Small-dose ketamine decreases postoperative morphine requirements.
Explore the source record for details and available documents.
Abdomen↗
Biomedical subjects
S Gürsoy
Publications and source records attributed to S Gürsoy.
Association of T102C polymorphism of the 5-HT2A receptor gene with psychiatric status in fibromyalgia syndrome.
Serotonin (5-HT) is a key neurotransmitter in the central nervous system. It is suggested that serotonergic dysfunction may be involved in the pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to investigate T102C polymorphism of the 5-HT2A receptor gene in FS. Fifty-eight patients with FS and 58 unrelated healthy volunteer controls were included in the study. In both groups, the C/C, C/T, and T/T genotypes of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%), and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results were not significantly different between patients and controls (chi squared test, P>0.05). There was a significant correlation between patients with the T/T genotype and the subgroup according to the SCL-90-R test, (analysis of variance, P<0.05). We also saw that patients with the T/T genotype had the lowest pain threshold. CONCLUSION. T102C polymorphism of the 5-HT2A receptor gene is not associated with the etiology of FS. Our results also indicate that the T/T genotype may be responsible for psychiatric symptoms of FS.
Adult↗
Fibro-osseous lesion of rib.
A 3 x 4 cm homogeneous opacity was incidentally detected over the first rib at routine chest radiography. Radionuclide bone scan identified a hot spot, not excluding malignancy and excision of the rib revealed fibro-osseous lesion. A review of the literature showed 12 cases of this extremely rare lesion.
Bone Diseases↗
A case of giant benign localized fibrous tumor of the pleura.
A 60-year-old man had noted exertional dyspnea and left anterior chest pain. A chest roentgenogram showed the presence of a giant mass and computed tomography (CT) of the chest confirmed the mass with an inhomogeneous density in the left hemithorax. A transthoracic TruCut needle biopsy of the mass showed benign fibrous tissue. The patient underwent a thoracotomy. A tumor arose from the visceral pleura of left lower lobe and pedinculated. Size of the tumor was 19 x 18 x 7 cm and weighed 1500 g. It was successfully resected. The pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura.
Humans↗
Chondrosarcoma of the chest wall with Ollier's disease.
A 15 x 15 cm mass in the right hemithorax of a 25-year-old woman was incidentally detected at routine chest radiography. Radical excision of the bony chest wall, including right CII-VI, revealed chondrosarcoma. Large, expansile parosteal chondromas were radiographically visualized in the pelvis and bones of the lower leg, representing Ollier's disease. Chondrosarcoma of the chest wall appears to be rare in Ollier's disease.
Adult↗
Prediction of bone marrow involvement in patients with malignant lymphoma by GM-CSF stimulation test.
Recently, a stimulation test with colony stimulation factors was found useful to predict bone marrow cellularity. We examined the usefulness of this test to predict the bone marrow involvement in patients with malignant lymphoma. A single dose of GM-CSF (5 micrograms/kg) was given subcutaneously to 12 patients with malignant lymphoma. Six patients had normocellular bone marrow. Five of these 6 patients showed an increase in neutrophils of more than 5 x 10(9)/l after GM-CSF administration. The remaining 6 patients who had bone marrow lymphoma involvement had a neutrophil count of less than 5 x 10(9)/l. Therefore, the change in neutrophil count with a cut-off value of 5 x 10(9)/l distinguished the marrow lymphoma involvement with a sensitivity and specificity of 83% and 100%, respectively. The nadir neutrophil count was significantly higher in patients with normal marrow than in patients with marrow involvement after chemotherapy (P < 0.02). In conclusion, the GM-CSF stimulation test is useful to predict the marrow involvement in patients with malignant lymphoma.
Adolescent↗
The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia.
