Control of Refractory Supraventricular Arrhythmias After Unsuccessful Closed-Chest His Bundle Ablation

Six patients underwent attempted catheter ablation of the His bundle for control of refractory supraventricular tachyarrhythmias. Permanent complete heart block was achieved in only three patients. All six patients have remained asymptomatic without antiarrhythmic medications over a follow-up period of six to 17 months (mean 10 months). There were no complications of the procedure apart from mild elevation of creatine kinase levels in three patients. In this series, resumption of atrioventricular (AV) conduction following attempted His bundle ablation was not associated with recurrence of symptomatic arrhythmias. Preservation of AV conduction may also obviate the need for permanent ventricular pacing.     

A comparison of vincristine and doxorubicin infusional chemotherapy with methylprednisolone (VAMP) with the addition of weekly cyclophosphamide (C-VAMP) as induction treatment followed by autografting in previously untreated myeloma

In a sequential nonrandomized study, 204 consecutive unselected patients aged < 70 years received induction chemotherapy with infusional vincristine and adriamycin with oral methyl prednisolone (VAMP; n =75) or with additional cyclophosphamide, C-VAMP ( n =129). 38/129 C-VAMP patients also received verapamil during induction as part of a controlled trial with the aim to overcome drug resistance. A median of five courses (range 1–11) of chemotherapy were required before maximal response was attained and this was similar in both groups. An over-all response rate of 71% was noted at the end of induction. The complete remission (CR) rate with C-VAMP was 24%, which was significantly higher ( P =0.04) than the CR rate with VAMP alone (8%). The addition of verapamil did not alter the response rate of C-VAMP. Compliance to VAMP was overall 83% and not affected by the addition of cyclophosphamide. The proportion of patients going on to receive high-dose chemotherapy and an autograft was the same for VAMP and C-VAMP treated patients (71%). The median overall survival (OS) and progression-free survival (PFS) for the whole group were 4.4 years and 2.0 years and no difference in outcome was observed between the different treatment groups. Therefore the addition of weekly cyclophosphamide to VAMP induction therapy has significantly improved the response rates of previously untreated myeloma patients. C-VAMP was not more toxic and did not compromise the chances of receiving an autograft. Verapamil was without influence on any parameters in this study.     

Evaluating the Effects of Somatization Disorder for Patients With Severe End‐Stage Lower‐Extremity Osteoarthritis

This study examined how somatization disorder relates to physical and psychosocial measures for patients with chronic lower‐extremity osteoarthritis (OA). A cohort of 421 patients with lower‐extremity OA of the hip or knee consented to preoperative evaluations. The Patient Health Questionnaire was administered to identify patients with and without somatization disorder. Analyses were conducted to determine differences between demographic and preoperative physical and psychosocial variables. Patients with somatization disorder scored significantly worse on measures of pain, stiffness, function, perceived disability, and quality of life measures. Somatization disorder can have profound effects on patients' physical and psychosocial measures. Recommended treatment for chronic pain patients often includes using a biopsychosocial approach, which involves treating both the psychological state along with the pain condition.     

Elucidation of a pericentric inversion of a D-group chromosome in the mother of a child with Patau''s syndrome

The mother of a child with Patau's syndrome has an inversion of chromosome 13. The karyotype is designated 46, XX, inv (13) (p13q21). It is deduced that the deceased child had the karyotpye 46, XY, rec(13), dup q, inv(13) (p13q21).     

Assessing the quality of facility-based child survival services

The facility-based assessment (FBA) method is a co-ordinatedset of data collection activities, designed to determine theextent to which children are properly diagnosed and effectivelytreated at health facilities. Eleven African countries haveconducted facility-based assessments since 1986, with supportfrom the African Child Survival Initiative-Combatting ChildhoodCommunicable Diseases project. Components of the FBA includeobservations of health worker performance; exit interviews withcaretakers; interviews with health service personnel; reviewsof clinic records; and inventories of available equipment andsupplies. Data resulting from applications of the method canbe used to identify training needs among health personnel, andlogistic problems that limit the quality of service delivery.Repeated surveys can be used to assess the impact of trainingand other interventions designed to improve service quality.     

THE PLACE OF PROPHYLACTIC ANTIBIOTIC IN PERITONEAL DIALYSIS

The use of prophylactic antibiotic in peritoneal dialysis fluid is still widely recommended. Over a 12-month period, a trial was carried out in order to assess the necessity for the use of antibiotic, and, when infection occurred, to correlate bacterial sensitivity with the antibiotic used. Patients requiring peritoneal dialysis for acute or chronic renal failure, who were dialysed in the one nursing environment using standard techniques, were included in the trial. Ampicillin, in a concentration of 12 x 5 µg/ml, was added to the dialysate, or withheld, according to the patient's unit record number. A total of 248 dialyses were performed for 56 patients, the number per patient varying from one to 21. The incidence of peritoneal infection was found to be low whether or not antibiotic was used. The infecting organism was insensitive to ampicillin on each occasion. It was concluded that the use of prophylactic antibiotic in peritoneal dialysate is unnecessary, when present techniques are employed, and that the organisms involved are not sensitive to any safe, broad spectrum antibiotic.