Medical Library

Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials.

BACKGROUND: For allocation of primary ICD-therapy, a possible lower limit of inclusion criteria-defining overly advanced heart failure-is less well investigated. Also, a multi-variable approach to stratification beyond ejection fraction (LVEF) appears warranted. We examined whether adding a selection limit of peak VO(2) </= 14 ml/kg/min to LVEF </= 20% improves stratification. Furthermore, we sought to provide current survival data and a size-estimate for prospective trials based on real-life data for this high risk cohort. METHODS: In our prospective clinical registry 1,926 patients with systolic CHF were recruited consecutively since 1994. Of these patients, 292 met the selection criteria described above. The mean age was 57.6 +/- 9.5 years, 83% were male, 37% had ischemic cardiomyopathy and 28% received primary ICD-therapy. All cause mortality was considered as end point. RESULTS: Median follow-up was 45 (18-86) months. ICD was not a significant predictor of outcome either for the entire population, or grouped according to aetiology of CHF. Still, 3-year mortality was 15% (ICD-patients) Vs. 28% (non-ICD-patients); P = 0.05; under combination medical therapy. Inversely, in ICD-patients medical combination therapy conveyed a significant survival benefit (P < 0.001). Consequently, the number-needed-to-treat was eight under combination therapy and the size estimate amounts to 300 patients for a prospective trial in this cohort. CONCLUSION: A cut-off of LVEF </= 20% and pVO(2) </= 14 ml/kg/min could identify patients that do not draw a significant survival benefit from adjunct primary ICD-therapy. Our results indicate the need for a specific randomized trial in this cohort. The according mortality data and a size estimate are provided.

Frankenstein L, Zugck C, Nelles M, Schellberg D, Remppis A, Katus H.

Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, lutz_frankenstein@med.uni-heidelberg.de.

[Brachytherapy in combination with function-preserving surgery : An interdisciplinary challenge.]

A multimodal, interdisciplinary approach known as intensity-modified brachytherapy is a promising alternative for patients with advanced head and neck cancer infiltrating the orbita and skull base. An 87-year-old man presented with a recurrence of squamous cell carcinoma of the medial corner of the left eye that had been locally resected and irradiated by external beam radiotherapy multiple times. The cancer was resected with preservation of the eye with close margins, implantation of afterloading catheters, and reconstruction of the defect with a median forehead flap. The patient was irradiated with a total radiation dose of 30 Gy IMBT. After 1 year, there was no evidence of locoregional recurrence. The background of this therapeutic process and analysis of the current literature regarding this interdisciplinary treatment of head and neck cancer infiltrating the orbita and skull base are discussed based on this case report.

Meyer JE, Brocks C, Gehrking E, Kovács G, Neppert B, Gliemroth J, Wollenberg B.

Klinik für HNO-Heilkunde und Plastische Operationen, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland, Jens.Meyer@hno.uni-luebeck.de.

[Effectiveness of radiofrequency ablation of lung tumours :]

BACKGROUND: There has been great success in the treatment of primary and secondary tumours of the liver using radiofrequency ablation (RFA) therapy, resulting in this method being used for other solid tumours such as in the lung. However, concerning lung cancer only few data are available about the histomorphological effects of this method. The aim of this study was to analyse the effects of RFA therapy in tumours of the lung. PATIENTS AND METHODS: Eleven patients with non-small-cell lung cancer and one with a lung metastasis (primary tumour identified as urothelial carcinoma) underwent RFA therapy followed by resection of the affected lobe. One patient with a metastasis of the liver was included for comparison of treatment effects. Histomorphological analysis of the collected material was used to measure the amount of necrosis. RESULTS: None of the treated tumours of the lung showed complete necrosis after applying RFA therapy. In contrast, this method with the control metastasis of the liver resulted in complete thermal destruction. CONCLUSION: Our results indicate that RFA therapy is not adequate for successful induction of necrosis in tumours of the lung. Therefore the use of this method has to be considered extremely carefully as a palliative treatment option in tumours of the lung.

Schultheis KH, Schroeder-Finckh R, Schultheis A, Kappes R, Sommerer F, Tannapfel A.

Klinik für Allgemein-, Viszeral-, Thorax- und Endokrine Chirurgie, Florence-Nightingale-Krankenhaus, Kreuzbergstraße 79, 40489, Düsseldorf, Deutschland, sekretariat-schultheis@kaiserswerther-diakonie.de.

[Procedural analgesia : Concepts and practice.]

The effect of severe pain and its hazardous stress-related cardiocirculatory consequences have been well documented for the perisurgical setting. Independently of surgical intervention however, even short and simple measures (e.g. thorax drain removal, repositioning a limb fracture) and longer diagnostic procedures such as MRI are potentially very painful or stressful to the patient. Though longer diagnostic procedures are frequently supported by systemic medication, short interventions regularly lack this aspect. Specific challenges result from the need to counteract sometimes great changes in pain intensity. Moreover procedural analgesia represents a multidisciplinary measure not restricted to anaesthesiology, as most of these measures are performed without anaesthesia. To avoid endangering the patient, the choice of drugs and patient monitoring have to meet certain professional and technical standards. Competence in respiratory management is of paramount importance. This paper outlines these requirements and serves as an orientation outside the anaesthesiological speciality.

Heid F, Gerth M, Roth W, Hessmann M, Werner C.

Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz, Deutschland, heid@uni-mainz.de.

[In memoriam.]

Tako-Tsubo Cardiomyopathy Associated with Seizures.

