Subtest profiles of the WISC-R and WAIS in mentally retarded patients with epilepsy

In this study, WISC-R and WAIS subtest profiles of mentally retarded patients with epilepsy are analysed with respect to the Verbal-Performance IQ Discrepancy scores and rank order of mean subtest scores. The relative strengths and weaknesses in cognitive patterns of this sample are compared with subtest profiles mentioned in the literature on mentally retarded populations and samples of normal intelligent patients with epilepsy in order to determine the impact of epilepsy factors on cognition. The results indicate that people with mental retardation have problems with the verbal subtests Arithmetic, Vocabulary and Information, while patients with epilepsy have problems with Coding (Digit Symbol), Digit Span and Information. For this sample of mentally retarded patients with epilepsy, the most difficult subtests are Digit Span and Coding. The results concerning subtest profiles in different populations are discussed in light of the deleterious impact of epilepsy on cognition, which may superimpose the general effect of brain damage in mentally retarded patients. It is suggested that especially attentional processes, as measured with the subtest Coding, are vulnerable for epilepsy factors.     

Initiation of Ventricular Tachycardia by Interruption of Pacemaker-Mediated Tachycardia in a Patient with a Dual-Chamber Implantable Cardioverter Defibrillator

A 74-year-old man with a dual-chamber implantable cardioverter defibrillator implanted 3 years before experienced multiple ventricular tachycardias (VTs). All episodes were initiated by pacemaker-mediated tachycardia (PMT) that was either stopped by atrial undersensing or the tachycardia termination algorithm of the device. After the termination of PMT, two rapid ventricular paced beats, the first initiated by artificial triggering and the second due to retrograde conduction of the first one, initiated VT that was successfully terminated by antitachycardia pacing or a direct current shock of the device . All episodes revealed this pattern of initiation with a short-long-short ventricular sequence inducing VT.     

Measurement of cardiac output in normal pregnancy by a non-invasive two-dimensional independent Doppler device

Aims: To compose a normogram regarding cardiac output during pregnancy measured with ultrasonic cardiac output monitor (USCOM), a non-expensive simple continuous wave Doppler device and to investigate if this machine could be useful for haemodynamic monitoring during pregnancy.
Methods: Cardiac output was measured in 172 pregnant women with a gestational age < 21 weeks ( n  = 59), 21–32 weeks ( n  = 48), and > 32 weeks' gestation ( n  = 48). Interobserver differences were determined by measuring 24 patients and comparing results between three different observers.
Results: A good signal could be obtained in 155 (90.2%) pregnant women. Haemodynamic profiles were in line with data published in the literature. In 9.8 % of cases it was difficult to get a good result. Interobserver variations between the research officer (CK) and two clinicians were good ( r  = 0.9359 and r  = 0.9609).
Conclusion: USCOM appears to be a reliable and fast method to measure cardiac output compared with existing highly complex ultrasounds machines used in cardiology. It is easy to learn, cheap and quite reproducible between different observers. Further research is required to define its place in the management of hypertensive complications during pregnancy.     

A functional variant in the thrombospondin‐1 gene and the risk of small for gestational age infants

Summary. Introduction: Thrombospondin‐1 (TSP‐1) is a prothrombotic and anti‐angiogenic glycoprotein expressed in the placenta. A functional single nucleotide polymorphism in the TSP‐1 gene (TSP‐1 A2210G) is a risk factor for familial premature myocardial infarction. Small for gestational age (SGA) infants are at increased risk of coronary artery disease in adult life and common genetic factors may underlie both conditions. We investigated the association of TSP‐1 A2210G in SGA infants and their parents. Method: The 3234 nulliparous pregnant women, their partners and babies were recruited in Adelaide and Auckland to a prospective multicenter cohort study. Amongst 2123 Caucasian women, 216 (10.2%) delivered an SGA infant, defined as birth weight < 10th customized centile adjusted for maternal height, weight, parity and ethnicity, as well as gestational age at delivery and infant sex. Uncomplicated pregnancies served as controls (n = 1185). DNA extracted from peripheral/cord blood or buccal swabs was genotyped using Sequenom MassARRAY. Multivariable logistic regression was used to compare the odds of SGA between the genotype groups adjusting for potential confounders. Results: Paternal (adjOR, 1.4; 95% CI 1.0–2.0) and neonatal (adjOR, 1.8; 95% CI, 1.1–2.7) TSP‐1 A2210G associates with SGA. The maternal polymorphism approaches significance for an association with SGA (adjOR, 1.3; 95% CI, 0.9–1.9). Maternal TSP‐1 A2210G associates with a reduced maternal birth weight adjusted for gestational age at delivery (P = 0.03). Conclusion: The TSP‐1 A2210G polymorphism, which is a risk factor for myocardial infarction, is associated with SGA pregnancies, suggesting that this polymorphism may associate with the risk of vascular disorders across the life course.     

