Acute compartment syndrome of the thigh complicated with a pseudoaneurysm of the arteria profunda femoris.

Compartment syndrome of the thigh and a pseudoaneurysm of the arteria profunda femoris are rare entities that usually occur independently. Untreated, both can lead to life-threatening complications making prompt diagnosis and management mandatory. The diagnosis of an acute compartment syndrome can be suspected clinically, and subsequently needs to be confirmed by intra-compartmental pressure measurement. Treatment should be done by urgent fasciotomy within 6 hours. A pseudoaneurysm can also be suspected clinically. Various imaging modalities exist to confirm the diagnosis, with duplex ultrasound being the diagnostic test of choice. Treatment is depending on the importance of clinical symptoms and on the size of the pseudoaneurysm. We present the first case in which an acute compartment syndrome of the thigh was complicated by a pseudoaneurysm of the arteria profunda femoris. The pseudoaneurysm was subsequently complicated by hemorrhage and infection.

Investigation the relaxant effects of proton pump inhibitors and their relaxation mechanism on sheep sphincter of Oddi.

BACKGROUND: Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications. STUDY AIMS: We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect. PATIENTS AND METHODS: The sheep SO was mounted in an organ bath filled with Krebs-Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10-6 mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs. RESULTS: The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca+2-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05). CONCLUSIONS: The present study suggests that PPIs create relaxation on SO partially via Ca+2-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.

Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies.

The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group (n = 50) and control group (n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) (n = 14) and aCL (-) (n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 (n = 15) and SLEDAI < 6 (n = 35); disease period ≥ 5 years (n = 21) and disease period < 5 years (n = 29); major organ involvement (+) (n = 19), major organ involvement (-) (n = 31). The ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E') for the study group was found to be higher than the control (p < 0.01). Systolic septal motion velocity (Ssm) was lower in the study group compared with the control (p < 0.01). Left atrium (LA) dimension was greater in the study group than the control (p < 0.01). Ssm was found to be lower in the aCL (+) patients compared with the control and aCL (-) groups (p < 0.01, p < 0.05, respectively). LA dimension was greater in the aCL (+) and (-) groups compared with the control, (p < 0.01, p < 0.05, respectively) and aCL groups compared with each other (p < 0.05). The E/E' ratio for the aCL (+) and (-) groups was found to be greater than the control (p < 0.05). In the study, both the Ssm and the late diastolic septal velocity (sA') was found to be lower in the SLEDAI ≥ 6 group compared with SLEDAI<6 group, (p < 0.001, p < 0.05, respectively). LA dimension was statistically greater in the SLEDAI ≥ 6 group compared with the SLEDAI <6 group (p < 0.001). E' and early diastolic septal velocity (sE') were statistically lower in the disease period >5 years group compared with the disease period <5 years group (p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.

Soluble guanylyl cyclase activators increase the expression of tolerance to morphine analgesic effect.

OBJECTIVES: It is aimed to investigate the effects of guanylyl cyclase activation and inhibition on acute morphine antinociception and the development of tolerance to its effect. BACKGROUND: Nitric oxide-soluble guanylyl cyclase signal transduction cascade suggested to play an important role in the development of tolerance to antinociceptive effects of morphine. METHODS: Nociception was evaluated by tail flick and hot plate tests in male Wistar rats. The analgesic effects of intraperitoneal protoporphyrin IX (PPIX; an activator of soluble guanylyl cyclase), 3-morpholinosydnonimine hydrochloride (SIN-1; NO donor and activator of guanylyl cyclase), S-Nitroso-N-acetylpenicillamine (SNAP; an activator of guanylyl cyclase), 3,3-Bis (amino ethyl)-1-hydroxy-2-oxo-1-triazene (NOC-18; NO donor activating guanylyl cyclase) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; an inhibitor of guanylyl cyclase) alone or in combination with subcutaneous morphine injection were evaluated. Their effects on morphine tolerance development were evaluated by giving these agents 20 minutes prior to twice daily morphine injection during tolerance development for 5 days. On day 6, the expression of morphine tolerance was determined. RESULTS: PPIX, SIN-1, SNAP and NOC-18 significantly increased expression of morphine tolerance while ODQ decreased. CONCLUSION: These data suggested that sGC activators have a significant role in tolerance to the analgesic effect of morphine (Tab. 1, Fig. 4, Ref. 29).

