A descriptive study of 100 emergency department patients with abdominal pain

One hundred consecutive patients with abdominal pain attending the Department of Emergency Medicine of the Royal Hobart Hospital were studied. There was a bimodal age distribution, with peaks in the 10–30 and 60–80 year groups. Admitted patients were likely to be older, and were more likely to present in working hours. When compared with later diagnosis, the emergency department diagnosis was “correct” in 75% of cases. No patient admitted with “unspecified abdominal pain” was later diagnosed more definitively. The findings suggest that one may be reasonably confident of a diagnosis made in the emergency department in patients with abdominal pain.     

Comparison of Simultaneous Versus Sequential Defibrillation Pulsing Techniques Using a Nonthoracotomy System

The defibrillation threshold (DFT) using simultaneous (SIML) versus sequential (SEQ) pathways for shock delivery was compared in 16 patients with an implanted cardioverter defibrillator. All patients had three-lead nonthoracotomy systems (NTL) using a left chest subcutaneous patch, a right ventricular endocardial lead, and a lead in the coronary sinus (n = 5) or superior vena cava (n = 11). The DFT were determined 2–44 days (17 ± 17 days) after implantation. The DFT was defined as the lowest energy shock that resulted in successful defibrillation. The first pathway tested was SIML in 12 and SEQ in 4 patients with output beginning at or above the intraoperative DFT, routinely 18 J. The second pathway was tested beginning 2–4 J above the DFT of the first tested pathway. All shocks were delivered in 2–4 J decrement or increment steps. The SEQ pathway shocks resulted in a significantly lower DFT than SIML pathway shocks (14 ± 6 vs 18 ± 6 J; I < 0.01). There was no difference in the time delay after ventricular fibrillation initiation before shock delivery for the successful defibrillation between SIML versus SEQ pathways (7 ± 2 secs for both pathways). In 7 of 16 patients, defibrillation using SEQ pathway resulted in a > 5 J lowering of DFT, while only one patient had > 5 J lowering of DFT using SIML shocks (P <0.05). These results have important implications for selecting the optimal pathway for implantable cardioverter defibrillator therapy with a multilead NTL system.     

Chronic Performance of Steroid-Eluting Epicardial Leads in a Growing Pediatric Population:

Patient size and congenital heart defects complicate pacemaker therapy in children favoring an initial epicardial approach. Steroid-eluting (SE) epicardial (EPI) leads maintain stable, low pacing thresholds in the short-term when compared to the nonsteroid (NSE) epicardial (EPI) leads. The purpose of this study was to evaluate chronic, 10-year performance of SE leads in growing children compared with NSE EPI leads implanted during the same time interval. From 1990 to 2000, 35 patients (age 1 month to 18 year, median 3 years), 28 with and 7 without congenital heart disease (CHD) received 51 SE leads: 27 ventricular and 24 atrial. NSE leads were implanted in 27 patients (age 1–28 years, median 8 years), 24 with and 3 without CHD: 27 ventricular and 1 atrial. Pacing lead threshold, impedance, and energy were measured at implant and during a 10-year follow-up. Unpaired t-test showed that impedance remained stable for all leads with lower mean values for the SE   (376 ± 55 vs 443 ± 109 Ω) (P = NS)   . The mean energy requirement for SE leads at 10 years   (1.2 ± 0.9 μJ)   was significantly lower than for NSE   (4.4 ± 5.5 μJ) (P < 0.05)   . At 2.5-V output, chronic thresholds for SE leads did not significantly differ from implant values for atrial (0.08 vs 0.09 ms) or ventricular (0.08 vs 0.08 ms) sites. There were no differences in SE lead performances among patients with or without CHD. Fracture or dislodgement occurred in two SE (4%) and four NSE (14%) leads. SE outperform NSE EPI leads and show stable, chronic low thresholds over time in all growing children. (PACE 2003; 26[Pt. I]:1467–1471)