Indication for hyperbaric oxygen treatment as a predictor of tympanostomy tube placement.

INTRODUCTION: Hyperbaric oxygen therapy (HBO2) has been utilized for many years for a multitude of disease entities. One commonly encountered side-effect is otic barotrauma. OBJECTIVE: To determine if patients with specific disease processes are at increased risk of requiring tympanostomy tubes during HBO2. METHODS: Data was obtained from Jan. 2000 to Dec. 2004, retrospectively. The requirement for tympanostomy tubes during a course of HBO2 was established. RESULTS: 325 met inclusion criteria. Fifteen percent of patients overall (95% CI= 11-19%) required tympanostomy tubes. Tubes were required in: 5% necrotizing soft tissue infection (p=0.33); 10% failed/threatened graft (p=0.39); 15% problem wounds; 17% chronic refractory osteomyelitis (CRO) (p=0.64); 22% soft tissue radionecrosis (STRN)/osteoradionecrosis (ORN) (p=0.02); 33% of crush injuries (p=0.10). Twenty-nine percent of nasopharyngeal radiation injury patients (p=0.001) and 10% of the non-nasopharyngeal radiation patients (p=0.36) received tympanostomy tubes. CONCLUSION: A significant increase in tympanostomy tubes were required in nasopharyngeal radiation injury patients.

Maurice Campbell: first editor of Heart.

Maurice Campbell was the first editor of the British Heart Journal, now Heart, and was called the journal's progenitor and formative influence, an untiring editor who virtually produced each issue single handedly. Campbell was also valued for his scholarly opinions, organisational and editorial skills, and for his careful statistical work which was advanced for its time and of great importance in the early understanding and treatment of congenital heart disease and arrhythmias. In addition, his collaboration with Russell Brock was instrumental in developing surgery for rheumatic and congenital heart disease at Guy's Hospital.

Alfred Lewis Galabin and the first human documentation of atrioventricular block.

Using an apexcardiogram, Galabin was the first person to document atrioventricular (AV) block in humans. He performed his studies while working as a house officer at Guy's Hospital, London, United Kingdom. His patient was 34 years old, experienced attacks of near syncope, and had a pulse rate that varied between 25 and 30 beats/min. A laddergram of the patient's apexcardiogram suggests advanced AV block with 3 to 1 and 2 to 1 AV conduction with Wenckebach periodicity. We review the history of AV block beginning with the introduction of graphic recordings in 1847 by Ludwig, and include the contributions of Stannius, Luciani, Gaskell, Wenckebach, Hay, and Mobitz. Although he is little known today among cardiovascular physicians, we recognize Galabin as the first person to demonstrate AV block in humans.

To die in one's prime: the story of Paul Wood.

Paul Wood, the leader of European cardiology during the mid-20th century, was internationally admired for his bedside teaching, clinical investigations, and an important textbook on cardiology. His studies, based on a unique quantitative approach to the grading and recording of clinical data, introduced cardiac physiology to the bedside, brought accuracy to the preoperative assessment of cardiac disease, and became the foundation for much of our current understanding about congenital and rheumatic heart disease and pulmonary hypertension. At the bedside, in front of a crowd of postgraduate students, registrars, and visitors, he was renowned for his showmanship and dazzling ability. His commanding personality--caustic, sarcastic, and combative--impressed many and offended some as he openly argued with himself and others to sleuth out the correct diagnosis. His 1950 textbook, Diseases of the Heart and Circulation, characterized by his lucid and personal style of writing and a fresh physiologic approach to cardiology, brought Wood worldwide recognition as the European authority on heart disease. The incessant demands to see patients, teach, and lecture, the burden of writing his third edition of the book, and his heavy smoking eventually took their toll. On July 13, 1962, at the age of 54, Paul Wood, the gale force wind of British cardiology and the inspiration and role model for many students, died quietly following a myocardial infarction. He left a legacy of great accomplishments as the transition figure between the old and modern era of cardiology.

Luigi Luciani and the earliest graphic demonstration of Wenckebach periodicity.

