Dronedarone in patients with atrial fibrillation

Dronedarone is a recently developed new class III antiarrhythmic drug which possesses electrophysiological properties of all four Vaughan-Williams classes. An important difference with amiodarone is that it does not contain an iodine component and therefore lacks the iodine-related adverse effects. Based on currently available data, dronedarone can not be recommended as first-line therapy for either rhythm or rate control. We recommend to initiate rhythm or rate control with drugs as indicated in the 2006 guidelines of the ESC and other organisations. As amiodarone, dronedarone can be given to patients for whom standard drug therapy is not effective, or limited by (severe) side effects, although it is less effective than amiodarone. Nevertheless, it may be considered to give dronedarone initially to patients who would otherwise have received amiodarone, since the latter has more severe side effects than the former drug. The daily dosage of dronedarone is oral administration, 400 mg twice daily. Dronedarone is contraindicated in patients with impaired left ventricular function (NYHA class III/IV) and haemodynamic instability. (Neth Heart J 2010;18:370-3.)     

Purulent pericarditis,an uncommon entity in modern practice: a case report

We report an 82-year-old female with pneumococcal pneumonia. Antimicrobial therapy was started in an early stage of the disease. On the 10th day of admission she developed peripheral pitting oedema with elevated jugular venous pressure and a drop in blood pressure. Her electrocardiogram showed sinus tachycardia and concave upward ST-segment elevation in almost all leads. A transthoracic two-dimensional echocardiogram revealed a large circumferential pericardial effusion, with diastolic collapse of the right atrium and a mitral inflow pattern that suggested cardiac tamponade. Emergency pericardiocentesis was performed, releasing 600 cc of thick green purulent material, followed by good haemodynamic recovery. The haemodynamic state, pneumonic infiltrate and inflammatory parameters responded gradually to antimicrobial therapy and the patient recovered and was discharged after six weeks. We conclude that even susceptible strains of Streptococcus pneumonia in a patient with no predisposing factors may still cause purulent pericarditis, even in the era of adequate antibiotic therapy.     

Influence of oxygen adsorption on the dynamic K(L)a measurement in three-phase slurry reactors

To check for possible mass transfer limitations of oxygen and/or carbon dioxide in kinetic experiments on microbial desulphurization of coal, it is important to properly measure the volumetric mass transfer coefficient (k(L)a) especially at high slurry densities. Volumetric mass transfer coefficients of oxygen, at different solid hold-up values (epsilon(s) = 0 to 0.28) of coal slurries (d(par) < 100 * 10(-6) m), were measured in a lab scale fermentor and in a lab scale pachuca tank, using the dynamic gas-liquid absorption method. It was shown that serious errors could occur due to oxygen adsorption at the coal surface. Using the data of an independently measured adsorption isotherm, the real k(L)a could be calculated from the measured apparent k(L)a. The results show a k(L)a decrease of 40% to 50% at a volumetric solid hold-up of 28%. Estimation of the oxygen and carbon dioxide transfer rates, from the measured mass transfer coefficients, indicates that the stirred fermentor is suitable for kinetic experiments at high slurry densities, whereas the pachuca tank and shake flask are not. (c) 1992 John Wiley & Sons, Inc.     

Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup

Objectives

To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands.

Background

Controversy remains about the safety and efficacy of PPCI in off-site PCI centres.

Methods

We retrospectively analysed clinical and procedural data as well as 6?month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven.

Results

PPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4?% VieCuri vs. 12.3?% Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9?%) patients in the VieCuri group and 9 (8.1?%) in the Catharina Hospital group had a major adverse cardiac event.

Conclusion

Performing PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.

     

The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes

Objectives

Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo.

Background

Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome.

Methods

Retrospective cohort study reporting characteristics, PCI and FFR specifications, complications and 6-month follow-up for all consecutive patients from the beginning of off-site PCI in Venlo until July 2012. If possible, the data were compared with those of Medical Centre Alkmaar, the first off-site PCI centre in the Netherlands.

Results

Of the 333 patients, 19 (5.7 %) had a procedural complication. At 6 months, a major adverse cardiovascular event (MACE) occurred in 43 (13.1 %) patients. There were no deaths or emergency surgery related to the PCI or FFR procedures. There was no significant difference in occurrence of a MACE or adverse cerebral event between the Alkmaar and Venlo population in the 30-day follow-up.

Conclusion

This study demonstrates off-site PCI at VieCuri Venlo to have a high success rate. Furthermore, there was a low complication rate, low MACE and no procedure-related mortality.     

