Nocturnal phantom shock cessation with zolpidem.

A 77 year old man with a biventricular ICD-pacemaker complained of painful, electric jolts disturbing him nightly from sleep. Extensive work-up including device interrogation revealed no defibrillations or arrhythmia, and he was subsequently diagnosed with phantom shocks (PS). His nightly PS symptoms terminated after starting zolpidem 10 mg each night. To date, literature review reveals fifteen articles reporting 163 phantom shock (PS) cases. PS affects 5-9% of ICD recipients. Risk factors include psychiatric disease, atrial fibrillation, NYHA functional status III or greater, prior shock storm, and intraoperative awareness during ICD placement, with defibrillation threshold testing. This report describes a successful PS intervention, and reviews the current knowledge available in the pathophysiology and treatment of PS.

Effects of antiarrhythmic drugs on inappropriate shocks in patients with implantable cardioverter defibrillators.

BACKGROUND: Patients with atrial fibrillation (AF) or congestive heart failure (CHF) are more vulnerable to inappropriate shocks from implantable cardioverter-defibrillators (ICDs), but the effect of antiarrhythmic drugs in these patients remains unknown. METHODS AND RESULTS: A total of 55 patients with AF and/or CHF (New York Heart Association functional class > or =III) who had ICDs were divided into 3 groups [amiodarone (n=24), sotalol (n=12), beta-blocker (n=19)] and the cumulative rates of inappropriate shocks were compared. The baseline characteristics of the 3 groups were not significantly different. The 4-year event rate of inappropriate shocks was 27.3% in the amiodarone group, 54.3% in the sotalol group, and 70.6% in the beta-blocker group (amiodarone vs beta-blocker: log-rank p=0.003; sotalol vs beta-blocker: log-rank p=0.16; amiodarone vs sotalol: log-rank p=0.29). Amiodarone reduced the risk of inappropriate shocks significantly as compared with beta-blockers (hazard ratio (HR) 0.17; 95% confidence interval (CI) 0.05-0.64; p=0.008), whereas sotalol did not (HR 0.57; 95%CI 0.19-1.68; p=0.3). Amiodarone was discontinued in 4 patients (16.7%) because of pulmonary toxicity and the dose was reduced in 4 patients (16.7%) because of a thyroid function abnormality. CONCLUSIONS: Amiodarone is more effective than sotalol or beta-blockers in preventing inappropriate ICD shocks in patients with AF or CHF, but it has a significant risk of drug-related adverse effects.

Alteration in gastrointestinal and neurological function after electrical injury: a review of four cases.

OBJECTIVE: Individuals exposed to an electrical injury develop a variety of complications, several of which are recognized years after the initial electrical shock. Alteration in gastrointestinal and nervous system function has been described in these patients, yet the frequency and character of these abnormalities are poorly understood. We reviewed records of 40 individuals with a history of electrical injury to identify evidence of delayed onset of complications. METHODS: Forty consecutive patients with electrical shock injuries were monitored for up to 5 yr after their traumatic event using a comprehensive systems review. Of the eight patients who described an alteration in their gastrointestinal and neurological functions, four agreed to undergo further testing. Investigations included a flexible sigmoidoscopy, anorectal manometry, stool evaluation, serological and biochemical serum analysis, and a psychological examination. RESULTS: Each of the four patients described an increase in stool frequency and urgency. Anorectal manometry detected a reduction in threshold to rectal balloon distention and an abnormal anal sphincter control. Bowel function improved with meselamine. Psychiatric symptoms involving memory and concentration were observed in varying degrees. CONCLUSIONS: To our knowledge, these induced physiological and psychological changes after exposure to electrical shock injury have not yet previously been described. Our findings should encourage further clinical investigations to better anticipate, diagnose, and manage these and other as yet unrecognized delayed complications of electrical shock injury.

Interleukin-2 and interleukin-6 in relation to burn wound size in the acute phase of thermal injury.

Thermal injury induces significant physiologic responses of acute inflammation, acute phase reaction and cell repair and growth, mediated by interleukins, cytokines and growth factors. To determine the relative role of interleukin-2 (IL-2) and interleukin-6 (IL-6) in the acute phase of thermal injury, 60 patients (47 men and 13 women, with average age of 37 years [1.5 to 70.0 years]) were analyzed within the first 36 hours and at five to seven days postoperatively. The patient population was categorized by percent burn (2 or 3, or both, degrees): less than 20 percent, n = 22; 20 to 40 percent, n = 18, and greater than 40 percent, n = 20. The average percent burn was 32 percent (range 4 to 95 percent). The mechanism of injury was by flame (25 instances), explosion and flame (19 instances), scald (12 instances), electric (three instances) or chemical (one instance). Twelve patients had an associated inhalation injury; 14 patients had sepsis syndrome. The overall mortality rate was 13 percent. Within 36 hours of onset of injury, IL-6 and IL-2 levels increased in proportion to the severity of the burn wound size. IL-2 levels were significantly elevated in the 20 to 40 percent burn group as compared with the greater than 40 percent group and patients in a control group (p < 0.0001). IL-6 levels increased with burn wound size and were significant only in the greater than 40 percent group (p < 0.0007). Any physiologic modulation of the thermal injury by biologic modifiers must be adapted to the extent of burn wound size and phase of injury: acute, recovery or reparative for optimal benefit and results.

[Correlations between the pharmacological effects of menilon and its concentrations in the plasma and brain of experimental animals]. / Korelatsii mezhdu niakoi farmakologichni efekti na preparata menilon i kontsentratsiite mu v plazma i mozuk na opitni zhivotni.

The authors carried out studies on the preparation menilon in order to establish eventual correlations between some pharmacological and pharmakokinetic indices. For this purpose they examined the activity of menilon in rats and mice during electric shock and hypothermia and determined the concentrations of the preparation in plasma and brain in rats. The obtained results from the pharmacological investigation revealed manifested action against the seizures after electric shock in both groups of animals. It was established as early as 30 minutes after oral administration of the preparation reached maximal activity after 1-2 hours and disappeared after 6 hours. The authors found strong and continuous hypothermic activity. The hypothermic effect of the doses used was preserved up to the end the 24 th hour. The lowering of temperature in rats was comparatively weaker and shorter. The pharmacokinetic studies showed quick oral resportion of menilon. It was found in plasma and brain of the experimental animals on the 30 th minite after its administration, reached maximal concentration between the first and second hour and still was established on the 24 th hour after administration. The maximal level of the preparation in plasma and brain after oral administration correlated well with the time of maximal activity of its antiseizure and hypothermic effects. The preparation menilon was comparatively slightly toxic.

The treatment of electrical injury compared to burn injury: a review of pathophysiology and comparison of patient management protocols.

Because of basic differences in pathophysiology, patients with electrical injury require therapeutic measures quite separate and distinct from patients with flame burns. Fluid requirements are much greater for the electrical-injured patient due to the depth of the injury and frequent occurrence of pigment in the urine. Fasciotomy with surgical exploration for determination of tissue viability is usually required in areas of obvious or questionable viability in patients with electrical injury. Sulfamylon is preferred for topical antibacterial therapy in electrical injury, because of its excellent penetration into deeper tissues. With this regimen of conservative surgical debridement of necrotic tissue, in many patients we have been able to salvage limbs and, in particular, preserve function.