Atrioventricular Node Ablation for Optimization of Pacemaker Treatment in Hypertrophic Obstructive Cardiomyopathy

Dual chamber pacing is a new indication for the treatment of drug resistant hypertrophic obstructive cardiontyopathy (HOCM) in patients with normal atrioventricular (AV) conduction. In sinus rhythm, the efficacy of the treatment is mainly related to the ability to bypass the normal AV conduction system in order to obtain a complete and permanent right ventricular (RV) capture. This is achieved by programming short AV delays. On the other hand, patients with HOCM frequently have co-existing left ventricular diastolic dysfunction, and the atrial contribution to left ventricular filling is critical. The lack of improvement, rarely encountered, is probably due to incomplete RV capture andlor to the deleterious effect of short AV delay. Instrumental AV node prolongation may he indicated in this situation. This procedure should be undertaken when previous drug-induced AV prolongation has failed. In theory, AV node modulation (i.e., creating a I ± AV block) seems ideal. However, this technique remains difficult, with disappointing chronic results. Most authors hence perform "conventional" AV node ablation. Particular attention is taken in order to perform a proximal node ablation, resulting in a complete AV block with narrow QRS escape rhythm. The reported incidence of AV node prolongation ranges from 7.5%-37.5%. The efficacy of the procedure on symptoms is explained by improved left ventricular filling and/or a further reduction in the systolic gradient evoked by complete RV capture. Another indication for AV node ablation in HOCM is the occurrence of atrial fibrillation, in order to restore adequate and permanent RV capture .     

ETHANOL DECREASES BASAL CYTOSOLIC-FREE CALCIUM CONCENTRATION IN CULTURED SKELETAL MUSCLE CELLS

We analysed the effect of ethanol on basal cytosolic-free calciumconcentration ([Ca²⁺]₁) in cultured rat myocytes. Ethanol causeda dose-dependent decrease of the resting [Ca²⁺]₁). Removal ofethanol was followed by a transitory increase of [Ca²⁺]₁ abovethe basal level. In cells chronically exposed to ethanol, [Ca²⁺]₁normalized to the previous level.     

Randomized Evaluation of an Inflatable Femoral Artery Compression Device After Cardiac Catheterization

Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure < 160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterization .     

DISTANCE LEARNING: THE ROLE OF TELEMEDICINE

Growing awareness of the potential benefits of advanced medicine, emerging democracies, growing middle classes and an ageing population world-wide are significant forces shaping future demand for world-class health care. Coupled with an increased awareness of the potential benefits of advanced modern medical technologies, these factors will have a dramatic impact on medical education systems. Traditional academic institutions might not represent the optimal approach to education in the 21st century. They are expensive to build and run, typically reward academic excellence not exceptional health care delivery, teach matriculating students on site, and tend to perpetuate themselves. The expertise of centres of excellence needs to be disseminated more widely, to a 'student' or client base interacting with the institution only episodically. As relevant geographic distances increase, access to such centres becomes more difficult. To attack this problem on a global basis, we must be able to teach and interact at a distance. Telemedicine is likely to form an essential part of the solution.     

Ovarian Histopathology of Bitches Immunized With Porcine Zonae Pellucidae

ABSTRACT: The ovarian histopathology of bitches immunized with crude (cPZP) or partially purified (pPZP) porcine zona pellucida proteins was examined in order to determine the cause of abnormal estrous cycles. The majority of immunized bitches had ovarian cytes. Those immunized with cPZP had follicular cysts lined with a thin layer of granulosa cells, while in those immunized with pPZP, the cysts were lined by a basement membrane with a clump of luteinized cells. In two bitches immunized with cPZP, oocytes were present only in primordial follicles. Similar abnormalities were not found in a bitch immunized with human serum albumin or in 12 untreated bitches. Oocytes flushed from the oviducts of mated, immunized bitches were degenerating, which may have been a primary cause of infertility in such bitches. Ovaries studied 2–6 weeks after immunization showed no loss of gap junctional communication between oocytes and granulosa cells, nor was any inflammatory reaction seen. IgG was bound to the zona as revealed by fluoresceinated protein A staining of frozen sections of those ovaries. Abnormal estrous cycles in PZP-immunized bitches appear to result from follicular dysgenesis or cyst formation, but the etiology of these conditions is unresolved.     

Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy

The first case of cobalamin deficiency with megaloblastic anaemia in a patient under long-term omeprazole therapy is presented. This patient received omeprazole at a daily dose of 40–60 mg for 4 years as treatment for a gastro-oesophagal reflux complicated by peptic oesophagitis. Seric vitamin B12 was dramatically decreased at 80 pmol L^-1. The Schilling test was normal (13%) with crystalline [⁵⁷Co] cobalamin and it was at 0% with [⁵⁷Co] cobalamin-labelled trout meat. All other assimilation tests were normal except an expiratory hydrogen breath test performed with lactulose. The haematological status was restored after intramuscular treatment with cobalamin. In conclusion, prolonged omeprazole therapy can be responsible for a cobalamin deficiency due to protein-bound cobalamin malabsorption.     

Is the tongue position influenced by the palatal vault dimensions?

Summary The influence of the palatal vault dimensions on tongue position is here studied through evaluation of the in‐mouth air cavity (IMAC) volume when the mandible is in maximal intercuspal position. A sample of 35 women (mean age 21·2 ± 1·0) and 15 men (mean age 22·1 ± 0·9) was selected. The sagittal cross‐section area of the IMAC, which is modulated by the tongue position, was measured on lateral cephalograms. Dental casts were used to measure the palatal vault volume, which was defined by the occlusal plane, the hard palate and the posterior face of the second molars. Palatal vault volume allowed deduction of the IMAC volume through a rule of three procedure relating volume to area ratios. No IMAC could be calculated from cephalograms of 10 subjects who had the tongue stuck to the palate. For the 40 other subjects, the IMAC volume was 8·9 ± 4·8 mL. It was 2 mL larger in men (n = 14) than in women (n = 26) and was the largest in skeletal Class III and the smallest in skeletal Class II (P > 0·05). IMAC volume was strongly correlated with palatal vault height but neither with palatal width nor length. It was thus assumed that the height of the palatal vault could influence the most observed position of the tongue but this does not exclude a possible growth influence of the tongue on its surrounding skeletal structures.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.