Neurocardiac Responses to Vagoafferent Electrostimulation in Humans

To determine if cardiac vagal tone is enhanced by vagal electrostimulation (VES), we examined the heart rate autospectrum (HRA) in eight patients with implanted stimulators for complex partial seizures. In four patients the VES was activated at 30 Hz and 500-msec pulse (HiStim group) compared to 2 Hz and 130-msec pulse for the LoStim group (n = 4). Continuous ECG and respiratory waveforms were recorded for 45 minutes every 8 hours (7–8 AM; 3–4 PM 11–12 PM) during resting supine wakeful epochs both before and 15 days after surgical implantation. From the HRA cardiac sympathovagal balance was expressed as the ratio of the low frequency (LF) power to the high frequency (HF) power. RESULTS: There were no presurgical differences between the groups in heart rate, its variance, or the energies contained in any autospectral band. The LoStim group showed no significant change in heart rate (HR), HF peak power, or LF:HF ratios during 2 weeks of VES. Conversely, in the HiStim group, the LF:HF peak power ratio fan expression of sympathetic dominance) decreased from 2.5 ± 1.5 preimplant to 1.5 ± 0.49 (P < 0.02) with VES. During VES there was a significantly higher HF power in the HiStim compared to LoStim group. No diurnal variations in HRA values were seen for either group. CONCLUSIONS: (1) A relationship exists between selective vagal nerve electrostimulation and the HRA; and (2) high stimulation frequency of the vagus nerve in man is associated with sustained augmentation of cardiac vagal tone throughout a 24-hour cycle.     

Barriers to Disclosure Among Sexually Abused Male Children

This article identifies, through a critical review of current research, several factors that may account for the reluctance of male children to disclose details of sexual abuse. The factors then are related to implications for practice and research that are relevant for child and adolescent mental health nurses.     

Influence of wind on chronic ultraviolet light-induced carcinogenesis

Wind enhances the carcinogenic effect of chronic ultraviolet radiation (UVL). This was demonstrated in hairless mice that were irradiated for 42 weeks with mercury are lamps. One group of animals was exposed to continuous wind flow of 2.7 m/s except for the daily 1-2 min time interval when they were removed from the wind tunnel and irradiated. Another group of animals received identical irradiation but were protected from wind. The first tumour appeared in the UVL and wind group after 105 days of irradiation, and at 164 days of irradiation all surviving mice in the group had developed tumours. The group of mice receiving identical irradiation but protected from wind had their first tumour appear at 154 days of irradiation, and by 164 days of irradiation only 40% of the mice had developed tumours.     

Catheter Ablation of Premature Ventricular Contractions Arising from the Mitral Annulus after Mitral Valvoplasty

A 57-year-old man undergoing mitral valvoplasty underwent catheter ablation of symptomatic premature ventricular contractions (PVCs) with a right bundle branch block and right inferior axis QRS morphology. Left ventriculography revealed a normal left ventricular function and visualized the anatomical relationships between the left ventricular outflow tract and the mitral annuloplasty ring. Electroanatomic mapping during the PVCs revealed a centrifugal activation pattern arising from the mitral annulus, and the PVCs were likely to be idiopathic. Successful radiofrequency ablation was achieved at the site close to the antero-paraseptal end of the mitral annuloplasty ring, which was located adjacent to the fibrous trigone.     

Retinoid-induced skin fragility in a patient with hepatic disease

A patient with psoriasis and alcoholic cirrhosis developed increased skin fragility, blistering and leg ulceration whilst taking etretinate (Tigason-Roche). The aromatic retinoids frequently cause dose-related side-effects such as cheilitis, palmar-plantar desquamation, conjunctivitis and hair loss. Skin fragility has also been previously reported but not accompanied by blistering as in this patient. Long-term therapy in our case resulted in excessive accumulation of the drug and, because of pre-existing liver disease, excretion was further delayed and tosicity enhanced.     

Experience with tissue expansion vaginoplasty

Summary. In vaginal agenesis, a vagina can be treated by tissue expansion vaginoplasty. We have performed 17 such procedures. One procedure was abandoned because of infection of the temporary implant. In four women the first stage had to be repeated: in one the implant was placed too superficially, in another it did not provide adequate expansion, in a further instance the implant became infected and the fourth woman received a surgical wound to her labia. The second stage was successful in all 16 women who now have a vagina lined with viable epithelium. The vaginal length was satisfactory in all but one. Two women complained of a vaginal discharge due to hair at the vaginal vault, two women developed postoperative haematomas and one experienced introital stenosis. The disadvantage of the procedure is that it requires two operative stages and involves a prolonged hospital stay but it is not technically complex and results in a full length vagina that does not require dilatation.     

Severe mental retardation in children from socially disadvantaged families

Children receiving ESN(S) education, attending special day schools, and living at home, were categorized into those whose handicap had been medically recognized in infancy and those of unknown aetiology, 'non-specific'. Information obtained from interviews with their families was used to identify a subgroup of those who were relatively socially disadvantaged. Both factors, medical and social, are shown to have a significant effect on early provisions for special needs. The non-specific cases from disadvantaged families tended to have been recognized at a later age than the rest; their parents had less information, less access to services, and less contact with others who could provide aid and support. It is argued that the theoretical model which distinguishes pathogenic and subcultural aetiologies of severe mental subnormality is inappropriate. It may be wrongly applied by fieldworkers, especially those serving families with a developmentally backward preschool child. The result may discriminate against socially disadvantaged families with a child whose handicap is not medically diagnosed.     

Reversion to Back-Up Mode (VOO) in a DDD Pacemaker Model

Sorin recently identified mode reversion to backup mode (VOO). They estimate a prevalence of 1% and suggest electromagnetic interference (EMI) as the cause. We identified ten patients being followed in our pacing clinic, of whom four were found to have suffered mode reversion. We, therefore, conclude that the prevalence of this problem may be greater than predicted. None of the patients who were found to have mode reversion gave any history to suggest that they had been exposed to EMI.     

The free-flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis

Summary. The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology.     

A HOSPITAL RENTAL SYSTEM FOR LOW VISION AIDS

Costly low vision aids are rented to patients by the Otago Hospital Board Occupational therapists see the patients in the Low Vision Clinic and then as necessary in their homes As a consequence accurate follow-up and analysis of the help provided by these aids is available Patients with senile macular degeneration use telescopic reading aids for an average of 27 months after they are prescribed