Catecholaminergic polymorphic ventricular tachycardia and midventricular Takotsubo cardiomyopathy: a novel association?

Takotsubo cardiomyopathy (TTC) is a recently recognized clinical syndrome characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease. TTC primarily affects postmenopausal women; TTC in children and adolescents is only rarely reported. Furthermore, simultaneous occurrence of Takotsubo cardiomyopathy and primary electrical diseases has been previously reported in only four recent cases of female patients with congenital long QT syndrome. Here, we report the novel association of catecholaminergic polymorphic ventricular tachycardias and a midventricular type of TTC observed in a young female patient.

Metal-organic framework luminescence in the yellow gap by codoping of the homoleptic imidazolate ∞(3)[Ba(Im)2] with divalent europium.

The rare case of a metal-triggered broad-band yellow emitter among inorganic-organic hybrid materials was achieved by in situ codoping of the novel imidazolate metal-organic framework ∞(3)[Ba(Im)2] with divalent europium. The emission maximum of this dense framework is in the center of the yellow gap of primary light-emitting diode phosphors. Up to 20% Eu2+ can be added to replace Ba2+ as connectivity centers without causing observable phase segregation. High-resolution energy-dispersive X-ray spectroscopy showed that incorporation of even 30% Eu2+ is possible on an atomic level, with 2-10% Eu2+ giving the peak quantum efficiency (QE = 0.32). The yellow emission can be triggered by two processes: direct excitation of Eu2+ and an antenna effect of the imidazolate linkers. The emission is fully europium-centered, involving 5d → 4f transitions, and depends on the imidazolate surroundings of the metal ions. The framework can be obtained by a solvent-free in situ approach starting from barium metal, europium metal, and a melt of imidazole in a redox reaction. Better homogeneity for the distribution of the luminescence centers was achieved by utilizing the hydrides BaH2 and EuH2 instead of the metals.

[Role of intraosseous access in emergency]. / Der intraossäre Zugang. Eine wichtige Alternative im Notfall.

As alternative for drug administration, the intraosseous access is an important option in emergency medicine. Plasma concentrations of drugs, safety and rapidity as well as rate of complications are comparable to the intravenous access. These findings are reflected in the recent resuscitation guidelines, which recommend intraosseous access as an alternative to intravenous access both in children and adults, considering the tracheal route as backup only if the other two options fail. Rescuers should learn safe techniques of establishing an intraosseous access. Equipment of rescue vehicles with adequate devices for children and adults should be considered standard.

Relationship among cardiac index, inspiration/expiration ratio, and perfluorocarbon dose during partial liquid ventilation in an oleic acid model of acute lung injury in sheep.

BACKGROUND: The aim of this study was to demonstrate the influence of different inspiration/expiration (I/E) ratios on cardiac index (CI) and hemodynamics during partial liquid ventilation (PLV) using a large animal model of acute respiratory failure in a prospective, randomized controlled animal laboratory trial. METHODS: After induction of respiratory failure by right atrial injection of 0.09 mL/kg oleic acid, (1) determination of agreement between reversed Fick and pulmonary artery thermodilution (QTD) techniques with progressive doses of perflubron (LiquiVent, Alliance Pharmaceutical Corp, San Diego, Calif) (n = 7 sheep) and (2) comparison of 4 groups with I/E ratios of 3.4:1, 2:1, 1:1, and 1:2 were performed, applying identical ventilatory patterns in all I/E groups (n = 28 sheep). PLV was established with intratracheal instillation of 25 mL/kg perflubron. Cardiac index was assessed at 15-minute intervals for a 120-minute experimental period by QTD. RESULTS: During progressive doses of PLV, the correlation (r) between Fick and QTD techniques was 0.82. Thermodilution deteriorated after induction of lung injury and recovered after PLV start. Regarding QTD, no significant changes after PLV onset (within-group comparison) and between I/E groups were observed (P < .05). CONCLUSION: The QTD technique is a satisfactory reflector of CI during PLV, and I/E ratio has no significant influence on CI, even using extreme inverse ratio ventilation.

