Correlative Anatomy for the Electrophysiologist: Ablation for Atrial Fibrillation. Part I: Pulmonary Vein Ostia,Superior Vena Cava,Vein of Marshall

Anatomy for Atrial Fibrillation. Ablation procedures for atrial fibrillation (AF) have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of AF and ablation procedures are varied and include the pulmonary veins (PVs), other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms, and, importantly, to avoid complications from damage of adjacent structures within the chest. We have presented this information in a 2‐part series. In the present article, we examine the general anatomic characteristics of the PVs, superior vena cava, and vein of Marshall. Features of particular relevance for the invasive electrophysiologist are pointed out. In a subsequent article, we discuss the regional anatomy of the left and right atria and anatomic considerations in preventing complications during AF ablation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 721‐730, June 2010)     

Reactions of C-terminal ω-amino acid residues in liquid hydrogen fluoride

The benzyl-ester bond linking the C-terminal δ-aminovaleric acid residue of a peptide to a polymeric support was cleaved with liquid hydrogen fluoride in the presence of anisole, added as scavenger. Instead of the expected peptide with a free carboxyl group at the C-terminus, a peptide terminating in a ketone derivative was obtained. The unusual extent of this known side-reaction was attributed to the effect of the distance between the amino group and the carboxyl group in the C-terminal residue. The results of model experiments corroborated this view.     

Dental Practitioners and Eating Disorders

To better understand how dental practitioners identify, counsel, and refer patients with eating disorders. A questionnaire was mailed to 625 dental practitioners, 54 (19%) of the dentists and 69 (20%) of the dental hygienists responded. Most dental practitioners were aware of eating disorder patients in their practices and most discussed their findings with their patients or parents. However, one of the suggestions most commonly given to patients, to brush immediately after vomiting, may be counter therapeutic, and a few offered referral for more health services. Collaboration between dental practitioners and mental health practitioners who work with eating disorder patients should be improved.     

Review: Single-subject clinical-outcome research: designs,data, effect sizes,and analyses

In the last 20 years, single-subject research designs have become important forms of aphasia-treatment research for assessing the effectiveness of treatment on a subject-by-subject (or patient-by-patient) basis. In that time, several important developments in the statistical literature centring on the reliability and validity of single-subject research have occurred. This work assesses the state of aphasia-treatment single-subject research in the context of that scholarship and proposes recommendations for future applications through a tutorial-like presentation. This paper details the analysis of published single subject results and proposes recommendations concerning future applications of single-subject designs. The work focuses on four domains: designs, data, effect sizes, and analyses. The findings indicate that aphasia-treatment singlesubject studies, which are well designed for the most part, yield a short series of autocorrelated data manifesting generally large treatment effects. However, only one analysis satisfactorily controlled Type I and Type II errors under typical clinical-aphasiology applications. That procedure, ITSACORR, is easily accomplished and it expresses outcome in familiar terms. To facilitate understanding, the review promotes a hands-on understanding of the various analysis options through worked examples and clarifies the (in)appropriateness of each procedure for clinical applications. Although the focus of the work is treatment for aphasia, the central thesis has general application across disorder categories.     

Current concepts in hypophosphatasia: case report and literature review

International Journal of Paediatric Dentistry 2013; 23: 153–159 Background. Hypophosphatasia (HP) is characterized by defective mineralization of bone and teeth because of deficient alkaline phosphatase activity. There are generally six recognized clinical forms, of which the most severe is often lethal prenatally or early in life. In milder forms, such as odontohypophosphatasia (OHP), premature exfoliation of primary teeth may be the only clinical manifestation. Case Report. A 20‐month‐old girl was referred to the Specialist Paediatric Salaried Dental Service within the Harrogate and District NHS Foundation Trust with mobility of tooth numbers 71 and 81. Clinical examination revealed grade III mobile 71 and 81, with minimal gingival inflammation and plaque deposits. There were no other dental findings and no significant medical history. Tooth numbers 71 and 81 exfoliated prematurely with no evidence of root resorption, shortly after presentation. Haematological and urinary investigations showed no abnormalities. Histological examination showed a complete absence of cementum. A diagnosis of OHP was made. After 10 months of dental follow‐up, no further teeth have increased mobility. Conclusion. Odontohypophosphatasia should be included as a differential diagnosis in children presenting with early loss of primary teeth. The dentist may be the first health care professional to whom the patient presents.     

