Radiofrequency Catheter Ablation of the Slow Reentrant Pathway of Sustained Ventricular Tachycardia

The article reports the cases of two patients with severe coronary artery disease and associated recurrent sustained ventricular tachycardia successfully treated with radiofrequency catheter ablation. In the first patient, two different types of ventricular tachycardia (one incessant) were eliminated. In all procedures, an area of slow conduction critical for tachycardia maintenance was localized by endocardial mapping techniques. Radiofrequency energy delivered to this area could permanently modify the anatomical substrate of the arrhythmia. After single follow-ups of 19, 14, and 13 months regarding the arrhythmic entities, the patients are well and free from spontaneous recurrences.     

Isolated Disruption of the Right Coronary Artery Following a Steam Pop during Cavotricuspid Linear Ablation with a Contact Force Catheter

A 70‐year‐old woman with persistent atrial fibrillation underwent pulmonary vein isolation and linear ablation with a contact sensor catheter. During cavotricuspid isthmus ablation, a steam pop resulted in cardiac tamponade, and the patient developed severe hypotension despite successful pericardial puncture and minimal residual pericardial effusion. Right coronary artery angiography revealed extravasal contrast medium accumulation posterior of the Crux Cordis. Emergent cardiac surgery confirmed isolated disruption of the artery in the absence of additional heart perforation. Although contact sensor catheters may reduce complications, steam pops can still occur and result in dramatic complications.     

Blood pressure variability over 24 hours: its different components and its relationship to the arterial baroreflex

SUMMARY  This paper describes several different methods for the analysis of blood pressure and heart rate variability over the 24 hours, both in the time and in the frequency domain. The mechanisms possibly involved in the genesis of the variations in blood pressure and heart rate which occur over a 24-hour period are also discussed. Finally, new approaches to the dynamic evaluation of the sensitivity of baroreflex control of heart rate and of its changes over the 24 hours in daily life conditions, based on computer analysis of the interaction between fluctuations in blood pressure and heart rate, are described. Data obtained by applying these methods in different clinical conditions (normotensive vs. hypertensive subjects, young vs. elderly individuals and pure autonomic failure patients) are presented.     

Comparative Analysis of the Vascular Actions of Diterpenes Isolated from Euphorbia canariensis

We have analysed the effects of 2,3-diepiingol 7,12-diacetate-8-isobutyrate (compound 1 ), ingenol-3-angelate-17-benzoate (compound 2 ), ingenol-3-angelate-17-benzoate-20-acetate (compound 3 ) and 3,5,7,8,9,15-hexahydroxyjatropha-6(17),11-dien-14-one-5,8-bis(2-methylbutyrate)-7-(2-methylpropionate) (compound 4 ), four diterpenes isolated from E. canariensis, on the isometric tension developed by isolated rabbit basilar and carotid arteries. Concentration-response curves to these compounds were obtained cumulatively in both arteries at resting tension and active tone (KCl, 50 mM). At resting tension a concentration-dependent contraction was induced by the four compounds. In the basilar artery the order of potency was 3 = 1 > 2 = 4 , without significant differences between E_max values. In the carotid artery the order of potency was 3 > 2 = 1 = 4 and there were no significant differences between the E_max (maximum effect) values of compounds 1–3 , all of which were higher than that of compound 4 . In pre-contracted basilar artery compounds 1–3 induced concentration-dependent relaxation and compound 4 was almost ineffective; the order of potency was 3 > 2 = 1 without significant differences between E_max values. In the carotid artery with active tone the four compounds tested induced further contractions; the order of potency was 3 > 2 = 4 > 1 without significant differences between E_max values. These results show that the four diterpenes are potent active substances in rabbit basilar and carotid arteries and that there are regional differences between their action. The four compounds tested contract basilar and carotid arteries at resting tension. Compounds 1–3 relax pre-contracted basilar artery but not carotid artery.     

Sleep-related painful erections: Clinical and polysomnographic features

The aim of this study was to describe the clinical characteristics and the polysomnographic findings of a sample of patients affected by sleep-related painful erections (SRPE). In a 6-y period 18 patients were diagnosed as having SRPE. The mean age at the onset of the disease was 39.8±11.6 y and the mean duration of SRPE was 5.4±3.5 y. According to ICSD criteria, about 60% of patients had a severe form of the disease. None of the patients met any DSM IV Axis-I and Axis-II diagnoses. Twelve patients complained of excessive daytime sleepiness. SRPE patients, compared to age-matched controls, showed a reduced sleep efficiency, an increased wake after sleep onset and a reduced percentage of REM sleep. This study confirms that in SRPE there are no clear predisposing factors, no familial pattern, but REM sleep fragmentation. Concerning the pharmacological treatment, in the history of patients, propranolol and paroxetine, but not amitriptiline and lorazepam, showed a temporary efficacy in some patients.     

