ABSTRACT
This case report describes our first experience performing percutaneous epicardial catheter ablation for Burugada syndrome in our hospital. We describe the good results achieved in this case. The patient was a man in his 30s with no remarkable medical history. However, his family history was notable for the sudden death of his grandfather at age 37 years and his father at age 27 years. While asleep, the patient experienced convulsions and lost consciousness. During emergency transportation, defibrillation was performed 7 times by the ambulance crew. When the patient arrived at our hospital, sinus rhythm was observed on ECG. During resuscitation, Burugada syndrome was diagnosed based on ECG findings. On hospital day 6, an internal cardioverter defibrillator was implanted. After discharge, the defibrillator operated 10 times, so we opted for ablation treatment. Fractionated potential of over 150 ms was confirmed in the right ventricular outflow tract. A low voltage zone of <1 mV could be mapped, and the same site was cauterized a total of 46 times. As a result, ST segment amplitude decreased significantly in lead V1 on ECG. Percutaneous epicardial catheter ablation performed with reference to Nademanee’s report achieved good results in this case of Burugada syndrome.
ABSTRACT
Hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning is performed after oxygen therapy and breathing therapy. The usefulness of HBO therapy in emergency treatment has been reported. In this study, we examined the effectiveness of HBO for CO poisoning that was performed at our hospital over the past 5 years. Subjects were 23 patients who had HBO therapy for CO poisoning in the period January 2008-November 2013. The male to female ratio of the cases was 14:9 and the mean age was 54.6±20.8 years. The cause was suicide in 39.1% of cases and accident in 60.9%. The mean number of treatments was 5.4±6.8. The atmosphere absolute was 2ATA:2.8ATA=12:11. The ratio of direct conveyance of the patient to our hospital to indirect conveyance of the patient from another hospital was 15:8. The effectiveness of HBO therapy at the time of discharge was 73.9%. However, delayed neuropsychiatric sequelae (DNS) was detected in 3 of the 23 cases of CO poisoning. No correlations were found between elapsed time after CO inhalation and various blood parameters. However, time to start of therapy is important for DNS, and our results suggest that early treatment at a hospital with a hyperbaric chamber is necessary.
ABSTRACT
Recent evidence indicates that the voltage (cyclic activation and deactivation of membrane ion channels) and Ca2+ clocks (rhythmic spontaneous sarcoplasmic reticulum Ca2+ release) jointly regulate sinoatrial node (SAN) automaticity. Since the intact SAN is a heterogeneous structure that includes multiple different cell types interacting with each other, the relative importance of the voltage and Ca2+ clocks for pacemaking may be variable in different regions of the SAN. Recently, we performed optical mapping in isolated and Langendorff-perfused canine right atria. We mapped the intracellular calcium (Cai) and membrane potentials of the intact SAN simultaneously. Using previously described criteria of the timing of the late diastolic Cai elevation (LDCAE) relative to the action potential upstroke to detect Ca2+ clock activity, we demonstrated that the sinus rate increased and the leading pacemaker shifted to the superior SAN with the robust LDCAE during beta-adrenergic stimulation. We also showed that the LDCAE was caused by spontaneous diastolic SR Ca2+ release and was closely related with heart rate changes. We conclude that the Ca2+ and voltage clocks work synergistically to generate SAN automaticity.
Subject(s)
Action Potentials , Calcium , Heart Rate , Membrane Potentials , Membranes , Sarcoplasmic Reticulum , Sinoatrial Node , Sympathetic Nervous SystemABSTRACT
Since April 1992 we have introduced a beclomethasone dipropionate (BDP) inhalation therapy with a large spacer for patients with bronchial asthma who were admitted to the internal medicine department of our hospital because of the exacerbation of asthma.<BR>To find out the effect of this BDP inhalation therapy, we investigated the number of emergency room visits by the patients with bronchial asthma who had been admitted to our hospital with asthmatic attacks before and after the introduction of the new therapy.<BR>From April 1991 to March 1994, the proportion of asthma patients decreased significantly (p<0.05): from April 1991 to March 1992 (before the introduction of the BDP inhalation therapy) 10.4±3.0%; from April 1992 to March 1993 5.3±1.4%, from April 1993 to March 1994 3.7±1.4%.<BR>We checked the inhalation technique of 21 patients who visited our hospital regularly during the same period. The BDP therapy could decrease the number of emergency-room visits by 10 patients whose inhalation technique was imperfect, as well as by the other 11 patients whose inhalation technique was perfect.