Usefulness of a New Active-Fixation Lead in Transvenous Temporary Pacing from the Femoral Approach

DE COCK, C.C., et al .: Usefulness of a New Active-Fixation Lead in Transvenous Temporary Pacing from the Femoral Approach. Temporary transvenous pacing is associated with a high incidence of complications with a substantial dislocation rate reported to occur in more than one-third of patients. This article describes a novel 3.5 Fr temporary pacing lead using active fixation in a consecutive series of 42 patients with prolonged (≥48 hours) temporary pacing. The dislocation rate was 4.8%, while in 7.1% of patients inappropriate pacing (more than a twofold increase of initial pacing threshold) was observed. The total procedural related complication rate (dislocation, inappropriate pacing, local infection, and/or thrombosis) was 31% during a mean duration of pacing of   5.96 ± 2.6 days   . Ambulatory pacing was performed in the vast majority (74%) of patients. Temporary transvenous pacing using an active-fixation lead is safe and permits long-term ambulatory pacing with a low dislocation rate.(PACE 2003; 26[Pt. I]:849–852)     

Handwriting,visuomotor integration,and neurological condition at school age

Aim The study investigated the relationships between handwriting, visuomotor integration, and neurological condition. We paid particular attention to the presence of minor neurological dysfunction (MND). Method Participants were 200 children (131 males, 69 females; age range 8–13y) of whom 118 received mainstream education (mean age 10y 5mo, SD 1y 4mo) and 82 special education (mean age 10y 8mo, SD 1y 2mo). Each child had four assessments: a neurological examination, which paid attention to the type and severity of MND, a test to measure motor performance, a handwriting test, and the Developmental Test of Visual Motor Integration. Results Dysgraphic handwriting and slow writing speed were closely related to the severity of neurological dysfunction (both p<0.001); impaired visuomotor integration was related to the presence of MND (p<0.001) but somewhat less to its severity. Impaired handwriting and visuomotor integration were strongly related to two specific dysfunctions: fine manipulative disability and coordination problems (both p<0.001). Impaired visuomotor integration was weakly related to dysfunctional muscle tone regulation (p=0.009) and sensory dysfunction (p=0.042). Interpretation Poor handwriting and impaired visuomotor integration are related to MND, but in a differential way. Poor handwriting is related to the severity of neurological dysfunction and to dysfunctions of complex supraspinal circuitries. Impaired visuomotor integration is associated with the presence of any of the most common types of MND.     

Electromagnetic Interference of an Implantable Loop Recorder by Commonly Encountered Electronic Devices

De COCK, C.C., et al. : Electromagnetic Interference of an Implantable Loop Recorder by Commonly Encountered Electronic Devices. Electromagnetic interference of pacemaker systems has been well established and can lead to an inappropriate function of these devices. Recently, an implantable loop recorder (ILR) (REVEAL, Medtronic Inc.) has been introduced to evaluate the possible arrhythmic etiology of patients with recurrent syncope. We evaluated the interference of this device in two patients with implantable ILR and in three nonimplanted ILRs with four electromagnetic sources: cellular phones (GSMs), electronic article surveillance systems (EASs), metal detector gates (MDGs), and magnetic resonance imaging (MRI). The GSM did not affect appropriate function of the ILR whereas radiofrequency (RF) EAS could interfere with normal function in implanted and nonimplanted systems. The MDG had no influence on ILR function. The magnetic field induced by the MRI resulted in an irreversible error in one nonimplanted ILR. Therefore, although interference between electromagnetic sources and ILRs appears to be rare in our study, physicians should be aware of possible malfunctioning of these devices.     

胆固醇酯转运蛋白基因373 Ala→Pro和451 Arg→Gln的突变频率及其对脂质代谢的影响

为了进一步探讨胆固醇酯转运蛋白基因突变３７３Ａｌａ→Ｐｒｏ和４５１Ａｒｇ→Ｇｌｎ的及其对血脂代谢的影响，采用致突变分离聚合酶链反应技术，检测了９１例健康德国大学生和４０９例冠心病患者在胆固醇酯转运蛋白基因第３７３和第４５１位密码子的基因型，并对照测定其血脂参数。     

The Premenstrual Syndrome: Current Findings, Treatment, and Implications for Nurses

Premenstrual tension is a widely occurring cross-cultural phenomenon. Its etiology is largely unknown, although common symptoms can be identified. During the premenstrual phase personality disorders and accidents increase. Nurses need to understand the menstrual cycle and the related premenstrual syndrome that occurs. They should be able to offer appropriate counsel to others and to be aware of the risks of diminished mental alertness in their own life cycles.     

