[Bowel perforation because of ingestion of a blister-wrapped tablet after post-interventional coronary perforation]. / Dünndarm-Perforation durch einen verschluckten Tabletten-Blister nach postinterventioneller Koronarperforation.

HISTORY AND ADMISSION FINDINGS: A 70-year-old woman was admitted to hospital with progressive chest pain. Coronary angiography demonstrated a significant stenosis of the left descending artery (LAD), which was treated by percutaneous coronary intervention (PCI) and stent implantation. During this intervention, a coronary perforation occurred which was remedied immediately. Five days after the intervention, the patient complained about severe atypical chest and abdominal pain with nausea and vomitting, but no fever. Physical examination revealed an acute abdomen of uncertain origin. INVESTIGATIONS: Laboratory tests revealed leukocytosis and elevated levels of C-reactive protein while cardiac enzymes were in normal range. The electrocardiogram showed no signs of acute myocardial ischemia. Abdominal x-ray was performed without any pathological findings. Further diagnostic tests, especially computed tomography of the abdomen, revealed an ingestion of a blister-wrapped tablet which had caused small bowel perforation and peritonitis. DIAGNOSIS, TREATMENT AND COURSE: An acute abdomen due to ingestion of a foreign body was diagnosed and an emergency laparotomy was performed immediately. The blister pack was removed by ileostomy. The further course was uneventful. CONCLUSION: The clinical presentation of abdominal pain is a frequent medical condition in hospital. Determining the cause requires precise assessment and examination and implicates a variety of differential diagnosis including non-cardiac and cardiac pain. Iatrogenic causes must be considered in differential diagnosis.

[Influences of medical education on first aid and AED knowledge among laypersons]. / Einflüsse medizinischer Aufklärungsarbeit auf Erste-Hilfe- und AED-Kenntnisse in der Allgemeinbevölkerung.

BACKGROUND AND AIM: Although most laypersons have incomplete knowledge of first aid, the placement of automated external defibrillators (AED) on public places suggests AED application by laypersons. Unfortunately, previous results are disappointing; many people don't even recognize AED. Therefore, most authors suggest to force medical education about sudden cardiac death and AED use among laypersons. We wanted to find out whether intensive medical education can improve the recognition of AED at public places and the attendance to acquire knowledge in first aid. METHODS: In 2001 eight AED were placed in the amusement swimming park "LAGO - die Therme". Contemporaneously, we started public education regarding sudden cardiac death, resuscitation and AED among layperson visiting the LAGO. After 10 years we interviewed the visitors with special regard to their knowledge of first aid and AED use. RESULTS: 531 persons (260 men, age 48,4 ± 21,9 [range 8-95] years) fulfilled the questionnaire. 59 (11,1%) stated heart disorder, 219 (41,2%) at least one cardiovascular risk factor. As ten years ago, knowledge of first-aid (59,1%) and AED use (45,2%) was poor, especially among persons younger than 17 years or older than 67 years. 398 (75%) of the interviewed visitors recognized the installed AED, 511 (96,2%) supported the placement of AED. CONCLUSION: The placement of AED on public places in combination with an intensive medical education results in a high acceptance and recognition of AED. Nevertheless, following our date it seems to be doubtful that this results automatically in a higher attendance to acquire knowledge in first-aid and AED use.

[Congenital left ventricular aneurysm in a 17-year-old competitive athlete]. / Angeborenes linksventrikuläres Aneurysma bei einem 17-jährigen Leistungssportler.

We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.

Propranolol inhibits IK(Ado) by competitive A1-receptor interaction.

