Effect of intravenous lidocaine on manifestations of fibromyalgia.

BACKGROUND AND OBJECTIVES: The objective of our study was to evaluate the effect of intravenous lidocaine on the manifestations of fibromyalgia. METHODS: A randomized, double-blind, comparative study was conducted on 30 patients. All patients received 25 mg amitriptyline. Group 1 (n = 15) received 125 mL of saline; group 2 (n = 15) received 240 mg lidocaine in 125 mL of saline once a week for 4 weeks. The following parameters were evaluated: clinical manifestations before and 4 weeks after treatment; pain intensity on a numerical scale. RESULTS: All patients were female, and the mean age was 44.7 +/- 10.5 years in group 1 and 40.9 +/- 11.6 years in group 2. No difference in pain intensity or the number of tender points was observed between groups at any time point. Both groups demonstrated a significant decrease in the two parameters after treatment. A significant reduction in sleep disorders, paresthesia, and headache was observed after treatment in the two groups, but there was no significant difference between groups. There was no significant reduction in fatigue, subjective edema or morning stiffness after treatment in either group, without a significant difference between groups. CONCLUSIONS: The addition of 240 mg intravenous lidocaine (once a week) to 25 mg amitriptyline for 4 weeks did not modify pain intensity or manifestations in patients with fibromyalgia compared with amitriptyline alone.

Myocardial infarction scar plication in the rat: cardiac mechanics in an animal model for surgical procedures.

BACKGROUND: The immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined. METHODS: Cardiac mechanics were analyzed before and after myocardial infarction scar plication in 11 isolated infarcted rat hearts. RESULTS: Despite a decrease in myocardial stiffness, an increase in chamber stiffness was noted after myocardial infarction scar plication. Systolic function was favored in more than one way. For the same diastolic pressures, maximal developed pressures were higher after myocardial infarction scar plication, and the slope of the systolic pressure-volume relationship was steeper afterwards as compared with before; this means that Frank-Starling recruitment is accentuated in smaller cavities. In addition, the developed net forces needed to generate these pressures were clearly lower afterward than before, indicating reduced ventricular afterload. CONCLUSIONS: The study results show that diastolic function is harmed and systolic function is favored by myocardial infarction scar plication. We suggest that preoperative evaluation of the degree of diastolic dysfunction and impairment of the Frank-Starling mechanism may help to identify patients who may have a poor postoperative outcome due to diastolic or systolic dysfunction.

Stentless valves treated by the L-hydro process in the aortic position in sheep.

Calcification of glutaraldehyde-treated bioprosthetic heart valves is a major cause of long-term failure. We studied porcine aortic valves treated by the L-Hydro process and implanted into 14 juvenile sheep (group 1). Another 10 sheep were implanted with glutaraldehyde-treated porcine bioprostheses (group 2). The animals were sacrificed after 150 days and the explanted valves were analyzed for calcification. Hemodynamic measurements by echocardiography and angiography were carried out prior to sacrifice. Macroscopic analysis showed calcification and loss of mobility of the leaflets in all group 2 implants and in one group 1 implant. Light microscopy showed foci of calcification in all group 2 implants and in 3 valves from group 1. A significant reduction in the level of calcification was found in porcine bioprostheses treated by the L-Hydro process and implanted into the juvenile sheep model.

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue