Direct immunofluorescence on cytological smears in oral pemphigus

Direct immunofluorescence was performed on washed oral epithelial smears from thirteen patients with pemphigus vulgaris, thirteen patients with other oral diseases and from ten subjects with clinically healthy oral mucosa. The intercellular deposition of IgG was observed on cytological smears from oral lesions in all patients with active pemphigus. In contrast, smears from pemphigus patients in remission, from patients with other oral diseases and from healthy controls, did not show any fluorescence. Therefore, direct immunofluorescence on cytological smears may be of value in the diagnosis of pemphigus.     

Placement of a Pacing Lead at the Inferior Portion of the Interatrial Septum Without Special Tools

Introduction: Previous studies have suggested that, among septal sites, the inferior portion of the interatrial septum (IAS) is the most likely to prevent atrial fibrillation, though inserting an active fixation lead at this site can be tedious and time consuming. We describe a relatively straightforward technique to insert a lead at this site without special tools .
Method: We studied 117 consecutive patients (mean age = 76 ± 8 years, 69% men) with ACC/AHA class I and II pacing indications and histories of paroxysmal or permanent atrial fibrillation, undergoing implantation of a dual chamber pacing system. A technique using the "preshaped" stylet and fluoroscopic guidance is described.
Results: The insertion was successful in 111 patients (95%). Acute dislodgement occurred in six patients (5%). The intrinsic P-wave duration was 117 ± 22 ms, and the paced P-wave duration was 90 ± 20 ms (23% shortening, P < 0.001). The mean time required to insert the atrial lead was 12 ± 8 minutes. No complications occurred.
Conclusions: Insertion of an active fixation lead at the inferior portion of the interatrial septum was safe and highly successful in the majority of patients with this technique.     

Paramyosin: a candidate vaccine antigen against Schistosoma japonicum

Paramyosin, a 97 kDa myofibrillar protein, is a candidate vaccine antigen for prevention of infection with the human parasite Schistosoma mansoni . To determine if paramyosin would also induce protection against Schistosoma japonicum , paramyosin was biochemically purified from S. japonicum adult worms. SDS-PAGE demonstrated a single protein with a molecular weight of 97 kDa. In four separate experiments, vaccination of mice with S. japonicum paramyosin without adjuvant induced significant resistance (62%–86%, P < 0.001) against cercarial challenge as compared to controls. These data suggest that S. japonicum paramyosin may represent a candidate vaccine for immunization against schistosomiasis japonica.     

Clinical guidelines on central venous catheterisation

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence‐Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow‐up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide‐bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long‐term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long‐term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator‐assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow‐up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.     

Nurses'' Role in Preventing Birth Defects in Offspring of Women With Phenylketonuria

Most women who began nutrition support as neonates for a diagnosis of phenylketonuria, an inherited defect in phenylalanine metabolism, are of normal intelligence, no longer require a restricted diet, and wish to have children of their own. Phenylketonuria that is untreated when a woman conceives and during gestation results in poor reproductive outcomes. Treatment with and careful monitoring of a phenylalanine-restricted diet can improve reproductive outcome. Nurses have the primary responsibility in locating women of childbearing age with phenylketonuria; developing strategies to improve palatability of the diet, thereby enhancing compliance; providing ongoing monitoring and support of the mother-child dyad; and counseling couples at risk.     

Echocardiographic Predictors of Survival in Patients Undergoing Radiofrequency Ablation of Postinfarct Clinical Ventricular Tachycardia

Predictors of Survival in Postinfarct VT. Introduction: The aim of this study was to determine the predictive value of echocardiographic parameters of systolic left ventricular (LV) dysfunction for survival in a group of patients with “mappable” ventricular tachycardia (VT) after myocardial infarction who underwent radiofrequency ablation (RFA) of their clinical VT(s). Methods and Results: RFA of at least one inducible, “mappable,” and clinical VT was attempted in 61 patients. In total, 63 (79%) of 80 target clinical VTs were ablated successfully, such that clinical VT(s) were noninducible in 49 (80%) of 61 patients. At the last recorded follow‐up (range 2 to 98 months; mean 21 ± 20), nonfatal VT recurrences were observed in 11 (22%) patients; 10 (16%) patients died. On univariate analysis, a higher LV end‐diastolic volume (LVEDV; P = 0.008) and, by multivariate analysis, applying backward selection of variables, older age (P = 0.03) with a higher LVEDV (P = 0.003) predicted patients more likely to die. When age and LV ejection fraction (LVEF) were excluded, LV end‐systolic diameter (LVESD; P = 0.007) was the most significant predictor of survival. Conclusion: In our patient population with postinfarct VT who underwent RFA of mappable clinical VT(s), LVEF did not predict survival. In this group of patients with overall low mean LVEF (<35%), older age together with higher LVEDV and LVESD predicted patients who were more prone to die. LV size rather than LVEF correlated with survival.