Anatomical patterns of patent foramen ovale (PFO): do they matter for percutaneous closure?

AIM: The aim of this study was to describe and classify the various anatomical pattern of patent foramen ovale (PFO) with transesophageal echocardiography (TEE) and to relate such classification to the selection of PFO closure devices. METHODS: This study enrolled 216 PFO patients (118 females) mostly with previous cryptogenic stroke or transitory ischemic attack (TIA) who underwent percutaneous closure of PFO with deep sedation under TEE control. Anatomical patterns were classified as follows: simple: PFO characterised by central/superior eccentric shunt or with a valve mechanism (45%); reduse: widely redundant septum primum (22%); ASA: atrial septal aneurysm (11%); EASA: entire atrial septal aneurysm (1.4%); CRIB: cribriform septum primum (9%); tunnel: tunnel between septum primum and secundum >10 mm (11%). Degree of right-to-left shunt, either at basal condition or at Valsalva manoeuvre, was classified as: 1=mild (45%); 2=moderate (42%); 3=severe (13%). Additional right-atrium anatomical features are also described. RESULTS: Procedure was successful in 100% of the cases. At follow-up recurrent TIA occurred in two patients. Residual shunts were present in 4.9% of the patients after Valsalva manoeuvre. Palpitations were reported in 4%. CONCLUSIONS: Closing the PFO choosing the device following strict anatomical criteria based on TEE assessment allowed excellent immediate and late results minimizing residual shunts.

DES implantation in saphenous vein and left internal mammary grafts.

Forty percent of patients treated with CABG need further revascularizations after 10 years mainly due to saphenous--more than arterial--graft disease. In this issue, the Authors make a critical review of current available literature on the treatment of saphenous and arterial graft disease, a subset of lesions for which a clear consensus for DES use is still lacking. The Authors examine both the positive and negative aspects of DES use in this setting. Percutaneous revascularizations with DES are feasible and safe. The antiproliferative properties of DES seem to be effective even in the treatment of bypass disease, in particular in saphenous grafts. The clinical efficacy of a treatment with DES is expressed mainly in the reduction of in-stent restenosis and, therefore, in the rates of target lesion revascularization (TLR). Moreover, the use of DES is not associated to higher rates of stent thrombosis and, in case of reintervention, recurrence rates seem to be limited. However, the benefit provided by DES in prevention of restenosis may be limited by the progression of the disease in other segments than those treated with stents. Percutaneous treatment of arterial bypass with DES is feasible and safe. Most of available data on DES are on anastomotic disease (data on bypass ostium and shaft are too scarce to draw any conclusion). In this case, where the use of stents is imperative, there is no evidence of advantages gained by the use of DES over BMS in terms of new revascularizations. Some unanswered questions on DES use in this setting still remain. For this reason new randomized trials are required to definitively give a reliable answer on DES efficacy in this subset of lesions.

Endovascular intervention in the treatment of congenital heart disease in adults.

Over the last years, endovascular intervention have become an important part of treatment in patients with congenital heart disease particularly for residual defects after surgery done in infancy. These transcatheter procedures can be described as dilatation of stenotic sites (angioplasty, endovascular stenting and valvuloplasty) or as a closure of anomalous openings (device closure defects and vascular embolisation). Balloon valvuloplasty, without or with stent, is the procedure of choice in adults with pulmonary valve stenosis, pulmonary arteries stenosis, bicuspid aortic valve stenosis without calcification, aortic re-coarctation. Treatment of native aortic coarctation is still under debate. Devices for closing atrial and ventricular septal defects or patent ductus arteriosus have been developed and are now widely used. Transcatheter, plug or coil occlusion is nowadays the goal treatment in a wide range of arterial and venous vascular connections. This review describes the current role of each major catheter-directed therapy in the treatment of congenital heart disease in adults.

Drug-eluting stents: towards new endpoints.