Three‐Dimensional CT Overlay in Comparison to CartoMerge for Pulmonary Vein Antrum Isolation

CT Overlay for PV Antrum Isolation . Introduction: Three‐dimensional (3D) navigation systems are widely used for pulmonary vein antrum isolation (PVAI). To circumvent left atrial (LA) mapping, 3D CT reconstructions of the LA can be superimposed directly (CT overlay) on the fluoroscopy image to guide ablation catheters and to mark ablation sites. Methods and Results: Sixty‐eight patients (pts) with symptomatic AF refractory to medical therapy were randomly assigned to CT overlay (group 1, n = 38) or CartoMerge (group 2, n = 30). In group 1 registration of the CT image was performed with contrast injections in 2 orthogonal projections. In group 2, visualization of all pulmonary vein (PV) ostia was done by PV angiography, followed by merging of the CT image and the Carto shell. We compared procedural success, procedure time, fluoroscopy time and radiation burden, measured as dose area product (DAP). Baseline characteristics were comparable in both groups. Procedural success, defined as disappearance of PV potentials in all PVs, was achieved in 37/38 (97%) of group 1 patients and 27/30 (90%) patients in group 2 (P = NS). Total procedure time was significantly shorter in group 1 compared to group 2 (129 ± 34 vs 181 ± 30 min, P < 0.0001). Although fluoroscopy time tended to be longer in the CT overlay group (47 ± 16 vs 40 ± 13 min, P = 0.06), proper use of diaphragmation resulted in comparable radiation values for both groups (DAP 53 ± 27 vs 56 ± 35 Gy cm², P = 0.76). Conclusions: CT overlay for PV isolation is feasible and may, in comparison to conventional LA navigation systems, shorten procedural time without increases in radiation burden. (J Cardiovasc Electrophysiol, Vol. 21, pp. 634‐639, June 2010)     

PROCEEDINGS OF A PRELIMINARY WORKSHOP AT GASTRO 2009 – NARROW BANDING IMAGING IN DIGESTIVE ENDOSCOPY: CLINICAL OUTCOME OF CLASSIFICATION (OMED‐JGES EDUCATIONAL MEETING HELD ON 22 NOVEMBER, 2009)

This publication reports the proceedings of the preliminary meeting of the working party that met at Gastro 2009 during the World Congress in London. The purpose of the preliminary meeting was to consider the areas that require attention, to discuss some of the findings that have already been published and to agree on the way forward. Our reason for publishing these proceedings is to stimulate interest in this venture and to provide the opportunity for input from the endoscopy community worldwide. The next meeting of the working party will be at the JGES Society meeting in Aomori in April 2011 when we hope to prepare a preliminary classification. This will be presented for general discussion and debate at the International Congress of Endoscopy (ICE) in Los Angeles in September 2011.     

