PETROLEUM JELLY IS AN IDEAL CONTACT MEDIUM FOR PAIN REDUCTION AND SUCCESSFUL TREATMENT WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

PURPOSE: Various minimally invasive approaches to reduce pain during extracorporeal shock wave lithotripsy (ESWL) have been described. We compared petroleum jelly (Vaselinet) and ultrasound gel in vitro as a contact medium based on the stone fragmentation rate. The analgesic effect of cutaneous petroleum jelly was tested against eutectic mixture of local anesthesia. We also evaluated the outcome of ESWL in a large group of patients treated with petroleum jelly. MATERIALS AND METHODS: In vitro 3 artificial stones were completely fragmented with a MFL 5000* lithotriptor using petroleum jelly or ultrasound gel as a contact medium. A total of 110 patients (group 1) received petroleum jelly before treatment with the same lithotriptor. After retrospective analysis of group 1 we matched 32 patients (group 2) receiving cutaneous eutectic mixture of local anesthesia. Because of the favorable results with petroleum jelly, we used it in another 148 patients, for a total of 258 patients (group V). Treatment dependent pain was scored using a questionnaire as 1--no, 2--minor, 3--tolerable and 4--intolerable. ESWL without additional analgesics had a pain score of 1 to 3. RESULTS: In vitro petroleum jelly had a superior fragmentation rate compared to ultrasound gel. Our long-term experience with the lithotriptor indicated that only 30% of patients required no additional analgesics with cutaneous ultrasound gel. In contrast, no additional analgesics were needed in only 38% of group 2 compared to 81.8% of group V. The stone fragmentation rate did not differ statistically between groups. CONCLUSIONS: Cutaneous petroleum jelly offers a noninvasive, highly effective, inexpensive treatment modality with no side effects and significant reduction in pain. This ointment is our contact medium of choice.     

Treatment of chronic HCV infection in compensated and decompensated cirrhosis

Abstract   Currently, we are faced with an increasing number of patients with HCV-induced end-stage liver disease. Per year, up to 4% of the patients with compensated cirrhosis develop complications subsequently leading to a substantial decrease in survival. Decompensated liver cirrhosis due to hepatitis C is the leading indication for liver transplantation (OLT). However, reinfection of the graft is common with an accelerated course of the disease in many patients. Depending on the disease stage, the aims of antiviral therapy may differ between patients with HCV-induced liver cirrhosis. Antiviral therapy can reverse the extent of fibrosis. Even without viral clearance, the incidence of hepatocellular carcinoma is lowered by interferon. In naïve patients with compensated HCV-induced cirrhosis, sustained virological responses can be achieved in up to 50% of the cases. Retreatment of non-responders may clear the virus in about 10% of the patients. Though elimination of HCV prior to OLT is certainly desirable, treatment is often limited by severe cytopenia and decompensation of liver function. Of the eligible patients 20% sustain viral clearance after OLT.     

Thromboembolic Risk of Patients Referred for Radiofrequency Catheter Ablation of Typical Atrial Flutter Without Prior Appropriate Anticoagulation Therapy

GRÖNEFELD, G.C., et al.: Thromboembolic Risk of Patients Referred for Radiofrequency Catheter Ablation of Typical Atrial Flutter Without Appropriate Prior Anticoagulation Therapy. Background: Radiofrequency catheter ablation of isthmus dependent atrial flutter is considered the therapy of choice. There is, however, controversy with regard to the thrombogenicity of atrial flutter in comparison with atrial fibrillation. Methods: Consecutive patients scheduled for catheter ablation of documented typical atrial flutter receiving insufficient (INR < 2.0) or no anticoagulation during the three weeks preceding the procedure underwent multiplane transesophageal echocardiography (TEE). Patients with exclusive documentation of atrial flutter were classified as group I, whereas patients with additional documentation of atrial fibrillation were classified as group II. Results: The study included 201 patients, 62 of whom were not on therapeutic anticoagulation (mean age   64 ± 9   years, 87% men). In 10 of these 62 patients (16%), TEE detected a left atrial (LA) appendage thrombus in 4, or dense spontaneous echo contrast (SEC) in 6 patients. Comparison of patients with versus without SEC or thrombus, revealed a higher incidence of valvular heart disease (60% vs 26%,   P = 0.05   ), but no differences with respect to age, gender, LA diameter, left ventricular end-diastolic diameter, or left ventricular ejection fraction. The incidence of positive TEE findings in group I was 1 in of 36 versus 9 of 26 in group II (3% vs 35%, P < 0.001), and the relative risk for thromboembolism in group II versus group I was 12.5 (95% CI: 3-55, P < 0.001). Conclusion: There is a significant risk for thromboembolism in patients referred for ablation of typical atrial flutter who have not been appropriately anticoagulated. (PACE 2003; 26[Pt. II]:323–327)     