Drug-eluting stents (DES) have significantly reduced the rates of in-stent restenosis (ISR). As previously observed with bare-metal stents (BMS), either patient's clinical characteristics and lesion morphology may influence the risk of recurrence even with DES. In this review we will focus on the most recent available data on clinical settings where DES efficacy on long-term outcomes are largely unknown. In particular, we report on very complex lesions (bifurcations, small vessels, chronic total occlusions, in-stent restenosis) myocardial infarction, multivessel disease, treatment of bypass graft and of unprotected left main disease. Several issues are still open on DES routinary use for these indications, mainly as far as stent thrombosis is concerned. Recent pathological studies show that DES are characterized by chronic inflammatory infiltrates and delayed endothelialization. Therefore, this effect could translate in a ''vulnerable period'' for thromboses longer than with BMS. Even though large meta-analysis have excluded higher rates of stent thrombosis with DES rather than with BMS, few cases of unusual very late stent thrombosis have been described, pointing out that this problem seems to be still unsolved. Although DES provide better angiographic outcomes in each clinical setting, further randomized studies are running to assess their safety and efficacy on currently off-label indications.

Static and dynamic properties of synaptic transmission at the cyto-neural junction of frog labyrinth posterior canal.

The properties of synaptic transmission have been studied at the cyto-neural junction of the frog labyrinth posterior canal by examining excitatory postsynaptic potential (EPSP) activity recorded intraaxonally from the afferent nerve after abolishing spike firing by tetrodotoxin. The waveform, amplitude, and rate of occurrence of the EPSPs have been evaluated by means of a procedure of fluctuation analysis devised to continuously monitor these parameters, at rest as well as during stimulation of the semicircular canal by sinusoidal rotation at 0.1 Hz, with peak accelerations ranging from 8 to 87 deg.s-2. Responses to excitatory and inhibitory accelerations were quantified in terms of maximum and minimum EPSP rates, respectively, as well as total numbers of EPSPs occurring during the excitatory and inhibitory half cycles. Excitatory responses were systematically larger than inhibitory ones (asymmetry). Excitatory responses were linearly related either to peak acceleration or to its logarithm, and the same occurred for inhibitory responses. In all units examined, the asymmetry of the response yielded nonlinear two-sided input-output intensity functions. Silencing of EPSPs during inhibition (rectification) was never observed. Comparison of activity during the first cycle of rotation with the average response over several cycles indicated that variable degrees of adaptation (up to 48%) characterize the excitatory response, whereas no consistent adaptation was observed in the inhibitory response. All fibers appeared to give responses nearly in phase with angular velocity, at 0.1 Hz, although the peak rates generally anticipated by a few degrees the peak angular velocity. From the data presented it appears that asymmetry, adaptation, and at least part of the phase lead in afferent nerve response are of presynaptic origin, whereas rectification and possible further phase lead arise at the encoder. To confirm these conclusions a simultaneous though limited study of spike firing and EPSP activity has been attempted in a few fibers.

Biophysical properties of the silent and activated rat sympathetic neuron following denervation.

A biophysical description of the denervated rat sympathetic neuron is reported, obtained by the two-electrode voltage-clamp technique in mature intact superior cervical ganglia in vitro. At membrane potential values negative to -50 mV, the normal, quiescent neuron displays voltage-dependent K and Cl conductances; following direct or synaptic stimulation (15Hz for 10 s), the neuron moves to a new resting state characterized by increased amplitude and voltage dependence of Cl conductance. Denervation produces two main effects: 1) resting Cl conductance gradually increases while its voltage-dependence decreases; by 30 days a high-conductance resting state prevails, almost independent of membrane potential in the -50/-110 mV range; 2) the increase in amplitude and voltage-dependence of Cl conductance, produced by direct stimulation in control neurons, is less marked in denervated neurons, and is observed over an increasingly small range of membrane potentials. Thirty days after denervation, the prevailing high-conductance resting state appears virtually insensitive to changes in membrane potential and stimulation. Voltage-dependent potassium currents involved in spike electrogenesis (the delayed compound potassium current and the fast transient potassium current) exhibit an early drastic decrease in peak amplitude in the denervated neuron; the effect is largely reversed after 6 days. Remarkable changes in fast transient potassium current kinetics occur following denervation: the steady-state inactivation curve shifts by up to +15 mV toward positive potential and voltage sensitivity of inactivation removal becomes more steep. A comprehensive mathematical model of the denervated neuron is presented that fits the neuron behavior under current-clamp conditions. It confirms that neuronal excitability is tuned by the conductances (mostly chloride conductance) that control the resting membrane potential level, and by fast transient potassium current. Impairment of the latter reduces both inward threshold charge for firing and spike repolarization rate, and fast transient potassium current failure cancels the voltage dependence of both processes.