Controlled proteolysis of mouse epidermal growth factor An RP-HPLC and 1H-n.m.r. study

Tryptic digestion of the mouse epidermal growth factor (mEGF) and the chromatographic separation of its proteolytic fragments by RP-HPLC affords the isolation of the pure hormone, of its 1–48 (Des(49–53)mEGF) and 1–45 (Des(46–53)mEGF) derivatives, and of the carboxyl-terminal pentapeptide W49–W50-E51-L52-R53. Kinetics of mEGF proteolytic degradation follows a two-state time-course: native mEGF being converted into Des(49–53)mEGF with an apparent half-time of 10min; and Des(49–53)mEGF subsequently hydrolyzed to Des(46–53)mEGF with an apparent half-time of 7 h. Native mEGF and its proteolytic fragments have been characterized by ¹H-n.m.r. spectroscopy. In the aromatic and aliphatic regions, the ¹H-n.m.r. spectrum proved to be a sufficiently sensitive probe for following controlled proteolysis, and for analyzing the influence of the carboxyl-terminal sequence on the hormone conformation and stability.     

Medroxyprogesterone acetate in non-metastatic gestational trophoblastic disease

Summary. The effect of medroxyprogesterone acetate (MPA: Depo-Provera, Upjohn) as a contraceptive agent was assessed in 45 patients with non-metastatic gestational trophoblastic disease and compared with 13 patients using hormonal and 26 patients using non-hormonal methods of contraception. In the whole group of 84 patients 18 (21.4%) required chemotherapy. There was no statistically significant difference in the incidence of persistent trophoblastic disease between MPA (9/45) and the oral contraceptive group (2/13) and MPA and the non-hormonal contraceptive groups (7/26).     

GERIATRIC NURSES’ ATTITUDES TOWARDS THE USE OF NASOGASTRIC FEEDING-TUBES IN DEMENTED PATIENTS

Geriatric nurses’ attitudes towards the use of nasogastric feeding-tubes in severely demented patients were evaluated. A questionnaire was administered to 232 geriatric nurses asking whether they would favour enteral feeding for demented patients who were unable or refused to eat. The great majority of nurses (73.3%) were favourable; previous experience with nasogastric feeding-tubes and a moderate to high level of religiosity were both significantly associated with this attitude. For the great majority (70.6%) of those favourable the patient's mental status was immaterial to their attitude. Also irrelevant were patients’ and/or caregivers’ wishes and economic and quality of life issues. This survey suggests that the majority of nurses consider enteral feeding as an ordinary basic practice, disregarding the complexity of the problem, which needs an individualized, multifaceted approach.     

Drugs and Psychosis Project: A multi‐centre European study on comorbidity

Introduction and Aims. This paper describes the sociodemographic characteristics of 196 psychotic patients admitted to acute psychiatric wards in the UK, Denmark, Germany and Italy, with the aim of comparing comorbid with non‐comorbid patients. Design and Methods. It is a prospective field study with repeated measures at 1, 6 and 12 months. Patients were recruited from acute psychiatric wards in four European centres. They were grouped as comorbid or not on the basis of urine analysis. The Schedules for Clinical Assessment in Neuropsychiatry was used to provide a psychiatric diagnosis, and the Positive and Negative Symptom Severity Scale for further information on specific symptoms with results from the Fragerstrom test for nicotine dependence also reported. Results. Comorbid patients were younger than those who were not but did not differ significantly in the other sociodemographic measures. Differences in sociodemographic characteristics of patients between centres were apparent. Comorbid patients had higher levels of positive and lower levels of negative symptoms than those who were non‐comorbid. Differences were found in the patterns of drug use between comorbid patients who were using cannabis compared with those who were not. Discussion and Conclusions. Cross‐cultural differences in the sociodemographic characteristics of the comorbid patient population give us a better insight into this heterogenous group.[Baldacchino A, Blair H, Scherbaum N, Grosse‐Vehne E, Riglietta M, Tidone L, Criaco C, Marelli MC, Sommer B, Tan L, Little H, Ghodse H. Drugs and Psychosis Project: A multi‐centre European study on comorbidity. Drug Alcohol Rev 2009;28:379–389]