Efficacy and safety of low- and high-dose sotalol versus propranolol in the prevention of supraventricular tachyarrhythmias early after coronary artery bypass operations

Supraventricular tachyarrhythmias are reported in up to 40% of patients early after coronary artery bypass graft operations. In a randomized study, we compared the efficacy and safety of the class III antiarrhythmic beta-blocking drug sotalol versus propranolol at low and high doses in the prevention of supraventricular tachyarrhythmias in 429 consecutive patients after coronary artery bypass graft operations. Patients with severely depressed left ventricular function and other contraindications for beta-blockers were excluded. From the fourth hour up to the sixth day after coronary artery bypass, 74 patients received low-dose sotalol (40 mg every 8 hours), 66 patients low-dose propranolol (10 mg every 6 hours), 133 patients high-dose sotalol (80 mg every 8 hours), and 156 patients high-dose propranolol (20 mg every 6 hours). Baseline characteristics were comparable in all groups. Supraventricular tachyarrhythmia was observed in 10 of 72 (13.9%) who received low-dose sotalol, 12 of 64 (18.8%) who received low-dose propranolol, 13 of 119 (10.9%) who received high-dose sotalol, and 19 of 139 (13.7%) who received high-dose propranolol (not significant). Drug-related adverse effects necessitating discontinuation of the drug occurred in four receiving low doses (2.9%) and in 31 receiving high doses (10.7%) (p less than 0.02). In conclusion, no medication was found to be superior, although supraventricular tachyarrhythmias tended to be less prevalent in patients treated with sotalol than in those treated with propranolol. Moreover, significantly fewer adverse effects were noted in both low-dose groups. Therefore, low-dose beta-blocking treatment, especially low-dose sotalol, seems preferable.     

Sustained attention problems in children with early treated congenital hypothyroidism

Sustained attention was studied in 48 children with early treated congenital hypothyroidism and 35 healthy controls, using a computer-paced and a self-paced continuous performance task. The performance of the patients, particularly those in the low T4 group (38 patients with T4 levels < 50 nmol/1 at neonatal screening), declined in the final stage of the computer-paced task, suggesting a problem in remaining attentive over time. The performance of all children declined in the first and improved in the final stage of the self-paced task. This pattern was most pronounced in the low T4 group, reflecting greater variability in their task performance over time, again indicating a problem in sustaining attention. No correlation was found between onset of treatment and sustained attention. The small size of the intermediate T4 group (10 patients with T4 levels ≥ 250 nmol/1 at neonatal screening) made the results more difficult to interpret and may have concealed a problem with sustained attention in this group.     

Anterior pole ischemia and carotid stenosis

PURPOSE/METHODS: We present the case of a 69 year-old male patient who developed an anterior pole ischemia syndrome in his right eye. He did not have any personal history of diabetes or previous ocular pathology. Indirect ophthalmoscopy did not show any pathological finding. RESULTS/CONCLUSIONS: Carotid Duplex scanning and Nuclear Magnetic Resonance detected a severe carotid stenosis on the same side, which explained the case. We reviewed different forms of presentation of venous stasis syndrome in carotid stenosis and present this uncommon case of anterior segment ischemia syndrome without posterior segment findings.     

Which manufacturing characteristics are predictors of outlet strut fracture in large sixty-degree Björk-Shiley convexo-concave mitral valves? The Björk-Shiley Study Group

BACKGROUND: Identification of predictors of outlet strut fracture is important for recipients of large (>/=29 mm) 60-degree Bj?rk-Shiley convexo-concave mitral valves when it comes to decision making on prophylactic explantation. An association between the manufacturing process of Bj?rk-Shiley convexo-concave valves and the risk of fracture has been suggested. OBJECTIVE: The aim of this study was to determine which items from the manufacturing records, in addition to known risk factors, were predictive of fracture of large 60-degree Bj?rk-Shiley convexo-concave mitral valves. METHODS: All Dutch recipients (n = 2264) of Bj?rk-Shiley convexo-concave valves were followed up until fracture, death, reoperation, or end of the study (July 1, 1996). Information was abstracted from the manufacturing records of large 60-degree Bj?rk-Shiley convexo- concave mitral valves (n = 655) in Dutch recipients and included items that described the manufacturing process and items for which an association with strut fracture had been suggested. Manufacturing records were available for 637 valves (97%), including 25 fractured valves. RESULTS: Multivariate analysis identified age at implantation (hazard ratio 0.95, 95% confidence interval 0.93-0.97), lot size (<175 valves versus >/=175 valves; hazard ratio 6.6, 95% confidence interval 2.2-20.1), number of hook deflection tests performed (0 or 1 versus >/=2; hazard ratio 4.7, 95% confidence interval 1.4-16.2), number of disks that were used (1 versus >/=2; hazard ratio 5.9, 95% confidence interval 1.9-18.5), and lot fracture percentage (hazard ratio 1.6, 95% confidence interval 1.4-1. 8) as independent predictors of fracture. Although the added predictive value of a model with these 5 variables was sizable compared with a model containing age only, it was only slightly better than a model with age, lot size, and lot fracture percentage. CONCLUSION: If the serial number of a large 60-degree Bj?rk-Shiley convexo-concave mitral valve is known, manufacturing information can add significantly to the prediction of fracture. Information on lot size and lot fracture percentage should be made available to clinicians for risk assessment of prophylactic explantation.     

