Sinus Discharge Research Articles

Hodgkin's Disease Presenting with Multiple Cervical Sinuses and Abscess Formation

Hodgkin's Disease Presenting with Multiple Cervical Sinuses and Abscess Formation

Staged management of infected humeral nonunion.

Fourteen patients with infected humeral nonunion complicated by sinus discharge were treated with a staged protocol consisting of (1) radical debridement with local antibiotic beads implantation, and (2) external skeletal fixation with autologous bone grafting. In the first stage, a thorough debridement and sequestrectomy were done. Antibiotic beads were used to obliterate the bone defect, and the wound was then directly closed. In the second stage, the bead chains were replaced with autogenous cancellous bone graft. Unilateral Hoffman external skeletal fixators were applied simultaneously. The mean follow-up period was 73.6 months (range, 29 months to 9 years). The length of time to achieve bony union ranged from 3.5 to 8 months (average, 4.3 months). Hoffman pin complication was found in two cases, which were then shifted to plate internal fixation. All the infections were eradicated, and the wounds healed without further skin graft or flap coverage. All the fractures achieved bony union except for one in a patient who died. Most patients acquired satisfactory function of elbow motion after removal of external fixation and physical therapy. The method of two-stage management was effective for infected humeral nonunion. Not only was the infection eradicated and osseous union achieved, but also the limb function and joint motion were preserved.

NO modulates autonomic effects on sinus discharge rate and AV nodal conduction in open-chest dogs.

The purpose of this study was to investigate the role of nitric oxide (NO) in mediating vagal and sympathetic modulation of spontaneous sinus cycle length (SCL) and atrioventricular (AV) nodal conduction time (A-H interval) in 62 open-chest mongrel dogs anesthetized with alpha-chloralose. Infusion of an NO synthase (NOS) inhibitor, NG-monomethyl-L-arginine (L-NMMA, 4 mg/ ml), into the sinus and AV nodal arteries attenuated significantly (P < 0.01) the negative chronotropic and dromotropic responses to vagal nerve stimulation (VS) and VS during ansae subclaviae stimulation (SS) or isoproterenol (Iso) infusion. Intravenous administration of L-arginine (100 mg/kg) reversed these responses toward control values, whereas D-arginine did not have a significant effect. L-NMMA significantly (P < 0.01) enhanced the effects of SS and Iso on SCL and A-H interval; L-arginine reversed these changes toward baseline. L-NMMA increased the minimum concentration of ACh needed to induce 50 or 100% prolongation of SCL or second-degree or complete AV block during concomitant Iso infusion. L-Arginine reversed these effects. NOS inhibition did not affect the direct cholinergic actions of ACh on SCL and A-H interval but enhanced adrenergic positive chronotropic and dromotropic effects. We conclude that NO plays a stimulatory role in mediating vagal neurotransmission and vagal modulation of sympathetic effects and an inhibitory role in mediating sympathetic neurotransmission.

The effect of halothane on phrenic and chemoreceptor responses to hypoxia in anesthetized kittens.

We examined the effect of halothane on phrenic never and carotid sinus discharge during hypoxia in anesthetized kittens. In 12 animals, phrenic amplitude was measured during normoxia, during isocapnic hypoxia, and after a return to normoxia, both with and without halothane. Without halothane, all animals had an increase in phrenic amplitude during hypoxia. With halothane, half the animals showed an increase in phrenic amplitude followed by a decline. In a second group of animals, recordings were obtained from single or a few fiber strands of carotid sinus nerve. Without halothane, an increase in chemoreceptor discharge frequency during hypoxia was seen. With 1.0% halothane, frequency was decreased during normoxia and did not increase during hypoxia. Thus, halothane's effect on the ventilatory response to hypoxia, as measured by phrenic discharge, is at least partially explained by an effect on peripheral chemoreceptors.

