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At least 631 records · Page 35Linked to original sources
PubMed2006

Antiarrhythmic efficacy of azimilide in patients with atrial fibrillation. Maintenance of sinus rhythm after conversion to sinus rhythm.

BACKGROUND: Azimilide dihydrochloride (azimilide) is an investigational antiarrhythmic drug that has been tested in patients with a variety of arrhythmias. In patients with atrial fibrillation, it has shown excellent efficacy in some previous trials and minimal efficacy in others. METHODS: Patients who had symptomatic atrial fibrillation for > 48 hours but < 6 months were eligible for this multicenter, randomized, placebo-controlled clinical trial. Patients were admitted to a hospital and randomly assigned to receive either azimilide 125 mg or a matched placebo twice daily for 3 days and then once daily. Patients who were in sinus rhythm spontaneously or had sinus rhythm restored by electric cardioversion on day 4 were discharged from the hospital. Recurrence of atrial fibrillation was documented by electrocardiogram. In the primary efficacy analysis, time to recurrence in the 2 treatment groups was compared with the log-rank test in the subgroup of patients with structural heart disease. Safety was assessed as deaths, adverse events, and serious adverse events. RESULTS: A total of 446 patients were randomized in the study; 314 were in the subgroup with structural heart disease. The median time to arrhythmia recurrence in both treatment groups with structural heart disease was 13 days, and the difference between treatments was not significant (P = .4596, n = 314). The relative risk for recurrence (placebo:azimilide) was 1.104 (95% CI 0.849-1.436). There was 1 death in the placebo group and 3 in the azimilide group. CONCLUSIONS: Azimilide did not demonstrate clinically important or statistically significant efficacy in reducing the risk for arrhythmia recurrence in patients with structural heart disease who were in atrial fibrillation and converted to sinus rhythm.

Aged↗
PubMed1984

Latent abnormalities of sinus node function in patients with organic heart disease and normal sinus node on clinical basis.

Sinus node (SN) function was analyzed in 22 patients (mean age: 46.2 +/- 12.9 years) with organic heart disease and normal SN on clinical basis (group I) and in 20 normal subjects (mean age: 43.9 +/- 15.6 years), (control group). Sinus cycle length (SCL), corrected sinus node recovery time (CSRT) and sinoatrial conduction time (SACT) were analyzed. After the control study, autonomic blockade (AB) was induced by i.v. propranolol (0.2 mg/Kg) and atropine (0.04 mg/Kg). Measurements of SCL, CSRT and SACT were then repeated. The mean SCL values were very similar in the two groups during the control state and after AB. There were no significant differences in SACTs between the two groups during the control state or after AB. On the contrary, the CSRT of group I was significantly longer than that of control group during the control state (344.8 +/- 78.9 versus 262.2 +/- 46.3 msec, P less than 0.001) and after AB (238.9 +/- 72.8 versus 166.8 +/- 39.3 msec, P less than 0.001). The analysis of real depression of SN automaticity (CSRT minus SACT) in the two groups shows that prolongation of CSRT in group I during the control study and after AB is related to an intrinsic abnormality of SN automaticity; on the contrary, no dysfunctions of the autonomic nervous system appear. These data indicate that the intrinsic abnormality of SN automaticity represents the earliest involvement of the SN in subjects with organic heart disease and normal SN on clinical basis, although this conclusion is speculative and requires experimental verification.

Adolescent↗
PubMed2003

Does sinus rhythm beget sinus rhythm? Effects of prompt cardioversion on the frequency and persistence of recurrent atrial fibrillation.

Recent clinical and experimental studies have demonstrated that atrial fibrillation (AF) alters the electrical and mechanical remodeling of the atrium, which subsequently promote the maintenance and recurrence of AF. If atrial remodeling can be prevented with prompt and repeated cardioversion, the likelihood of AF recurrence may be reduced. Recent clinical studies have demonstrated that the strategies of transesophageal echocardiography facilitated early cardioversion and early repeated cardioversion may be clinically valuable in some patients who have persistent AF and recurrence of arrhythmia after the initial cardioversion. Furthermore, the use an implantable atrial defibrillator (IAD) for early repeated device-based cardioversion to maintain sinus rhythm appears to be safe and clinically feasible. Early cardioversion by IAD reduces AF burden, reverses atrial remodeling and prevents subsequent AF recurrence in selected patients without structural heart disease implanted with this device, indicating possible "sinus rhythm begets sinus rhythm". Despite encouraging initial observations, further long-term clinical studies in a larger patient population are needed to confirm this finding. Furthermore, whether the use of IAD in the fully automatic mode to provide immediate termination of AF episodes could intensify the potential beneficial effect and the clinical efficacy of this approach in patients with structural heart disease needs to be evaluated.

