Predictors of a high defibrillation threshold test during routine ICD implantation.

BACKGROUND: There is growing evidence that routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation is not necessary. However a small group of patients might be at risk if no DFT testing is performed. METHODS: Patients with a new pectoral ICD implantation in our hospital between 2006 and 2014 were included in a retrospective registry. A clinical high DFT was defined as a safety margin <10 J of the maximal device output. Logistic regression for prediction of high DFT was performed using patient characteristics, clinical, echocardiographic and device-related parameters. RESULTS: DFT testing was performed in 788/864 (91.2%) procedures. In 76 (8.8%) patients no DFT testing was performed mainly due to atrial fibrillation, intra-cardiac thrombus, hemodynamic instability or logistical reasons. A high DFT was present in 44 (5.6%) patients. A QRS duration ≥150 ms, a low left ventricular ejection fraction (LVEF ≤25%), a severely dilated left ventricle ≥60 mm and right sided pre-pectoral implantations were univariate predictors of a high DFT. Independent predictors of a high DFT were a LVEF ≤25% (HR 2.195, 95%CI 1.085-4.443) and right sided pre-pectoral implantations (HR 3.135, 95% CI 1.186-8.287). CONCLUSIONS: A high DFT is still present in about 5% of patients and is more frequent in patients with a severely dilated left ventricle, a very low LVEF, right sided pre-pectoral implantation and wider QRS duration. It might be clinically important to continue DFT testing in these high risk patients.

Cancer After Heart Transplantation: A 25-year Single-center Perspective.

BACKGROUND: Cancer is a major cause of morbidity and mortality after heart transplantation. METHODS: We studied 541 heart transplant patients from a single center over a period of 25 years, with a mean follow-up of 10.7 years. We determined incidence, type, risk factors, and prognosis for cancer after heart transplantation. RESULTS: Cancer was diagnosed in 181 patients, at a mean of 7.7 years after transplantation. Cumulative incidence of cancer at 5, 10, and 20 years was 14%, 29%, and 60%, respectively. The most frequent cancers were spinocellular skin cancer (22%), basocellular skin cancer (19%), lung cancer (16%), lymphoma (11%) and prostate cancer (10%). Age at transplantation > 50 years (hazard ratio, 2.9; P < .001) and male recipient gender (hazard ratio, 1.7; P = .038) were significant risk factors for posttransplant malignancy on multivariate Cox proportional hazards analysis. Median patient survival after diagnosis of cancer was 2.9 years for patients with noncutaneous cancer, versus 13.1 years for patients with only skin cancer (P < .001).

Unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus in an immune-competent adult.

PURPOSE: To report an immune-competent patient with unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus, and to highlight the importance of diagnostic vitreous biopsy and specific antiviral therapy in this condition. METHODS: Case report. RESULTS: A 75-year-old man with good general health had two episodes of acute retinal necrosis syndrome affecting his left eye. Vitreous biopsy was performed in each episode, and polymerase chain reaction analysis on the vitreous specimen was positive for cytomegalovirus and negative for varicella zoster virus and herpes simplex virus 1 and 2. On each occasion, investigations indicated past cytomegalovirus infection but no evidence of a systemic re-activation. No indication of immunodeficiency was found over a 2-year follow-up period. His management, which included systemic and intravitreal antiviral therapy, is discussed. CONCLUSIONS: To the authors' knowledge, only two other cases of acute retinal necrosis syndrome caused by cytomegalovirus have been reported previously in immune-competent patients. This case illustrates the importance of vitreous biopsy for viral polymerase chain re-action studies in cases of acute retinal necrosis syndrome, in order to direct appropriate antiviral treatment. It also illustrates the role of an intravitreal antiviral drug that is effective against all three herpetic viruses.

Comparison of the effect of sodium hyaluronate (Ophthalin) and hydroxypropylmethylcellulose (HPMC-Ophtal) on corneal endothelium, central corneal thickness, and intraocular pressure after phacoemulsification.

PURPOSE: To prospectively evaluate the effects of 2% hydroxypropyl-methylcellulose (HPMC-Ophtal) and sodium hyaluronate 1% (Ophthalin) on intraocular pressure, corneal thickness, and endothelial cell loss in small incision cataract surgery with implant. METHODS: A total of 110 patients undergoing routine phacoemulsification with implant received either 2% hydroxypropyl methylcellulose or sodium hyaluronate 1% as ophthalmic viscosurgical device. Pre- and postoperative slitlamp examination, intraocular pressure measurement (preoperatively and at 1-4 hours, 1 day, and 7 days postoperatively), ultrasonic pachymetry (preoperatively and at 1 week, 4-6 weeks, and 12 weeks post operatively), and corneal endothelial cell count (preoperatively and 12 weeks postoperatively) were performed. Data were analyzed using two-way analysis of variance. RESULTS: All measurements were comparable between the two groups preoperatively. Intraocular pressure was significantly lower in the Ophthalin group at 1 day post operatively, while no significant difference was found between the two groups on the 1-4 hours and 7 days examination. The central corneal thickness was not significantly different between the two groups at any postoperative visit . However, the mean cell density demonstrated a significant fall of 11.76% for Ophthalin and 4.27% for HPMC-Ophtal at 12 weeks post-operatively, the difference between the two being significant (p=0.009). CONCLUSIONS: 2% Hydroxypropyl methylcellulose, compared with sodium hyaluronate 1%, is superior in protecting the corneal endothelial cells, has the same effect on central corneal thickness, and is associated with slightly higher intraocular pressure 1 day post operatively. It compares favorably with sodium hyaluronate 1% and can be used as an effective and cheaper alternative in routine small incision cataract surgery with implant.