Using an isolated frog heart preparation with ligatures around the atria, Luigi Luciani, an Italian physiologist working in 1873 in Carl Ludwig's famous laboratory in Leipzig, was the first to demonstrate cardiac group beating, which he named periodic rhythm. He attributed this to increased resistance to impulse propagation between the atria and the ventricle. Karel F. Wenckebach, in his 1899 landmark report of group beating in a patient in which he also used pulse tracings, credited Luciani with this discovery. Wenckebach referred to the phenomena as "Luciani periods." With the advent of electrocardiography in the early 20th century, this form of group beating became known as Wenckebach periodicity and then as Mobitz type I atrioventricular block. We reanalyzed Luciani's original paper and pulse tracings, and we show that periodic rhythm does indeed meet the criteria of second-degree atrioventricular block as established by Wenckebach. We also reviewed the career of Luciani, who was an important investigator, outstanding teacher and mentor, and distinguished leader of 19th-century physiology. We conclude that Wenckebach still deserves to have his name eponymously attached to this type of atrioventricular block because he was the first to unravel the complicated relationship between atrial and ventricular conduction.

Success in using non-invasive mechanical ventilation is predicted by patient pathophysiology. A retrospective review of 199 patients.

BACKGROUND: To determine the effect of patient pathophysiology on the success or failure of noninvasive mechanical ventilation as determined by the need for subsequent endotracheal intubation. METHODS: Center-based, retrospective case analysis of all patients placed on non-invasive mechanical ventilation for acute respiratory distress. MEASUREMENTS AND RESULTS: Retrospective chart review was performed on patients who were treated with non-invasive mechanical ventilation from 1/94-6/97. Patients were divided into those with rapidly reversible disease processes (RRDP), and those with non rapidly reversible disease processes (NRRP). The proportion of patients requiring subsequent intubation in each group was compared. There were 116 patients with RRDP and 83 patients with NRRD. In the RRDP group, 85.8 percent (95 percent confidence interval 80.9-90.7 percent) of patients did not require intubation. In the NRRP group, 35.7 percent (95 percent C.I. 29.0-42.4 percent) did not require intubation (X2 analysis, p < .001). Multivariate analysis identified patient pathophysiology as the only variable associated with subsequent intubation. CONCLUSIONS: Patient pathophysiology based upon their expected clinical course can be used to predict the success of non-invasive mechanical ventilation (NIMV). Patients with NRRD, such as pneumonia, myocardial infarct and sepsis, are much more likely to fail non-invasive mechanical ventilation and require subsequent endotracheal intubation.

A view from the millennium: the practice of cardiology circa 1950 and thereafter.

The knowledge and treatment of cardiology as practiced circa 1950 is discussed as abstracted from authoritative textbooks of that time and other sources. Advances in treatment and diagnostic techniques since 1950 are presented. Dramatic changes in cardiology have come at the expense of bedside cardiology which needs to be balanced with the technology.

Postoperative pulmonary edema.

BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. METHODS: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.

The Wenckebach phenomenon: a salute and comment on the centennial of its original description.

In 1899, Karel F. Wenckebach unraveled the complicated arrhythmia that bears his name--one of the most famous eponyms in medicine. He reported his findings before the benefit of clinical electrocardiography or the discovery of the sinoatrial and atrioventricular nodes. Born and educated in The Netherlands, Wenckebach first worked in Utrecht in the physiology laboratory of T.W. Engelmann, his respected mentor, where he became familiar with kymographic recordings and rhythm disturbances in frog experiments. He then entered country practice in 1891, where he gained great respect for practicing physicians as well as the importance of clinical experience. In 1896, he returned to Utrecht to work again in the laboratory with Engelmann. In 1898, a woman consulted Wenckebach about her irregular pulse. His investigation of her irregular heart action by using radial arterial pulse tracings and experimental atrial and ventricular pulse tracings from the heart of a frog enabled him to discover the mechanism of partial heart block. In later years, he continued to be a leader in academic medicine, chairing the departments of medicine in Groningen, Strasbourg, and Vienna. He achieved fame for investigating cardiac arrhythmias and other contributions and is considered to be one of the founders of modern cardiology. He is remembered for his insight into atrioventricular conduction, which is as valid today as it was a century ago.

Diagnosis of cardiac sarcoidosis aided by MRI.

We describe herein a case of dilated cardiomyopathy. The diagnosis of myocardial sarcoid was suggested by abnormal findings on an MRI of the chest. This was subsequently confirmed by a histology of a subcutaneous nodule. MRI is well suited in imaging myocardial scarring associated with sarcoidosis. Its use should be considered where sarcoidosis is suspected. Early detection and intervention with steroids may improve function.