Phenotype commitment in vascular smooth muscle cells derived from coronary atherosclerotic plaques: differential gene expression of endothelial nitric oxide synthase.

Unstable angina and myocardial infarction are the clinical manifestations of the abrupt thrombotic occlusion of an epicardial coronary artery as a result of spontaneous atherosclerotic plaque rupture or fissuring, and the exposure of highly thrombogenic material to blood. It has been demonstrated that the proliferation of vascular smooth muscle cells (VSMCs) and impaired bioavailabilty of nitric oxide (NO) are among the most important mechanisms involved in the progression of atherosclerosis. It has also been suggested that a NO imbalance in coronary arteries may be involved in myocardial ischemia as a result of vasomotor dysfunction triggering plaque rupture and the thrombotic response. We used 5' nuclease assays (TaqMan PCRs) to study gene expression in coronary plaques collected by means of therapeutic directional coronary atherectomy from 15 patients with stable angina (SA) and 15 with acute coronary syndromes (ACS) without ST elevation. Total RNA was extracted from the 30 plaques and the cDNA was amplified in order to determine endothelial nitric oxide synthase (eNOS) gene expression. Analysis of the results showed that the expression of eNOS was significantly higher (p<0.001) in the plaques from the ACS patients. Furthermore, isolated VSMCs from ACS and SA plaques confirmed the above pattern even after 25 plating passages. In situ RT-PCR was also carried out to co-localize the eNOS messengers and the VSMC phenotype. The eNOS gene was more expressed in ACS plaques and VSMCs cultured from them, thus indicating that: a) the expression of the most important differentiation markers is retained under in vitro conditions; and b) NO may play a pivotal role in coronary artery disease. Our findings suggest a new cell system model for studying the pathophysiology of unstable angina and myocardial infarction.

Clinical utility of IVUS in 2005.

Intravascular ultrasounds (IVUS) allowed an innovative visualization of coronary artery disease. This technique developed first in the research field and, then, it was introduced in clinical practice as a supplement to coronary angiography in diagnosis of the severity of ischemic heart disease. The characteristic tomographic view of coronary plaque supplied by IVUS allowed to overcome the limitations of coronary angiography and to add important supplemental information in understanding the mechanism of action of several interventional devices. In this review we analyze current indications of use of IVUS in clinical practice and the future applications of IVUS-related techniques for the diagnosis of coronary artery disease.

Dynamics of intracellular calcium in hair cells isolated from the semicircular canal of the frog.

Changes in cytosolic free Ca(2+) concentration ([Ca(2+)]i) were monitored optically in hair cells mechanically isolated from frog semicircular canals using the membrane-impermeant form of the Ca(2+)-selective dye Oregon Green 488 BAPTA-1 (OG, 100 microM). Cells stimulated by depolarization under whole-cell voltage clamp conditions revealed Ca(2+) entry at selected sites (hotspots) located mostly in the lower (synaptic) half of the cell body. [Ca(2+)]i at individual hotspots rose with a time constant tau1 approximately 70 ms and decayed with a bi-exponential time-course (tau2 approximately 160, tau3 approximately 2500 ms) following a 160 ms depolarization to -20 mV. With repeated stimulation [Ca(2+)]i underwent independent amplitude changes at distinct hotspots, suggesting that the underlying Ca(2+) channel clusters can be regulated differentially by intracellular signalling pathways. Block by nifedipine indicated that the L-type Ca(2+)channels are distributed at different densities in distinct hotspots. No diffusion barrier other than the nuclear region was found in the cytosol, so that, during a prolonged depolarization (lasting up to 1s), Ca(2+) was able to reach the cell apical ciliated pole. The effective Ca(2+) diffusion constant, measured from the progression of Ca(2+) wavefronts in the cytosol, was approximately 57 microm(2)/s. Our results indicate that in these hair cells, buffered diffusion of Ca(2+) proceeds evenly from the source point to the cell interior and is dominated by the diffusion constant of the endogenous mobile buffers.

Cerebellar cortex delayed maturation in sudden infant death syndrome.