The "Low Intensity Treadmill Exercise" Protocol for Appropriate Rate Adaptive Programming of Minute Ventilation Controlled Pacemakers

The objective of rate adaptive pacemakers that measure minute ventilation by tmnsthoracic impedance is to simulate the physiological relationship of the sensed signal to the sinus node response during exercise, thus achieving an appropriate matching of heart rate with patient effort. The purpose of this study was to determine the physiological relationship between heart rate and minute ventilation (HR/VE) during peak exercise testing in order to develop a database for appropriate rate adaptive slope programming of minute ventilation controlled pacemakers. Due to several clinical limitations of peak exercise testing, it was additionally determined whether the 35-watt “low intensity treadmill exercise” (LITE) protocol can be used as a substitute for peak exercise test using the “ramping incremental treadmill exercise” (RITE) protocol in order to assess the correct HR/VE slope below the anaerobic threshold. The stress tests were performed on a treadmill with the collection of breath-by-breath gas exchange. Linear regression analysis was used to determine the HR/VE slope below and above the anaerobic threshold and during the early, dynamic phase of low intensity exercise with the RITE and LITE protocols, respectively. The results of this testing in 41 healthy subjects demonstrated that the HR/VE relationship throughout treadmill exercise using the RITE protocol was not linear but curvilinear in nature, with a steeper HR/VE slope of 1.54 ± 0.51 below versus 1.15 ± 0.37 above the anaerobic threshold (P < 0.005). The HR/VE slope determined during the early, dynamic phase of the LITE protocol (1.58 ± 0.88) did not differ from the HR/VE slope from rest to anaerobic threshold obtained using the peak exercise RITE test (1.54 ± 0.51; P = 0.79), Rate adaptive pacing should simulate the curvilinear relationship between heart rate and minute ventilation from rest to peak exercise. The HR/VE slope determined during the early, dynamic phase of low intensity exercise represents the HR/VE slope derived from the RITE protocol below the anaerobic threshold. According to the peak exercise database, the slope above anaerobic threshold can easily be calculated as a percentage of the slope below the anaerobic threshold. The LITE protocol can, therefore, be effectively performed as a substitute for peak exercise stress tests to determine the correct pacemaker rate response factor in order to obtain a physiological heart rate to minute ventilation relationship for the appropriate matching of paced heart rate with patient effort.     

The Special Effects of Hypnosis and Hypnotherapy: A Contribution to an Ecological Model of Therapeutic Change

There is ample evidence that hypnosis enhances the effectiveness of psychotherapy and produces some astounding effects of its own. In this paper, the effective components and principles of hypnosis and hypnotherapy are analyzed. The “special” hypnotic and hypnotherapeutic effects are linked to the fact that the ecological requirements of therapeutic change are taken into account implicitly and/or explicitly when working with hypnotic trances in a therapeutic setting. The hypnotic situation is described—theoretically and in case examples—as a therapeutic modality that gratifies and aligns the basic emotional needs to feel autonomous, related, competent, and oriented. It is shown how the hypnotic relationship can help promote a sound ecological balance between these needs—a balance that is deemed to be a necessary prerequisite for salutogenesis. Practical implications for planning hypnotherapeutic interventions are discussed.     

Third‐Generation Mobile Phones (UMTS) Do Not Interfere with Permanent Implanted Pacemakers

Aims: Third‐generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. Methods and Results: The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T‐Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single‐chamber and 77 dual‐chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a “worst‐case scenario,” which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 ± 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. Conclusion: Third‐generation mobile phones are safe for patients with permanent pacemakers. This is due to the high‐frequency band for this system (1,800–2,200 MHz) and the low power output between 0.01 W and 0.25 W. (PACE 2010; 860–864)