Radiofrequency Catheter Ablation of Two Right Mahaïm-like Accessory Pathways in a Patient with Ebstein's Anomaly

A 17-year-old woman with Ebstein's anomaly and recurrent episodes of antidromic tachycardia with two distinct morphologies is described. The tachycardias were produced by two separate Mahaïm-like accessory pathways. These were localized by their activation potentials at the anterolateral ventricular margin of the tricuspid annulus and ablated in a single session using radiofrequency current.     

Fertility issues in patients with prostate cancer

OBJECTIVE

To describe fertility issues, only rarely discussed with patients with prostate cancer, although paternity after treatment might be an important component of quality of life for some, as exemplified by two of our patients.

PATIENTS

During pretreatment counselling two patients with newly diagnosed prostate cancer initiated the discussion of paternity after treatment. Patient 1 then opted for radiotherapy as the treatment least likely to damage fertility, whereas patient 2 had semen cryopreservation before external beam radiotherapy combined with 6 months adjuvant hormone treatment.

RESULTS

Patient 1 became a father to a healthy child 9 months after starting radiotherapy, with conception two days after he had received one session of brachytherapy with ¹⁹²Ir (total dose 10 Gy, testicular dose, 0.1 Gy). Patient 2 fathered a child 36 months after completing external beam radiotherapy (total dose 74 Gy, testicular dose 1.2–2.3 Gy), which was combined with medical castration of 6 months’ duration.

CONCLUSION

Fertility issues should be considered in patients before curative treatment of prostate cancer.     

Treatment of atrial fibrillation by silencing electrical activity in the posterior inter-pulmonary-vein atrium.

AIMS: The recurrence of atrial fibrillation (AF) after pulmonary vein (PV) isolation is still a challenge. We investigated a new approach to treating AF patients by silencing electrical activity in the posterior inter-pulmonary-vein atrium (PIA). METHODS AND RESULTS: Three ablation steps are required to obtain PIA electrical silence: electrical PV isolation, the creation of two lines of lesions between the two superior and inferior PVs and the abolition of residual electrical signals within the PIA. The endpoint was the electrical silence and the inability to pace in the PIA. The posterior inter-pulmonary-vein atrium silence was obtained in 42 AF patients (56 +/- 9 years, four women). Recurrence of AF and atrial flutter was observed in 14 (33.3%) patients after the first procedure. Freedom from atrial arrhythmias after the second procedure was displayed by 94.4, 85.7, and 60.0% of patients with paroxysmal, persistent, and permanent AF, respectively. The left atrium (LA) volume was larger, and the percentages of the silent area of the LA surface and voltages were lower in patients with AF recurrence than in recurrence-free patients. CONCLUSION: Posterior inter-pulmonary-vein atrium electrical silence can greatly decrease the AF recurrence. The clinical AF recurrence may be related to an enlarged LA, a low percentage of electrically silent area, and low voltage in the LA.     

Beyond the EPR: Complementary roles of the hospital-wide electronic health record and clinical departmental systems

Background  

Many hospital departments have implemented small clinical departmental systems (CDSs) to collect and use patient data for documentation as well as for other department-specific purposes. As hospitals are implementing institution-wide electronic patient records (EPRs), the EPR is thought to be integrated with, and gradually substitute the smaller systems. Many EPR systems however fail to support important clinical workflows. Also, successful integration of systems has proven hard to achieve. As a result, CDSs are still in widespread use. This study was conducted to see which tasks are supported by CDSs and to compare this to the support offered by the EPR.     

The impact of maternal negative affectivity on dietary patterns of 18‐month‐old children in the Norwegian Mother and Child Cohort Study

Early dietary habits are formative for dietary habits later in life. Maternal personality might be an important factor in unhealthy feeding of children. The current study aims to assess the degree to which the personality trait of negative affectivity in mothers predicts their child's diet at age 18 months. This study is a part of the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health. A total of 27 763 mothers completed 3 repeated assessments of negative affectivity before and after childbirth and of the child's diet when the child was 18 months old. Exploratory factor analysis was used to identify the dietary patterns, and structural equation modeling was used to investigate the relationship with negative affectivity adjusted for socio‐demographical variables. Exploratory factor analysis of a foods frequency questionnaire revealed two dietary patterns in the child, labeled unhealthy diet and wholesome diet. The unhealthy diet comprised foods rich in sugar and fat; the wholesome diet comprised foods rich in fibre, vitamins and minerals. Mothers high in negative affectivity were more inclined to feed their child an unhealthy diet. The results were adjusted for maternal age, years of education, relative income, marital status, number of children, having the child in daycare, maternal smoking, maternal body mass index, and child gender. This study shows that a maternal personality trait, negative affectivity, is related to feeding the child an unhealthy diet after controlling for key socio‐demographic variables.