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At least 19 recordsLinked to original sources

Shifting of dural arteriovenous malformation from the cavernous sinus to the sigmoid sinus to the transverse sinus after transvenous embolization. A case of left spontaneous carotid-cavernous sinus fistula.

The angiographic features of left spontaneous carotid-cavernous sinus fistula and multiple dural arteriovenous malformations that developed after transvenous embolization are described. A dural arteriovenous malformation involving the left sigmoid sinus was demonstrated, along with a marked decrease in size of the left carotid-cavernous sinus fistula and the disappearance of venous drainage from the left cavernous to the right cavernous sinus after embolization with spring coils via the left superior ophthalmic vein. The dural arteriovenous malformation of the left sigmoid sinus subsequently extended to the transverse sinus after partial embolization of the sigmoid sinus. Finally, a dural arteriovenous malformation involving the left transverse sinus developed, with the disappearance of the arteriovenous malformation affecting the sigmoid sinus and left carotid-cavernous sinus fistula following complete embolization of the sigmoid sinus via the left transverse sinus.

Adult

The duration of the sinus node depolarization on transvenous sinus node electrograms can identify sinus node dysfunction and can suggest its severity.

Catheter recorded sinus node electrograms (SNE) allow visualization of sinus node depolarization (SND). The SND on a bipolar SNE is probably a composite reflecting both P cell action potentials and intranodal conduction. Reduced rate of rise, prolonged action potential duration and/or delayed intranodal conduction might each prolong the SND duration. Thus, SND duration might reflect several clinically important sinus node abnormalities and aid in the recognition of sick sinus syndrome. Moreover, the SND duration might be expected to be the most prolonged in patients with the most severe sinus node dysfunction. To test this hypothesis, we determined SND duration in 32 patients and correlated it with the presence or absence of evidence of sinus node dysfunction by ECG and/or electrophysiological (EP) studies. Seven patients had no sinus node dysfunction (group 1); 10 patients had mild sinus node dysfunction (a single abnormality of corrected sinus recovery time, sinoatrial conduction time, PCLp, or ECG) (group 2); and 15 patients had two or more abnormalities electrocardiographically and/or by EP testing (group 3). The SND duration (mean/range) was 129/95-190 msec in group 1, 151/95-225 msec in group 2, and 196/140-260 msec in group 3. In group 3, three patients who had ECG evidence of sick sinus syndrome and abnormalities on all three EP parameters, the SND duration was 230/200-260 msec. Carotid sinus massage (CSM) was found to prolong the SND duration in 5/7 patients in groups 2 and 3 where the SND could be measured both before and during CSM. CSM was necessary to allow visualization of the SND in 3/7 group 1 patients; thus their recorded values may be falsely long. The normal with a SND duration greater than 150 (190 msec) had it measured during CSM. None of the group three patients with SND duration less than msec had a prolonged CSRT or ECG evidence of sick sinus syndrome. Literature review revealed SNE recordings on 18 patients with sick sinus syndrome on which the SND duration could be measured; it was greater than or equal to 200 msec in all. Thus, the SND duration appears to reflect the presence and degree of sinus node dysfunction. Sinus node dysfunction appears unlikely if the SND duration is less than 150 msec and is likely to be severe if the SND duration is greater than 200 msec.

Adult

Effects of digoxin on sinus nodal function before and after vagal blockade in patients with sinus nodal dysfunction: a clue to the mechanisms of the action of digitalis on the sinus node.

To increase the limited knowledge of the effects of digitalis on sinus nodal function in patients with sinus nodal dysfunction and to initiate an investigation into the mechanisms underlying its effects, 34 patients with sinus nodal dysfunction were studied. Twenty patients underwent determination of sinus cycle length, estimated sinoatrial conduction time and maximal corrected sinus recovery time before and after the administration of 0.75 mg of intravenous digoxin. For the group, sinus cycle length did not change, sinoatrial conduction time increased insignificantly and maximal corrected sinus recovery time shortened; however, individual variation occurred. The effects of acute digitalization appeared to predict the effects of chronic digitalis administration on sinus nodal function in the eight patients who subsequently continued to take digoxin. Fourteen patients received digoxin after vagal blockade with atropine. After vagal blockade, digoxin lengthened sinus cycle length, sinoatrial conduction time and maximal corrected sinus recovery time. The effects of digoxin administered after atropine could be antiadrenergic, direct, or both, and are opposite to those induced by atropine alone. Because these effects are similar to those of vagotonia yet are not apparent when the vagi are unblocked, digoxin may have direct excitatory, adrenergic or previously unrecognized vagolytic effects on sinus nodal function in man and their manifestation may be dependent on heart rate or autonomic tone.