The cerebellum shows afferent and efferent connections with intrinsic bulbar nuclei and plays an important role in respiration and cardiovascular control. Pathological and neurochemical abnormalities of bulbar nuclei including the arcuate nucleus have been postulated in sudden infant death syndrome (SIDS). Most of these abnormalities have been related to impairment in brain development. The cerebellar cortex has a well-documented evolution from fetal life until infancy; thus, it may be a very good model to assess brain maturation in SIDS. The present study was conducted to investigate changes in the cerebellar cortex in 19 SIDS cases compared with 12 age-related controls using morphological, quantitative, and statistical approaches. Five-microns paraffin sections from the midsagittal cerebellar vermis were stained with hematoxylin and eosin (H&E). Immunohistochemical staining was carried out using a polyclonal antiserum to glial fibrillary acidic protein (GFAP). Each case consisted of a 25-microns parallel paraffin section stained with H&E, where the cerebellar external granular layer (EGL) cell density was obtained in one field magnification (x1,000) using an optical dissector procedure on the basis of a stereological method. A statistically significant high EGL cell density, mostly related to the presence of immature bipolar, elongated neuronal cells of the premigratory zone with hyperchromatic, oval or poor differentiated nuclei, was observed in SIDS. In these cases, EGL expressed immunoreactivity for GFAP mainly in the subpial and the postmitotic zone. These findings demonstrate a delayed or slower decline in the number of EGL neurons in SIDS, suggesting either a prolongation of the growth phase related to postnatal cerebellar foliation or a delay in inward migration. These results suggest that in SIDS there is delayed maturation of the cerebellar cortex/EGL, which may support the hypothesized cardiopulmonary control dysfunction, leading to death in a vulnerable period of postnatal development.

Clinico-pathological correlations in meningiomas: a DNA and immunohistochemical study.

We have studied 41 meningiomas classified histologically as benign, atypical or anaplastic. There were 26 females and 15 males and the mean age was 53 years. 36 tumours were supratentorial, 4 infratentorial and one spinal. Flow cytometry was performed on paraffin-embedded tissue using a selective staining technique for DNA. The ploidy index of DNA and percentage of cells in the S and G2/M phases were calculated. Results were correlated with clinical, histological and immunohistological data. 16/41 tumours were found to be diploid, 17/41 aneuploid and 8/41 could not be analysed. Significant correlations were found between aneuploid tumours and some qualitative features such as recurrence, pleomorphism, high cellular density, mitotic activity and brain and soft tissue infiltration. A high proliferative index appeared to be associated with clinical aggressiveness. No particular correlation between the expression of cytokeratin and epithelial membrane antigen markers and flow cytometry was found. Our results suggest that DNA flow cytometry in meningiomas may be of value in predicting the behaviour of these neoplasms and confirm that epithelial pattern in meningiomas is not linked to increased anaplasia or poor prognosis.

Immunohistological signposts in central nervous system tumours with neuronal differentiation.

25 neuronal tumours with a panel of antibodies were studied and it was found that vimentin was present in 15 tumours. It was also found in a few cells within rosettes. PGP 9.5 showed a somatic pattern of staining with nuclear and perinuclear positivity in 23. Neurofilament reactivity was found in 14. Retinal S-antigen was detected only in one medulloblastoma, 3/4 pineal tumours and 2/2 retinoblastomas. Reactivity, for synaptophysin was present in 2/5 medulloblastomas, 3/10 neuroblastomas and 2/2 retinoblastomas. GFAP was demonstrated in scattered tumour cells in 4/5 medulloblastomas. Two of these were the only tumours featuring bipolar differentiation whilst it was unipolar in the remainder. The significance of these findings in relation to the ontogeny of these tumours is discussed.

Mononuclear cell infiltrate, HLA-Dr expression and proliferation in 37 acoustic schwannomas.

Frozen sections from 37 schwannomas of the VIII nerve were reacted with a panel of monoclonal antibodies to macrophage, lymphocyte, HLA-Dr invariant chain and nuclear proliferation antigens. A moderate number of macrophages was demonstrated in 96% of tumours. CD8- and CD4-lymphocytes were detected in slightly smaller numbers in up to 87% and 23% of tumours respectively. B-lymphocytes were present in only 2/32 cases and NK-cells were absent from all 16 cases tested. HLA-Dr antigen was expressed by macrophages in most cases and by tumour cells in 13/24 tumours. These findings may represent evidence for a degree of cellular immune response. Occasional cells featuring nuclear proliferation were detected in 15/27 cases.

