Visual screening in a school for hearing-impaired children

Hearing-impaired children use vision to compensate for impaired auditory information. This fact, and the relatively high incidence of visual defect among the deaf population, render regular visual screening essential. The Royal School for Deaf Children, Margate, caters for children with a wide range of needs; screening involving a single-assessment structure for all pupils is felt to be inappropriate. This paper describes the implementation of a 'tiered' screening system, and the factors affecting allotment of pupils to particular 'tiers'. The screening structure is illustrated by a case study, and generalization of the system to other educational settings is discussed.     

Better Predictors of Successful His-Bundle Ablation Analysis of First Shocks

IWA, T., ET AL.: Better Predictors of Successful His-Bundle Ablation Analysis of First Shocks. We have reported here that a longer HV interval in asssociation with a larger His amplitude yields a high rate of success when used to position the ablating catheter for His-bundle ablation. Additionally, we have shown that double discharge shocks are more effective than single discharge shocks, and that negative polarity is more effective than positive polarity. The use of bipolar or tripolar, and not quadripolar catheters, was also associated with a higher success rate. In our institution, using a bipolar catheter, we attempt to record an HV interval > 55 msec and a His amplitude > 0.35 mV. When both of these criteria are fulfilled, we use 3 to 4 joules per kg, and a single discharge shock. When one or the other of these criteria are not fulfilled, we use the double discharge shock method. Using these techniques, we have achieved successful His-bundle ablation with only one shock in all but one of the most recent 21 consecutive patients.     

THE USE OF THE DECISION TREE TECHNIQUE AND IMAGE CYTOMETRY TO CHARACTERIZE AGGRESSIVENESS IN WORLD HEALTH ORGANIZATION (WHO) GRADE II SUPERFICIAL TRANSITIONAL CELL CARCINOMAS OF THE BLADDER

The aggressiveness of human bladder tumours can be assessed by means of various classification systems, including the one proposed by the World Health Organization (WHO). According to the WHO classification, three levels of malignancy are identified as grades I (low), II (intermediate), and III (high). This classification system operates satisfactorily for two of the three grades in forecasting clinical progression, most grade I tumours being associated with good prognoses and most grade III with bad. In contrast, the grade II group is very heterogeneous in terms of their clinical behaviour. The present study used two computer-assisted methods to investigate whether it is possible to sub-classify grade II tumours: computer-assisted microscope analysis (image cytometry) of Feulgen-stained nuclei and the Decision Tree Technique. This latter technique belongs to the Supervised Learning Algorithm and enables an objective assessment to be made of the diagnostic value associated with a given parameter. The combined use of these two methods in a series of 292 superficial transitional cell carcinomas shows that it is possible to identify one subgroup of grade II tumours which behave clinically like grade I tumours and a second subgroup which behaves clinically like grade III tumours. Of the nine ploidy-related parameters computed by means of image cytometry [the DNA index (DI), DNA histogram type (DHT), and the percentages of diploid, hyperdiploid, triploid, hypertriploid, tetraploid, hypertetraploid, and polyploid cell nuclei], it was the percentage of hyperdiploid and hypertetraploid cell nuclei which enabled identification, rather than conventional parameters such as the DI or the DHT.     

Alteration of QT Rate Dependence Reflects Cardiac Autonomic Imbalance in Patients with Obstructive Sleep Apnea Syndrome

QT rate dependence is one of the major properties of ventricular repolarization with its circadian and autonomic modulations. The authors postulated that dynamic alterations in QT interval adaptation could help characterize patients with cardiac autonomic alterations, like those with obstructive sleep apnea syndrome (OSAS). To assess ventricular repolarization features in patients with OSAS, QT parameters and their dynamicity along RR intervals were compared from 24-hour ECG data of patients with and without this syndrome, assessing cardiac autonomic nervous system equilibrium by means of time-domain and frequency-domain analyses of heart rate variability (HRV). The study group consisted of 74 consecutive patients referred to the Sleep Laboratory for clinically suspected OSAS. The syndrome was confirmed in 30 (40.5%) patients according to standard polysomnographic criteria. QT length related to heart rate (HR) was found significantly shorter for HR < 70 beats/min in patients with OSAS   (−1.32 ± 0.35)   compared with patients without OSAS   (−1.99 ± 0.40; P < 0.01)   . This flattened relationship was correlated with the severity of the sleep related disorder. Using multiple linear regression analysis, the apnea/hypopnea index and nocturnal normalized high frequencies (HFnu) were the most significant predictors of the QT/RR slope   (R = 0.61; P < 0.0001)   . OSAS is significantly associated with a flattened relationship between QT duration and RR interval at low HRs. The alteration of cardiac parasympathetic tone occuring in severe OSAS patients may explain this altered rate dependent adaptation of myocardial repolarization. (PACE 2003; 26[Pt. I]:1446–1453)     

Severe hyponatraemia after plastic surgery in a girl with cleft palate, medial facial hypoplasia and growth retardation

A ten-year-old girl with middle face hypoplasia, cleft lip and palate developed severe hyponatraemia on the first day following surgery. Final diagnosis was inappropriate secretion of antidiuretic hormone (ADH) and complete hormonal investigation revealed partial deficit in growth hormone secretion. The incidence of hormonal deficiency associated to midline facial malformations is discussed.     

Atrial Tachycardia Confined Within the Left Atrial Appendage

AT Confined Within the LAA. Left atrial tachycardias are often seen following catheter ablation of persistent atrial fibrillation (AF). We report here an unusual case where AF was converted to sinus rhythm following catheter ablation, but ongoing atrial tachycardia confined within the left atrial appendage (LAA) was observed. Although the LAA tachycardia was dissociated from the atrium in sinus rhythm, bidirectional conduction between the left atrium and the LAA was, however, demonstrated after tachycardia termination. (J Cardiovasc Electrophysiol, Vol. 21, pp. 933‐935, August 2010)     

Structure and Neural Modulation of Cardiac Calcium Channels

Regulation of Cardiac Ca Channels . The L-type, voltage-gated calcium (Ca) current plays a key role in excitation and initiation of contraction in cardiac muscle cells and is partly responsible for the plateau of the action potential. The ionic channels underlying this current are targets for modulation by the autonomic nervous system. This article reviews recent developments in understanding how these channels are regulated by phosphorylation and G proteins and attempts to relate these findings to recent studies on the molecular structure of the Ca channel.