Adult

[Clinical feature of odontogenic maxillary sinusitis--symptomatology and the grade in development of the maxillary sinus in cases of dental maxillary sinusitis].

Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of the second and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal discharge from an early stage. The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.

Adolescent

Papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as cavernous sinus syndrome. A case report.

Primary carcinoma of the sphenoid sinus is a rare tumor that may present with dramatic neuro-ophthalmological-symptoms and signs of which spheno-cavernous syndrome is the best known clinical entity. The most frequently encountered histological types of the sphenoid carcinomas are squamous cell carcinoma and papillary carcinoma, in decreasing order of frequency. In this article, a papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess is presented. We are not aware of previously reported papillary carcinoma of the sphenoid sinus associated with sphenoid sinus abscess presenting as a cavernous sinus syndrome.

Abscess

Sinus node echoes and concealed concealed conduction: additional sinus node phenomena confirmed in man by direct sinus node electrography.

Direct sinus node electrography has been previously used to assess several aspects of sinus node physiology: sinus node pauses, overdrive suppression, sinoatrial entrance block. This report presents data in which sinus node electrograms confirm two additional physiologic phenomena in man: concealed conduction in the sinoatrial junction and sinus node reentry. These findings verify the presence of previously suspected phenomena by careful deductive analysis of electrocardiographic and electrographic tracings.

Adult

Developmental aspects of the sinus valves and the sinus venosus septum of the right atrium in human embryos.

In 32 human embryos from 5 to 27 mm of length, stages 13 to 23 (according to the Carnegie system of stages), the contributions of the sinus venosus septum and the right sinus valve of the right atrium to the formation of the Eustachian and Thebesian valve were examined by scanning electron microscopy. The sinus septum takes part in the subdivision of the right sinus valve into the Eustachian and the Thebesian valves. From its first origin the sinus septum forms a septal structure between the orifices of the right hepatic vein (hepatic portion of the inferior caval vein), the precursor of the inferior caval vein, and the left horn of the sinus venosus, the precursor of the coronary sinus. Before the incorporation of the sinus venosus into the right atrium, it has an intra-sinusal position, and extends between the bases of the left and the right sinus valve. During the incorporation of the sinus venosus into the right atrium the sinus septum receives an intra-atrial position, and its positional relationships to the sinus valves and the orifices of the corresponding veins remain unchanged in principle. Due to the connection between the sinus septum and the right sinus valve, after completion of the incorporation of the sinus, the superior portion of the right sinus valve branches y-like into a lateral limb, (i.e. its original inferior portion) and into a medial limb, (i.e. the sinus septum).(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Septum

[Cardioinhibitory carotid sinus hypersensitivity in subjects with symptomatic sinus dysfunction].

Cardioinhibitory carotid sinus hypersensitivity is present in about one third of patients affected by sinus dysfunction. Aim of the study was to evaluate whether carotid sinus hypersensitivity is related to a well defined (intrinsic or extrinsic) sinus node damage. Fifty-four patients with ecg signs of sinus dysfunction underwent an electrophysiological study and carotid sinus massage. Spontaneous heart rate and corrected sinus node recovery time were measured in basal condition, after adrenergic blockade (propranolol 0.2 mg/Kg i.v.) and after autonomic blockade (propranolol 0.2 mg/Kg i.v. plus atropine 0.04 mg/Kg i.v.). The association between sinus dysfunction and cardioinhibitory carotid sinus hypersensitivity was found in 18/54 pt. (16 men, 2 women; mean age +/- 1 SD 63.6 +/- 14.5 years). The remaining 36 patients (19 men, 17 women; mean age +/- 1 SD 65.8 +/- 9.8 years), affected by sinus dysfunction alone, were used as controls. No electrophysiological differences between the two groups were found; particularly, an abnormal intrinsic heart rate (according to Jose values) or an abnormal intrinsic corrected sinus node recovery time (greater than 385 msec.) were present in 83% of the patients in both groups. Among sinus dysfunction clinical features, heart rate, presence of spontaneous syncope, sino-atrial block or sinus arrest and organic heart disease were similar in the two groups while the percentage of patients with spontaneous atrial tachyarrhythmias (bradi-tachy syndrome) was significantly smaller (11% vs 44%; p less than 0.01) in carotid sinus hypersensitivity group. In conclusion, in sinus dysfunction patients, the presence of carotid sinus hypersensitivity cannot be used as a criterion to differentiate a subgroup with peculiar clinical and electrophysiological sinus node characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Sinus node electrogram in patients with the hypersensitive carotid sinus syndrome.

