Unusual variant of atrioventricular nodal reentrant tachycardia.

Electrophysiologic study in a patient with supraventricular tachycardia revealed an unusual activation pattern in the coronary sinus (CS) electrodes. Pacing maneuvers confirmed the tachycardia was a slow-slow AV nodal reentrant tachycardia with double potentials in the distal CS electrodes due to an earlier left atrial signal (50 ms) and later CS musculature activation. The left-sided AV nodal inputs were successfully ablated from within the CS.     

A PRE‐TRAINING ASSESSMENT TOOL FOR HOME DIALYSIS (JPAT)

A tool for assessing the suitability of candidates for home dialysis (Jo‐Pre‐training Assessment Tool version 2.1 — JPAT) was developed, pilot‐tested at one hospital and field‐tested at two major teaching hospitals in Sydney. JPAT acts as a screening instrument to distinguish suitable candidates for the home dialysis programme, identifying patients with the greatest chance of learning to manage the programme. This study included an interview/test of home dialysis patients based on the Medical Outcomes Study Short‐Form 36‐Item Health Survey (SF‐36). JPAT version 2.1 is in the form of an interview questionnaire consisting of 38 assessment items in six domains: physical stability, nutritional status, communication ability, ability to maintain self‐care, psychological suitability and social support. Overall, results suggest that JPAT version 2.1 is sufficiently reliable to be used as a tool for assessing patients who suffer from end‐stage renal disease (ESRD), and to identify patients most likely to succeed in a home dialysis programme.     

中国初期防疟工作简史

中国的防疟工作开始于 194 0年 ,由云南遮放疟疾研究所施行。虽然规模很小 ,但进行得较有系统。该所名义上是前中国卫生署与美国罗氏基金社 (Rock-feller Foundation)合办 ,实际是后者负责一切 ,并由该社驻沪的远东代表 (M.C.Balfour)筹设 (为省篇幅 ,本文中的姓名皆未加称谓 ,并无不敬之意 )。抗日战争开始后 ,我国大部分海岸线被日军封锁 ,为从仰光输入物资 ,遂修筑一条长约 10 0 0 km由昆明到畹町 (中缅边界 )的滇缅公路。云南疟疾为患 ,在唐朝白居易“新丰折臂翁”诗提及 :“闻道云南有泸水 ,椒花落时瘴烟起 ,大军徒涉水如汤 ,未过十…     

The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria

PURPOSE: To determine the natural history of immunoglobulin (Ig) A nephropathy among patients who presented with hematuria and minimal proteinuria, and factors associated with the development of adverse clinical events, such as proteinuria. SUBJECTS AND METHODS: In Hong Kong, all patients who present with isolated hematuria are referred for renal biopsy after urologic diseases are ruled out. We reviewed the clinical course of 72 consecutive patients with histologically confirmed IgA nephropathy who presented with hematuria and minimal proteinuria (0.4 g/day or less). All patients were normotensive and had normal renal function at presentation. Adverse events were defined as proteinuria greater than 1 g per day, hypertension, or impaired renal function (serum creatinine level 120 micromol/L or estimated creatinine clearance < 70 mL per minute).RESULTS: The mean (+/- SD) age at presentation was 27 +/- 8 years; 56 (78%) were female. Nine patients (13%) had grade 2 histologic lesions. During a median follow-up of 7 years, 32 patients (44%) developed adverse events: 24 (33%) developed proteinuria of 1 g per day or more, 19 (26%) became hypertensive, and 5 (7%) developed impaired renal function. Another 30 patients (42%) had persistently abnormal urinalysis examinations. Only 10 patients (14%) had complete resolution of hematuria. The median time for progression from proteinuria (> l g/day) to renal impairment was 84 months (range 56 to 132). In a multivariate analysis, age at presentation (relative risk [RR] per 10 years of age = 2.0; 95% confidence interval [CI], 1.2 to 3.4) and histologic grade (grade 2 versus grade 1, RR = 4.5; 95% CI, 1.7 to 12) were independent predictors of developing an adverse event.CONCLUSIONS: IgA nephropathy that presents with hematuria and minimal proteinuria is usually a progressive disease. Life-long follow-up with regular monitoring of blood pressure and proteinuria is recommended.     

Therapeutic regimens for anorectal gonococcal infection in males.

Anorectal gonococcal infection is particularly prevalent in women and homosexual men. Although the currently recommended Public Health Service therapeutic regimens for uncomplicated gonorrhea appear to be effective also for anorectal gonorrhea in women, their efficacy for anorectal infection in men has not been adequately evaluated. We report a case of gonococcal proctitis in a homosexual man that did not respond to therapy with ampicillin plus probenecid and tetracycline, but subsequently responded to spectinomycin therapy. Currently available therapeutic regimens for anorectal gonococcal infection in males are reviewed.     

Serious infections in adults due to group B streptococci: Clinical and serotypic characterization

Serious infections in adults due to group B streptococci have been infrequently reported. We describe 24 such patients. Bacteremic pyelonephritis, pneumonitis and endometritis were the most common clinical syndromes observed. Group B streptococcal infections tended to occur in patients with underlying illnesses, particularly genitourinary disorders and diabetes mellitus. Mortality was surprisingly low (8 per cent). Type III was the serotype most commonly isolated, and there was no significant correlation of different serotypes with specific organ-system involvement. Group B streptococcal isolates from these patients were uniformly sensitive to penicillin, ampicillin, cephalothin, chloramphenicol, erythromycin and clindamycin; all were highly resistant to kanamycin. Eighty-seven per cent were resistant to tetracycline. Although consistently sensitive to penicillin, the minimal inhibitory concentrations were significantly higher for group B than group A streptococci (p < 0.0005).     

Pharmacokinetics and safety of antimicrobial agents during pregnancy

The use of antimicrobial agents during pregnancy poses unique concerns because of both potential toxicity and special pharmacokinetic considerations that have important therapeutic implications for both mother and fetus. Various physiologic adaptations occur with advancing gestation, including marked increases in maternal intravascular volume, glomerular filtration, and hepatic and metabolic activities; thinning and maturation of the fetomaternal membrane; and increases in transplacental diffusion capacity. The net result is that maternal antimicrobial concentrations tend to be 10%-50% lower in late pregnancy and the immediate postpartum period than in the nonpregnant state. Placental transfer of antimicrobial agents and their excretion in amniotic fluid or breast milk are similarly affected by hemodynamic changes, membrane transport characteristics, and maturation or metabolic activity of the specific organs involved. Review of the literature suggests that, although the need for caution in the use of antimicrobial agents during pregnancy has been well emphasized, firm data on the pharmacokinetics, efficacy, and optimal use of these drugs in this situation are extremely sparse and urgently needed. However, recommendations regarding the use of specific antibacterial, antifungal, antiviral, and antiparasitic agents against selected infections during pregnancy can be made.