Inter- and Intraday Variability in Major Electrocardiogram Intervals and Amplitudes in Healthy Men and Women

DOTA, C.D., et al. : Inter- and Intraday Variability in Major Electrocardiogram Intervals and Amplitudes in Healthy Men and Women. The ECG may vary during the day (intra-day), and between days (interday), for the same subject. Variability in ECG characteristic measurements between different investigators is well documented and is often large. During days 1–6 of each placebo period of a two-way crossover Phase I study, digital ECGs were recorded at about 8 and 12 am in 16 healthy volunteers (8 men, 8 women). Two observers independently analyzed leads V₂ and V₆ using EClysis software. The durations and amplitudes of major ECG waves and the intervals between major electrocardiographic events were analyzed in a mixed model ANOVA, in which subject, observer, time, and day were treated as random factors. The influence of various corrections for heart rate on the variability of QT intervals was investigated. The difference among subjects explained between 44–81% of the total variability in ECG intervals and amplitudes. Overall, inter- and intraday variability was not statistically significant for any variable. The individualized exponential correction of the QT interval for heart rate eliminated the QT interval dependence on the RR interval in all subjects. Changes in T wave morphology and shortening of the QT interval from morning to noon were observed in ten subjects. The interobserver variability was close to zero   (SD < 0.005 ms)   for all variables except the PQ interval (SD 1.4 ms). The various sources of variability in determinations of ECG wave characteristics should be considered in the design of clinical studies. The use of EClysis software for ECG measurements in this study made the results highly observer independent. (PACE 2003; 26[Pt. II]:361–366)     

NUTRITION, OVERNUTRITION, AND OBESITY IN THE FIRST YEAR OF LIFE IN MALMÖ, SWEDEN

ABSTRACT: Sveger, T., Lindberg, T., Weibull, B. and Olsson, U. L. (Department of Paediatrics, Malmö General Hospital, Malmö, Sweden). Nutrition, overnutrition, and obesity in the first year of life in Malmo, Sweden. Acta Paediatr Scand, 64:635, 1975___The feeding pattern, calorie intake, weight and height were studied at various ages during the first 12 months in 243 infants born in Sweden. The feeding pattern and calorie intake was close to that recommended. 0–6% in each age group were found to be obese (20–40% above the standard weight) and 15–23% overweight (10–20% above the standard weight). The mean calorie intake during the months before and when obesity and overweight were diagnosed exceeded the normal by 10% or less. When re-examined at age 2±½ years, 50% of those children obese up to 1 year remained so, and only 2 earlier overweight had become obese. 25 % of the obese children had one obese parent, compared with 10% of the normal children and overweight ones. The low incidence of overnutrition and the low freqency of obese and overweight infants in this study compared with previous studies support the idea that high calorie intake is of importance in the development of obesity during infancy. Accordingly, overnutrition seems to be one factor, in the multifactorial aetiology of obesity, and reduction of overnutrition can reduce, but not abolish, infantile obesity. Whether the reduction of this will subsequently prevent adult obesity remains to be proved.     

Coronary Artery Surgery Without Cardiopulmonary Bypass: Usefulness of the Surgical Blower-Humidifier

Coronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower-humidifier (custom made [Research Medical, Inc.]) for improved visualization and facilitation of coronary artery surgery without CPB.     

Technical Aspects of Warm Heart Surgery

Intermittent hypothermic cardioplegia has been adopted as the method of choice for myocardial protection by most surgeons. The most important aspect of this protection is believed to be adequate hypothermia. An alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. With this method of myocardial protection the heart is maintained at 37 degrees C throughout the operative procedure. The specific technical aspects used shall be described in detail.     

