The proximity between styloid process and internal carotid artery as a possible risk factor for dissection: a case-control study.

PURPOSE: The anatomical proximity of the styloid process (SP) to the ipsilateral internal carotid artery (ICA) has been recently recognized as a possible risk factor for carotid artery dissection (CAD). We aimed to verify this hypothesis by comparing the minimum distance between SP and ICA in young adult patients (< 55 years) with and without CAD. METHODS: Thirty-one CAD patients (cases) were compared with 41 sex-matched patients without dissection, group one of control (G1), and with 16 sex-matched patients with vertebral artery dissection (VAD), group two of control (G2). Two independent observers measured, on CT angiography images, the minimum distance on the axial plane between the SP and ICA in cases and controls. They evaluated both the intercentric and the marginal distance. Differences between groups were estimated by Student t-test. RESULTS: SP-ICA intercentric distance ipsilateral to dissection was significantly shorter compared to that of the contralateral side of cases (p < 0.001), to those of left and right side of G1 patients (p < 0.001 for both), and to those of left and right side of G2 patients (p < 0.001 for both). SP-ICA marginal distance of cases was significantly shorter compared to those of left and right side of G1 patients (p < 0.001 for both) and to those of left and right side of G2 patients (p < 0.001 for both). CONCLUSION: A short SP-ICA distance appears to be a risk factor for CAD as it likely induces a continuous microtraumatism of the vessel wall during normal head and neck movements.

Cardiomyoplasty as an isolated procedure to treat refractory heart failure.

OBJECTIVE: Cardiomyoplasty represents a controversial therapy for chronic heart failure. The aim of this study is to review our experience of such a surgical procedure as an isolate approach to treat refractory left ventricular dysfunction. METHODS: Twenty-two patients were considered candidates for cardiomyoplasty because of chronic heart failure. Mean age was 58.7 +/- 5.3 (range 48-71 years), 19 patients were male and 3 were female. Ischemic or idiopathic etiology was present in 11 cases, respectively. Traditional as well as innovative techniques were used to assess hemodynamic function. Pre-operative hemodynamic profile included mean left ventricular ejection fraction of 20 +/- 5.8% (9-28%), absence of severe right ventricular failure, and mean left ventricular end-diastolic diameter of 75.5 +/- 7.4 mm (range 61-92 m). All patients were in New York Heart Association Class III or Intermittent IV despite conventional medical therapy. RESULTS: There was no intra-operative death. No additional surgery was performed. Left latissimus dorsi (LD) muscle was used in 20 cases, and right LD in two patients. Early mortality occurred in one patient (low cardiac output syndrome), whereas late mortality in five patients (three sudden deaths, one lung cancer, one heart failure). Mean follow-up is 20.7 +/- 16.7 months (3-51 months). Actuarial survival at 4 years is 70%. Cardiac index increased at 6 months (3.08 +/- 0.5 l/min per m2, P = 0.04), but no other significant changes were observed in the long term (3.03 +/- 0.7 l/min per m2, 3 +/- 0.7 l/min per m2, and 2.85 +/- 0.7 l/min per m2, at 12, 24 and 36 months, respectively). Ejection fraction improved at 6 and 12 months (29.1 +/- 1.03%, P = 0.0017; and 27.3 +/- 5.6%, P = 0.0091, respectively), while no substantial augmentation was documented at 2 and 3 years (25.6 +/- 2.5% and 25.1 +/- 4.0%, respectively). Left ventricular end-diastolic diameter was markedly reduced at 6 (73.2 +/- 8.0 mm, P = 0.0176), 12 (69.4 +/- 8.5 mm, P = 0.002) and 24 months (71.1 +/- 7.0 mm, P = 0.011), and was then stable (74.0 +/- 9.1 mm, P = 0.47) at 36 months. Postoperative pressure/volume loop evaluation showed some improvement of hemodynamic function from skeletal muscle assistance. Acute pulmonary edema episodes, as well as number of hospitalizations, were considerably reduced following cardiomyoplasty. CONCLUSIONS: In our experience, cardiomyoplasty was shown to exert moderate beneficial influence on left ventricular performance, to significantly reduce cardiac dilatation and to promote the stabilization of the disease course.

Evaluation of activated charcoal-sorbitol suspension as an antidote.