Atrial Fibrillation↗
PubMed1996

Comparison of continuously recorded sensor and sinus rates during daily life activities and standardized exercise testing: efficacy of automatically optimized rate adaptive dual sensor pacing to simulate sinus rhythm.

The normal sinus rhythm remains the gold standard to compare the rate response of a rate adaptive pacemaker. The aim of this study was to assess an automatically optimized dual sensor system by continuous comparison of the normal sinus (SR) and sensor indicated rates (SIR). Twelve patients with complete heart block (mean age 60 +/- 9 years) with normal sinus rhythm received a dual sensor pacemaker driven by combined, automatically adaptive activity and QT sensors. After 1 month of automatic adaptation, patients performed a treadmill exercise in the VDD mode with simultaneous collection of SR and combined SIR. Thereafter the difference between SR and SIR was recorded over a 1-month period using a software downloaded into the pacemakers, with the patients ambulatory during this period. During exercise testing, the SR and SIR were significantly correlated (r = 0.96 +/- 0.02, P < 0.001), and the mean difference between SR and SIR was 4.01 +/- 4.47 beats/min. The percentages of paced beats, over the 1 month ambulatory period, that exhibited a difference between SR and SIR of 8 beats/min were 98% +/- 2%, 90% +/- 4% and 67% +/- 8% for low, medium, and high workloads, respectively (P < 0.05, ANOVA), whereas > 95% of SIR were within 15 beats/min of SR independent of the level of activities. Thus, an automatically programmed dual sensor gives an accurate reflection of SR during exercise. SIR was less accurate for more vigorous daily life activities, but most of the SIR were within the normal SR variation of 15 beats/min.

Activities of Daily Living↗
PubMed2004

Does sinus rhythm beget sinus rhythm? Long-term follow-up of the patient activated atrial defibrillator.

The aim of this study was to determine the effect of early patient activated cardioversion of atrial fibrillation (AF) using the atrial defibrillator on recurrence of AF. Fifteen patients, mean age 63 +/- 14 years, 80% men, with drug-resistant persistent AF were implanted with the Jewel AF atrial defibrillator. All patients performed self-administered cardioversion for AF recurrences. Over a 2 year follow-up, 238 patient-activated cardioversions were performed in 14 patients. Sinus rhythm was restored on every occasion with 96% of episodes terminating with a single shock. The median time from AF onset to patient awareness of symptoms was 2.5 hours. The median time from onset of symptoms to cardioversion was 3.5 hours. Comparison of the first and second six month period following implant showed a nonsignificant increase in mean total AF duration (75.7 +/- 107.8 hours vs 146.6 +/- 194.1 hours, P = 0.28). Two patients (13%) had a decreasing frequency of AF recurrences. The majority continued to have regular recurrences of AF. The atrial defibrillator is an extremely effective method of restoring sinus rhythm in patients with persistent AF. Regular early use of the atrial defibrillator, increased the duration of sinus rhythm in a minority of patients during long-term follow-up. Most patients had regular recurrences of AF requiring patient-activated cardioversion.

Adult↗
PubMed1989

Coronary sinus pressure and arterial flow during intermittent coronary sinus occlusion.

The relationship between coronary artery flow and coronary venous pressure during intermittent coronary sinus occlusion was studied in dogs at normal perfusion, left anterior descending artery occlusion, and reperfusion. Coronary sinus occlusion and release phases were varied systematically. The periodicity of the data and the assumption of a linear relationship between pressure and flow suggested Fourier analysis as a methodological approach. To show the systematic slow oscillations of coronary venous pressure and arterial flow induced by intermittent occlusion of the coronary sinus, the data were smoothed by superimposing consecutive cycles of identical occlusion-release timing and filtering the higher frequencies. A small number of Fourier components, corresponding to the time scale of the respective occlusion-release cycle, was sufficient to study the long wavelength behavior. The effect of arbitrarily varying the occlusion-to-release ratio at a given total cycle length was investigated in hypothetical pressure and flow curves based on interpolation of experimental Fourier coefficients. By means of a transfer function relating pressure and flow in the frequency domain, it was possible to predict the arterial flow curve using coronary venous pressure measurements only. Because at zero frequency the pressure-flow relationship cannot be assumed to be linear, the mean value of flow could not be obtained in this way. However, the deviation of flow from the mean, i.e., the shape of the flow curve, was reproduced satisfactorily.

Animals↗
PubMed1985

An enzyme histochemical study of human sinus node, coronary sinus, and mitral valve muscle.

