First Lessons from Radiofrequency Catheter Ablation in Patients with Ventricular Tachycardia

Fourteen patients (12 men, 2 women; 61 ± 9 years) with ventricular tachycardia and underlying heart disease underwent an attempt at radiofrequency energy catheter ablation. Twelve patients had coronary disease and two patients had dilated cardiomyopathy. Two patients had two clinical tachycardias, the ejection fraction was 38%± 11%. All tachycardias were inducible and hemodynamically well tolerated (cycle length = 357 ± 56 msec). Ablation was initially successful in nine patients (no tachycardia inducible after ablation and before discharge). Two patients had recurrences (in-hospital and 4 months) and one patient had a tachycardia of a different morphology, which was also successfully ablated. Ablation was overall successful in seven patients and unsuccessful in seven patients (including all patients with cardiomyopaihy). Mid-diastolic potentials were observed in all the patients in whom ablation was successful but not observed in four of seven unsuccessful patients. The successful patients remain free of recurrences at 9 ± 8 months follow-up. Conclusions: (1) in ventricular tachycardia following an old infarction radiofrequency energy ablation is possible with a high success rate if a critical component of the tachycardia circuit can be localized. Localizing isolated mid-diastolic potentials and ensuring these potentials are part of the reentrant circuit with concealed entrainment can help to enhance the results. (2) A negative predischarge electrophysiological study may be predictive of success.     

Placement of Intracoronary Stents Mounted on "Over the Wire" Balloon Catheters Without Using Long Guidewires

The aim of this study is to investigate the feasibility, effectiveness, and safety of placement of intracoronary stents mounted on "over the wire" balloon catheters without using long guidewires. Fifteen consecutive patients underwent GR II stent placement. Over the wire balloon catheters and short guidewires were used. The new method was successful in 14 of 15 cases. No complications were observed. This novel technique using a short (instead of long) guidewire to place intracoronary stents mounted on over the wire balloon catheters was successful, and more convenient. (J Interven Cardiol 2000; 13:27–30)     

The effect of the antiprogestin mifepristone (RU 486) on maturation and in-vitro fertilization of human oocytes

Summary. The effect of RU 486 (mifepristone), a potent antiprogestin, on the in-vitro fertilization of human oocytes was investigated. In 40 normal volunteer women requesting laparoscopic sterilization, follicle aspiration for oocyte recovery was attempted 34 h after the injection of 5000 i.u. human chorionic gonadotrophin (hCG). Twenty women were allocated to receive 100 mg RU 486 orally 1 h before the hCG injection, the remaining 20 women acted as controls. There was no significant difference in the cleavage rate of the ooctyes after fertilization in vitro between the two groups (56% and 66% respectively). Also, the morphological characteristics of the cleaving oocytes and the concentrations of oestradiol, progesterone and androstenedione in the follicular fluid of the leading follicle did not differ significantly between the two groups. Since RU 486 was detected in substantial amounts in the follicular fluid specimens, these results suggest that progesterone is not critical for the final stages of human oocyte maturation.     

A comparison of fixed regimens for obtaining human cleaving oocytes for research purposes

Summary. A fixed schedule for ovarian stimulation and follicular aspiration, previously used in our department for research purposes, was modified in an attempt to increase the recovery and cleavage rates of the oocytes. Three different clomiphene regimens were used to stimulate the ovaries of normal volunteer women requesting laparoscopic sterilization (50 mg and 150 mg daily for 5 days, and 50 mg daily for 10 days). Oocytes were recovered from 83% of the aspirated follicles, i.e. 1·6 oocytes/patient: 65% of the oocytes cleaved after in-vitro fertilization and, on average, 1·0 cleaving egg was obtained per patient. There were no differences in the recovery and cleavage rates between the three clomiphene regimens. It is concluded that a sufficient number of cleaving embryos for research purposes can be generated with the present fixed regimen, which offers little inconvenience to the volunteers as the day of egg recovery can be predicted some time in advance.     

