BACKGROUND The number of existing wrinkle assessment scales makes it difficult to compare the efficacy of cosmetic techniques in rejuvenating photoaged skin. A single and simple assessment scale that reliably quantifies wrinkle depth is needed.
Ventricular fibrillation in patients without recognizable heart disease is uncommon and electrophysiologic data on such patients is limited. Over a 7 year period, five patients (three men and two women, ranging in age from 24 to 52 years) without demonstrable heart disease underwent electrophysiologic studies with pharmacologic drug testing because of single (four patients) or multiple (one patient) documented episodes of ventricular fibrillation. The arrhythmic event was unrelated to myocardial ischemia or infarction, metabolic or electrolyte disturbances, drug toxicity, preexcitation, or prolonged QT syndromes. In all three patients receiving no antiarrhythmic drugs and in two pretreated with amiodarone, a rapid poorly tolerated ventricular tachyarrhythmia requiring cardioversion was induced by programmed ventricular stimulation with up to two extrastimuli. In all instances, addition of either oral quinidine or oral disopyramide prevented the induction of sustained ventricular arrhythmias. All five patients were placed on antiarrhythmic drug regimens found effective during electrophysiologic studies and remained asymptomatic during follow-up periods ranging from 12 to 93 (mean 52) months. We conclude that in the patients with idiopathic ventricular fibrillation in our study: (1) programmed ventricular stimulation reliably replicated the spontaneous arrhythmia, (2) class I antiarrhythmic agents effectively prevented induction of the arrhythmia in the laboratory, and (3) in contrast to the severity of the presenting arrhythmia, a benign clinical course was observed during longterm therapy with class I antiarrhythmic agents. Circulation 75, No. 4, 809-816, 1987.
Evolence30 is a new, porcine-derived collagen product based on the Glymatrix cross-linking technology that enables a safe and effective correction of the nasolabial folds. This correction lasts significantly longer than that with Zyplast.
BACKGROUND
The use of bovine collagen implants for dermal contour correction is associated with a 3% to 5% incidence of hypersensitivity, which necessitates pretreatment screening by an intradermal skin test.
OBJECTIVE
The objective was to determine the incidence of hypersensitivity with the recently developed cross‐linked, porcine collagen implant, EVOLENCE (ColBar LifeScience Ltd.), which is used intradermally for correction of rhytids and scars.
MATERIALS AND METHODS
Enrolled subjects (n=530) received an intradermal injection of 0.1 mL EVOLENCE implant in the left forearm and a second injection in the right forearm after 2 weeks. Injection sites were assessed clinically at 30 minutes and 72 hours after each injection and at 30 days after the second injection. Serum anticollagen antibody determinations were performed at screening and at the end of the study.
RESULTS
Study assessments were completed by 519 subjects. No significant erythematous reactions suggestive of positive hypersensitivity were observed. Most subjects did not display antibodies against porcine Type I collagen at any time, and those who did showed no changes in levels during the study. The single‐sided 95% upper confidence limit for the possibility of moderate‐to‐severe erythematous reactions with the EVOLENCE implant was determined as 0.58% of subjects.
CONCLUSION
Because the EVOLENCE implant has a low potential for hypersensitivity, intradermal skin testing before its use appears unnecessary.
The effects of adenosine-5'-triphosphate (ATP) on atrioventricular reentrant tachycardia (AVRT) were studied in 18 patients. Nine patients had AV nodal reentrant tachycardia and the remaining nine patients had AVRT with an accessory pathway for retrograde conduction. After electrophysiologic control study, ATP was administered (20 mg iv, rapid bolus) during sustained tachycardia and during right ventricular pacing (150 beats/min). ATP terminated the tachycardia within 16 sec of administration in eight of nine patients with AV nodal reentry and in all patients with accessory pathways. Termination of the tachycardia was related to a block in the antegrade slow pathway in patients with AV nodal reentry and to a block in the AV node in patients with accessory pathways. In one patient with AV nodal reentry, ATP resulted in a slowdown of the rate of the tachycardia due to delayed conduction in the slow antegrade pathway. No change in the conduction in the retrograde fast nodal pathway or in the accessory pathway was noted in any patient before termination of the tachycardia. The administration of ATP during ventricular pacing resulted in transient complete ventriculoatrial (VA) block or slight prolongation of VA conduction in five of nine patients with AV nodal reentry. VA conduction was not affected in four of nine patients with AV nodal reentry nor in all patients with accessory pathways. Short-lived and benign side effects were commonly noted after administration of ATP. Transient episodes of second-degree or complete AV block and sinus bradycardia were noted in eight patients and did not require any treatment. These results suggest that intravenous ATP is a safe and effective drug for rapid termination of AVRT. Circulation 68, No. 4, 827-833, 1983. FOR MANY YEARS adenosine-5'-triphosphate (ATP) has been successfully used in Europe to treat paroxysmal supraventricular tachycardia (PSVT) in adult patients. More recently ATP was established as a drug of first choice for quick termination of PSVT in infancy.6In spite of the wide clinical use of ATP, information on its electrophysiologic effects in patients with atrioventricular reentrant tachycardia (AVRT) is rather limited. In this study we assessed the efficacy and safety of ATP and evaluated its electrophysiologic mechanism of action in patients with AVRT.
Material and methodsPatients.The criteria for patient selection were the following:(1) a history of documented recurrent PSVT, (2) inducible sustained AVRT during electrophysiologic study, and (3) no contraindication for the administration of ATP (asthma The study group consisted of 18 patients, six women and 12 men, ages 25 to 72 years (49 ± 14). Fifteen patients had no evidence of organic heart disease and three patients had coronary heart disease. In seven patients (Nos. 3,5,8,9,14,16,and 18) the tachycardias responded to vagal maneuvers, and in the remaining 11 patients pharmacologic intervention was required to terminate tachycardias.Electrophysiologic studies. Electrophysiologic studies were perfor...
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