The effects of L type calcium channels on the electroencephalogram recordings in WAG/RIJ rat model of absence epilepsy.

BACKGROUND: Epilepsy is one of the most important central nervous system disorder and 1% of the total world population suffers from this disorder which require a chronic drug treatment. Most of the researchers suggested that excessive calcium entry into neurons is the main triggering event in the initiation of epileptic discharges but the role of L type calcium channels has not been clarified in absence epilepsy. AIM: In this study, it is aimed to investigate the antiepileptic effects of nifedipine, an L type calcium channel blocker and BAY K8644, an L type calcium channel opener in a genetic model of absence epilepsy in WAG/Rij rats. MATERIALS AND METHODS: Thirty two WAG/Rij rats were allocated into four groups; sham (only saline injected), only nifedipine (an L type calcium channel blocker) injected group (40 µg/2 µl; 60 µg/2 µl; 80 µg/2 µl), only BAY K8644 (1,4 Dihydro-2,6-dimethyl-5-nitro-4-trifluoromethyl- phenyl-3-pyridine carboxylic acid methyl ester) (L-type Ca2+-channel activator) injected group (40 µg/2 µl; 60 µg/2 µl; 80 µg/2 µl) and combination of their most effective doses BAY K8644 (60 µg/2 µl) after nifedipine (60 µg/2 µl) injected group. All agents were given by intracerebroventricular injection. The beta, alpha, theta and delta wave ratios of electroencephalogram recordings and the frequency and duration of SWDs (spike and wave discharges) were analyzed and compared between four groups. RESULTS: Nifedipine increased the number and duration of spike wave discharges whereas BAY K8644 decreased both of them. When BAY K8644 was given after nifedipine, there was no significant difference with control group. CONCLUSIONS: L type calcium channels play an activator role on spike wave discharges and have positive effects on the duration and frequency.

Effect of allograft amniotic membrane use on adhesion formation after Cesarean section in pregnant rat.

UNLABELLED: We aimed to investigate the effect of allograft amniotic membrane utilization to prevent the post-operative adhesion formation. BACKGROUND: In 24 pregnant inbreed Wistar-Albino rats, pregnancy was terminated by forming bilateral uterine horn defect via cesarean section at 20th gestational day. Rats were assigned in three groups randomly. METHODS: In the first group, abdomen closure was achieved without administration of any intra-peritoneal material following standard surgical intervention. In the second group Seprafilm was used to cover the defect at anterior horn of uterus; whereas amniotic membrane of the rat itself was used in the third group. After 3 weeks, all rats were sacrificed and re-laparotomy was performed to determine adhesions scores. RESULTS: No significant difference was found in adhesion scores between the group 1 and group 3 and also between group 2 and group 3, supporting the previous findings in the literature. CONCLUSION: We observed that direct application of allograft amniotic membrane, which is an adhesion barrier used after cesarean section, to injured surface had no effect in the prevention of adhesions (Tab. 3, Fig. 5, Ref. 28).

The effect of sorafenib in postoperative adhesion formation in a rat uterine horn model.

OBJECTIVE: Postoperative adhesions are a serious problem. In this study, we aimed to observe the effects of sorafenib in postoperative adhesions and, to examine the effects of sorafenib on tissue levels of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). MATERIAL AND METHODS: Twenty female Wistar albino rats were randomized into two equal groups; sorafenib group (sorafenib treated) and control group; then all rats underwent laparotomy. Adhesions were developed by scalping on the anti-mesenteric surfaces of the right uterine horns. After 14 days, adhesions were investigated by using macroscopic, histopathological and immunohistochemical (for VEGF and PDGF) methods. RESULTS: The sorafenib group had lower scores of total adhesions [1 (0-2.5) vs 1.5 (1-4); p: 0.037], staining of VEGF [1 (0-1) vs 1 (1-3); p: 0.029] and PDGF [1 (0-2) vs 2 (1-3); p: 0.006], and vascular proliferation [1 (0-2) vs 2 (1-3); p: 0.038] than the control group. CONCLUSION: The findings of the present study show that sorafenib, a tyrosine kinase inhibitor, significantly reduced postoperative adhesion formation. This effect may be explained by inhibition of VEGF, PDGF, and thus vascular proliferation.

