[Bioadhesives in ocular surgery]. / Bioadhesivos en cirugía ocular.

PURPOSE: To evaluate the histological inflammatory activity that bioadhesives such as fibrin, cyanoacrylate, unsutured valved closure and suturing, generate when applied on scleral tissue. METHODS: We used a total of 80 eyes of 80 white rabbits which we divided into 8 groups of ten eyes each and distributed according to the two periods of time (1 week and 30 days) and four technique used for closure: 10/0 nylon suture, sutureless self-sealing, cyanoacrylate glue (Histoacryl), and fibrin glue (Tissucol). ANOVA was used for the statistical study of histological inflammation. Descriptive statistical analysis was used for the study of the degree of healing. RESULTS: After 7 days, the fibrin bioadhesive led to greater inflammatory response than did the other techniques (p<0.001). The cyanoacrylate adhesive caused less inflammatory activity than did suturing material (p<0.005). On day 30, the inflammatory reaction generated by the fibrin and cyanoacrylate adhesives was greater than of the suturing and self valved closure technique (p<0.005). After 7 days, the degree of healing with the suture, sutureless technique and cyanoacrylate adhesive was incomplete, while healing was moderate with the fibrin glue. After 30 days the degree of healing with cyanoacrylate glue was incomplete. At this time the degree of healing, with the suture, sutureless technique and fibrin adhesive was complete. CONCLUSIONS: Fibrin causes greater inflammatory reaction than do the other techniques. The cyanoacrylate adhesive shows a biological tolerance identical to the suture technique. This shows that cyanoacrylate bioadhesives are a viable alternative to suturing in scleral surgery.

Bioadhesivos en cirugía ocular / Bioadhesives in ocular surgery

Objetivo: Evaluar la actividad inflamatoria histológica que los bioadhesivos de fibrina, cianoacrilato, cierre valvulado sin sutura y material de sutura generan al ser aplicados en el tejido escleral. Métodos: Utilizamos un total de 80 ojos de 80 conejos albinos, que clasificamos en 8 grupos de 10 ojos cada uno, distribuidos según los dos tiempos (1semana y 30 días) y las cuatro técnicas utilizadas: sutura de nylon 10/0, cierre autovalvulado sin sutura, adhesivo de cianoacrilato (Histoacryl®) y de f¦brina (Tissucol®). El análisis estadístico del grado de inflamación histológica fue realizado con el test del análisis factorial de la Varianza (ANOVA). El estudio sobre el grado de cicatrización se realizó mediante análisis estadístico descriptivo. Resultados: A los 7 días, el bioadhesivo de fibrina indujo una respuesta inflamatoria superior al resto de técnicas (p<0,001). El adhesivo de cianoacrilato demostró una actividad inflamatoria inferior a la sutura (p<0,005). A los 30 días la reacción inflamatoria generada por los adhesivos de fibrina y cianoacrilato superó a la presentada por las técnicas con sutura y cierre autovalvulado (p<0,005). A los 7 días, se observa una respuesta cicatricial incompleta con las técnicas con sutura, sin sutura y con cianoacrilato, y moderada con la técnica de fibrina. El grado de cicatrización observado con la técnica con cianoacrilato es incompleto al cabo de los 30 días. En este tiempo, el grado de cicatrización con las técnicas sin sutura, con sutura y con fibrina es completo. Conclusiones: El bioadhesivo de fibrina demuestra ser una sustancia más inflamatoria que el resto de técnicas. El adhesivo de cianoacrilato presenta una tolerancia biológica semejante a la sutura. Según esto, los bioadhesivos de cianoacrilato pueden constituir una alternativa al material de sutura en cirugía escleral (AU)

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Automatic measurement of corrected QT interval in Holter recordings: comparison of its dynamic behavior in patients after myocardial infarction with and without life-threatening arrhythmias.

This study was designed to determine the value of automatic corrected QT-interval measurement in Holter tapes in patients after myocardial infarction as a marker of life-threatening ventricular arrhythmias. We compared the corrected QT interval, automatically measured in 24-hour Holter recordings, in two groups of patients after myocardial infarction: group I was composed of 14 patients admitted consecutively to our hospital for documented sustained ventricular tachycardia or out-of-hospital cardiac arrest. Group II consisted of 28 patients with previous myocardial infarction with characteristics similar to those of group I, but without malignant ventricular arrhythmias in the follow-up. The global mean 24-hour corrected QT interval was longer in group I (425 +/- 20 msec) than in those patients after myocardial infarction without arrhythmias (group II) (405 +/- 17 msec; p < 0.01). Furthermore, a significant proportion of patients of group I (seven of 14) exhibited more peaks of corrected QT longer than 500 msec compared with patients of group II (two of 28; p < 0.005). A circadian rhythm of corrected QT peaks was observed in group I, having a significantly higher incidence from 11 PM to 11 AM (p < 0.05). We conclude that automatic corrected QT-interval measurement on Holter electrocardiogram is now available and feasible. Our results suggest that this is a marker for risk assessment of life-threatening ventricular arrhythmias. Large-scale trials are needed to confirm these results and to determine the predictive value of this technique for risk stratification.

Active vs passive rhythms as an explanation of bigeminal rhythm with similar P waves.

We describe the criteria for differential diagnosis between 3:2 sinoatrial block from atrial bigeminy due to an ectopic focus in the sinus or parasinus zone. In the 3:2 sinoatrial block the RR interval of the basic rhythm is similar to the short R-R interval of the paired rhythm. In atrial bigeminy, the R-R interval of the basic rhythm is similar to the long R-R interval of the paired rhythm.