and pericardial closure with SM. There was one episode of cardiac tamponade on the seventh postoperative day. One patient developed fever and leukocytosis due to a mediastinal hematoma. During a mean follow-up of 15 months, four patients had to be reoperated upon three, four, eight weeks, and eight months after primary operation. The anterior wall of the heart had no adhesion with the SM and the other parts of pericardium could be dissected easily. Scanning electron microscopic examination of the explanted SM patches showed neither cellular ingrowth nor immunocompetent cellular elements. The Gore-Tex Surgical Membrane has the advantages of easy availability and lack of reaction between its surface and the epicardium and pericardium. We believe its routine use should be encouraged in patients with high probability of reoperation after repair of complex cardiac anomalies, implantation of bioprostheses, coronary revascularization for one- or two-vessel disease, and repair of degenerative disease of the ascending aorta.     

Do women with epilepsy have increased frequency of menstrual disturbances?

PROBLEM: Menstrual disorders, reduced fertility and sexual problems seem to be more frequent in women with epilepsy than in the general population. Most investigations concerning menstrual disturbances in epilepsy patients, however, are small and based on selected materials. We therefore wanted to investigate the frequency of menstrual disturbances in a large, unselected population of epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of female outpatients, aged 18-45 was conducted. Each patient chose a close female friend who served as control, to optimise matching regarding age and lifestyle. RESULTS: Answers were received from 265 patients and 142 controls. Menstrual disturbances were more frequent in patients with epilepsy (48.0%) than in controls (30.7%) (P=0.004). Menstrual disturbances were more frequent in patients on polytherapy versus monotherapy (P=0.049) and more frequent in patients with high seizure frequency (>5seizures/year) compared to patients with a lower seizure frequency or those seizure free (P=0.006). The frequency of menstrual disturbances was higher in patients on valproate compared to carbamazepine monotherapy (P=0.045). CONCLUSION: This investigation confirms that women with epilepsy have an increased frequency of menstrual disturbances compared to women without epilepsy. In women with high seizure frequency and in those on polytherapy, the frequency of menstrual disturbances are further increased. The highest frequency of menstrual disturbances occurred in women using valproate.     

Fluorescence from dentin and cementum in human mandibular second premolars and its relation to age

Abstract – Investigations were carried out to study the fluorescent properties of human dentin and cementum and their relation to age. One hundred mandibular second premolars were ground according to the "half tooth" technique. The intensity to the red fluorescence was measured during illumination of dentin and cementum with a green light. The results were analyzed with the use of the SPSS. The intensity of the fluorescent light recorded from cementum was stronger than that recorded from dentin. A paired t -test showed no statistically significant left/right difference in fluorescence. Pearson's correlation coefficient indicated a strong relationship between age and fluorescence from dentin (r = 0.73) and from cementum (r =0.77). The sex of the individual had no significant influence on the fluorescence. Teeth removed from decreased individuals emitted fluorescence with a slightly stronger intensity than did teeth extracted from living patients. Regression analysis indicated a linear relationship between age and the fluorescence from either dentin or cementum. There was strong correlation between the intensity of the fluorescence and color estimates from the same teeth and the partial correlation coefficient was still statistically significant whtn controlling for the effect of age.     

Comprehensive Level One Trauma Center Could Lower In-hospital Mortality of Severe Trauma in China

<正>Trauma is a major health and social problem in the US and China.It constitutes the main cause of death in people aged 45 or under in both countries~([1-2]).There is clear evidence from clinical studies that a large percentage of these deaths are needless and preventable if better treatment and prevention programs are available~([2-3]).     

Catheter Ablation of Long‐Standing Persistent Atrial Fibrillation: A Lesson from Circumferential Pulmonary Vein Isolation

Catheter Ablation of Long‐Standing Persistent AF. Introduction: Circumferential pulmonary vein isolation (CPVI) is associated with a high success rate in patients with paroxysmal and persistent atrial fibrillation (AF). However, in patients with long‐standing persistent AF, the ideal ablation strategy still remains a matter of debate. Methods and Results: Two‐hundred and five patients underwent catheter ablation for long‐standing persistent AF defined as continuous AF of more than 1‐year duration. In a first step, all patients underwent CPVI. If direct‐current cardioversion failed following CPVI, ablation of complex fractionated atrial electrograms (CFAEs) was performed. The goal was conversion into sinus rhythm (SR) or, alternatively, atrial tachycardia (AT) with subsequent ablation. A total of 340 procedures were performed. CPVI alone was performed during 165 procedures in 124 of 205 (60.5%) patients. In the remaining 81 patients, additional CFAE ablation was performed in 45, left linear lesions for recurrent ATs in 44 and SVC isolation in 15 patients, respectively, resulting in inadvertent left atrial appendage isolation in 9 (4.4%) patients. After the initial ablation procedure, 67 of 199 patients remained in SR during a mean follow‐up of 19 ± 11 months. Six patients were lost to follow‐up. After a mean of 1.7 ± 0.8 procedures, 135 of 199 patients (67.8%) remained in SR. Eighty‐six patients (43.2%) remained in SR following CPVI performed as the sole ablative strategy. Conclusions: CPVI alone is sufficient to restore SR in 43.2% of patients with long‐standing persistent AF. Multiple procedures and additional ablation strategies with a significant risk of inadvertent left atrial appendage isolation are often required to maintain stable SR. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1085‐1093)     