Effects of systemic anti-androgen drugs on the ocular surface.

PURPOSE: To investigate the effect of systemic anti-androgen drugs on tear function tests and the ocular surface. METHODS: Sixty-four male subjects were included in this study. Subjects who were on anti-androgen treatment for prostate cancer (Group A, n: 31) and those who had received only surgical treatment for prostate cancer (Group B, n: 17) were recruited from the department of urology. Age-matched subjects who had never received anti-androgen treatment (Group C, n: 16) constituted the control group. Group A was divided into two subgroups according to the number of anti-androgen drugs used (Group A1: one drug, Group A2: two drugs). All cases underwent a complete ocular examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and ocular surface disease index (OSDI) questionnaire. RESULTS: The mean Schirmer's values were 6.87mm, 11.41mm, and 13.03mm in Groups A, B, and C, respectively (P=0.001). TBUT was 5.45±2.01, 9.85±2.52 and 9.81±1.96seconds in Groups A, B, and C, respectively (P=0.001). Schirmer and TBUT were significantly lower, and corneal staining and OSDI questionnaire scores were higher in Group A compared to groups B and C (P<0.01). Conjunctival impression cytology results according to the Nelson grading system revealed no statistically significant difference between the groups (P=0.422). CONCLUSION: Anti-androgen drugs alter tear function tests, cause increased corneal and conjunctival staining scores and worsen complaints of dry eye in patients with prostate cancer.

Intraoperative Cycling Pressure Variation in the Treatment of Central Retinal Artery Occlusion.

A 45-year-old male presented to the clinic of ophthalmology with central retinal artery occlusion (CRAO). There was no response to medical treatment, ocular massage, and anterior chamber paracentesis. CRAO was resolved by pars plana vitrectomy and intraoperative cycling pressure variation. The best-corrected visual acuity improved to 20/100 on the first day and to 20/20 on the first month, postoperatively.

Effect of Dexamethasone Implant on Subfoveal Choroidal Thickness in Early Period in Vitrectomized Eyes with Diabetic Macular Edema.

AIM: To investigate the change in subfoveal choroidal thickness (SFCT) in vitrectomized eyes with intravitreal dexamethasone (IVD) implant injection for the treatment of diabetic macular edema (DME). METHOD: In this prospective and controlled study, the vitrectomized eyes of diabetic patients were included. The study group (Group 1) was formed by diabetic vitrectomized eyes with DME. The control group (Group 2) was formed by diabetic vitrectomized eyes without DME. Only one intravitreal IVD implant was injected into the eyes in Group 1. In the first, second, and fourth months, choroidal layers were measured by optical coherence tomography and complete ophthalmologic examinations were performed for all cases. RESULTS: Ninety-six eyes of 96 cases were included in the study. There were 48 eyes of 48 different patients in each group. After IVD injection, statistically significant improvement was observed in the best corrected visual acuity in Group 1. The mean SFCT in eyes with DME was statistically significantly thinner (p < 0.01) and thinness became more pronounced during the four-month follow-up period after IVD implant injection (p < 0.01). CONCLUSION: In the presence of DME in vitrectomized eyes, the thinness of the SFCT may become evident after dexamethasone implant injection.

The Effect of the Idiopathic Epiretinal Membrane and Surgically Induced Posterior Vitreous Detachment on the Retinal Nerve Fiber Layer.