OBJECTIVES: Betablocking agents are known to exert anti-arrhythmic effects in ischemic myocardium due to blockade of myocardial beta-1-receptors. Since adenosine (Ado) induced muscarinic potassium current (IK(Ado)) and ATP sensitive potassium current (IK(ATP)) are discussed to be activated during ischemia we studied the effect of propranolol on IK(Ado) and IK(ATP). METHODS AND RESULTS: The effect of propranolol on muscarinic potassium current and IK(ATP) was studied in isolated rat atrial myocytes by means of the whole-cell voltage clamp tech- nique. Propranolol (50 microM) completely inhibited IK(Ado). IC50 was 7 microM. Inhibition of acetylcholine induced current (IK(ACh)) and GTP-gamma-S induced muscarinic potassium current was less potent (IC50 29 microM and 31 microM respectively). Propranolol was active from the outside only. Intracellular application did not significantly affect muscarinic potassium current. (+)-propranolol, an isomer without beta-blocking properties, was as effective as (+/-)-propranolol. The inwardly rectifying potassium current IK(ATP) showed minor sensitivity to the compound (10% current reduction, propranolol 50 microM). CONCLUSIONS: Propranolol inhibits IK(Ado). Inhibition is not due to beta-receptor blockade. Predominantly an interaction with A1-receptors seems to be involved. The observations in part might explain the anti-arrhythmic properties of the drug in ischemic/fibrillating myocardium based on the prolongation of refractoriness.

Inhibition of G protein-coupled and ATP-sensitive potassium currents by 2-methyl-3-(3,5-diiodo-4-carboxymethoxybenzyl)benzofuran (KB130015), an amiodarone derivative.

2-Methyl-3- (3,5-diiodo-4-carboxymethoxybenzyl) benzofuran (KB130015; KB), a novel compound derived from amiodarone, has been proposed to have antiarrhythmic properties. Its effect on the G protein-coupled inward rectifying K+ current [IK(ACh) or IK(Ado)], ATP-sensitive K+ current [IK(ATP)], and background inward rectifying current (I(K1)) were studied in guinea pig atrial and ventricular myocytes by the whole-cell voltage-clamp technique. Receptor-activated IK(ACh/Ado), induced in atrial myocytes by the stimulation of either muscarinic or Ado receptors was concentration dependently (IC50 value of approximately 0.6-0.8 microM) inhibited by KB. Receptor-independent guanosine 5'-O-(3-thio)triphosphate-induced and background IK(ACh), which contributes to the resting conductance of atrial myocytes, were equally sensitive to KB (IC50 value of approximately 0.9 microM). IK(ATP) induced in atrial myocytes during metabolic inhibition with 2,4-dinitrophenol (DNP) was also suppressed by KB, whereas IK1 measured in ventricular myocytes was insensitive to the drug (KB < or =50 microM). Although being effective when applied from the outside, intracellular application of KB via the patch pipette affected neither IK(ACh) nor IK(ATP). 3,3',5-triodo-L-thyronin, which shares structural groups with KB, did not have an effect on the K+ currents. Consistent with the effects on single myocytes, KB did not depolarize the resting potential but antagonized the shortening of action potential duration by carbamylcholine-chloride or by DNP in multicellular preparations and antagonized the shortening of action potential duration by acetylcholine in single myocytes. It is concluded that KB inhibits IK(ACh) and IK(ATP) by direct drug-channel interaction at a site more easily accessible from extracellular side of the membrane.

Diadenosine-5-phosphate exerts A1-receptor-mediated proarrhythmic effects in rabbit atrial myocardium.