Prognostic analysis of astrocytic gliomas correlating histological parameters with the proliferating cell nuclear antigen labelling index (PCNA-LI).

Eighty out of 250 cases of astrocytic glioma collected from a practice served by a single clinical team over a 15-year period were studied using a full complement of clinical, follow up, histopathological analysis and proliferating cell nuclear antigen (PCNA) immunostaining for the obtention of the PCNA-labelling index (LI). A statistical evaluation and discriminant analysis were carried out with the aim of clarifying the importance of various parameters as predictors of tumor behaviour. Data are correlated with survival (with a 10-year follow up). A significant correlation with survival was found when histological grouping and the PCNA-LI were studied with the Cox test. Most significant features were histological as detected using classical techniques including histological grading. The utilization of objective values (mitosis, cellular density and necrosis) appears to be useful in grading astrocytic tumors. Our results emphasize the importance of cytological, histological and PCNA-LI parameters as predictors of tumor behaviour.

Haemangioblastoma: histological and immunohistological study of an enigmatic cerebellar tumour.

Paraffin-embedded blocks of 36 cerebellar haemangioblastomas were reacted with a panel of antibodies including glial fibrillary acidic protein, vimentin, epithelial membrane antigen, cytokeratin, Factor VIII, a neuroendocrine marker and with Ulex europaeus. agglutinin The main histological features, apart from the characteristic large abnormal vessels, were a prominent reticulin network, a cystic architecture and cellular and nuclear polymorphism. Two cell types were identified: endothelial and stromal. Twenty tumours were positive for glial fibrillary acidic protein because of included or reactive astrocytes as well as positive stromal cells. Vimentin was positive in all tumours with a diffuse distribution and a somatic pattern; blood vessels, stromal cells and reactive astrocytes were strongly positive. Factor VIII and Ulex europaeus agglutinin reactivity were present in a similar pattern of staining in endothelium and in five cases there were stromal cells that were positive with the latter. We were not able to ascertain the histogenesis of the stromal cell, which remains enigmatic.

Immunocytochemical study of the cellular immune response in meningiomas.

Twenty four meningiomas (17 benign and seven "atypical" were reacted with a panel of monoclonal antibodies to macrophages, lymphocytes, and HLA DR antigens. All the tumours contained macrophages but these cells were more numerous in the atypical meningiomas. Lymphocytes, almost exclusively of the CD8 subtype, were also present in 70% of benign meningiomas and in all atypical meningiomas and were more abundant in the latter. B lymphocytes were present in minimal numbers in three atypical meningiomas and in one benign meningioma. CD4 positive T lymphocytes were present in small numbers in one benign meningioma and in moderate numbers in one atypical meningioma. HLA DR antigen expression on tumour cells was present in about 60% of both tumour groups. The numbers of macrophages and T and CD8 lymphocytes in meningiomas seem to be related to atypical histological features, and the presence of these cells raises questions about host immune response and the relation of this to prognosis.

Inhibitors of platelets glycoprotein IIb/IIIa (GP IIb/IIIa) receptor: rationale for their use in clinical cardiology.

The glycoprotein IIb/IIIa (GP IIb/IIIa) receptor is the most important receptor involved in platelet aggregation. A stable GP IIb/IIIa inhibition is required when a massive platelet activation triggers thrombosis. Three GP IIb/IIIa inhibitors are currently approved for clinical use: abciximab, tirofiban and integrilin. Their different pharmacodynamic and pharmacokinetic properties reflect a different efficacy in platelet inhibition.

Ca2+-dependent kinetics of hair cell Ca2+ currents resolved with the use of cesium BAPTA.

Hair cells in the frog semicircular canal, studied by the whole-cell patch-clamp technique, display three distinct Ca2+ currents: two non-inactivating components (L type and R type, the latter termed R2 in the following) and a second R type current (termed R1), which runs down first and inactivates in a Ca2+-dependent fashion. Since intracellular EGTA, up to 5 mM, did not display major effects on such inactivation, we used increasing amounts of BAPTA in the patch pipette, to control [Ca2+]i more efficiently and investigate whether modifications in [Ca2+]i at the cytoplasmic side of the channel affect the inactivation of the RI component and in general the gating of all channel types. The results here reported show that (1) K+ currents heavily contaminate recordings obtained using high concentrations of BAPTA in its commercially available K+ salt form; (2) BAPTA Cs+ salt can be satisfactorily employed to obtain reliable recordings; (3) the kinetics of channel gating and R1-channel inactivation are indeed markedly affected by effectively buffering [Ca2+]i.