Self-Selected Diets of Lactating Women Often Fail to Meet Dietary Recommendations

Objective To assess longitudinally nutrient intakes of lactating women during the postpartum period.Design Dietary data from lactating women were collected by means of 2-day food records at 3 and 6 months postpartum. Intake of energy and selected nutrients was tabulated and compared with dietary standards.Subjects The 52 lactating women enrolled in the study lived in a university community, were apparently healthy, had a body mass index within normal range, were successfully nursing a term infant, and planned to nurse for at least 6 months.Statistical analyses performed Paired t tests and Stuart-Maxwell χ² analysesResults Mean energy intakes were below the Recommended Dietary Allowance. Mean intakes of most nutrients met or exceeded recommended standards except for zinc and vitamins D and E at both 3 and 6 months postpartum. Calcium and folate intakes were also below standards at 6 months. Although mean iron intake exceeded the standard at both measurement times, there was a significant decline from 3 to 6 months. Relative frequencies of mothers meeting various percentages of standards differed significantly from 3 to 6 months for calcium; iron; folate; and vitamins E, D, and B-6. At 6 months, significant increases were noted in the number of women reporting calcium, folate, and vitamin B-6 intakes at less than one half of the recommended amounts.Applications/conclusions Guidance for lactating women should stress food sources of nutrients likely to be limited in their diets: calcium; zinc; folate; and vitamins E, D, and B-6. J Am Diet Assoc. 1998;98:297–302.     

Anesthesia for major general surgery in neonates with complex cardiac defects

Centers with large cardiac workloads may be presented with neonates who need major general surgery before correction or palliation of a serious cardiac defect. This is still a rare situation with only three short case reports available in the medical literature ( 1–3 ). We have reviewed the anesthetic and analgesic regimens of 18 such neonates who presented to the Birmingham Children's Hospital in the 4-year period 2004–2007. These children require meticulous preoperative evaluation and although it might be anticipated that they would pose a serious challenge to anesthetists, in reality with thorough investigation, preparation, and careful management, they tolerate general anesthesia well. These children may be transferred to centers of specialist pediatric cardiac anesthesia to be benefited from experience obtained there.     

Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium

Background: Pentobarbital and propofol are commonly used to sedate children undergoing magnetic resonance imaging (MRI). The Pediatric Sedation Research Consortium (PSRC) was created in 2003 to improve pediatric sedation process and outcomes. Objective: To use PSRC records to compare the effectiveness, efficiency and adverse events of propofol vs pentobarbital for sedation of children undergoing MRI. Methods: Pediatric Sedation Research Consortium records of children aged 6 months to 6 years who were primarily sedated with either i.v. pentobarbital or propofol were included. Participating PSRC investigators obtained institutional review board approval before data collection. Results: Of 11 846 sedations for MRI, 7079 met inclusion criteria (propofol: n = 5072; pentobarbital: n = 2007). Demographic details were similar between the two groups. Ideal sedation was produced in 96.45% of the pentobarbital group and in 96.8% of the propofol group (P = 0.478), but pentobarbital was more likely to result in poor sedation canceling the procedure (OR 5.88; CI 2.24, 15.40). Propofol resulted in physiologic changes more frequently than did pentobarbital (OR 5.69; CI 1.35, 23.97). Pentobarbital was associated with prolonged recovery (OR 16.82; CI 4.98, 56.8), unplanned admission (OR 5.60; CI 1.02, 30.82), vomiting (OR 36.76; CI 4.84, 279.2) and allergic complication (OR 9.15; CI 1.02, 82.34). The incidence of airway complications was not significantly different between the two. The median recovery time for patients receiving propofol was 30 min, whereas for pentobarbital it was 75 min (P < 0.001). Conclusion: Among institutions contributing data to the PSRC, it is found that propofol provides more efficient and effective sedation than pentobarbital for children undergoing MRI. Although apnea occurred with a greater frequency in patients who received propofol, the rate of apnea and airway complications for propofol was not statistically different from that seen in patients who received pentobarbital.