A 68-year-old woman presented with mild chest pressure typical of myocardial ischemia. The initial ECG revealed normal sinus rhythm with ST-segment elevations in leads V 2 through V 5 (Figure 1). Troponin T level was 3.4 ng/mL (normal Ͻ0.01 ng/mL), and creatinine kinase level was 250 U/L (normal Ͻ220 U/L). The patient underwent emergency coronary angiography, which demonstrated minimal atherosclerotic disease. However, contrast left ventriculography demonstrated marked akinesis of the mid and distal segments of all walls, with compensatory hyperkinesis of the base (Figure 2). Transthoracic echocardiography also demonstrated akinesis of the midanterior, apical septal, apical inferior, apical lateral, and apical anterior segments. The right ventricle was normal in size and function. No valvular abnormalities were observed. The patient remained clinically and hemodynamically stable during her 3-day hospitalization.Serial cardiac markers trended down. Viral titers, iron studies, thyroid function tests, and serum protein electrophoresis were noncontributory. Her discharge medications included an aspirin, an ACE inhibitor, a ␤-blocker, and a statin. Repeat echocardiography 1 month later demonstrated complete resolution of the regional systolic dysfunction.Tako-tsubo-like (Japanese word for octopus-catcher, Figure 3) left ventricular dysfunction is an enigmatic cardiomyopathy, characterized by marked apical asynergy in the absence of significant coronary disease. Typically, these patients are elderly women who present with mild to moderate chest pain, have ST-segment elevation in leads V 3 through V 6 , and have a modest rise in cardiac markers. The exact etiology remains unknown, but the transient dysfunction may be secondary to microvascular spasm or regional myocarditis.

Since 1992 a small air-cooled opthalmological argon laser (Argus system, 3 W max.) equipped with a fiberoptic microhandpiece has been used for stapedotomy at the Inselspital, Berne. The microhandpiece has been developed especially for otological purposes in our electronic laboratory. In order to measure the effect of argon laser pulses applied through the handpiece to the ear, we performed temperature measurements in a saline-filled inner ear model by using ultrathin (2 microns thick), ultrafast (4 ns) thermosensitive rhodamine-coated polyurethane films. Multiple laser pulses of 1-2.5 W and 0.1 s duration - as used in clinical applications - produced a temperature elevation of about 1 degree C in the liquid of the inner ear model. The local laser effect was then examined histologically on the isolated stapes. The thermal damage zone around the stapedotomy perforation was limited to about 100 microns. In a clinical study we compared the results of argon laser stapedotomy (n = 54) with those of a skeeter microdrill stapedotomy (n = 29). Substantial hearing gains were found in all cases in both groups. In the laser stapedotomy group the mean residual air-bone gap (0.5-2 kHz) was 10 dB or less in all cases but one. Inner ear function remained unchanged except for a 40-dB loss at 4000 Hz in one case. Transient vertigo with nystagmus occurred in one case. Facial nerve dysfunction did not occur in any patient. The most important advantage of the laser found was the absence of mechanical trauma to the stapes. Stapes luxation and a floating footplate were avoided. In contrast, thick footplates were more easily perforated with the skeeter. Use of an argon laser equipped with a fiberoptic microhandpiece and a skeeter microdrill as needed seems particularly advantageous for stapedotomy.

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