Efferent control of posterior canal afferent receptor discharge in the frog labyrinth.

EPSP and spike discharges were intracellularly recorded from 90 afferent fibres of the posterior nerve in the isolated frog labyrinth and the effects of electrical activation of the efferent system were tested. Posterior canal efferent synapses were activated, via an axon reflex, by electrical shocks to the anterior-horizontal nerves. The afferent resting discharge of all fibres tested was affected by efferent stimulation: 39 units were inhibited (43%) and 51 (57%) were facilitated. The efferent system was activated with several stimulation frequencies in the 10-200 Hz range applied for different times (250 ms-10 s). By changing the stimulus parameters, inhibition did not reverse to facilitation or vice versa. Facilitation appeared within the train above a threshold frequency of about 10 Hz. The peak response was readily reached within the first second and then, with long lasting stimulation, a marked adaptation ensued. The increase in firing rate was independent of previous resting activity. The relationship between frequency and facilitatory response is described by a logarithmic function over the 30-200 Hz range tested. At the end of short trains a consistent post-stimulation after-discharge appeared, whose intensity is positively related to stimulation frequency and time. Inhibition was achieved at stimulation rates above 10 Hz, and a post-stimulation rebound discharge was evident, which was linearly dependent on previous stimulation rate. The latency values of both inhibitory and facilitatory effects were measured by taking into account either the EPSP release rate or the spike discharge modifications at all the frequencies tested. Latency proved to decrease exponentially with increasing stimulation time from a minimal value of 3 ms to a maximum of 200 ms, with minor differences between inhibition or facilitation. These long latency values, the presence of a threshold frequency and the stimulus- and frequency dependence indicate that the efferent synapses must be activated repetitively to produce detectable effects on the afferent discharge; this is in line with the discharge pattern of the efferent system fibres physiologically measured in some systems. The present results show that the dual central control of the crista ampullaris of frog posterior canal is potentially capable of setting the receptor population at a variable level of sensitivity to mechanical stimuli, with profound modifications in the canal transfer function and the spike encoding mechanism.

The effect of barium and some channel blockers on sensory discharge of the frog labyrinth posterior canal recorded at rest and during rotation.

The effect on the afferent synaptic transmission of Ba2+, Sr2+, tetraethylammonium (TEA) and 4-aminopyridine (4-AP) has been investigated in the isolated frog labyrinth by intracellularly recording the posterior canal resting and evoked receptor discharge. BaCl2 (0.3 mM) or SrCl2 (1.8 mM) substitution for normal external CaCl2 restored the afferent activity without affecting the membrane potential of the sensory fibres. On further increasing Ba2+ concentration (0.5-5 mM) a dose-dependent increase in the EPSP and spike discharges was observed in all the units examined. Ba2+ (1.8-4 mM) removed the depression of the sensory activity operated by CoCl2 (3 mM), while its facilitatory effect was completely antagonized by raising Ca2+ concentration (up to 10 mM). TEA (20 mM) elicited a clear-cut increase in the EPSP and spike discharges which, however, was less consistent than that produced by Ba2+ (1 mM). The increment in spike frequency produced by TEA and Ba2+ proved to be inversely related to the initial resting firing level of the different units. The 4-AP (4-20 mM) effect resulted in a decrease of the sensory activity, which was fully restored by TEA or Ba2+. In normal saline a linear relationship was found between the mean unit resting discharge and the respective excitatory peak response during sinusoidal rotation (0.1-0.3 Hz). This result suggest that the mechanical response is mainly determined by the unit resting level. Consistent evoked responses were obtained under TEA and Ba2+ treatment which proved to depend linearly on the new mean resting discharge of the different units. Conversely, a reduced evoked response was invariably observed in all the fibres tested in the presence of 4-AP. The present results suggest that Ba2+ and Sr2+ may substitute for Ca2+ in the transmitter release process at the cyto-neural junction, the ability of Ba2+ being even larger than that of Sr2+ and Ca2+ itself. The effects of TEA and 4-AP are discussed in the light of their possible interaction with the presynaptic K+-currents recently described in hair cells.