The 12-lead surface electrocardiogram is a simple and useful tool for the differential diagnosis of regular wide QRS complex tachycardia. However, criteria do not as yet exist to discriminate between ventricular tachycardia and supraventricular tachycardia with anterograde conduction over an accessory pathway (preexcited tachycardia). Therefore, we designed a new stepwise approach with three criteria for the electrocardiographic differential diagnosis between ventricular tachycardia and preexcited tachycardia and prospectively studied 267 regular tachycardias with electrophysiologically proven mechanism and a wide QRS complex (> or = 0.12 s): 149 consecutive ventricular tachycardias and 118 consecutive preexcited regular tachycardias. Underlying heart disease was old myocardial infarction in 133 of 149 (89%) ventricular tachycardias. The patients presenting with preexcited tachycardia had no additional structural heart disease. Atrial fibrillation with preexcited QRS complex was not included. The criteria favoring ventricular tachycardia were: (1) presence of predominantly negative QRS complexes in the precordial leads V4 to V6, (2) presence of a QR complex in one or more of the precordial leads V2 to V6, and (3) AV relation different from 1:1 (more QRS complexes than P waves). The final sensitivity and specificity of these three consecutive steps to diagnose ventricular tachycardia were 0.75 and 1.00, respectively. This new stepwise approach is sensitive and highly specific for the differential diagnosis between ventricular tachycardia in coronary artery disease and preexcited regular tachycardia.
Coronary Disease↗
Cardiac depolarization and repolarization in Wolff-Parkinson-White syndrome.
Delta wave and QRS complex polarities have been extensively studied in preexcitation syndromes. However, only limited data exist about ventricular depolarization and repolarization in the setting of maximal preexcitation in relation to the site of insertion of the accessory pathway. Therefore this study was designed to systematically analyze cardiac depolarization and repolarization in patients with maximal preexcitation. We analyzed the polarity of the QRS complex and T wave on the frontal plane on the conventional 12-lead electrocardiogram in 118 patients with maximal preexcitation. Fast atrial pacing was used to provoke maximal ventricular preexcitation. The 32 patients with a left lateral accessory pathway showed right-axis deviation of the QRS complex (110 +/- 20 degrees) with a left-axis deviation of the T-wave axis (-40 +/- 25 degrees). The 54 patients with a posteroseptal accessory pathway had a left axis of the QRS complex (-50 +/- 20 degrees) with a right-axis deviation of the T-wave axis (95 +/- 15 degrees). The 11 patients with a right lateral accessory pathway had a left axis of the QRS complex (-40 +/- 20 degrees) and a right axis of the T wave (110 +/- 10 degrees). In 7 patients with a left anterolateral accessory pathway and 14 patients with a right anteroseptal accessory pathway, the axis of the QRS complex was 50 +/- 25 degrees and 45 +/- 20 degrees, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Bedside recordings of His-bundle electrograms using conventional twelve-lead surface electrocardiography.
INTRODUCTION: Endocavitary His-bundle electrograms are usually recorded using high fidelity amplifiers and special filters. METHODS AND RESULTS: To evaluate whether similar recordings could be obtained using a 12-lead surface electrocardiograph, we compared recordings obtained during an electrophysiologic study in 33 patients to those obtained by connecting the two poles of the bipolar catheter, used during the study as the His catheter, to the right and left arm leads of the surface electrocardiograph. We recorded His-bundle electrograms using both techniques in all patients. There were no differences in measurements obtained between the two techniques. CONCLUSION: His-bundle electrograms can be recorded reliably with a conventional electrogram without sophisticated systems.
Amplifiers, Electronic↗
Value of clinical variables for risk stratification in patients with sustained ventricular tachycardia and history of myocardial infarction.
Explore the source record for details and available documents.
Female↗
Investigation of palpitations.
The uncomfortable awareness of a beating heart--palpitations--is a common complaint that can occur under normal or abnormal circumstances. For example, normal palpitations occur with exercise, emotions, and stress, or after taking substances that increase adrenergic tone or diminish vagal activity (coffee, nicotine, and adrenergic or anticholinergic drugs). Normal palpitations are recognised as such because individuals who experience them realise or are told that something happened to accelerate the normal rhythm of the heart. However, some people find sinus tachycardia troublesome enough to seek medical attention. In other situations palpitations are clearly abnormal. The heart beat which is felt for no apparent reason, may be fast, or strong and slow, or feel like a missed or extra beat. Although these abnormal palpitations usually point to a cardiac arrhythmia, this is not always the case. Moreover, many patients with arrhythmias do not have palpitations but manifestations such as syncope, shock, and chest pain (sudden death is also possible). We will discuss the approach to the patient who seeks medical attention because of a history of palpitations, with special emphasis on the history, physical examination, and 12-lead electrocardiogram (ECG) because they are simple and inexpensive diagnostic tools that are available to most physicians.