Sinus node electrograms were obtained in two patients with unexplained syncope and the cardioinhibitory form of the hypersensitive carotid sinus syndrome. Direct recordings of sinus node potentials were obtained using a transvenous electrode catheter. Sinus node function was normal in both patients during standard electrophysiologic evaluation. Carotid sinus massage was performed in both patients and the sinus node electrogram was continuously recorded. After the onset of carotid sinus massage, prolongation of sinoatrial time, slowing of sinus rate of depolarization, sinoatrial exit block and finally sinus node arrest were recorded. After termination of carotid sinus massage, sinus node potentials did not precede the first atrial impulse; subsequent beats showed markedly prolonged sinoatrial times as well as changes in the P wave on the surface electrocardiogram. Sinus rate and sinoatrial time returned to control values gradually, as did the P wave configuration. Intravenous atropine (1.0 mg) abolished the abnormal response to carotid sinus massage. It is concluded that the application of carotid sinus massage in patients with the hypersensitive carotid sinus syndrome produces profound changes in sinoatrial conduction including sinoatrial exit block, as well as shifts in primary pacemaker site and sinus node arrest. These alterations in conduction and automaticity are reversible with atropine and may be secondary to denervation sensitivity to acetylcholine.

Aged

The dynamics of antegrade cardioplegia with simultaneous coronary sinus occlusion. Effects on aortic root infusion pressure, coronary sinus pressure, and myocardial cooling.

It has been suggested that antegrade cardioplegia with coronary sinus occlusion improves homogeneous myocardial cooling and reduces myocardial injury in the presence of coronary artery occlusion. Little data are available on the exact relationships among the basic elements or this intervention, including antegrade infusion rate, aortic root pressure, the degree of coronary sinus occlusion, coronary sinus pressure, and myocardial cooling. The purpose of this study was to determine these relationships and to provide some basic guidelines for better understanding of this intervention. Twenty-two sheep were placed on cardiopulmonary bypass, the distal left anterior descending artery was occluded, and the proximal coronary sinus was snared. Sixteen combinations of infusion rate (3, 5, 7, or 9 ml/kg/min) and coronary sinus occlusion (total, subtotal, or moderate occlusion or no occlusion) were adopted for each 2 minutes of antegrade cardioplegia, yielding 96 measurements. Myocardial temperatures in the occluded and nonoccluded regions, aortic root infusion pressure, and coronary sinus pressure were measured during each infusion of cardioplegic solution. Coronary sinus occlusion was then released, and the whole heart was reperfused for 30 minutes for another infusion of cardioplegic solution and measurements. Results showed good degrees of linearity between infusion rate and aortic root infusion pressure for all coronary sinus occlusion and noninfusion groups (p less than 0.01). A positive effect of coronary sinus occlusion on aortic root infusion pressure was observed. The graded increases in infusion rate with various degrees of coronary sinus occlusion were constantly associated with elevation of coronary sinus pressure (p less than 0.01). It was also noted that myocardial temperatures in the region of the occluded left anterior descending artery were significantly lower in coronary sinus occlusion groups than in nonocclusion groups (p less than 0.01 or 0.05). Myocardial temperature in the nonoccluded region decreased significantly with the stepwise increases in infusion rate (p less than 0.01), but not with the increases in coronary sinus occlusion (not significant). Based on this and previous studies, we recommend that the induced coronary sinus pressure be safely maintained in the range of 25 to 35 mm Hg and that further studies be focused on the infusion rate of 5 ml/kg/min with subtotal or total coronary sinus occlusion for the intervention of antegrade cardioplegia plus coronary sinus occlusion.

Animals

Sinus automaticity and sinoatrial conduction in severe symptomatic sick sinus syndrome.

Electrophysiologic studies with recordings of sinus node electrograms were performed in 38 patients with severe symptomatic sick sinus syndrome. Thirty-two of the 38 patients had episodic tachyarrhythmias and 17 presented with syncope. The clinically documented sinus or atrial pause was 5.6 +/- 2.8 s (mean +/- SD). Patients were divided into three groups according to electrophysiologic findings. Group I consisted of nine patients with complete sinoatrial block. Sinus node electrograms were recorded during the episodes of long pauses. Seven patients had unidirectional exit block, with the atrial impulse being capable of retrograde penetration to the sinus node causing suppression of sinus automaticity; two had bidirectional sinoatrial block. Group II consisted of 22 patients with either 1:1 sinoatrial conduction (group IIa = 13 patients) or second degree sinoatrial exit block (group IIb = 9 patients) during spontaneous sinus rhythm. Sinoatrial exit block, ranging from 1 to greater than 14 sinus beats, was observed during postpacing pauses that ranged from 1,650 to 37,000 ms (mean 7,286 +/- 6,989). The maximal sinus node recovery time ranged from 770 to 5,580 ms (mean 3,004 +/- 1,686) and was normal in 5 patients and prolonged in 17. Group III consisted of seven patients with no recordable sinus node electrogram, reflecting either a technical failure or a quiescence of sinus activity. The sinus node recovery time in these seven patients ranged from 1,190 to 4,260 ms (mean 2,949 +/- 1,121). Thus, abnormalities in both sinus node automaticity and sinoatrial conduction are responsible for the long sinus or atrial pauses in the sick sinus syndrome. However, complete sinoatrial exit block can occur and cause severe bradycardia with escape rhythm; repetitive sinoatrial exit block plays a major role in producing posttachycardia pauses.