AIM: To investigate the changes in the retinal nerve fiber layer (RNFL) following pars plana vitrectomy (PPV) with surgically induced posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. METHODS: Patients with unilateral ERM with vitreomacular traction were included in this prospective, randomized, and controlled clinical trial. The control group (Group 1) was formed with the nonoperated fellow eyes of the patients, and the study group (Group 2) was formed with the eyes that underwent PPV including idiopathic ERM and ILM peeling. In the preoperative and postoperative periods (1st, 2nd, 3rd, 6th, and 12th months), complete ophthalmological examination of the eyes was performed and RNFL measurements were examined in 4 different quadrants (superior, temporal, inferior, and nasal) with the help of spectral domain optical coherence tomography (OCT). RESULTS: There was no statistically significant change in Group 1 during the follow-up period in all quadrants (p > 0.05). The mean RNFL thickness in Group 2 was statistically significantly higher than in Group 1 in superior, inferior, and temporal quadrants (p < 0.01), preoperatively. The mean RNFL in Group 2 was higher in the 1st, 2nd, 3rd, and 6th months and lower in the 12th month in superior, inferior, and temporal quadrants (p < 0.01) when compared to the preoperative period. The mean RNFL thickness in the nasal quadrant in Group 2 was higher in the 1st, 2nd, and 3rd (p < 0.01) months, same in the 6th month (p > 0.05), and lower in the 12th (p < 0.01) month when compared to the preoperative period. CONCLUSION: Idiopathic ERM may cause an increase in RNFL thickness in superior, inferior, and temporal quadrants with possible tractional effect. PPV with PVD induction and ERM and ILM peeling may cause these RNFL changes.

A Female Case of X-Linked Retinoschisis with Macular Hole Bilaterally.

PURPOSE: We aimed at reminding that X-linked retinoschisis may also be seen in female patients and share our vitreoretinal surgical experience. METHODS: The patient underwent pars plana vitrectomy including the closure of the macular holes with inverted ILM flap technique bilaterally. Lens extractions were performed by phacoemulsification during the removal of silicone oil endotamponade. Patient. An 18-year-old girl with X-linked retinoschisis and large macular holes in both eyes presented to the clinic of ophthalmology. It was confirmed that the patient had RS1 mutation. RESULTS: Nine-month-follow-up was uneventful for retinal findings. Significant improvement in visual acuity was achieved, and macular holes were remained closed. CONCLUSION: In cases with large macular holes due to XLR, an inverted ILM flap technique might be safe and effective. Four-month-silicone-endotamponade might be sufficient.

Comparing the Effect of Monofocal and Multifocal Intraocular Lenses on Macular Surgery.

AIM: To compare the effects of previously implanted monofocal and multifocal intraocular lenses (IOL) on macular surgery. METHODS: Seventy eyes of 70 patients with epiretinal membrane (ERM) and symptomatic vitromacular traction syndrome that previously had IOL implantation for cataract surgery were included in this prospective randomized clinical trial. Cases were divided into two groups. Group 1 and Group 2 were composed of eyes with monofocal and multifocal IOLs, respectively. The effects of refraction error and IOL decentration at the time of macular surgery performed for ERM and ILM peeling, according to the lens type, were investigated. Pars plana vitrectomy (PPV) was performed to peel ERM and ILM in all cases. Complete ophthalmological examination, fundus fluorescein angiography, and optical coherence tomography imaging were made to all cases, preoperatively and postoperatively. RESULTS: The mean BCVA in Group 1 and Group 2 improved from 0.69 ± 0.15 and 0.38 ± 0.14 logMAR to 0.40 ± 0.14 and 0.10 ± 0.04 logMAR, respectively, at the 6th month. There was no statistically significant difference between the groups in terms of the mean spherical refraction error (P > 0.05) and IOL decentration level (P > 0.05). The mean time required for macular surgery in Group 2 was statistically significantly longer than that for Group 1 (P < 0.05). There was no statistically significant relationship between IOL decentration and macular surgery time in Group 1 (P > 0.05), but there it was found in Group 2 (P < 0.05). In Group 2, there was a positive correlation between IOL decentration and macular surgery time. CONCLUSION: In cases with multifocal IOL implants, especially with lens decentration, the time of macular surgery for ERM and ILM peeling during PPV is longer than that of eyes with monofocal IOL due to fluctuations in the clarity of the surgeon's view.

Recurrent trauma histories of two 'unlucky teeth': 42-month follow-up.