An enzyme histochemical study of the sinoatrial node, the coronary sinus, and the atrial muscle extending into the anterior mitral valve was performed on human hearts. Investigation of the activity and localization of the structurally bound enzymes was performed by conventional histochemical techniques. Determination of the activity of nonstructurally or weakly structurally bound enzymes was performed by histochemical techniques in which leakage of enzymes during the incubation period was reduced by the application of semipermeable membranes. The sinoatrial node is characterized by a high degree of anaerobic enzyme capacity and a relatively low degree of aerobic enzyme capacity. The discriminatory nature of these reactions allows examination of the structure of the sinoatrial node and its approaches. The presence of transitional cells was confirmed; isolated clusters of nodal cells were found in the atrial myocardium around the sinoatrial node, but no evidence of specialized tissue forming the beginning of an internodal pathway was found by this technique. The specific histochemical reactions that characterize the sinoatrial node also occur in the atrial muscle, extending into the anterior mitral valve, the anterior wall of the coronary sinus, and the atrial tissue near the orifice of the coronary sinus. These observations seem to corroborate the hypothesis that arrhythmic ectopic foci can arise in these regions.

Acetylcholinesterase↗
PubMed1993

[Comparison between the blood from orbital sinus and heart in analizing plasma biochemical values--increase of plasma enzyme values in the blood from orbital sinus].

Plasma biochemical values, blood urea nitrogen (BUN), glucose, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CPK), were compared between the samples collected from orbital sinus, heart and tail vein in mice, rats and hamsters. The significant higher values of AST, LDH and CPK were shown in samples from orbital sinus as compared with that from other sites. The blood from orbital sinus was bleeding by two methods and compared in the plasma enzyme values. It is suggested that the leakages of these enzymes from destroyed ocular tissues result in the increase of the plasma enzyme values.

Animals↗
PubMedDate not supplied

Paranasal sinus radiology, Part 4B: Maxillary sinuses.

The maxillary sinus is frequently involved by inflammatory change. It is also the sinus that is most often affected by intrinsic or neighboring neoplasms. Since neoplasia and inflammatory disease may mimic each other, radiologic examination often becomes the principal means of differentiating them. Principles of radiologic diagnosis, with attention to changes in the various bony margins in maxillary disease processes, form the basis of this article.

Humans↗
PubMed1999

Urokinase-type plasminogen activator and plasminogen activator inhibitor antigen in tissue extracts of paranasal sinus mucous membranes affected by chronic sinusitis and antrochoanal polyps.

We examined the effect of pH on the extraction of urokinase-type plasminogen activator (u-PA) and plasminogen activator inhibitor-1 (PAI-1) from paranasal sinus mucous membrane associated with chronic sinusitis and antrochoanal polyps. The specific activity of u-PA extracted with buffer at pH 7.4 was stronger than that extracted with buffer at pH 4.2. The antigen level of u-PA extracted with the acidic buffer was significantly higher than that extracted with the neutral buffer. In contrast, the difference in antigen levels of PAI-1 extracted with the acidic buffer and neutral buffer was not significant. Based on these results, we inferred that the u-PA-PAI-1 complex was extracted by the acidic buffer and the activity of u-PA was therefore decreased.

Antigens↗
PubMed1991

Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome.

It is generally accepted that a positive response to carotid sinus massage (CSM) or head-up tilt (HUT) in patients affected by syncope suggests a reflex cause of the syncope. To study the role of the autonomic nervous system in causing syncope in the sick sinus syndrome (SSS), CSM and HUT were performed in 35 consecutive patients (20 men, mean age 70 +/- 9 years) with syncope and SSS. Results were compared with those in 35 patients affected by syncope that, despite careful cardiovascular and neurologic examination, were of uncertain origin (21 men; mean age 68 +/- 9 years) and with those of 35 subjects without syncope (20 men; mean age 69 +/- 10). All patients underwent CSM in the supine and standing positions for 10 seconds and HUT to 60 degrees for 60 minutes. In the patients with SSS, the full reproduction of spontaneous symptoms by CSM occurred in 21 (60%) and by HUT, in 19 (54%). At least 1 test was positive in 28 patients (80%): cardioinhibitory or mixed responses in 69%, vasodepressor responses in 11%. The percentages of positive tests in the patients with syncope of uncertain origin were similar to or slightly less than those of patients with SSS (CSM 63%, HUT 26%, overall 74%) with cardioinhibitory or mixed responses in 54% and vasodepressor in 20% (p less than 0.05). In control subjects, syncope was induced by CSM in 1 (3%) and by HUT in 2 (6%); overall positivity was 9%. In conclusion, in most patients affected by syncope and SSS, an abnormal neural reflex probably plays a major role in causing syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Update on diagnosis and treatment of sinus disease: the functional endoscopic sinus surgery approach.