An Instrument to Assess the Quality of Maternal Behavior

Early assessment, detection, and therapeutic intervention in maladaptive maternal behavior can be facilitated by a simple nursing appraisal instrument employed initially on the third postpartum day. The Funke-Irby Interactional Assessment not only discriminates between early adaptive and maladaptive maternal behaviors, but it also illustrates a mother's progress or lack of progress toward adaptive mothering, making the instrument useful to the community health nurse during the early postdelivery weeks. This instrument has been effectively used as a screening device for nurses making decisions about the need for further referral for family therapy.     

High Quality Stress Echocardiography Using Simultaneous Transesophageal Echocardiographic Imaging and Atrial Pacing

The combination of transesophageal atrial pacing and transesophageal echocardiography (TEE) provides an alternative stress echocardiographic technique capable of assessing pacing-induced wall-motion abnormalities and ischemia-induced mitral regurgitation. The rationale for combining pacing with TEE resulted from experiences with inadequate transthoracic stress studies in up to 15% of the patients and second, from failure of transesophageal atrial pacing with a single lead in another 15% of the patients. Simultaneous TEE and transesophageal atrial pacing was performed in 90 consecutive patients using continuous short-axis monitoring obtained at papillary muscle level. All but one patient had good image quality at rest and during pacing. No complications occurred, in five patients (6%) pacing had to be discontinued prematurely because of discomfort. Early atrio-ventricular Wenckebach block occurred in eight patients (9%). In 83 patients (92%) coronary artery angiography was performed. Sensitivity for assessment of suspected coronary artery disease was 83%, and specificity 94%. Multivessel disease in patients with prior myocardial infarction was assessed with sensitivity of 77%, and specificity of 100%. In 6 of 25 patients (24%) new or increasing mitral regurgitation after induction of wall-motion abnormalities was observed. In conclusion, TEE in conjunction with atrial pacing is feasible, safe, and an alternative echocardiographic stress technique, capable of detecting wall-motion abnormalities and changes in mitral regurgitation. Because of its semi-invasive nature, only patients with a poor transthoracic window are candidates.     

Long-Term Outcome of Patients with Multiple (≥ 3) Noninfected Transvenous Leads: A Clinical and Echocardiographic Study

To prospectively assess the incidence and clinical significance of thromboembolic complications in patients with multiple (≥ 3) noninfected transvenous leads; 48 consecutive patients were evaluated. Half of the patients had two ventricular leads and one atrial lead, 15 patients had two atrial leads and one ventricular lead, while 9 patients had two ventricular and two atrial leads. No additional care was provided except for aspirin (80 mg bid) and annually performed echo-Doppler studies. Clinical follow-up included signs and symptoms of subclavian and/or axillary vein thrombosis, the presence of right congestive heart failure, the number of hospital admissions, and death. Echo-Doppler studies assessed the presence of an enlarged right atrium or ventricle, right atrial or ventricular spontaneous contrast, and the presence of tricuspid regurgitation. During a total follow-up of 7.4 ± 2.2 years there were no differences in the incidence of clinical variables as compared to age-matched controls with DDD pacemakers. The most common complication was transient venous thrombosis (mostly presenting as venous prominence 1–2 weeks after implantation), which was seen in 17% of the study group versus 15% in controls (NS). Cumulative mortality was not different in both groups (13% in the study group vs 15% in controls). No differences were present with respect to hospital admissions (1.1 ± 0.27/year in the study group vs 1.2 ± 0.30/yearin the controls). In patients with multiple ventricular leads, tricuspid regurgitation on echo-Doppler studies was more frequent (24%) as compared to controls (4%); however, clinical signs of right heart failure were equally distributed. Thus, patients with multiple (≥ 3) noninfected leads have no clinical adverse outcome during long-term follow-up.