Exchange technique for opacified hydrophilic acrylic intraocular lenses.

PURPOSE: To report an exchange technique for opacified hydrophilic acrylic intraocular lenses (IOLs). METHODS: . Twenty patients with two different types of opacified hydrophilic acrylic IOLs underwent IOL exchange by a single surgeon. Circumferential enlargement of the pre-existing capsulorrhexis was a critical step of the procedure, and resulted in expression of the IOL with minimal traction to the capsule. Implantation of an in-the-sulcus IOL followed. Surgical technique, complications, and visual outcome are discussed. RESULTS: Time from the initial cataract operation varied from 15 to 61 months (mean 30.5), and in all cases marked fibrosis was encountered. Eighteen patients had uncomplicated IOL exchange. Posterior capsule rupture occurred in two cases. Vision improved in 16 cases, remained unchanged in 3 cases, and deteriorated in 1 case. CONCLUSIONS: IOL exchange of opacified hydrophilic acrylic IOLs is a particularly challenging procedure due to extensive fibrosis. Circumferential enlargement of the pre-existing capsulorrhexis significantly facilitates the mobilization of the IOL from its fibrous pocket, with the use of minimal forces. Thus, the risk of zonular dehiscence or posterior capsule rupture is minimized.

Clinical outcomes and complications of intraocular lens exchange in patients with opacified hydrophilic acrylic lenses SC600-2.

BACKGROUND: The purpose of this study was to present the outcomes of intraocular lens exchange in patients with opacified hydrophilic acrylic intraocular lenses. PATIENTS AND METHODS: Fifteen patients, who underwent uncomplicated phacoemulsification and hydrophilic acrylic intraocular lens (model SC600-2) implantation with good visual recovery, were re-referred to our department 76 - 188 weeks post-surgery due to progressive visual loss resulting from opacification of the implant. Intraocular lens exchange followed. The method of lens exchange is described. The effect on the best corrected visual acuity and on their refraction, the operative and postoperative complications are reported. RESULTS: All 15 patients underwent intraocular lens exchange. Twelve patients (80 %) had improvement of their best corrected visual acuity, in two cases (13 %) the best corrected visual acuity did not change, and in one case (7 %) the best corrected visual acuity deteriorated, this being attributed to progression of her age-related macular degeneration. None of the patients developed zonular dehiscence; in one patient the exchange was complicated with posterior capsule rupture, and an anterior chamber intraocular lens was implanted. One patient required cutting of the haptics before removal of the opacified intraocular lens. The mean Snellen (decimal) visual acuity was 0.35 (range 0.1 to 0.6) before lens exchange and 0.49 (range 0.1 to 0.6) six weeks after; the difference was significant (P < 0.05). Excluding the patient with the deterioration of her age-related macular degeneration, mean visual acuity of the remaining fourteen patients after the intraocular lens exchange was even better (0.56). CONCLUSION: Exchange of opacified hydrophilic acrylic intraocular lenses seems to be the only currently available effective treatment, leading to improvement of visual acuity.

Influence of membrane-bound tumor necrosis factor (TNF)-alpha on obesity and glucose metabolism.

OBJECTIVES: To investigate the influence of transmembrane tumor necrosis factor (TNF)-alpha on adipose tissue development and insulin-mediated glucose metabolism. METHODS AND RESULTS: TNF-alpha and lymphotoxin-alpha-deficient mice expressing non-cleavable transmembrane TNF-alpha (Tg-tmTNF-alpha) and TNF-alpha/lymphotoxin-alpha double knockout (control) mice were kept on high-fat diet for 15 weeks. The food intake and feeding efficiency of Tg-tmTNF-alpha mice were significantly higher compared with control mice. At the end of the study, Tg-tmTNF-alpha mice had a significantly higher total body weight, as well as subcutaneous and gonadal adipose tissue mass. Histological analysis revealed that the expression of Tg-tmTNF-alpha resulted in a significantly increased adipocyte area and blood vessel density. Plasma leptin levels correlated positively with adipose tissue mass. The plasma levels of total cholesterol and HDL-cholesterol were significantly increased and LDL-cholesterol levels significantly decreased in Tg-tmTNF-alpha mice. Fasting blood glucose and plasma insulin levels were not different between the two genotypes and intraperitoneal glucose and insulin tolerance tests did not show significant differences. CONCLUSIONS: Transmembrane TNF-alpha enhances adipose tissue formation without altering insulin-mediated glucose metabolism in mice with nutritionally induced obesity.