Comparison of static airway pressures during total liquid ventilation while applying different expiratory modes and time patterns.

To compare pump driven (active) and gravity-siphon (passive) expiration modes during perfluorocarbon total liquid ventilation (TLV), a liquid ventilator was developed capable of providing either expiration mode. In a prospective, controlled laboratory study, 90 rabbits (3.2 +/- 0.1 kg) were anesthetized, tracheotomized, killed. After prefill with 12 ml/kg perflubron and TLV for 90 minutes (tidal volume 12 ml/kg, I:E ratio 1:2), randomly using passive (height 40 or 80 cm) or active expiration, respiratory rates were 4, 8, or 12/min. Static peak inspiratory and end-expiratory intratracheal pressures were measured at 5 minute intervals. Peak inspiratory and end-expiratory were constant in active groups, and increases in all 40 cm and 80 cm passive groups were significant. Differences between groups were significant for expiratory mode but not for respiratory rates. Only passive groups showed significant increases in body weight after TLV. Percentage of fluorothoraces was 10% using active and 85% using passive expiration. Based upon the stability of intrapulmonary pressures and volumes and a reduced rate of fluorothoraces, active expiration is more efficient than passive drainage during TLV.

An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury.

Increased abdominal pressure is common in intensive care unit patients. To investigate its impact on respiration and hemodynamics we applied intraabdominal pressure (aIAP) of 0 and 20 cm H(2)O (pneumoperitoneum) in seven pigs. The whole-lung computed tomography scan and a complete set of respiratory and hemodynamics variables were recorded both in healthy lung and after oleic acid (OA) injury. In healthy lung, aIAP 20 cm H(2)O significantly lowered the gas content, leaving the tissue content unchanged. In OA-injured lung at aIAP 0 cm H(2)O, the gas content significantly decreased compared with healthy lung. The excess tissue mass (edema) amounted to 30 +/- 24% of the original tissue weight (455 +/- 80 g). The edema was primarily distributed in the base regions and was not gravity dependent. Heart volume, central venous, pulmonary artery, wedge, and systemic arterial pressures significantly increased. At aIAP 20 cm H(2)O in OA-injured lung, the central venous and pulmonary artery pressures further increased. The gas content further decreased, and the excess tissue mass rose up to 103 +/- 37% (tissue weight 905 +/- 134 g), with homogeneous distribution along the cephalocaudal and sternovertebral axis. We conclude that in OA-injured lung, the increase of IAP increases the amount of edema.

Thrombogenicity is not reduced when heparin and phospholipid bonded circuits are used in a rabbit model of extracorporeal circulation.

In an effort to better mimic the thromboresistive nature of vascular endothelium, extracorporeal circuits bonded with heparin or phospholipids were developed. Using no systemic heparinization, these circuits were compared with standard poly(vinyl)chloride (PVC) (Tygon) in a rabbit model of extracorporeal circulation (ECC). Control circuits were run with and without systemic heparinization and used as comparison groups against the test circuits. Two New Zealand White rabbits were used per study: One was used as the platelet donor for 111Indium platelet labeling; the other animal was placed on bicaval ECC for 4 hours. Circuits (heparin coated n = 6, phospholipid coated n = 8, nonheparinized controls n = 14, heparinized controls n = 18) consisted of 1 m of tubing, two downsizing connectors, and two venous cannulae. ECC blood flow was at least 75 ml/min. Platelet and fibrinogen measurements were made hourly, and circuit dosimetry was performed at the end of the study or on circuit thrombosis. Thrombosis of the circuit occurred in one heparin coated, two phospholipid coated, and eight nonheparinized control circuits. None of the heparinized control circuits thrombosed. There was no significant difference between the groups with regard to platelet count or platelet adhesion. Test circuits exhibited preservation of fibrinogen levels. In this rabbit model of ECC, circuits coated with heparin or phospholipids appeared to preserve fibrinogen levels but did not reduce platelet adhesion or consumption.