Problems of Sensing Tachyarrhythmias by an Antitachycardia Pacemaker (Symbios 7008)

Atrial burst pacing is an effective method of terminating supraventricular tachycardia. In the patient presented in this report, a Symbios 7008 pacemaker (Medtronic Inc., Minneapolis, MN, USA) was implanted for two reasons: (1) severe AV conduction defect (AH, 230 msec; HV, 150 msec) and bifascicular block following anterior myocardial infarction; and (2) paroxysmal atrial flutter. The conduction defect ruled out programming other than atrial burst in DDD mode. Activation of burst pacing required appropriate programming of the "tachycardia detection window" on the basis of the cycle length of the flutter waves. In the case reviewed, episodes of atrial flutter with variable cycle lengths of 230 to 280 msec necessitated reprogramming of the AV interval, the refractory period, and the upper rate interval. The use of an antitachycardia device in automatic mode may be limited by variations in tachycardia cycle length.     

Cerebral vasculitis in severe Kawasaki disease: early detection by magnetic resonance imaging and good outcome after intensive treatment

Kawasaki disease is an acute vasculitis, that has a classic complication of acquired coronary artery aneurysm. Severe forms with multi‐organ involvement or neurological dysfunction are rare. Cerebral vascular involvement has been related to large‐vessel injury or cardioembolism, leading to focal brain infarction. A 4‐year‐old female presented with unusual, rapidly catastrophic Kawasaki disease with refractory shock, acute renal failure, and coma, requiring intensive haemodynamic management. The observation of diffuse micro‐haemorrhages (T2*‐weighted sequence) associated with white matter injury on brain magnetic resonance imaging (MRI) pointed towards lesions of the medium/small blood vessels. Cerebral vasculitis was suspected and the immunosuppressive treatment was increased Subsequently, the patient’s recovery was rapid. On follow‐up severe, bilateral vitritis was evident and surgery improved visual outcome. Early recognition of severe or unusual forms of Kawasaki disease could lead to more favourable outcome using appropriate treatment strategies. Diffuse cerebral micro‐haemorrhages on T2* brain MRI sequences might be a key sign for the diagnosis of medium or small cerebral vessel involvement.     

Trypanosoma brucei infection in nude mice: B lymphocyte function is suppressed in the absence of T lymphocytes

B lymphocyte function was assessed in outbred nude mice and nu/+controls infected with Trypanosoma brucei brucei. On day 10 of the infection in outbred nu/nu mice in which the initial wave of parasites was strongly controlled, B cell function was unaltered on enhanced compared with uninfected animals or infected nu/+. In other nu/nu mice unable to control the initial parasitaemia, thymidine incorporation and Ig secretion by spleen cells were increased on day 10 and their response to lipopolysaccharide in vitro negated. By day 15 however, even the spleen cells of infected nu/nu which controlled the initial wave of parasites were proliferating and secreting Ig on removal from the mice and they were unable to respond to LPS in vitro. These experiments confirm results of a previous study of B cell function in T cell-depleted mice (Askonas et al. 1979). T. b. brucei infection of mice causes both enhanced Ig production and suppression of the ability of B cells to respond to mitogen even in the absence of T cells, but the presence of T cells may accelerate the changes which occur in B lymphocytes following this infection.     

Hand function in relation to brain lesions and corticomotor‐projection pattern in children with unilateral cerebral palsy

Aim To investigate relationships between hand function, brain lesions, and corticomotor projections in children with unilateral cerebral palsy (CP). Method The study included 17 children (nine males, eight females; mean age 11.4 [SD 2.4] range 7–16y), with unilateral CP at Gross Motor Function Classification System level I and Manual Ability Classification System level I or II. Hand function was assessed with the Box and Blocks test and Assisting Hand Assessment (AHA). Conventional structural magnetic resonance images were assessed visually for type, location, and extent of brain lesions. Single‐pulse transcranial magnetic stimulation (TMS) provided information on organization of corticomotor projections. Results The most favourable hand function was seen in children who had white‐matter damage of immaturity with mild white‐matter loss and contralateral motor projections. Children with ipsilateral projections had the most impaired function. Nevertheless, in this subgroup a range of ability was seen (AHA 29–59%). Motor‐projection patterns appeared to be influenced by lesion extent and location, but not by lesion type. Interpretation Combining information from structural magnetic resonance images and TMS can improve prediction of hand function. A wide variation in hand function was seen within all motor‐projection patterns. Although the most impaired hand function was seen in the ipsilateral motor‐projection group, some children in this group had fairly good ability. Such information is important for treatment planning.     

Is Pleasantness of Biscuits and Cakes Related to their Actual or to their Perceived Sugar and Fat Contents?

Perceptions of sugar, fat and moisture contents, as well as their influences on pleasantness were investigated in commercial foods. One-hundred-and-two-normal-weight men rated the “pleasantness”, “flavour intensity”, “moisture”, “sweetness” and “fatness” of 39 different biscuits and cakes. Sugar content was accurately perceived up to a maximum content of about 33% weight/weight. The perception of fat content was less accurate and depended on both fat and sugar contents. High sugar contents seemed to decrease perception of fatness. Pleasantness was influenced mainly by sugar content and less by fat content. Pleasantness was better predicted by rated contents than by actual contents; it was even better predicted by the overall flavour intensity. Preferences for high fat stimuli did not appear to be based on conscious perception of their fat content. We conclude that the classical results obtained with simple experimental stimuli remain valid, as a first approximation, for commercial biscuits and cakes, despite their complex sensory characteristics.     

