[Highlighting the expression of a nifedipine resistant l type calcium current in human atrial cardiomyocytes]

In the heart, two types of calcium currents were described, the L-and T-type. In addition to these two types, a dihydropyridine-resistant Ca[2+] component has been described to be up-regulated in rat ventricular cardiomyocytes during their differentiation-dedifferentiation process. The aim of our study is to examine if such calcium current component is present in human cardiomyocytes. The patch clamp technique was used to record Ca[2+] current in atrial cells. In the presence of 2 micro M nifedipine, residual current was activated [-2.7 +/- 0.7 pA/pF, n=6] in the same voltage range as the L-type, nifedipine-sensitive Ca[2+] current [-2.1 +/- 0.4 pA/pF, n=6], but its steady-state inactivation was negatively shifted by 10 mV. This nifedipine-resistant Ca[2+] current was completely blocked by 500 micro M cadmium chloride and significantly enhanced by 1 micro M isoproterenol [-7.5 +/- 0.5 pA/pF, n=6; p <0.01]. These results give evidence that a nifedipine-resistant Ca[2+] current, similar to the one which has been shown to be developmentally expressed in rat ventricular cardiomyocytes, is observed in human atrial cells. Its molecular identity, its expression level as well as its role in pathophysiologic conditions remain to be studied

Cervical plexus block for carotid endarterectomy followed by general anesthesia for abdominal aortic surgery - A case report

The aim of this clinical report is to describe the use of sequential regional and general anesthesia for concomitant carotid and abdominal aortic surgery. We performed, in a 70-year-old man, a cervical plexus block for carotid endarterectomy [CEA] followed immediately by general anesthesia for resection of an abdominal aortic aneurysm. This anesthetic approach provided adequate surgical conditions. Intraoperative neurological status and cardiovascular parameters were stable and postoperative course was uneventful. Sequential regional and general anesthesia may be an alternative to general anesthesia for concomitant carotid and abdominal aortic surgery. This approach offers an adequate neurological monitoring during the CEA phase of the combined surgery and the opportunity to postpone the aortic surgery should the CEA be associated with a non-reversible neurological deficit

Infection du site operatoire en chirurgie cardiaque Etude prospective multidisciplinaire.

In an attempt to define the incidence of surgical wound complications following open heart surgery, 210 consecutive patients were included in a prospective monocentric study. All were adults with a mean age of 61 years. The different variables incriminated in pathogenesis of surgical wound infections were analyzed in order to evaluate their respective influence. No cases of mediastinitis were noted. The incidence of surgical wound infections was 5.5%. Body mass index > 25 and extensive surgical saphenous dissection in the lower extremities were the only two factors found to show as statistical significance

Reeducation du syndrome de la traversee thoraco-brachiale. A propos de 60 malades

Sixty patients were treated by physical therapy for thoracic outlet syndrome [TOS] between 1995 and 1999. Females were predominant [76%] the average age was 34.5 years [I8 to 60]. Risk factors were hypermobility, cervical traumatism and profession. Neurological signs were predominant and positive provocation tests were found Adson [4S%], sonnette [62%], E.A.S.T. [51%]. Thoracic pain inaugurated the symptoms in 3 times pseudo-angina [2], dyspnea [1]. Radiological results were positive for cervical rib [8], apophysomegaly of C7 [25], clavicular traumatism [1]. Electromyogram was positive in 2 out of 3 patients, RMI in 2 of 4, and dynamic echo doppler in 3 of 4. After rehabilitation, immediate results were satisfactory in more than 70% of cases. After six months one patient had recurrence of symptoms, 66% were compliant with treatment, and 84% were satisfied. At one year the symptoms recurred in 2 patients, 15% were still compliant, and 81% were satisfied. Surgery was needed in 4 patients with cervical ribs