Two Mechanisms of Arrhythmia Induction by a DDD Pacemaker: A Case Report

A 68-year-old man with sick sinus syndrome and a history of intermittent atrial fibrillation was treated by implantation of a DDD pacemaker. He subsequently developed recurrent episodes of shortness of breath and tachycardia. Investigation revealed two different arrhythmias, both induced by the pacemaker: (1) a tachycardia in which the dual-chamber pacemaker system provided the antegrade limb and the AV node provided the retrograde limb and (2) a triggered, ventricularly paced tachycardia caused by the pacemaker sensing atrial fibrillation waves. Both rhythms were abolished by reprogrammingto the DVI mode.     

Psoriasis and occlusive vascular disease

To test the hypothesis that psoriasis is associated with an increased incidence of occlusive vascular disease (thrombophlebitis, myocardial infarction, pulmonary embolization, and cerebrovascular accident), the clinical records of 323 psoriatic and 325 non-psoriatic patients admitted to the dermatology service of the Roger Williams General Hospital were examined. The data obtained in this study suggest that (1) the occurrence rate of occlusive vascular disease is significantly greater in the psoriatic than in the non-psoriatic dermatological patient. This is particularly true in the male population; (2) psoriasis predisposes to occlusive vascular disease; and (3) the psoriatic patient with certain predisposing factors is at greater risk of experiencing an occlusive vascular episode than both the non-predisposed psoriatic and the non-psoriatic dermatological patient.     

Correlation of disease activity in systemic vasculitis with serum C-reactive protein measurement. A prospective study of thirty-eight patients

In a prospective study over 2 years, serum C-reactive protein (CRP) concentration and erythrocyte sedimentation rate were measured serially in thirty-eight patients with various types of necrotizing systemic vasculitis. The CRP concentration was always elevated in patients with active vasculitis and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. In contrast the sedimentation rate responded more slowly to changes in disease activity and did not necessarily reflect the level of inflammation at a particular time. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial measurement of the serum CRP fills the urgent need for an objective index of the activity of the systemic vasculitides and their response to therapy.     

THE HYPERCALCIURIA OF DIABETES MELLITUS: ITS AMELIORATION WITH INSULIN

Calcium and phosphous metabolism was investigated in 20 patients with diabetes mellitus when their diabetes was under poor metabolic control and again once optimal glycaemic control was achieved with aggressive insulin therapy. Ten of the twenty uncontrolled diabetics had hypercalciuria; insulin therapy returned calcium excretion to normal in five. Twenty-four hour calcium excretion fell in all but two patients when optimal diabetic control was achieved and calcium excretion was positively correlated with glucose excretion. Urinary cyclic AMP excretion, which was in the high normal range during poor control, decreased significantly during optimal insulin therapy. These data suggest that the hypercalciuria of uncontrolled diabetes may be a form of renal hypercalciuria which could result in parathyroid stimulation which might contribute to the development of osteopenia in patients with diabetes mellitus.     

Biofeedback as an aid to childbirth

Summary. Self-controlled relaxation in childbirth is claimed to relieve pain and speed labour. A comparative study of two methods of relaxation training based on biofeedback techniques has shown that electromyographic (muscular) relaxation can readily be taught at antenatal classes, while skin-conductance (autonomic) relaxation cannot. The techniques were of some use in early labour but did not postpone the onset of severe pain nor help women to cope with painful uterine contractions. There were no differences in the outcome of labour between women using biofeedback and the women in the control groups.     

POLYTETRAFLUOROETHYLENE (PTFE) GRAFTS FOR HAEMODIALYSIS IN CHRONIC RENAL FAILURE: ASSESSMENT OF DURABILITY AND FUNCTION AT THREE YEARS

The utilization of 162 PTFE grafts for anglo access in 131 patients over a three year period is reported. One hundred and three new PTFE arterlo-venous flstulae were constructed in addition to 59 patch and tube incorporations Into pre-existing graft flstulae. At three years, the cumulative patency of newly constructed grafts was 85%. Seventy four per cent of the grafts have had no thrombosis and are functioning up to 38 months following insertion. An aggressive approach was adopted towards the 15% of grafts that had at least one episode of thrombosis prior to flow being successfully restored. Graft occlusion which occurred up to 18 months following Insertion, represented 11% of the group In this series. PTFE has provided an important advance In angio access for chronic renal failure with high patency and excellent durability after three years.     

Ascending Colon Volvulus Due to a Vitelline Duct Remnant in an Elderly Patient

A 77-year old female is presented with volvulus of the ascending colon due to torsion around a vitelline duct remnant. Symptoms were mild and intermittent. Roentgenograms are presented which demonstrated this lesion preoperatively. At surgery the ascending colon was found to be twisted around a fibrous band extending from the umbilicus to the ileum.