Anticipatory postural adjustments in a bimanual load‐lifting task in children with developmental coordination disorder

Aim Postural control is a fundamental component of action in which deficits have been shown to contribute to motor difficulties in children with developmental coordination disorder (DCD). The purpose of this study was to examine anticipatory postural adjustments (APAs) in children with DCD in a bimanual load‐lifting task. Method Sixteen children with reported motor problems (two females, 14 males; mean age 9y; SD 2y) and 16 typically developing, age‐matched children (six females, 10 males; mean age 9y; SD 2y) took part in the study. The task required the children to maintain a stable elbow angle, despite imposed or voluntary unloading of the forearm. APAs were assessed using electromyography and kinematics analysis. Results Although children with DCD could compensate for the consequences of unloading, the results demonstrated that APAs were less efficient in children with DCD than in typically developing children. A positive and significant coefficient of regression between the flexor inhibition latency and the postural stabilization was only found in typically developing children. Interpretation The impaired fine‐tuning of the muscle contribution and the poor stabilization performances demonstrate poor predictive modelling in DCD.     

Katamnestische Untersuchungen griseofulvinbehandelter Onychomykosen

Insgesamt 359 Onychomykosen, die in der Hautpoliklinik der Freien Universität Berlin mit Griseofulvin behandelt wurden, konnten nachuntersucht werden. Es handelte sich um 160 Onychomykosen in Fingern und um 199 Onychomykosen an Zehen. 114 Finger– und 141 Zehennagelmykosen wurden konservativ mit Griseofulvin behandelt. Die übrigen 46 Finger– und 58 Zehennagelmykosen erhielten Griseofulvin in Verbindung mit der Extraktion der erkrankten Nägel. Bei konservativer Therapie wurden 62% der Fingernagelmykosen und 11% der Zehennagelmykosen geheilt. Bei kombinierter Behandlung waren es 80% Erfolge bei den Fingernägeln und 55% Erfolge bei den Zehennägeln. Der Behandlungserfolg hängt aber nicht nur von der Lokalisation der Mykose sondern auch vom Alter des Patienten und von der Höhe der Griseofulvingesamtdosis ab. Bei konservativer Griseofulvintherapie nimmt der Heilerfolg durchschnittlich um 3,1 % und bei kombinierter Behandlung durchschnittlich um 6,6 % mit je zehn Jahren Alterszunahme ab. Zwischen der Tablettenzahl und dem Heilerfolg besteht nach Aussage des Korrelationskoefflzienten für die konservative Therapie starke Abhängigkeit, d. h. je größer die Griseofulvingesamtdosis, die der Patient erhalten hat, ist, desto größer ist die Quote der geheilten Onychomykosen. Insgesamt 155 der 359 Onychomykosen (43 %) konnten geheilt werden. Von den 86 konservativ geheilten Onychomykosen rezidivierten je 9 innerhalb des ersten und des zweiten Jahres nach Therapieende. Zusammen 26 Rezidive traten bei 69 Heilungen durch kombinierte Griseofulvinbehandlung auf. 14mal innerhalb des ersten, 8mal innerhalb des zweiten und 4mal innerhalb des dritten Jahres nach Kurende. Bei beiden Behandlungsmethoden überwiegen die Rezidive der Zehennagelmykosen. 10 Rezidiven bei Onychomykosen der Zehen stehen 8 Rezidive bei Onychomykosen der Finger nach konservativer Behandlung und 18 Rezidiven der Zehennagelmykosen stehen 8 Rezidive bei Fingernagelmykosen nach kombinierter Therapie gegenüber. Zusammenfassend läßt sich feststellen, daß unter den 155 erfolgreich behandelten Onychomykosen sich 108 Onychomykosen der Finger und 47 Onychomykosen der Zehen befanden. 92 der 108 geheilten Fingernagelmykosen (85 %) blieben wahrend einer Nachbeobachtungszeit von mindestens 18 und maximal 42 Monaten rezidivfrei. Bei den Zehennagelmykosen betrug der Anteil der rezidivfreien 19 von 47, d. h. nur 40 z% Bei insgesamt 44 Onychomykosen kam es also zu einem Rezidiv.     

Ontogeny of bovine neurohypophysial hormone precursors

Vasopressin, MSEL-neurophysin and a glycopeptide, here referred to as copeptin, are three fragments of a common protein precursor processed during axonal transport from hypothalamus to neurohypophysis. Neurohormones and neurophysins purified from 7–9-month-old bovine foetuses have previously been shown to be identical with those found in the adult. Copeptin has now been isolated from 7–9-month and 3-month-old bovine foetuses and chemically characterized. It can be concluded from the nature of the three precursors that the same vasopressin gene is expressed in the adult and the 7–9-month-old foetus.