Primary and secondary histiocytic lymphoma of the brain: CT features

The authors examined 19 patients with diffuse histiocytic lymphoma of the brain, including 8 with primary disease and 11 with secondary disease. Both primary disease and secondary disease involving the brainstem and deep nuclei exhibited the characteristic CT appearance, consisting of a large, solid, homogeneously enhanced mass with varying amounts of edema. However, most secondary lymphomas outside the brainstem and basal ganglia contained large areas of low attenuation consistent with necrosis. Multifocal lesions were seen only in patients with secondary lymphoma. Systemic chemotherapy for extracranial lymphoma had no effect on the CT appearance of intracranial lesions. The authors suggest that these "unusual" CT patterns are actually typical of a distinct subset of histiocytic lymphomas.     

Blood pressure, lipids, lipoproteins, body fat and physical activity of Singapore children

Objective: To determine body composition, coronary risk factors and physical activity and the inter-relationships of these variables in Singaporean school children.
Methodology: This study examined 1681 children (784 boys and 897 girls) from eight primary and seven secondary schools to determine percentiles for body stature and composition, blood pressure, lipids/lipoproteins and blood glucose by gender for three age divisions. An exercise and leisure pursuit questionnaire was administered to ascertain self-reported physical activity patterns. Anthropometric data and blood pressure readings were taken. Capillary blood was drawn from each child via finger prick sampling following an overnight fast. The concentrations of total cholesterol (TCHOL), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and glucose (GLU) were determined from plasma using a dry chemistry analyser. Low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL) and the TCHOL/HDL-C ratio were determined by calculation.
Results: While 47.7% of boys and 22.0% of girls disclosed active lifestyles, differences between the active and non-active children were found in coronary risk factors TCHOL, LDL-C, TG, TCHOL/HDL-C and per cent body fat. No differences were shown between the two groups in HDL-C, GLU and blood pressure. There was a high correlation between the various measures of body composition with the highest correlation ( r =0.806, P < 0.001) found between body mass index (BMI) and waist measurements.
Conclusions: Children in this study who reported no activity or relatively little activity were found to have TCHOL, LDL-C, TG, TCHOL/HDL-C and per cent body fat that were higher than those who reported moderately high or vigorous physical activity patterns.     

Susceptibility of 129/SvEv mice in two-stage carcinogenesis protocols to 12-O-tetradecanoylphorbol-13-acetate promotion

Embryonic stem cells derived from various derivatives of the murine 129/J strain are commonly used in the generation of knockout mice. Topical twice-weekly treatment of the 129/SvEv subline with either 2 or 5 microg of 12-O-tetradecanoylphorbol-13-acetate (TPA) for 4 weeks resulted in a sustained inflammation and hyperplasia. Identically treated C57BL/6 mice developed weaker inflammatory and hyperplastic responses over the same treatment course, and did not exhibit a sustained hyperplasia. SSIN mice treated with either 0.5 or 2 microg of TPA developed a sustained hyperplasia comparable to that seen in 129/SvEv mice, but a weak inflammatory response. Myeloperoxidase (MPO) measurements indicated dramatic infiltrations of the skins of all three murine strains by neutrophils within 48 h of a single TPA application. MPO activities remained significantly elevated in the skins of 129/SvEv mice and C57BL/6 mice following eight TPA treatments. In contrast, MPO activities in 8 X treated SSIN skins were comparable to those measured in solvent controls. 129/SvEv mice readily developed papillomas in two- stage skin carcinogenesis protocols employing DMBA as the initiator and TPA as the promoter. Papilloma incidences and multiplicities were dose- responsive with respect to promoter (using twice weekly applications of 1, 2 or 5 microg of TPA). With a promoting dose of 5 microg of TPA > or = 90% of the mice developed papillomas within 13 weeks, and maximum tumor multiplicities were reached within 18 weeks. These latter results, when compared to the published responses of other murine stocks and strains, demonstrate that 129/SvEv mice are very sensitive to TPA promotion in two-stage skin carcinogenesis protocols.      

Low back pain and disability in 14-year-old schoolchildren

In this cross-sectional prevalence study in 1503 14-year-old Finnish schoolchildren (n = 1503) low back pain was found to be the third most common form of pain interfering with schoolwork or leisure time during the past 12 months. The lifetime cumulative incidence of low back pain was 30% and that of sciatica 1.8%. Of the 417 pupils who had experienced low back pain at some time, 39% had suffered during the past month; 65% recovered in one month from the last pain episode, while 35.2% of those reporting disabling low back pain during the past year were aware of recurrent or continual pain. Thus, 7.8% (n = 107) of the whole population could be classified as "low back pain chronics": 86% of the low back pain chronics had trouble with at least one of the daily activities listed, most commonly with sitting at school. Excluding pain in the extremities or sciatica, girls reported various pains more commonly than boys. Moreover, girls reporting recurrent low back pain had more trouble with their daily activities due to pain than boys (p < 0.001), even though the recovery from the last pain episode took the same time in boys and girls. The pupils who had had sciatica at some time, in addition to recurrent low back pain, had more trouble with the 10 daily activities than others with recurrent low back pain (p = 0.014).