The root fractures occur relatively rarely and account for 0.5-2.5% of all dental injuries. The fracture type, severity of dislocation, mobility of fragments and diastasis have negative influence on the healing process. The aim of this study was to describe the treatment and the 42-month follow-up period of three trauma histories in a 12-year-old patient in 1 year and to emphasize the negative effects of recurrent traumas on the healing pattern and prognosis of root fractures.

Griscelli syndrome: a case report of Reye's syndrome and atopic dermatitis history.

Griscelli syndrome (GS) is a rare autosomal recessive disorder that results in pigmentary dilution of the skin and the hair (silver hair), with the presence of large clumps of pigment in hair shafts, and an accumulation of melanosomes in melanocytes. Sixty cases of GS have been reported in the literature, but we could find no description of its oro-dental symptoms. Reye's syndrome (RS) is characterized by acute noninflammatory encephalopathy and renal and hepatic failure, while atopic dermatitis (AD) is a skin disorder with an immunologic basis. The aim of this paper is to describe the oro-dental and physical findings in a girl who had been diagnosed with GS at 3.5 years of age; she also had AD as well as a history of RS at infancy. We discuss the possible relationship between the three syndromes.

Experimental and theoretical studies on IR, Raman, and UV-Vis spectra of quinoline-7-carboxaldehyde.

Spectroscopic properties of quinoline-7-carboxaldehyde (Q7C) have been studied in detail both experimentally and theoretically. The FT-IR (4000-50 cm(-1)), FT-Raman (4000-50 cm(-1)), dispersive-Raman (3500-50 cm(-1)), and UV-Vis (200-400 nm) spectra of Q7C were recorded at room temperature (25 °C). Geometry parameters, potential energy surface about CCH(O) bond, harmonic vibrational frequencies, IR and Raman intensities, UV-Vis spectrum, and thermodynamic characteristics (at 298.15K) of Q7C were computed at Hartree-Fock (HF) and density functional B3LYP levels employing the 6-311++G(d,p) basis set. Frontier molecular orbitals, molecular electrostatic potential, and Mulliken charge analyses of Q7C have also been performed. Q7C has two stable conformers that are energetically very close to each other with slight preference to the conformer that has oxygen atom of the aldehyde away from the nitrogen atom of the quinoline.

Unilateral Congenital Lacrimal Fistula with Renal Agenesis and Pelvic Kidney: A Case Report and Review of the Literature.

A 12-year-old boy presented to the clinic of ophthalmology because of watering and discharge from his left lower eyelid. The inspection examination revealed an orifice that was associated with congenital lacrimal fistula (CLF). He underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings. Systemic evaluation revealed multiple renal anomalies: right renal agenesis and left ectopic pelvic kidney. This case is unique because this is the first reported case of CLF accompanied with ectopic pelvic kidney in the literature.

Heart failure during first inferior acute myocardial infarction.

BACKGROUND: Inferior acute myocardial infarctions (AMI) have better in-hospital prognosis than do anterior AMI. Authors of several studies reported that patients with inferior AMI complicated by atrioventricular block, concomitant precordial ST-segment depression and involvement of right ventricle have larger infarctions and a worse prognoses than do patients without these features. OBJECTIVE: To analyse the incidence, clinical course and in-hospital prognosis of patients with heart failure and first inferior AMI. METHODS: We analysed in 257 consecutive patients with first inferior AMI who had been admitted to the coronary care unit during January 1991 and March 1995. The clinical and electrocardiographic characteristics, as well as the morbidities and in-hospital mortalities, of groups of patients with and without heart failure during inferior AMI were compared. RESULTS: Symptoms and signs of heart failure were noted for 49 patients (19%). We found that patients who had suffered heart failure during inferior AMI were older (62.1 +/- 9.86 versus 58.78 +/- 10.58 years, P < 0.05) than those who had not suffered heart failure. There was no significant difference between patients' sex, history of diabetes mellitus, hypertension, smoking status, thrombolytic therapy, involvement of right ventricle and QRS score for these two groups. We found a greater prevalence of ST-segment depression (ST-segment depression > or = 1 mV in more than one precordial lead with maximal ST-segment depression in leads V4-V6) of V4-V6 precordial leads (57 versus 26%, P = 0.00002) and a lesser prevalence of no ST-segment depression (ST-segment depression < 0.1 mV in each precordial lead; 14 versus 38%, P = 0.001) among patients who had suffered heart failure. We found greater incidences of serious ventricular arrhythmias (53 versus 26, P = 0.0002) and ventricular tachycardiafibrillation (16 versus 7%, P = 0.03) among patients who had suffered heart failure than we did among those who had not. Third-degree atrioventricular block was more often found in patients who had suffered heart failure (23 versus 12%, P = 0.07) but this difference was not statistically significant. We found that the in-hospital mortality among patients who had suffered heart failure was much higher than that among those who had not (24.5 versus 3.8%, P = 0.000001). CONCLUSION: We found that heart failure occurs primarily in old patients, and in those with precordial ST-segment depression, especially in leads V4-V6. The patients who suffer heart failure have worse in-hospital prognosis due to serious ventricular arrhythmias and cardiogenic shock.

