"Incessant" Atrioventricular (AV) Reciprocating Tachycardia Utilizing Left Lateral AV Bypass Pathway with a Long Retrograde Conduction Time

Two patients with incessant or nearly incessant episodes of atrioventricular (AV) reciprocating tachycardia were studied and were found to be unique because of the location of a slowly conducting retrograde AV bypass pathway in the left lateral position. During the tachycardia in both patients, negative P waves were present not only in ECG leads II, III, and aVF, but also in leads I and aVL. The R-P'/P'-R ratios were 1.3 and 1.9, respectively. Cardiac electrophysiologic study revealed that in both tachycardias, retrograde ventriculoatrial conduction occurred utilizing a concealed left lateral AV bypass pathway with a long conduction time. Verapamil prolonged conduction over the AV bypass pathway in both patients. One patient was successfully treated with oral verapamil. The other patient underwent successful surgical interruption of the AV bypass pathway.     

Effect and stage models in community intervention programmes; and the development of the Model for Management of Intervention Programme Preparation (MMIPP)

Recent years have seen the development of a number of diagrammatic‘models’ bearing on community intervention programmes.There have been two basic types, one involving actual or hypotheticalcausal relationships (effect, or how-it-works models) and theother, sequences of activities or events (stage, or how-to-do-itmodels). A selection of such models, with their roots in differenttheories of social change, health education and health promotion,are reviewed in the light of this distinction. Both types ofmodel are important. Existing stage models for health promotion programmes implyan ordered or cyclical set of activities, in which preparationis followed by implementation, maintenance, evaluation and revision.In the second part of the paper a new and more detailed typeof stage model is presented for the preparatory phase. In practice,this phase involves a series of parallel but interdependentactivity streams. These add up to a complex process that needsto be carefully planned and managed. In such circumstances itis important to be able to convey to the various people andorganisations involved how their different contributions meshtogether. The new model is designed to help with this. It hasbeen developed in the light of experience of planning community-baseddisease prevention programmes in Stockholm and elsewhere, withthe objective of making the lessons learned available for othersin a compact and accessible form.     

Oesophageal atresia in father and daughter

Abstract We report oesophageal atresia without tracheo-oesophageal fistula in a father and daughter, the first case of recurrence of oesophageal atresia without fistula to be reported in a parent and offspring.     

Hereditary trichilemmal cysts

One hundred and fifteen individuals from 60 families are described who had trichilemmal cysts. These were solitary or multiple intradermal cysts and occurred most frequently on the scalp. A punctum leading from the skin surface to the cyst was not seen in any patient. Because they are encapsulated they are easily removed. Histologicaily they resemble the external root sheath in the region of the follicular isthmus and are quite different from epidermoid cysts. They are not associated with Gardner's syndrome or any other diseases. In 46 of the 60 families an autosomal dominant mode of inheritance was demonstrated.     

TONSURE TRICHOTILLOMNIA

Summary— We describe 8 cases of trichotillomania in women in which the scalp exhibits a cropped appearance over the crown, extending to the frontal margin in some cases, but sparing the nape of the neck and lateral margins. The condition has persisted with no improvement for periods up to 17 years in one case.
The hair on the affected area is mostly less than 3 cm. long and of normal texture. Many of the short hairs have a tapered hypopigmented tip and when groups of hairs are plucked only anagen roots are found. There is no microscopical abnormality of the hair shaft and no exclamation mark hairs have been extracted. The only explanation for the persistence of newly growing short anagen hairs is the continual plucking of all those exceeding 3 cm. length.
All the patients but one repeatedly denied interfering with their hair, even after the significance of the changes in hair growth had been explained to them. In all the cases except one, psychiatric assessment showed a provocative social situation and personality traits likely to result in a disorder such as trichotillomania.
The disorder has many features in common with idiopathic trichoclasia as described by Sabouraud and other French writers. It could be mistaken for a congenital hair dystrophy and we believe other cases have been shown as "diffuse alopecia areata".
The tonsural pattern may be determined by a higher threshold for pain in the centre of the scalp than at the margins.     

Hypersensitive Carotid Sinus Syndrome Manifested as Cough Syncope

We describe a patient with cough syncope who was found to have carotid sinus hypersensitivity with mixed cardioinhibitory and vasodepressor responses. Symptoms were ameliorated by denervation of the more hypersensitive carotid sinus. Spontaneous atypical Wenckebach cycles in this patient were caused by the combined hypersensitive cardioinhibitory and vasodepressor responses. This report stresses the importance of checking blood pressure as well as heart rate in all pa-tients in whom carotid sinus syndrome is suspected.