Clinical and Electrophysiological Properties of a New Temporary Pacemaker Lead after Open-Heart Surgery

A new temporary pacemaker lead, Medtronic 6400, with a solid defined electrode surface area of 7.5 mm², has been impianted in 50 patients after open-heart surgery. One electrode was inserted intramyocardially on the right ventricle, while another was placed extracardially and served as a reference lead. Forty-six of the patients were followed postoperatively with measurements of myocardial stimulation threshold and resistance. In 25 of the patients, electrograms were recorded on magnetic tape for further computer analysis of amplitudes, slew rates, and signal source impedance. During constant current pacing, myocardial stimulation threshold increased from a median of 0.4 mA one hour postoperatively to a maximum value of 2.3 mA. In two patients (4.3%) intermittent pacing failure was seen. Stimulation resistance fell from a median of 875 Ω, to a minimum of 487Ω, with a subsequent increase to 598Ω before electrode removal. Both mean electrogram amplitude (7.35 mV) and slew rate (0.82 V/s) had their minimum values on the sixth postoperative day. Intermittent sensing failure was observed in 2/25 patients (8%). Signal source impedance was of a magnitude not likely to contribute to sensing failure. No complications were seen from the use of this lead. The new electrode is an important improvement in temporary pacemaker lead design. (PACE, Vol. 5, July-August, 1982)     

A Randomized Study of Secondary Prevention of Early Stage Problem Drinkers in Primary Health Care

The subjects were recruited from participants in a health examination of random samples of the adult population in Stockholm county. Those aged 18–64years who admitted a high alcohol consumption (>40 g 100% ethanol/day) among men and <30 g among women) or had an elevated value of serum-gammaglutamyltransferase (GOT) (cut-off point 1.0 microkatal/l for men and 0.6 microkatal/l for women) or had certain other indications of a high alcohol consumption were included. More severe cases, and those with an elevated GOT due to reasons other than alcohol, were excluded. The remaining subjects, 70 men and 13 women, were allocated at random to either an intervention or a comparison group. An elevated GGT was the main inclusion criteria. The subjects in the comparison group were advised by the general practitioner to cut their alcohol consumption, while those in the intervention group made further visits to their general practitioner, who gave general support and used an elevated GGT as an indication of the recent level of alcohol consumption at consecutive visits. There were three visits on average, so we are comparing a group receiving advice with a group receiving further minimal intervention. At the one-year follow-up there were greater, however not significant, reductions in GGT-level, in self-reported alcohol consumption and in a ‘problem index’ in the minimal intervention group than in the comparison group.     

Is breech presentation a risk factor for cerebral palsy? A Norwegian birth cohort study

Aim  To study whether breech presentation is a risk factor for cerebral palsy (CP).
Methods  Perinatal data from 177 272 children born in breech or vertex presentation in Norway during 1996 to 1998 were retrieved from the Medical Birth Registry of Norway. Data were collected between 1 January 2003 and 31 March 2006. Data on 245 children with CP were recorded in the Norwegian Cerebral Palsy Registry. Odds ratios (OR) with 95% confidence intervals (CI) for CP among children born in breech compared with vertex presentation were calculated. Confounding was addressed in logistic regression and stratified analyses.
Results  Among the 245 children with CP (46.5% females and 53.5% males), 31% had unilateral, 49% bilateral, 7% dyskinetic, and 5% the ataxic subtype, and 8% of cases were unclassified. Among children born in breech, the OR for CP was 3.6 (95% CI 2.4–5.3). The increased risk was reduced when adjusted for preterm birth, plurality, and smallness for gestational age. Among singletons born in breech by vaginal delivery at term, the OR for CP was 3.9 (95% CI 1.6–9.7). Severity or subtype of CP did not differ between breech and vertex presentation.
Interpretation  Breech delivery is a significant risk factor for CP, in particular among singletons born by vaginal delivery at term.     

Diencephalic Syndrome of Emaciation Report of a Case

A new case with diencephalic syndrome of emaciation is reported. The first symptoms occurred when the patient was 2 months old. Ventriculography demonstrated a probable tumour in the third ventricle. The patient is described and the findings shortly commented on.     

Clinical Course and Symptomatology of Angina Pectoris in a Population Study

ABSTRACT The clinical course of angina pectoris was studied in a follow-up study of 427 patients with angina from a general population sample. The subjects were men aged 56-65 years at the time of follow-up. After a mean follow-up time of 5.8 years. 55% were still suffering from angina pectoris, 15% had died and a further 19% were either free from chest pain or had chest pain considered to be of different origin. In the group with definite angina pectoris at follow-up (n = 236), 29% had sustained a myocardial infarction. 23% had symptoms of intermittent claudication, 36% were treated for hypertension and 15% had diabetes. Many of the angina patients suffered from other chest conditions in addition to anginal symptoms, Most of the patients (56%) had infrequent attacks (a few times per month or less often) and were not severely incapacitated by their symptoms. Only one fifth worked full time compared with more than half of those in the same age groups in the general population. Only 16 of those interviewed had undergone bypass surgery and a further 16 had disabling angina but, for various reasons, they had not been operated on. The implications are that most angina patients do well on pharmacological treatment alone even though they are limited socially as well as physically. Precipitating factors other than physical activity were also investigated and associations were found between susceptibility to cold, early morning angina, angina at rest and attacks of long duration, possibly indicating a mechanism of vasospasm superimposed on a fixed stenosis.     

Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations

Summary. Serum iron, serum iron-binding capacity, serum ferritin and erythrocyte protoporphyrin were determined during uncomplicated pregnancy in 45 healthy women; 22 were given oral iron while the others were given a placebo. When iron was not given, 15 out of 23 women had exhausted iron stores and iron deficiency at term, as judged from low serum ferritin, low serum transferrin saturation and high erythrocyte protoporphyrin values. Only seven of them had a haemoglobin concentration between 10 and 11 g/dl at term but none had values < 10 g/dl. In the iron-treated group ( n =22) none of the women developed iron deficiency. Serum ferritin was the most sensitive and specific test of iron deficiency. A practical procedure to detect iron deficiency and to control iron supplementation in pregnancy is suggested.