[The effect of brimonidine on postoperative hypertonia after an extracapsular cataract extraction]. / L'effet de la brimonidine sur l'hypertonie postopératoire après une extraction extracapsulaire de la cataracte.

PURPOSE: We conducted a prospective study to determine the effect of topical administration of brimonidine tartrate 0.2% on postoperative intraocular pressure (IOP) spikes during the first 24 hours after an extracapsular cataract extraction. MATERIAL AND METHODS: In a placebo-controlled study, we randomized 40 consecutive normotensive eyes undergoing extracapsular cataract surgery into two treatment modalities. Twenty eyes (group A) received placebo and 20 eyes (group B) were given brimonidine tartate 0.2% drops twice the day before and twice on the day of the operation. IOP was measured at baseline (prior to surgery) and then 4, 6, 12 and 24 hours postoperatively. RESULTS: Mean postoperative IOP was higher in the placebo group than in the brimonidine group at every time point studied. In both groups, peak elevation of mean IOP was recorded 6 hours after surgery. At that time, mean IOP was significantly higher in the placebo group (36.2+/-4.0 mmHg) than in the brimonidine group (24.7+/-3.8 mmHg) (p<0.001). A gradual reduction in IOP followed, yet with significantly higher values than those found preoperatively, even 12 hours after surgery (p<0.001). It was only the brimonidine group that achieved a near-to-normal mean IOP 24 hours after surgery (p>0.05). Four of the placebo group patients compared to 1 of the brimonidine group patients had an IOP higher than 40 mmHg 6 hours after surgery and therefore received additional therapy. CONCLUSION: Prophylactic treatment with brimonidine tartrate 0.2% drops twice a day for 2 days is effective in reducing IOP spikes throughout the first 24 hours after an extracapsular cataract extraction.

Inhibition of plasmin activity by sulfated polyvinylalcohol-acrylate copolymers.

The effect of four sulfated polyvinylalcohol-acrylate copolymers and heparin on plasminogen activation and on plasmin activity is studied. The molecules differing in charge (proportion of negatively charged units 40.5%-73.5% of the total) and in size (5600 Da-8800 Da) accelerate plasminogen activation by 2- up to 4-fold at a 7-fold molar excess of the polyvinylacrylates over plasminogen. They, however, exert a concentration and charge-dependent effect on plasmin: both the amidolytic (half-maximal effect at a 1.33-3.66 molar excess of the polyvinylacrylates) and fibrinolytic (half-maximal effect at 1.23-1.72 molar excess of the polyvinylacrylates) activities of plasmin are inhibited. In contrast, heparin (a similarly carboxylated and sulfated polymer) and polyvinylacrylates with a low number of sulfate groups (30% sulfated monomers) at concentrations up to 2.2 microM do not affect plasminogen activation and plasmin activity in a milieu of physiological ionic strength. Experiments with plasmin derivatives lacking N-terminal peptides of different length (des-kringle(1-4) and des-kringle(1-5) plasmin) show identical changes in the protease activities, precluding involvement of the kringle-domain in the interaction with the polyvinylacrylates. Fluorescence studies evidence the charge-dependent binding of the polyvinylacrylates to plasmin, but not to plasminogen. Thus, through non-covalent interaction with the protease-domain of plasmin the polyvinylacrylates inhibit fibrinolysis. Since these sulfated copolymers inhibit both thrombin [4] and plasmin activity, they may be a useful therapeutic tool in situations when both the blood coagulation and the fibrinolytic system are activated (such as intravascular coagulation and fibrinolysis, ICF).

[The role of plastic shock absorbers in dental implantation]. / Múanyag erótörók szerepe az implantációs fogpótlásokban.

The mechanical behaviour of different plastics (PE, PP, PI, PA, ABS, POM) was examined by static and dynamic loading. Detection of microdeformations and photoelastic stress analysis served as the examination method. According to the results, polyethylene is unsuitable, however the other plastics, with clauses, are suitable as shock absorbers. Apart from the mechanical investigation photoelastic stress analysis also revealed the benefit of osseointegration in force transmission to the bone.

Comparative studies on the efficacy of sulphachlorpyrazine and toltrazuril for the treatment of caecal coccidiosis in chickens.

The therapeutic efficacy of sulphachlorpyrazine and toltrazuril against experimentally induced Eimeria tenella infection was compared in battery and floor pen raised broiler chickens. In the battery studies, both drugs prevented coccidiosis-related mortality and decrease of weight gain to a similar degree, but toltrazuril was more effective in reducing intestinal lesions and faecal scores, when treatments were initiated 24 h postinfection. When medication was delayed until 72 h after inoculation, the sulphonamide proved to be more effective in preventing reduction of weight gain and intestinal lesions caused by the parasites. Under simulated use conditions both drugs showed an appropriate anticoccidial efficacy without major differences between them.