Ischaemia with no obstructive coronary arteries

Ischaemia with no obstructive coronary arteries (INOCA) is a common ischaemic heart disease with a female preponderance, mostly due to underlying coronary vascular dysfunction comprising coronary microvascular dysfunction and/or epicardial coronary vasospasm. Since standard ischaemia detection tests and coronary angiograms are not suitable to diagnose coronary vascular dysfunction, INOCA is often overlooked in current cardiology practice. Future research, including large outcome trials, is much awaited. Yet, adequate diagnosis is possible and treatment options are available and vital to reduce symptoms and most probably improve cardiovascular prognosis. This review intends to give a brief overview of the clinical presentation, underlying pathophysiology, and the diagnostic and treatment options in patients with suspected INOCA.

     

Estimating above-ground biomass and production in mangrove communities of Biscayne National Park,Florida (U.S.A.)

Total above-ground production isusually estimated by a combination of allometry andlitter collection. However, in coastal sites that aretidally influenced, or in juvenile or dwarf forestswhere the crown bases of dominant individuals maybegin within a few decimeters of ground level,estimates of community leaf production that depend onlitter collection may not be feasible. Thus, in thispaper, we present 1) allometric equations that allowaccurate estimation of total above-ground biomass ofthree mangrove species (Rhizophora mangle, Laguncularia racemosa, and Avicennia germinans)in very small to medium size classes, and 2) analternative method of estimating total above-groundproduction that overcomes the limitations of littercollection. The method we employ to estimate mangroveproductivity is an adaptation for woody plantcommunities of a procedure introduced by Dai andWeigert (1996) for grasslands. It incorporates adetailed census of all individuals within fixedsampling plots, along with periodic observations ofmarked leaf cohorts. The method allows the comparisonof biomass allocation patterns among forests thatdiffer widely in physiognomy and physiographicsetting.The method was applied to a South Florida fringemangrove forest in the early stages of recovery fromHurricane Andrew (August 1992), and an adjacent dwarfforest which was not substantially damaged by thestorm. Total above-ground production in the fringeforest from July 1996 through June 1997 was about 3times higher than dwarf forest production,26.1 Mg·ha^-1·yr^-1 vs.8.1 Mg·ha^-1·yr^-1, respectively. Furthermore, when compared to the dwarf forest, fringeproduction rates were approximately eight, six, six,and two times as high as dwarf forest rates forproproots, branches, stems, and leaves, respectively. Calculations of leaf production were based on mean redmangrove leaf longevities that ranged from about 189days to 281 days, depending on cohort and site.Repeated measures analysis of variance indicated thatleaf life spans did not differ significantly betweendwarf and fringe forests, but did differ among leafcohorts.Based on reported values for similar mangrove forests,the method provided reasonable estimates ofabove-ground biomass and production, while furnishingrelevant auxiliary information on spatial and temporalvariation in leaf demographic patterns. Furthermore,the partitioning of annual production between woodytissues and leaves followed the reported trend in mostforest ecosystems.     

Short-term changes in phosphorus storage in an oligotrophic Everglades wetland ecosystem receiving experimental nutrient enrichment

Natural, unenriched Evergladeswetlands are known to be limited by phosphorus(P) and responsive to P enrichment. However,whole-ecosystem evaluations of experimental Padditions are rare in Everglades or otherwetlands. We tested the response of theEverglades wetland ecosystem to continuous,low-level additions of P (0, 5, 15, and30 g L^–1 above ambient) in replicate,100 m flow-through flumes located in unenrichedEverglades National Park. After the first sixmonths of dosing, the concentration andstanding stock of phosphorus increased in thesurface water, periphyton, and flocculentdetrital layer, but not in the soil or macrophytes. Of the ecosystem components measured, total P concentration increased the most in the floating periphyton mat (30 g L^–1: mean = 1916 g P g^–1, control: mean =149 g P g^–1), while the flocculentdetrital layer stored most of the accumulated P(30 g L^–1: mean = 1.732 g P m^–2,control: mean = 0.769 g P m^–2). Significant short-term responsesof P concentration and standing stock wereobserved primarily in the high dose (30 gL^–1 above ambient) treatment. Inaddition, the biomass and estimated P standingstock of aquatic consumers increased in the 30and 5 g L^–1 treatments. Alterationsin P concentration and standing stock occurredonly at the upstream ends of the flumes nearestto the point source of added nutrient. Thetotal amount of P stored by the ecosystemwithin the flume increased with P dosing,although the ecosystem in the flumes retainedonly a small proportion of the P added over thefirst six months. These results indicate thatoligotrophic Everglades wetlands respondrapidly to short-term, low-level P enrichment,and the initial response is most noticeable inthe periphyton and flocculent detrital layer.     

Sea-Level Rise and the Persistence of Tree Islands in Coastal Landscapes

Ecosystems - Naturally formed forest patches known as tree islands are found within lower-statured wetland matrices throughout the world, where they contrast sharply with the surrounding...