HUMAN DIROFILARIASIS

Background. Subcutaneous and pulmonary dirofilariasis in humans appears to be a frequent disease in endemic areas, notably the Mediterranean region. Following increased air travel in recent years, the incidence of human dirofilariasis has increased in tourists as well. Methods. The clinical and parasitologic aspects in a series of six patients with cutaneous and pulmonary dirofilariasis, seen in a German unit for infectious and tropical diseases, are reviewed. Results. Four patients presented with subcutaneous tumors due to infection with Dirofilaria repens, whereas two patients had pulmonary infiltrates due to the canine heartworm, D. immitis. All infections were acquired in the Mediterranean region. Symptoms were only slight and nonspecific. Eosinophilia in the blood was absent in all patients. The serum IgE levels were normal and signs of a specific humoral response to antigens of Dirofilaria spp. were absent, although slightly elevated antibody levels to antigens of Onchocerca volvulus could be demonstrated in all patients. The diagnosis was established in all patients by the surgical removal of adult worms from the lesions. Oral treatment with diethylcarbamazine (DEC) (2 mg per kg t.i.d.) over a period of 4 weeks was added to the surgical treatment in all patients. In one patient this therapy was preceded by oral ivermectine (150 mg per kg). Conclusions. Dirofilariasis has to be considered as a differential diagnosis in patients presenting with subcutaneous or pulmonary tumors after travels to endemic areas within the last few years. Effective therapy is possible by surgical removal of the adult worms and oral ivermectine plus diethylcarbamazine.     

APOLIPOPROTEIN A-I AND B LEVELS IN ADOLESCENTS; A TRIAL TO DEFINE SUBJECTS AT RISK FOR CORONARY HEART DISEASE

ABSTRACT. The normal levels of apolipoprotein A-I and B (apo A-I, apo B) were determined in 220 male and 340 female 16–19-year-old adolescents. In addition to these apolipoproteins, total and high density lipoprotein cholesterol (total-C HDL-C) were analysed in an attempt to define subjects at high risk for coronary heart disease (CHD). The normal levels were for boys: apo A-I 0.96±0.13 g/l, apo B 0.64±0.14 g/l; for girls: apo A-I 1.04±0.18 g/l, apo B 0.65±0.14 g/l; for girls taking combined oral contraceptives: apo A-I 1.14±0.22 g/l, apo B 0.72±0.16 g/l. Subjects with the following high-risk profiles were selected for further follow-up: 1. Total-C and apo B ±95th percentile; 2. Total-C or apo B ±95th and HDL-C or apo A-I ±5th percentile. Seven adolescents had the combination of high total-C and apo B. None had any of the other combinations. One girl had lipid, apolipoprotein levels and a family history indicating familial hypercholesterolemia (f. h.). Another two adolescents were suspected of having f. h. while one girl might have abnormal levels secondary to oral combined contraceptives. The study suggests that the analyses of apolipoproteins, especially apo B, are of value to trace adolescents at risk for future CHD.     

Analgesic Treatment in Acute Myocardial Infarction: A Double-blind Comparison of Ketobemidone + the Spasmolytic A29 (Ketogan®) and Morphine

The analgesic effect of ketobemidone hydrochloride + the spasmolytic component A29 (Ketogan®) and morphine hydrochloride was compared double-blindly in patients with suspect acute myocardial infarction. The test drugs were administered i.v. in an initial dose of 0.5 ml (2.5 mg Ketogan, 5 mg morphine) followed, if necessary, by additional injections of 0.25 ml. Altogether, 309 patients participated in the trial. The total comsumption of the test drugs showed that 5 mg Ketogan was equipotent with 10 mg of morphine. Treatment with Ketogan resulted in a significantly higher proportion of patients who were completely free of pain 15 and 30 min after the initial injection: 16% and 15% more, respectively, compared to morphine. Within 2 hours after the initial injection, approximately 15% of the patients in both treatment groups had reported nausea and about 7 % had vomited (patients who vomited or were nauseated before treatment were not included in this analysis). The frequency of other side-effects was low, with no differences between the two treatment groups. Morphine caused a greater reduction of the systolic blood pressure than Ketogan. The effect of both drugs on pulse rate and respiration was the same.