The Effect of Halothane on Phrenic and Chemoreceptor Responses to Hypoxia in Anesthetized Kittens

We examined the effect of halothane on phrenic nerve and carotid sinus discharge during hypoxia in anesthetized kittens.In 12 animals, phrenic amplitude was measured during normoxia, during isocapnic hypoxia, and after a return to normoxia, both with and without halothane. Without halothane, all animals had an increase in phrenic amplitude during hypoxia. With halothane, half the animals showed an increase in phrenic amplitude followed by a decline. In a second group of animals, recordings were obtained from single or a few fiber strands of carotid sinus nerve. Without halothane, an increase in chemoreceptor discharge frequency during hypoxia was seen. With 1.0% halothane, frequency was decreased during normoxia and did not increase during hypoxia. Thus, halothane's effect on the ventilatory response to hypoxia, as measured by phrenic discharge, is at least partially explained by an effect on peripheral chemoreceptors. (Anesth Analg 1996;83:329-35)

Treatment of nontuberculous mycobacterial lymphadenitis with clarithromycin plus rifabutin

Treatment with clarithromycin plus rifabutin in children with nontuberculous mycobacterial lymphadenitis was associated with resolution of chronic sinus formation and discharge after incomplete excision in five of five cases, and involution of the enlarged lymph nodes in two of three cases treated without surgery. (J P EDIATR 1996;128:383-6)

Biofix fixation techniques and results in foot surgery

Biofix absorbable rods have been used for internal fixation for 10 years, and one of its most utilized applications has been osteotomies of the first metatarsal. This study evaluates 59 procedures on 49 patients completed over a 3-year period, using the 2.0-mm. Biofix rods. The transarticular technique for the fixation of osteotomies in the 1st and 5th metatarsals and the intramedullary technique used for digital fusions are described. All of the patients were followed for a minimum of 3 months, but most for > 1 year, and all of the procedures were evaluated for failure of fixation, osteolytic bone changes, sterile sinus development, and infection. There were no failures of fixation and no infections in this series. Patients (22.4%) developed radiographic osteolytic changes, and 4.1% of the patients developed sterile sinus discharge. However, these had no effect on the procedures' success or outcomes. An introduction to future application of the technology using Biofix screws and plates is made with a pantalar fusion case as an example.

Effectiveness of absorbable fixation devices in Austin bunionectomies.

Forty-eight Austin bunionectomies were fixated by using an absorbable fixation device. Twenty-three were fixated with a 1.5- or 2.0-mm diameter Biofix rod and twenty-five were fixated with a 1.3-mm diameter Orthosorb pin. To be included in this project, all patients were followed radiographically for a minimum of 3 months. One foot (4%) fixated with Biofix developed a sterile sinus discharge 3 months postoperatively after uneventful wound healing. There were no clinical or radiographic changes seen in the feet in which Orthosorb was used. Also, there were no infections or osteotomy dislocations with either fixation device.

Dissecting Cellulitis of the Scalp in 2 Girls

Two girls with dissecting cellulitis of the scalp are described. In one Pseudomonas aeruginosa was isolated from the sinus discharge. Both patients were controlled with prolonged antibiotic therapy and periodic aspiration of the fluctuant lesions. Role of infection in perpetuating the condition is highlighted.

Two-to-One Sinoatrial Block: Normalization by Carotid Massage

In a clinical case of 2:1 sinoatrial block, carotid massage, paradoxically, released the sinoatrial block and doubled the manifest sinus rate. This resulted from a deceleration of the sinus discharge rate which allowed consecutive sinus impulses to traverse the sinoatrial junction.

Slow ventricular tachycardia complicating acute myocardial infarction.

Among 200 consecutive cases of acute myocardial infarction (AMI) treated in a CCU, 117 episodes of slow ventricular tachycardia were observed in 72 patients. This figure represents a 36% rate of incidence. It is a relatively high figure because of the close monitoring to which the patient is submitted and because of the early admission to the unit. There were no significant differences of age, sex, or localization of the myocardial necrosis between patients with SVT and those without it. The different mechanisms of production described support an active origin in most of the patients for the following reasons: (1) coexistence of SVT and PVT in 51.3% of the patients; (2) identical QRS morphology in both rhythms; (3) onset of the SVT after a nonprolonged diastole in 70% of the tracings; (4) inhibition of the SVT after increase of the sinus discharge in only 14 occasions; and (5) irregular SVT rhythm in 76.9% of the recordings and ectopic mechanisms with different degrees of exit block. Because of the potential hazard of the SVT, especially if it is assumed to be of an active origin, we recommend lidocaine for patients with a sinus rate faster than 60 per minute or coexisting PVT. Atropine should be used when the sinus rate is slower than 60 per minute assuming a possible escape or passive origin.