Arrhythmias, Cardiac↗
Cibenzoline transforms random re-entry into ordered re-entry in the atria.
The goal of this study was to test the hypothesis that class I drugs modify the electrophysiological substrate of atrial fibrillation. The effects of a single intravenous dose (1.4 +/- 0.3 mg.kg-1) of the new class I drug, cibenzoline, were studied in 20 patients with spontaneous (n = 11) or induced (n = 9) atrial fibrillation, during an electrophysiological study. In one additional patient with chronic atrial fibrillation, the effects of a single intravenous dose of 2 mg.kg-1 of cibenzoline were studied intra-operatively before undergoing a 'corridor' operation. High resolution epicardial mapping (248 channels) was used to reconstruct the atrial activation patterns before and after administration of the drug. In 18 out of 20 patients administration of cibenzoline resulted in conversion of atrial fibrillation into regular monomorphic atrial tachycardia. In these 18 patients, the mean atrial cycle length was prolonged from 147 +/- 34 ms during atrial fibrillation to 302 +/- 34 ms after cibenzoline (P < 0.001). In eight out of the 18 patients, spontaneous (n = 3) or pacing induced (n = 5) conversion into sinus rhythm was observed after administration of the drug. In the patient undergoing the 'corridor' operation, epicardial mapping of both atria showed that the multiple wavelets present during atrial fibrillation fused into a single broad wavefront circulating counterclockwise around the caval veins after cibenzoline. In conclusion, cibenzoline transforms random re-entry into ordered re-entry in the atria. This effect seems related to the depression of conduction produced by the drug.
Adult↗
First lessons from radiofrequency catheter ablation in patients with ventricular tachycardia.
UNLABELLED: Fourteen patients (12 men, 2 women; 61 +/- 9 years) with ventricular tachycardia and underlying heart disease underwent an attempt at radiofrequency energy catheter ablation. Twelve patients had coronary disease and two patients had dilated cardiomyopathy. Two patients had two clinical tachycardias, the ejection fraction was 38% +/- 11%. All tachycardias were inducible and hemodynamically well tolerated (cycle length = 357 +/- 56 msec). Ablation was initially successful in nine patients (no tachycardia inducible after ablation and before discharge). Two patients had recurrences (in-hospital and 4 months) and one patient had a tachycardia of a different morphology, which was also successfully ablated. Ablation was overall successful in seven patients and unsuccessful in seven patients (including all patients with cardiomyopathy). Mid-diastolic potentials were observed in all the patients in whom ablation was successful but not observed in four of seven unsuccessful patients. The successful patients remain free of recurrences at 9 +/- 8 months follow-up. CONCLUSIONS: (1) in ventricular tachycardia following an old infarction radiofrequency energy ablation is possible with a high success rate if a critical component of the tachycardia circuit can be localized. Localizing isolated mid-diastolic potentials and ensuring these potentials are part of the reentrant circuit with concealed entrainment can help to enhance the results. (2) A negative predischarge electrophysiological study may be predictive of success.
Cardiac Pacing, Artificial↗
Radiofrequency current catheter ablation for control of supraventricular arrhythmias.
With the advent of radiofrequency energy, catheter ablation techniques have become an accepted form of treatment for a variety of supraventricular arrhythmias. The ablation of the atrioventricular (AV) node was performed first and is now widely used in patients with refractory atrial fibrillation or flutter. Ablation has also replaced surgery in patients with preexcitation syndromes, and as the complication rate in experienced centers is low, it has become the first line of treatment in these institutions. The results of catheter ablation in AV nodal reentrant tachycardia are excellent as well, although there is still debate about whether "slow" pathway ablation is superior to "fast" pathway ablation. Radiofrequency current ablation has also contributed to a better understanding of the pathophysiology of AV nodal reentrant tachycardia, as it has provided evidence for atrial participation in the reentrant circuit. Experience with atrial tachycardias and tachycardias due to Mahaim fibers remains limited. The ideal source of energy for specific arrhythmias is still unknown and improvement in catheter technology is needed.
Atrioventricular Node↗
[The predictors of success in the radiofrequency ablation of left accessory pathways using the single-catheter technic].
