POLYTETRAFLUOROETHYLENE (PTFE) GRAFTS FOR HAEMODIALYSIS IN CHRONIC RENAL FAILURE: ASSESSMENT OF DURABILITY AND FUNCTION AT THREE YEARS

The utilization of 162 PTFE grafts for anglo access in 131 patients over a three year period is reported. One hundred and three new PTFE arterlo-venous flstulae were constructed in addition to 59 patch and tube incorporations Into pre-existing graft flstulae. At three years, the cumulative patency of newly constructed grafts was 85%. Seventy four per cent of the grafts have had no thrombosis and are functioning up to 38 months following insertion. An aggressive approach was adopted towards the 15% of grafts that had at least one episode of thrombosis prior to flow being successfully restored. Graft occlusion which occurred up to 18 months following Insertion, represented 11% of the group In this series. PTFE has provided an important advance In angio access for chronic renal failure with high patency and excellent durability after three years.     

Ascending Colon Volvulus Due to a Vitelline Duct Remnant in an Elderly Patient

A 77-year old female is presented with volvulus of the ascending colon due to torsion around a vitelline duct remnant. Symptoms were mild and intermittent. Roentgenograms are presented which demonstrated this lesion preoperatively. At surgery the ascending colon was found to be twisted around a fibrous band extending from the umbilicus to the ileum.     

EVALUATION OF ALCOHOL CONSUMPTION LEVEL IN DRIVERS WHEN REGRANTING LICENCES AFTER DRIVING WHILE INTOXICATED IN FRANCE

Biological markers form an important part of the decision-makingprocess for regranting of driving licences in France. A majorcriterion in this respect is the need to distinguish betweenacute alcohol use and chronic abuse by applicants. Current markersreflect more hepatic damage than alcohol consumption and thisstresses the need for more reliable markers.     

A COMPARISON OF NORMAL AND PATHOLOGICAL SYNOVIAL FLUID

Synovial fluid from 16 normal subjects was compared with thatfrom 149 patients with a variety of rheumatic disorders. Normalfluid had fewer cells and a lower content of ß-glucuronidasethan osteoarthritic samples. Particles, including occasionalbirefringent crystals, were seen in normal fluids as well aspathological samples. Alizarin red staining particles (presumedto contain apatite) were seen in all diagnostic groups; theirnumbers showed some correlation with radiological calcificationin and around the joints and with a hypertrophic subchondralbone response. Lactate levels were highest in septic arthritis.No assay showed disease specificity. KEY WORDS: Synovial fluid analysis     

Using Intracardiac Catheter Recordings from the His and Proximal Coronary Sinus to Distinguish Isthmus Conduction Block During Catheter Ablation of Type I Atrial Flutter

Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6%) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48% and 100%, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.