Observations on atrio-sinus conduction. Single, repetitive and complete atrio-sinus block. Atrio-sinus concealed and wenckebach conduction

Summary Several electrocardiograms are presented that demonstrate different types of disturbances in retrograde impulse conduction from the atrial myocardium to the sinus pacemaker (atrio-sinus conduction). In two cases, interpolation of single atrial ectopic beats was ascribed to simple atrio-sinus block. In a third case, interpolation of two successive atrial ectopic beats was explained by concealed conduction of the first beat in the atrio-sinus pathway leading to atrio-sinus block of the second beat. In a case of atrial escape rhythm, the early appearance of sinus activity was ascribed to a Wenckebach type of conduction of the last few beats of the ectopic rhythm in the atrio-sinus pathway. In two other cases of spontaneous and mechanically induced atrial tachysystoles, the early appearance of the sinus rhythm was noted as an exception to the phenomenon of overdrive suppression of the sinus pacemaker and was explained by concealed conduction and repetitive block in the atrio-sinus pathway of one or more of the last ectopic beats in the paroxysm. In two other cases, complete atrio-sinus block (unidirectional block) was present. In these cases the sinus pacemaker acquired the characteristics of a parasystolic rhythm (sinus parasystole). One of the cases showed 2:1 sino-atrial block and an escape atrial rhythm with occasional periods of escape-capture bigeminy. The other case illustrated a double supraventricular parasystolic rhythm resulting from a spontaneous (sinus) and an artificial pacemaker competing for the control of the atria. Critical analysis of these findings suggests the presence of a pathway that conducts the impulse from the atrial myocardium to the site of the sinus pacemaker (atrio-sinus conduction). The pathway is probably also traversed by the sinus discharge on its way to the atrial myocardium (sino-atrial conduction). The present report extends further the analogy between the mechanism of impulse conduction at both the atrio-ventricular and sino-atrial pathways.

Intermittent ventricular parasystole with observations on its relationship to extrasystolic bigeminy

1. 1. Two cases of intermittent parasystole are described in which there is alternate extrasystolic and parasystolic impulse formation from the same focus; transitions between the two rhythms are repeatedly observed. 2. 2. It seems that intermittence results when the parasystolic focus is subjected to the enhancing effect of the sinus discharge whereby the automatic beat is prematurely precipitated, thus becoming a forced beat. 3. 3. This phenomenon can be explained on the basis of a property of automatic centers; namely, that their resting potentials exhibit a gradual upward “slope” of depolarization. With critical timing, the terminal part of the “slope” (i.e. its near threshold level) may encounter the enhancing effect of the preceding sinus beat and thus be precipitated prematurely. 4. 4. It is suggested that the form of extrasystolic bigeminal rhythm described may constitute a link between parasystolic and extrasystolic rhythm.

Gross pathology of sinus discharge.

The use of the naked eye in pathologic diagnosis is routine and has been since the early days of medicine. The application of this routine to study of the sinus discharge readily yields information of value which other methods fail to uncover. This information concerns the impairment of function of the lining membranes, the loss of resistance to infection, the loss of power to evacuate the sinus, and the persistence of purulent characteristics with a variety of appearance, all of which indicate persistent pathology within the sinus and the probable presence of infection. While pus-forming bacteria, when present, are readily detected in sinus discharge bycommon laboratory technique, it is not always possible to determine their significance in a given case. Dochez1and others have demonstrated the importance of viral agents in nasal pathology, and many workers have improved the cultural methods and means of identifying these agents. But here

Unusual arrhythmias due to multiple sites of conduction delay in the A-V junction in cases with a subsidiary ventricular pacemaker located above the bifurcation of the common bundle

Three cases of unusual arrhythmias associated with a ventricular pacemaker located above the bifurcation of the common bundle, presumably in the A-V node, are reported. In Cases 1 and 2 complete A-V dissociation is present. Certain sinus impulses, however, reach and discharge the ventricular pacemaker, but they are blocked below this point and thus are prevented from stimulating the ventricles. However, it is evident from the analysis presented that conduction is possible along the whole A-V conduction pathway. The sum of the conduction time from the auricles to the ventricular pacemaker and from this point to the ventricles can be determined and, when measured, indicates delayed A-V conduction. Case 3 shows auricular fibrillation with complete A-V block above the ventricular pacemaker and partial A-V block with the Wenckebach phenomenon in a region between the ventricular pacemaker and the bifurcation of the common bundle.