BACKGROUND: Takotsubo syndrome is a reversible neuromyocardial failure that has been thought to be related to an acute catecholamine toxicity of the myocardium brought upon by a stressful event. The neurocritical care unit population is particularly vulnerable for this condition given the acute presentation of neurological emergencies, which most often can be catastrophic. We present a case series of this syndrome and a review of the literature. METHOD: Our recent experience with three cases that were prospectively identified with the diagnosis of Takotsubo syndrome is reported with clinical presentation, evaluation, and management approach. Review of the literature is presented in the discussion. RESULTS: We present three episodes of Takotsubo neuromyocardial syndrome in two patients that were admitted to our neurointensive care unit that presented with seizures and had typical clinical presentation, echocardiographic and cardiac catheterization findings. All the episodes were treated with vasoactive medications, ventilatory support, afterload and preload reduction, and treatment of the underlying condition. There was complete reversal of their symptoms and findings in each episode. CONCLUSIONS: Patients with critical neurological illnesses such as large ischemic or hemorrhagic stroke, status epilepticus, recurrent seizure activities as in our study may be at a higher risk for Takotsubo neuromyocardial syndrome.

Lemke DM, Hussain SI, Wolfe TJ, Torbey MA, Lynch JR, Carlin A, Fitzsimmons BF, Zaidat OO.

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

The Co-effect of Vanadium and Fermented Mushroom of Coprinus comatus on Glycaemic Metabolism.

The effect of fermented mushroom of Coprinus comatus rich in vanadium (CCRV) on glycaemic metabolism was studied in this paper. Alloxan-induced hyperglycemic mice were used in this study. The insulin secretion and glycogen synthesis of the mice were analyzed. At the same time, the gluconeogenesis of the normal mice was also determined. The alloxan-damaged pancreatic beta-cells of the mice were also studied in this paper. After the mice were administered (i.g.) with CCRV, the level of insulin secretion and glycogen synthesis of alloxan-induced hyperglycemic mice elevated (p < 0.05, p < 0.01) and the gluconeogenesis of the normal mice was inhibited (p < 0.01). Also, the alloxan-damaged pancreatic beta-cells of the mice were partly recovered gradually after the mice were administered (i.g.) with CCRV 15 days later. These may account for the causes of CCRV-induced significant decreases of the blood glucose in hyperglycemic mice.

Zhou G, Han C.

College of Food and Bioengineering, Shandong Institute of Light Industry, Jinan, 250353, People’s Republic of China.

Vanadium Uptake by Biomass of Coprinus comatus and Their Effect on Hyperglycemic Mice.

The Vanadium uptake by Coprinus comatus and their co-effect on hyperglycemic mice were studied. By fermentation and AAS analysis, the optimal concentration of vanadium in medium was 0.4%, and the content of vanadium accumulated in the mycelia was 3,528.0 mug/g. At the concentration of 0.4%, the vanadium-associated toxicity was reduced, and its anti-diabetic effects were maintained.

Han C, Cui B, Wang Y.

School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of China, sdscipaper@126.com.

Irish contributions to the origins of antibiotics.

BACKGROUND: Pasteur commented that if we could intervene in the antagonism observed between some bacteria, it would offer \’perhaps the greatest hopes for therapeutics.\’ Some Irish scientists were crucially involved in the eventual realization of these hopes. RESEARCH: The earliest of these was John Tyndall, whose 1881 book, \’Floating matter in the air in relation to putrefaction and infection,\’ brought about general acceptance of Pasteur\’s germ theory. Sir Almroth Wright, a TCD graduate, who discovered the first vaccine against typhoid fever, recruited Alexander Fleming to the London hospital where he discovered penicillin. SEQUENCE OF EVENTS: This happened when Fleming was replicating an experiment originally carried out by Bigger, Boland and O\’Meara in TCD. One of Fleming\’s cultures was accidentally contaminated by a mould containing penicillin which came from the collection of Charles La Touche, an Irish mycologist who was researching whether cobwebs caused asthma in the same hospital, and who later taught in UCD.

Kingston W.

School of Business, Trinity College, Dublin, Ireland, wkngston@tcd.ie.

Genomic regulation of intestinal amino acid transporters by aldosterone.

Overexpression of renal LAT2, a Na(+)-independent L: -amino acid transporter, in spontaneous hypertensive rats (SHR) is organ specific and precedes the onset of hypertension (Pinho et al., Hypertension, 42:613-618, 2003). However, the expression of LAT2 correlates negatively with plasma aldosterone levels after high sodium intake (Pinho et al., Am J Physiol Ren Physiol 292:F1452-F1463, 2007). The present study evaluated the expression of Na(+)-independent LAT1, LAT2, and 4F2hc and Na(+)-dependent ASCT2 amino acid transporters in the intestine of normotensive Wistar rats chronically treated with aldosterone. In conditions of high salt intake, to keep endogenous aldosterone to a minimum, rats were implanted with aldosterone or spironolactone tablets. In aldosterone-treated and aldosterone + spironolactone-treated rats, aldosterone plasma levels were increased by fourfold. At the protein level, aldosterone treatment significantly increased LAT1 (62%), LAT2 (49%), 4F2hc (48%), and ASCT2 (65%) expression. The effect of aldosterone upon LAT1, LAT2, 4F2hc, and ASCT2 protein abundance was completely reversed by spironolactone. Aldosterone significantly increased intestinal LAT2 and 4F2hc mRNA levels (27% and 35% increase, respectively), with no changes in LAT1 and ASCT2 transcript levels. In conclusion, increases in intestinal Na(+)-independent LAT1 and LAT2 and Na(+)-dependent ASCT2 transcript and protein abundance during chronic treatment with aldosterone occur through a spironolactone-sensitive genomic mechanism.

Amaral JS, Pinho MJ, Soares-da-Silva P.

Faculty of Medicine, Institute of Pharmacology and Therapeutics, 4200-319, Porto, Portugal.