This article presents the latest techniques used to provide more accurate diagnosis and medical therapy for the patient with sinus disease. These techniques also provide the tools for performing more meticulous surgery and precise postoperative care and follow-up for patients with a multitude of sinus symptoms. The methods of diagnosis and medical management, indications and technique of surgery, and postoperative care and results are discussed.

Adult↗
PubMed2002

In vitro activity of gemifloxacin compared to seven other oral antimicrobial agents against aerobic and anaerobic pathogens isolated from antral sinus puncture specimens from patients with sinusitis.

Using a microbroth method for aerobes and agar dilution for anaerobes, we studied the comparative in vitro activity of gemifloxacin, three fluoroquinolones, two macrolides and two beta-lactams, against 207 aerobic and 162 anaerobic antral sinus puncture isolates. Gemifloxacin was active at < or = 0.25 ug/mL against 198/207 [96%] aerobes and 127/162 [78%] anaerobes or 325/369 [88%] of all isolates and was the most active quinolone on a weight basis against Gram-positive organisms. All Haemophilus and Moraxella species were susceptible to < or =0.06 ug/mL of gemifloxacin. Thirty-five anaerobic isolates [35/162, 22%] required > or =0.5 ug/mL of gemifloxacin for inhibition, including all Prevotella species [all except one strain of P. bivia were susceptible to < or = 2 ug/mL] and occasional strains of Bacteroides uniformis, Bacteroides fragilis, Bilophila wadsworthia, Peptostreptococcus magnus, Peptostreptococcus micros, Propionibacterium acnes, and Veillonella species. All fusobacteria were susceptible to < or =0.25 ug/mL of gemifloxacin. Based on our in vitro study results, we conclude that gemifloxacin may offer a therapeutic alternative for sinus infections.

Anti-Bacterial Agents↗
PubMed1991

Patrick Watson-Williams and the concept of focal sepsis in the sinuses: an historical caveat for functional endoscopic sinus surgery.

From 1900 to 1940 the theory of focal sepsis was invoked to justify a number of dubious surgical procedures. Surgeons believed they were acting rationally. Patrick Watson-Williams advocated suction exploration of the paranasal sinuses for mental patients, claiming to cure criminal insanity by sphenoidotomy. Favourable contemporary reviews showed international approval. The rational basis of treatment was emphasised, but there was little systematic evaluation of outcome. Current enthusiasm for functional endoscopic sinus surgery is also based on a rational approach, logical deductions from pathophysiological 'facts'. Outcome has still not been evaluated scientifically. We should learn from history. Treatment should not be based too readily on what seems to be rational now. Ideas of physiology and pathology change. What seems logical today may appear ridiculous tomorrow. Careful analysis of outcome, preferably by controlled clinical trials, is needed as a rational treatment requires empirical validation just as much as any other.

Endoscopy↗
PubMed2000

Sinusitis as the first indication of sarcoidosis an incidental finding in a patient with presumed 'odontogenic' sinusitis: case report.

Involvement of the paranasal sinuses and nose by sarcoidosis is uncommon, and has been reported in only 1-4% of patients with sarcoidosis. Clinical symptoms are nasal obstruction, epistaxis, nasal pain, discharge, anosmia or hyposmia, epiphora, and dyspnoea. We present a case of sarcoidosis in which sinusitis was the first clinical sign of the disease.

Diagnosis, Differential↗
PubMed2002

Tele-3-dimensional computer-assisted functional endoscopic sinus surgery: new dimension in the surgery of the nose and paranasal sinuses.

One of the main objectives of our 3-dimensional (3D) computer-assisted functional endoscopic sinus surgery was to design a computer-assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high-speed, wide-bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele-flythrough or tele-virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele-3D computer-assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.

Adult↗
PubMed2002

Cavernous sinus involvement by extramedullary plasmacytoma of the sphenoid sinus. An argument for the use of adjuvant chemotherapy.

A 63-year-old man with cavernous sinus involvement from extramedullary plasmacytoma (EMP) of the sphenoid sinus is described. Transient resolution of retro-orbital headache and continued progression of the locally extensive tumor were noted after chemotherapy was given following a poor response to 5400 cGy of local irradiation. To determine whether adjunctive chemotherapy will improve the outcome of these particular patients, we propose that a randomized trial comparing radiotherapy to chemoradiation be conducted.

Aged↗
PubMed1989

Allergic fungal sinusitis presenting as a paranasal sinus tumour.

Allergic fungal rhinosinusitis is a rare complication of atopic upper airways disease which may present initially as an expansive tumour of the paranasal sinuses. This reported case was caused by the rare fungal pathogen Bipolaris hawiiensis and illustrates typical clinical and laboratory features of this disorder. Although the optimum management of allergic fungal sinusitis is controversial, combined therapy with surgical clearance, antifungal agents and corticosteroids produced a favourable outcome.

Adult↗