Early and late advanced atrioventricular block in acute inferior myocardial infarction.

BACKGROUND: Advanced atrioventricular block is a frequent complication in patients with inferior acute myocardial infarction (AMI); in patients in hospital, it often occurs concurrently with other complications and is associated with high mortality. Very little information is available about early and late advanced atrioventricular block in inferior AMI. We hypothesized that the time of appearance of advanced atrioventricular block characterized by poor response to atropine requiring temporary pacemaker therapy may affect the prognosis of patients with inferior AMI. METHODS: We studied 51 patients with inferior AMI and advanced atrioventricular block characterized by poor response to atropine requiring temporary pacemaker therapy. According to pre-established electrocardiographic criteria and the time of appearance of the advanced atrioventricular block, patients were divided into two groups: an early block group consisting of 30 patients who developed advanced atrioventricular block during the first 24 h of inferior AMI, and a late block group consisting of 21 patients who developed advanced atrioventricular block after the first 24 h of chest pain. RESULTS: The groups were similar regarding age, coronary risk factors, frequency of right ventricular infarction, QRS score, atrial and ventricular rates, the time of return to first-degree atrioventricular block, cardiac arrhythmias, heart failure and mortality. The early advanced atrioventricular block group included a greater number of men than did the late group (P = 0.017). CONCLUSION: These data suggest that the time of appearance of advanced atrioventricular block does not affect the prognosis of hospital patients with inferior AMI.

Effect of aminophylline in patients with atropine-resistant late advanced atrioventricular block during acute inferior myocardial infarction.

BACKGROUND: Advanced atrioventricular (AV) block is a frequent complication in patients with acute inferior myocardial infarction (AIMI). This conduction abnormality is associated with narrow QRS complex in conducted or junctional escape beats, suggesting that the site of block is the AV node; however, its pathophysiology has not been properly established. HYPOTHESIS: This study investigated the effect of aminophylline in eight patients (5 men, 3 women, age range 51 to 78 years, mean 67.5 +/- 8.8 years) with atropine-resistant late advanced AV block during AIMI. METHODS: Advanced AV block was late in appearance in all patients, starting 2 to 5 days after AIMI, and consisted of second-degree Mobitz II type in two patients and of complete AV block in six patients; all patients had narrow QRS complexes. Before aminophylline administration, all patients had a temporary pacemaker installed which was switched off throughout the study. They were given intravenous atropine (1 mg) that was found to be ineffective. One-half h after atropine, the first aminophylline injection (240 mg) was given intravenously over 10 min. One h following the first injection, a second aminophylline dose (240 mg) was administered. Electrocardiographic rhythm strips were obtained before and after drug administration, and the type of AV block and atrial and ventricular rate were noted. RESULTS: Aminophylline restored 1:1 conduction with first-degree AV block in six patients, Mobitz I AV block in one patient, and normal sinus rhythm in one patient. Mean atrial and ventricular rates before aminophylline were 104 +/- 16 beats/min and 57 +/- 9 beats/min, respectively, and after drug administration 95 +/- 25 beats/min and 89 +/- 17 beats/min, respectively, (p = 0.012). CONCLUSION: These results indicate that aminophylline improves AV conduction in atropine-resistant late advanced AV block complicating AIMI.