Down to the Wire: Tricuspid Stenosis in the Setting of Multiple Pacing Leads

Tricuspid stenosis in the setting of endocardial pacing leads is a rare entity, attributed to infection or lead malposition. We report the case of a 37‐year‐old man without these risk factors, who presented with new onset severe tricuspid stenosis in the setting of multiple chronic pacing leads. (PACE 2010; e49–e52)     

THE CAUSES OF PATIENT DROPOUT FROM PENILE SELF-INJECTION THERAPY FOR IMPOTENCE

PURPOSE: Penile self-injection therapy, a second line treatment for erectile dysfunction, is the most efficacious means of reestablishing functional erections when first line therapies fail and the patient wants to avoid penile prosthesis implantation. Despite high efficacy rates, injection therapy has high dropout rates. To our knowledge studies to date analyzing patient attrition have reviewed small numbers of patients followed for only short periods. We elucidate the main reasons for patient dropout in a large penile self-injection program with long-term followup. MATERIALS AND METHODS: A questionnaire was mailed to 1,424 patients who completed the office training and home use phases of a penile self-injection program. RESULTS: The overall attrition rate was 31% of the 720 men who completed the questionnaire, with a mean followup of 38 months. The main reasons for dropout were cost of therapy, patient and partner problems with the concept of penile injection, lack of partner availability and spontaneous improvement in erections. Lack of efficacy of therapy was the primary reason for only 1 of 7 dropouts. Furthermore, adverse effects of penile injections (priapism, penile nodules, pain) appeared to be only minor contributors to dropout. CONCLUSIONS: To our knowledge this study is the largest published, single center cohort of patients treated with injection and followed for an analysis of dropout rates. Based on study data a reduction in dropout rates may be achieved by keeping the cost of therapy low, and ensuring patient and partner education as well as continued support throughout treatment.     

EFFECT OF INFLAMMATION ON PROSTATIC PROTEIN SYNTHESIS AND LUMINAL SECRETION IN VIVO

PURPOSE: Inflammation of the prostate, or prostatitis, can be caused by an infectious process or can occur in a reportedly non-bacterial form, the etiology of which is largely unknown. The present study was undertaken to establish a method of studying prostatic protein synthesis and secretion in vivo and determine the effects of lipopolysaccharide (LPS)-induced prostatic inflammation on these processes. MATERIALS AND METHODS: Sprague-Dawley rats were divided into three groups: control, 24 hours LPS-inflammation, and 24 hours LPS + antibody against tumor necrosis factor (anti-TNF). 35S-methionine was perifused in vivo around ventral prostate ducts for 3 hours. Ductal fluid (DF) was collected by micropuncture and ductal extract (DE) was collected by tissue homogenization. DE and DF were then subjected to SDS-PAGE and autoradiography. Densitometric analysis of gels and autoradiograms was used to compare protein synthesis (total DE 35S-proteins) and protein secretion (DF 35S-proteins) among the three groups. RESULTS AND CONCLUSIONS: The method proved to be effective for studying prostatic protein synthesis and secretion in vivo. LPS-induced inflammation caused an increase in total 35S-proteins in both the DE and the DF when compared with controls. There were significant increases in both the total number of proteins produced as well as the densitometric quantity of protein in the inflamed group. Some specific prostatic proteins were also upregulated by inflammation. The addition of anti-TNF did not significantly alter inflammation-induced protein synthesis or secretion at the time/dose studied.     

Complement (C3) levels and the effect of C3 depletion in infections of Trypanosoma brucei in mice

Summary Circulating C3 levels and parasitaemias have been measured in four groups of mice chronically infected with Trypanosoma brucei : group A (normal); group B (irradiated, reconstituted); Group C (T cell-deprived); and group D (T cell-deprived, C3-depleted by treatment with cobra venom factor). In groups A-C, C3 levels first rose two to three times normal, C3 thus behaving as an acute phase reactant. Three weeks after infection C3 returned to normal levels for the remainder of the infection. It is thus unlikely that the severe generalized immunodepression seen in mice infected with this trypanosome, is in any way dependent upon a reduction of circulating C3. The curves of parasitaemia in all four groups of mice were essentially similar, even though in group D mice, C3 levels were reduced to about 10% of normal for the first 3 weeks of infection. From this finding, it is argued that complement has no essential role in the mechanisms whereby mice control successive variant populations of T. brucei in the blood. Variant-specific IgM antibodies, acting as trypagglutinins, are probably all that are required to control blood stream infections.     

Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways*

Aim: To evaluate the new pediatric Glidescope^® (Cobalt GVL^® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope^® would perform as well as conventional laryngoscopy. Background: A new pediatric Glidescope^® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. Methods: We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL^® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. Results: We found no difference in time taken to tracheal intubation using the Glidescope^® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope^®, respectively. However, only 34% of participants said that they would definitely use the Glidescope^® in an emergency compared with 66% who would be willing to use the Miller laryngoscope. Conclusions: The new Glidescope^® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.     

Transpharyngeal Echocardiographic Diagnosis of Carotid Bulb and Left Internal Carotid Artery Stenosis

We report a patient in whom we were able to make an accurate diagnosis of left carotid bulb and left internal carotid artery stenosis by carefully and slowly withdrawing the probe from the esophagus into the pharynx.     

Risk factors for adverse outcomes of bacterial meningitis

Objective : To identify risk factors for adverse outcomes from bacterial meningitis.
Methodology : From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5–9 years following their illness.
Results : Major adverse outcomes included 8/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age ≤12 months, tertiary referral, symptoms >24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age ≤12 months, symptoms >24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities.
Conclusions : As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.