Cardiac Pacing, Artificial

Sinus node function after selective elimination of sympathetic influences on the sinus node area of the dog.

Six-hydroxydopamine (6OHDA) was injected directly into the subepicardium of the sinus node area in an attempt to damage sympathetic nerve terminals in the sinus node. The changes in sinus node function were observed for 4 weeks. The predominant rhythm was of sinus origin throughout the observation period. The sinus rate progressively decreased from 145.1 +/- 14.2 to 76.2 +/- 12.1 beats/min during the first week after injection of 6OHDA. The sinus rate remained at this level for 2 weeks, followed by a gradual increase to 89.3 +/- 18.2 beats/min 4 weeks after injection of 6OHDA. These sinus rates were only significantly different from control dogs through the 14th postoperative day. The sinus rate was considerably increased by intravenous atropine injections 5 to 7 days after the injection of 6OHDA into the sinus node area. The sinus node recovery time was much longer in dogs with an injection of 6OHDA than that in the control dogs throughout the observed period. These results suggest that elimination of the sympathetic influences on the sinus node can be achieved by direct injection of 6OHDA into the sinus node area in the dog, and that sinus node function can be depressed by decreasing sympathetic tone alone, in the absence of an intrinsic dysfunction of the sinus node.

Animals

[Usefulness of transesophageal stimulation in the evaluation of sinus node function in patients with sick sinus syndrome].

The purpose of this study was to find out whether transesophageal pacing could be utilized for assessment of sinus node function, besides Wenckebach point, in patients with sick sinus syndrome. In 17 patients with sino-atrial disease (group I) we compared the results of sinus node tests obtained both in the basal state and after pharmacological autonomic blockade by endocavitary stimulation and 24 hours later, by transesophageal pacing. In another group of 17 patients with sino-atrial disease (control group) we compared the results obtained from two endocavitary studies. In group I, sinus cycle length and corrected sinus recovery time did not show significant differences between the two studies either the basal state or after autonomic blockade, whereas sino-atrial conduction time was more prolonged during esophageal pacing (P less than 0.01). In the control group, sinus node measures did not show significant differences between the two studies. In group I, the following coefficients of correlation were obtained: A) in the basal state sinus cycle length, r = 0.65, corrected sinus recovery time, r = 0.57, sinoatrial conduction time, r = 0.52; B) after autonomic blockade sinus cycle length, r = 0.95, corrected sinus recovery time, r = 0.62 and sino-atrial conduction time, r = 0.53. In the basal state, the correlation for sinus cycle length and corrected sinus recovery time between the two studies was lower in the "study group" than in the "control group" (P less than 0.05). However, after autonomic blockade the correlation for sinus node measures did not show any significant differences between the two groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Intra-sinus echo: demonstration using direct intracavitary recording of the sinus potential].

The authors searched for intra-sinusal echos during electrophysiological investigation of 53 patients (41 men, 12 women, average age: 61 +/- 12 years). Cycles of sinus echos were recorded in 8 patients (15 per cent). The period during which sinus echos could be recorded was 125 ms (average 40.6 +/- 34 ms). Indirect assessment of sinus node function in patients with sinus echos was normal (corrected sinus node recovery time, estimated atrio-sino atrial conduction times using Narula's technique). A valid and reproducible direct recording of the sinus node potential was only possible in one patient. In this case the echo cycles were provoked by stimulation periods of between 440 and 320 ms (echo zone of 120 ms). All the echos obtained were preceded by a sinus node potential with a different duration and morphology to that observed during basal sinus cycles (respective sino-atrial conduction times 105 and 115 ms). In this patient we were also able to induce sinus echos after a single extrastimulus during the spontaneous rhythm. the echo zone was 130 ms and with a shorter coupling interval (310 ms) two successive sinus echos were recorded. The demonstration of intrasinusal echos by direct recording of the sinus node potential supports the experimental data of Allessie and Bonke on isolated right atrial tissues of the rabbit. Improvements in the technique of endocavitary direct recording of the sinus node potential in man should complete this data by showing the possibility of sinoatrial tachycardias due to reentry.

Action Potentials