Transesophageal Atrial Pacing—Stimulation and Discomfort Thresholds: The Role of Electrode Configuration and Pulse Width

A balloon catheter with six electrodes has been developed for transesophageal atrial stimulation of the human heart. Introduction is easy and its positioning is simple with the help of six unipolar atrial electrograms. In a group of 20 healthy volunteers, stimulation and discomfort thresholds (intolerable discomfort) were measured for three levels of pulse widths (12, 16, and 20 msec) and for five electrode configurations. Stimulation thresholds were below discomfort thresholds in each case. The stimulation threshold depended on pulse width and not on electrode configuration. The discomfort threshold, however, depended on the electrode configuration and not on the pulse width. A moderate but potentially important increase of the ratio between stimulation threshold and discomfort threshold could be achieved by combining a long pulse width (20 msec) and avoiding the largest distance between the active (cathode) and the passive (anode) electrode. Transesophageal atrial stimulation promises to be a practical noninvasive tool for the termination of regular supraventricular tachycardias, basal electrophysiological studies, and controlled acceleration of the heart rate in the study of myocardial ischemia.     

Aspirin-induced asthma and HLA-DRB1 and HLA-DPB1 genotypes

Background Aspirin-induced asthma (AIA) affects one in 10 individuals with adult-onset asthma. It is not known if aspirin sensitivity is due to immune mechanisms or to interference with biochemical pathways. Objective The study aimed to test for possible involvement of the genes of the Major Histocompatibility Complex (MHC) in AIA. Methods HLA-DPB1 and HLA-DRB1 genotyping was carried out by DNA methods in 59 patients with positive challenge tests for AIA and in 48 normal and 57 asthmatic controls Results The DPB 1*0301 frequency was increased in AIA patients when compared with normal controls (19.5% vs 5.2%, Odds Ratio = 4.4, 95% Confidence Interval (CI) 1.6–12.1, P= 0.002), and compared with asthmatic controls (4.4%, OR = 5.3, 95%CI= 1.9–14.4, P= 0.0001). The frequency of DPB 1*0401 in AIA subjects was decreased when compared with normal controls (28.8% vs 49.0%, OR = 0.42, 95%CI = 0.24–0.74, P= 0.003) and asthmatic controls (45.6%, OR = 0.48, 95%CI = 0.28–0.83, P= 0.008). The results remained significant when corrected for multiple comparisons. There were no significant HLA-DRB 1 associations with AIA. Conclusion The presence of an HLA association suggests that immune recognition of an unknown antigen may be part of the aetiology of AIA.     

Genetic susceptibility to viral exposure may increase the risk of cerebral palsy

Aim: Cytokine polymorphisms may alter the fetal inflammatory response, increasing susceptibility to cerebral palsy (CP). This study investigates associations between selected inflammatory mediator and cytokine gene polymorphisms (Toll-like receptor-4 (TLR-4) Asp299Gly, interleukin-6 G-174C and interleukin-4 C-589T) and CP from 443 CP infants and 883 control infants. Results were correlated with viral nucleic acids in the same samples.
Results: At all gestational ages (GA), TLR-4 was associated with a decreased risk of developing CP (homozygous/heterozygous odds ratio (OR) 0.70, 95% confidence interval (CI) 0.50–0.98) and interleukin (IL)-6 was associated with an increased risk of developing hemiplegia (OR 1.38, 95% CI 1.05–1.83). For infants born 32–36 weeks GA, there was a tenfold increase in the risk of quadriplegic CP with homozygous/heterozygous IL-6 (OR 10.42, 95% CI 1.34–80.82). Viral exposure in combination with IL-4 in preterm infants was associated with a fourfold increased risk of quadriplegia (homozygous/heterozygous OR 4.25, 95% CI 1.21–14.95). In very preterm infants, the absence of detectable viral exposure in combination with IL-4 decreased the risk of developing CP (homozygous/heterozygous OR 0.31, 95% CI 0.13–0.76).
Conclusion: Polymorphisms in TLR-4 may be associated with a decreased risk of CP. Polymorphisms in IL-6 or IL-4 may act as susceptibility genes, in the presence of viral exposure, for the development of hemiplegic and quadriplegic CP. These associations require confirmation but they suggest a hypothesis for CP causation due to double jeopardy from neurotropic viral exposure and genetic susceptibility to infection.