Unemployment and Drinking Behaviour: some data from a general population survey of alcohol use

The confusion in the alcohol-unemployment literature may be partly explained by methodological considerations. A standard instrument for measuring alcohol consumption was used in this study which reports data drawn from a general population study. Results show that unemployed males were particularly likely to binge drink and to report adverse effects from consuming alcohol. It is suggested that (a) the choice of consumption variables may influence the outcome of research in this area, and (b) unemployed men may be exposed to greater risks from drinking alcohol.     

Toxic epidermal necrolysis associated with pentazocine therapy and severe reversible renal failure

A 62-year-old man developed toxic epidermal necrolysis 8 days after starting treatment with pentazocine. Fluid loss through the skin caused severe uraemia (blood urea 420 mg/100 ml) which was rapidly reversible after prompt parenteral fluid and electrolyte replacement.     

Atrioventricular Canal Defects: Results of Repair in the Current Era

Between December 1986 and December 1990, 37 consecutive patients underwent repair of complete atrioventricular (AV) canal with the two-patch technique. Mean age at repair was 22 months and 51% were less than 1 year of age. Eighteen (48.6%) had undergone previous palliative operations. Two operative deaths (5.4%) occurred and another patient died in-hospital for an early mortality of 8.1%. One late death (2.9%) has occurred from a respiratory infection. Actuarial survival is 87.7% at 3 years. Small size (p less than 0.05), unbalanced ventricular size (p less than 0.05), New York Heart Association (NYHA) Class IV (p less than 0.05), and severe preoperative AV valve insufficiency (p less than 0.05) were significant preoperative risk factors for death. Five survivors (14.7%) required reoperation for severe AV valve insufficiency (two) or patch leaks (three). The risk for reoperation was increased in non-Down's patients (p less than 0.02). All survivors are in NYHA Class I (93%) or II (7%). The risk for early AV valve insufficiency was increased in patients who did not have the cleft sutured (p less than 0.05), and in those with unbalanced ventricles (p less than 0.01). Risk of late AV valve insufficiency was increased only by small size (p less than 0.02). Previous pulmonary artery banding did not increase the risk of repair or of postoperative AV valve insufficiency. Complete AV canal can be repaired with low mortality. Pulmonary artery banding may still have a role to play in the very small (4-5 kg) infant in refractory heart failure.     

The Role of Diastolic Outward Current Deactivation Kinetics on the Induction of Spiral Waves

The mechanism of induced reentry in an initially homogeneous repolurization matrix still remains undefined, In the present study we hypothesized that the slow deactivation rate of the delayed outward current (dIo/dt), which occurs during diastole after complete repolarizafion, can cause activation failure and facilitate reentry. We modeled the excitation-recovery process using the modified FilzHugh-Nagumo equations in a two-dimensional medium of 128 by 128 cells using the Connection Machine (CM-2), a massively parallel computer that is highly suitable for this class of problem. The model was one cell thick, uniformly excitable, and isofropic. When (he rate of Io deactivation was slowed to yield action potential duration (APD) restitution curves similar to experimentally observed arrhythmic ventricular muscle cells APD restitution curves, premature stimulation (S₂) induced nonstationary double spiral waves (Figure 8 reentry). A decrease in d/o/dt increased the radius of the circle around which the iip of the spiral waves rotates and decreased its angular velocity. Wave fronts propagated through areas where the residual dia-stolic Io was fully inactivated and blocked in areas where its amplitude was high. No such dynamics of wave front propagation could be induced when S₂ was applied after the completion of lo deactivation. We conclude that the kinetics of deactivation of the Io during diastole has a profound influence on the dynamics of two-dimensional wave front propagation. The similarities of the APD restitution curve implemented in the computer model with slow deactivation of Io and that observed in our canine model of quinidine induced ventricular fachyarrhythmias suggest that Io deactivation kinetics may play an important role in arrhythmogenesis in the intact ventricle.