INTRODUCTION AND OBJECTIVES: To determine the predictors of successful radiofrequency current ablation of an accessory pathway using the single-catheter approach, we retrospectively analyzed 46 consecutive patients with left sided accessory atrioventricular pathways and manifest preexcitation. METHODS: Ablation using a single catheter advanced retrogradely towards the mitral valve was successful in 42 (91%). A radiofrequency pulse resulting in permanent accessory pathway block was defined as a successful pulse; a pulse that had no effect or caused only transient accessory pathway block was defined as an unsuccessful pulse. RESULTS: Successful radiofrequency pulses (n = 37) did not differ from those that failed (n = 56) in the local atrium-accessory pathway potential interval, in the accessory pathway-ventricle interval nor in the cumulative energy delivered. But in successful radiofrequency pulses, the amplitude ratio of local atrium and ventricular potentials tended to be larger (0.29 +/- 0.17 vs 0.23 +/- 0.17; p = 0.053) and presumed accessory pathway potential was more often recorded (36 [97%] vs 38 [68%]; p = 0.006). The time elapsed from the beginning of the current application and the accessory pathway block was shorter in successful pulses as compared to those pulses producing only transient block (3.3 +/- 2 s vs 6.9 +/- 4 s). CONCLUSIONS: The recording of a presumed accessory pathway potential, a large local A/V ratio and the occurrence of early conduction block in the accessory pathway were the best predictors of successful radiofrequency current application using the single-catheter approach.
Adolescent↗
Brief report: the hemodynamic mechanism of pounding in the neck in atrioventricular nodal reentrant tachycardia.
Explore the source record for details and available documents.
Adult↗
Right-sided versus left-sided radiofrequency ablation of the His bundle.
UNLABELLED: Radiofrequency (RF) ablation of the His bundle was attempted in 30 consecutive patients with atrial flutter or fibrillation. A 7 French quadripolar catheter with a 4-mm distal electrode was advanced from the right femoral vein (21 patients), or subclavian vein (two patients) and positioned across the tricuspid valve. Adequate His-bundle potentials were obtained in all patients. However, in six patients atrioventricular (AV) block could not be obtained after multiple (mean = 8) applications of RF energy from the conventional right-sided approach. In these patients the same catheter was advanced to record a His potential through a retrograde arterial approach. AV block was created in all patients with one to three applications of RF energy. The duration of the procedure was 22 to 90 minutes for the right-sided approach and 5 to 10 for the left-sided approach (P < 0.005). Subsequently, in seven patients a left-sided approach was used first. One to six applications of RF energy were required to create AV block. The radiation exposure time was 3 to 20 minutes. No complications occurred. CONCLUSIONS: RF ablation of the His bundle seems easier using a left-sided than a right-sided approach, reduces procedure and radiation time, and avoids recovery of conduction. These data suggest that a left-sided approach, in spite of requiring arterial catheterization, may be preferable to a right-sided approach.
Atrial Fibrillation↗
Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways.
BACKGROUND: Septal accessory atrioventricular (AV) pathways may be located in close vicinity of the His bundle-AV nodal conduction system. Attempts at surgical or electrical interruption of these pathways may therefore result in impairment of normal AV conduction. This study focuses on a subset of septal pathways with an atrial insertion located inside the triangle of Koch. In this study, they were called "midseptal." METHODS AND RESULTS: Six patients with a midseptal accessory pathway (mean +/- SD age, 40 +/- 12 years; five with Wolff-Parkinson-White syndrome and one with a concealed accessory pathway) underwent attempts at ablation of their pathway using 500-kHz radiofrequency current applied to the atrial insertion of the accessory connection. Guided by the recording of accessory pathway activation potentials, the ablation catheter was positioned in all patients in an area bounded anteriorly by the tip electrode of the His bundle catheter and posteriorly by the coronary sinus ostium. All pathways were successfully ablated without the induction of complete heart block. First-degree AV conduction block occurred in one patient in whom a concealed accessory connection was located closer to the AV node than to the coronary sinus ostium. CONCLUSIONS: Radiofrequency current catheter ablation may be used effectively for midseptal accessory pathways and should be preferred in experienced centers as a safe alternative to surgical therapy.
Adult↗