In Vivo Effect of Carbon Dioxide Laser-Skin Resurfacing and Mechanical Abrasion on the Skin''s Microbial Flora in an Animal Model

BACKGROUND: Although beam-scanning carbon dioxide (CO2) lasers have provided a highly efficient tool for esthetic skin rejuvenation there has been no comprehensive animal studies looking into microbial skin changes following CO2 laser skin resurfacing. OBJECTIVE: To evaluate the in vivo effects of CO2 laser skin resurfacing in an experimental rat model in comparison with mechanical abrasion on the skin microbial flora. METHODS: Four separate cutaneous sections of the right dorsal surface of 10 Wistar rats were treated with a CO2 laser, operating at 18 W and delivering a radiant energy of 5.76 J/cm2, while mechanical abrasions of the skin were created on four sections of the left dorsal surface using a scalpel. Samples for culture and biopsies were obtained from the skin surfaces of the rats on day 1 of application of the CO2 laser or mechanical abrasion, as well as 10, 30, and 90 days after the procedure. The presence of four microorganisms (staphylococci, streptococci, diphtheroids, and yeasts) was evaluated as a microbe index for the skin flora, and colony counts were obtained using standard microbiological methods. RESULTS: Skin biopsy specimens, following CO2 laser treatment, initially showed epidermal and papillary dermal necrosis and later a re-epithelization of the epidermis as well as the generation of new collagen on the upper papillary dermis. The reduction in microbial counts on day 1 of the CO2 laser-inflicted wound was statistically significant for staphylococci and diphtheroids compared with the baseline counts (p=.004 and p<.001, respectively), and for staphylococci, diphtheroids, and yeasts compared with the scalpel-inflicted wound on the same day (p=0.029, p<.001, and p=.030, respectively). CONCLUSIONS: Skin resurfacing using CO2 lasers considerably reduces microbial counts of most microorganisms in comparison with either normal skin flora or a scalpel-inflicted wound. This might contribute to the positive clinical outcome of laser skin resurfacing.     

SUPEROVULATION INDUCTION IN WOMEN SUPPRESSES LUTEINIZING HORMONE SECRETION AT THE PITUITARY LEVEL

In superovulated women the pituitary response to GnRH is markedly attenuated by an unspecified ovarian factor(s). To examine the site of attenuation, the response of the pituitary to GnRH was investigated in five normally ovulating women during the late follicular phase of 3 cycles, i.e. a spontaneous (control) cycle, a cycle treated with 'pure' FSH, and a cycle treated with a combination of 'pure' FSH and pulsatile GnRH, via a pump (15 micrograms/pulse). The oestradiol levels (mean +/- SEM) at the time of the GnRH challenge were respectively 646 +/- 35, 1692 +/- 282 and 5976 +/- 1129 pmol/l. The size of the leading follicle was similar in all groups. Serum LH levels during treatment with FSH decreased significantly, while during treatment with FSH plus GnRH they increased initially and then decreased progressively. The response of pituitary LH to GnRH was significantly attenuated during treatment with FSH and FSH plus GnRH, as compared to the spontaneous cycles, but was not abolished. The attenuation was significantly greater in the FSH plus GnRH cycles (94%) than in the FSH cycles (59%). We conclude that in superovulated cycles, the attenuation of the pituitary response to GnRH increases with the degree of ovarian hyperstimulation. It is suggested that the responsible unspecified ovarian factor(s) exerts its effects at least at the pituitary level.     

The increase in illegal private duty nurses in public Greek hospitals

fouka g., plakas s., papageorgiou d., mantzorou m., kalemikerakis i. & vardaki z. (2013) Journal of Nursing Management  21 , 633–637 The increase in illegal private duty nurses in public Greek hospitals Aim To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. Background Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. Evaluation Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. Key issues Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. Conclusions It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. Implications for nursing management Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.