(1) Diadenosine polyphosphates have been described to be present in the myocardium and exert purinergic- and nonreceptor-mediated effects. Since the electrophysiological properties of atrial myocardium are effectively regulated by A(1) receptors, we investigated the effect of diadenosine pentaphosphate (Ap(5)A) in rabbit myocardium. (2) Parameters of supraventricular electrophysiology and atrial vulnerability were measured in Langendorff-perfused rabbit hearts. Muscarinic potassium current (I(K(ACh/Ado))) and ATP-sensitive potassium current (I(K(ATP))) were measured by using the whole-cell voltage clamp method. (3) Ap(5)A prolonged the cycle length of spontaneously beating Langendorff perfused hearts from 225+/-14 (control) to 1823+/-400 ms (Ap(5)A 50 micro M; n=6; P<0.05). This effect was paralleled by higher degree of atrio-ventricular block. Atrial effective refractory period (AERP) in control hearts was 84+/-14 ms (n=6). Ap(5)A>/=1 micro M reduced AERP (100 micro M, 58+/-11 ms; n=6). (4) Extrastimuli delivered to hearts perfused with Ap(5)A- or adenosine (>/= micro M)-induced atrial fibrillation, the incidence of which correlated to the concentration added to the perfusate. The selective A(1)-receptor antagonist CPX (20 micro M) inhibited the Ap(5)A- and adenosine-induced decrease of AERP. Atrial fibrillation was no longer observed in the presence of CPX. (5) The described Ap(5)A-induced effects in the multicellular preparation were enhanced by dipyridamole (10 micro M), which is a cellular adenosine uptake inhibitor. Dipyridamole-induced enhancement was inhibited by CPX. (6) Ap(5)A (

Divided attention, aging, and priming in exemplar generation and category verification.

Transfer-appropriate processing theories differentiate between conceptual- and perceptual-priming tasks. The former are said to be influenced by the nature of processing engaged in at study, but not by changes in modality between study and test; the latter are sensitive to changes in format between study and test, but not to variations in the extent of semantic processing at study. In the present experiments, we examined the effects of divided attention and aging on priming in exemplar generation and category verification, two tasks that require access to semantic information at test. Manipulations of attention during encoding affected the extent of priming in exemplar generation, but not in category verification. Priming effects were similar in young and older adults in exemplar generation following study in both full and divided attention. Although older adults did not demonstrate priming in category verification in one experiment, no effects of age or divided attention were observed in a second experiment. In addition, priming in category verification was unaffected by varying the level of processing at encoding. However, the absence of levels-of-processing and attention effects in category verification does not signal that priming in this task has a perceptual basis; priming in category verification was insensitive to modality shifts between study and test. The implications of these findings for theories of priming and cognitive aging are considered.

Functional specialization for semantic and phonological processing in the left inferior prefrontal cortex.

Neuroimaging and neuropsychological studies have implicated left inferior prefrontal cortex (LIPC) in both semantic and phonological processing. In this study, functional magnetic resonance imaging was used to examine whether separate LIPC regions participate in each of these types of processing. Performance of a semantic decision task resulted in extensive LIPC activation compared to a perceptual control task. Phonological processing of words and pseudowords in a syllable-counting task resulted in activation of the dorsal aspect of the left inferior frontal gyrus near the inferior frontal sulcus (BA 44/45) compared to a perceptual control task, with greater activation for nonwords compared to words. In a direct comparison of semantic and phonological tasks, semantic processing preferentially activated the ventral aspect of the left inferior frontal gyrus (BA 47/45). A review of the literature demonstrated a similar distinction between left prefrontal regions involved in semantic processing and phonological/lexical processing. The results suggest that a distinct region in the left inferior frontal cortex is involved in semantic processing, whereas other regions may subserve phonological processes engaged during both semantic and phonological tasks.

One-trial associative priming of nonwords in young and older adults.

In this article, three experiments in which single-trial associative priming for nonwords was investigated in young and older adults in a pronunciation task are reported. During an encoding task, associative priming was observed for young and older adults, although cued recall was near zero for both groups. Associative priming for young and older adults was found under full attention conditions, but when attention was divided at study, associative priming was observed in Experiment 3, but not in Experiment 2. Divided attention also disrupted recognition memory for new associations in young and older adults. The results limit the generality of findings of age-related decrements in associative priming by showing an absence of such decrements in tasks that do not require elaborative processing during encoding. They also argue against G. Musen and L. Squire's (1993) suggestion that formation of new connections in implicit memory requires multiple study opportunities, whereas declarative memory is specialized for rapid acquisition of new associations.