Endocardial Electrogram Analysis after Intramyocardial Injection of Mesenchymal Stem Cells in the Chronic Ischemic Myocardium

Background: Cell injection therapies have been introduced for the treatment of patients with coronary heart disease. However, intramyocardial injection of bone marrow (BM)-derived cells may generate proarrhythmogenicity.
Methods: Two weeks after the placement of a circumflex artery-ameroid constrictor, 21 pigs received mesenchymal stem cells (MSC, n = 9), mononuclear (BM)-derived stem cells (MNC, n = 6), and placebo (n = 6) using a electromechanical mapping (EMM)-guided percutaneous transendocardial injection catheter. At week 6, EMM was repeated and the injected areas were analyzed in detail to evaluate local bipolar electrogram fragmentation, duration, and amplitude. Myocardial fibrosis was evaluated by a quantitative histological analysis.
Results: At week 6, the injection of MSC or MNC did not increase local electrogram fragmentation (MSC group: 1.4 ± 0.3 vs. 1.3 ± 0.2; MNC group: 1.4 ± 0.2 vs. 1.3 ± 0.2; P = NS), prolong electrogram duration (MSC group: 27.1 ± 7.8 ms vs. 23.7 ± 2.0 ms; MNC group: 27.8 ± 3.5 ms vs. 26.8 ± 5.6 ms; P = NS), or decrease bipolar voltages (MSC group 2.7 ± 0.9 mV vs. 2.8 ± 1.0 mV; MNC group 2.0 ± 1.0 mV vs. 1.7 ± 0.4 mV). From week 2 to week 6, mean left ventricular ejection fraction increased in the MSC group (37.9 ± 4.2% vs. 45.9 ± 2.2%; P = 0.039) only. Histological analysis of the ischemic regions revealed 17.6 ± 5% myocardial fibrosis in the MNC group vs. 13.6 ± 3.4% MSC vs. 28.7 ± 8.7% in the control group (P = 0.038 and P = 0.013). No death occurred in any animal after the injection procedure.
Conclusion: Intramyocardial injection of MSC or MNC do not increase fragmentation and duration of endocardial electrograms in the injected ischemic myocardium but attenuate ischemic damage and therefore may not create an electrophysiological substrate for reentry tachycardias     

Slow Wall Motion Rather Than Electrical Conduction Delay Underlies Mechanical Dyssynchrony in Postinfarction Patients With Narrow QRS Complex

Post-MI Narrow QRS Dyssynchrony.   Introduction: The mechanism of mechanical dyssynchrony in postinfarction patients with a narrow QRS complex is not defined but essential for cardiac resynchronization therapy (CRT).
Methods and Results: Left ventricular electrical activation and subsequent wall motion were recorded for 16 patients with ischemic cardiomyopathy during intrinsic rhythm using a modified NOGA electromechanical mapping system. Ten patients presented mechanical dyssynchrony on tissue Doppler imaging, while 6 patients served as control subjects. The local activation time (LAT) was set by the maximum downslope of the unipolar electrogram. Local wall motion time (LMT) was defined as the time needed for the catheter tip to traverse half of its maximum inward deflection during systole. LAT and LMT were measured relative to the onset of the QRS complex. Electrical activation showed a septal-to-lateral pattern in all patients with a mean endocardial activation time of 65 ± 13 ms. Control subjects exhibited 97.5% of all LMTs <290 ± 17 ms. Delayed motion areas (cut-off LMT > 300 ms) showed no slowing of conduction. Wall motion time corrected for differences in electrical activation (LMT-LAT) was significantly longer in delayed (289 ± 34 ms) than in regular (204 ± 24 ms) motion areas (P = 0.002). Delayed motion segments were hypokinetic on echocardiography and presented a lower maximum inward motion (9.9 ± 1.1 mm) compared to regular segments (10.9 ± 1.2 mm) on electromechanical maps (P = 0.004). Viability, however, was preserved with unipolar and bipolar voltage amplitude >7 mV and >1.5 mV for 79% of all delayed motion areas.
Conclusion: Dyssynchronous segments of an ischemic myocardium show unimpaired local activation but slow wall motion, thereby limiting the benefit of ventricular preexcitation via CRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 70–77, January 2010)