Studies in rats were performed to evaluate the effect of sorbitol on the antidotal efficacy of activated charcoal against four test drugs and to investigate the influence of storage upon the antidotal effect of activated charcoal-sorbitol suspension. The antidotal potency of activated charcoal was not diminished by sorbitol solution 70% w/v. In fact, it was enhanced by the sorbitol solution, as indicated by greater decrease in peak tissue drug concentration, compared to the effect produced by activated charcoal in aqueous suspension. Furthermore, storage of activated charcoal in sorbitol for as long as 1 year did not reduce the antidotal-efficiency of the absorbent.

Saline cathartics and saline cathartics plus activated charcoal as antidotal treatments.

The results of this experimental study indicate that Na2SO4 reduces the gastrointestinal absorption of aspirin, but not that of pentobarbital, chlorpheniramine, or chloroquine. Activated charcoal (AC) and the combination of AC + Na2SO4 were effective in reducing gastrointestinal absorption of all four test drugs. The combination treatment was more effective than AC treatment in reducing gastrointestinal absorption of aspirin, pentobarbital, and chloroquine. We believe that saline cathartics should not be used in lieu of AC for treatment of poison ingestions, and their routine use to treat poison ingestion should be reevaluated. On the other hand, saline cathartics may be used in conjunction with AC to enhance the antidotal effect of the adsorbent.

Activated charcoal updated.

Activated charcoal, commonly recommended for treatment of chemical ingestions, is the residue from destructive distillation of various organic materials treated to increase its adsorptive power. Since there are no known side effects, the dose should be sufficiently large for optimum adsorption. In the literature, the recommended doses range from 30 gm to 120 gm, or in a charcoal-drug ratio of 10:1. For maximum effect, activated charcoal should be administered within 30 minutes of ingestion. It can be given while its effectiveness for a particular toxic substance is verified.

Evaluation of a charcoal-sorbitol mixture as an antidote for oral aspirin overdose.

The preparation of charcoal in a 70% sorbitol solution results in a suspension that is more palatable and less gritty than an aqueous slurry of charcoal. Although the charcoal-sorbitol mixture may be slightly less effective in reducing the extent of aspirin absorption compared with a charcoal slurry, it may prove to be of particular value in those cases where acceptance of a charcoal slurry presents a problem.

Cadmium levels in hair and other tissues during continuous cadmium intake.

Rats that received cadmium 300 ppm in drinking water (average daily cadmium intake = 4.5 mg/rat) for 12 wk attained peak cadmium levels of 112, 34, and 19 mug/g in hair, liver, and kidney, respectively, at week 4. Rats that ingested cadmium 200 ppm (average daily cadmium intake = 3.6 mg/rat) for 13 wk attained peak cadmium levels of 29 mug/g in kidney at week 7, and 94 and 27 mug/g in hair and liver, respectively, at week 9. Despite continuous exposure to the heavy metal, tissue cadmium concentrations declined to steady-state levels of 24-33 mug/g in hair and 10-17 mug/g in liver and kidney. Histopathologic effects were not observed in liver or kidney. In contrast to cadmium in hair, blood cadmium levels, which remained consistently low (less than 0.04 mug/ml) throughout the study, did not correlate with changes in cadmium levels in liver and kidney.

Acute effects of morphine and chlorpromazine on the acquisition of shuttle box conditioned avoidance response.

Morphine sulfate, 0.25-24.0 mg/kg, or chlorpromazine hydrochloride, 0.0625-4.0mg/kg were administered subcutaneously to naive rats 30 min prior to the start of massed-trials conditioned avoidance response (CAR) testing. The graded doses of both drugs were applied in each of three CAR task difficulty levels created by manipulation of the duration of conditioned and unconditioned stimuli, intertrial interval and shock intensity. Chlorpromazine, in a dose-related manner, caused a decrement in CAR acquisition in all tasks. Morphine, in comparison, produced a biphasic dose response. For a given task difficulty, low doses of morphine enhanced acquisition, whereas higher doses inhibited acquisition. With increasing task difficulty, relatively larger doses of morphine were required to inhibit or facilitate acquisition of CAR. These results emphasize the need to consider not only drug dosage levels, but also the interaction of task difficulty in the application of drugs in learning paradigms.