Plasma zinc in psoriatic in-patients treated with local zinc applications

Zinc is a major component of many local skin applications. An investigation into its systemic absorption in thirty-one psoriatic hospital in-patients is reported. Plasma zinc, copper and whole blood delta-aminolaevulinic acid dehydratase were followed before and during in-patient treatment over 14 days. No significant alteration in these parameters was detected. Significantly reduced plasma zinc levels were found in the patients compared to a matched control population.     

Assessment of Resynchronization Therapy on Functional Status and Quality of Life in Patients Requiring an Implantable Defibrillator

Background: The effect of cardiac resynchronization therapy (CRT) on physical function and Quality of Life (QoL) in patients who require an implantable defibrillator but do not meet guideline criteria for CRT has not been studied in detail. Methods and Results: This was a randomized study of 72 patients with high risk of sudden cardiac death, ejection fraction (EF) ≤35%, mild‐to‐moderate heart failure symptoms, and QRS > 120 ms. Patients received a CRT defibrillator and were randomized to CRT turned ON or OFF. Objective and subjective measures were performed at baseline and after 6 months. There was no difference in change in left ventricular end‐systolic volume (ESV) by radionuclid angiogram scan, the primary endpoint, between the CRT ON group (ΔESV =?7 ± 52 mL), and CRT OFF group (ΔESV =?30 ± 47 mL). Similarly, echocardiogram measures of ESV and EF showed no difference between the two groups. In the CRT ON group, selected measures of QoL and subjective exercise tolerance but not heart failure symptoms improved significantly. Six‐minute walk distance prolonged in the CRT ON group (baseline 313.6 ± 114.4 m, 6‐month 365.0 ± 122.5 m, P = 0.01), but the difference in change in walk distance between the two groups was not significant. Conclusion: Further studies with larger sample size and longer follow‐up will be required to allow definite conclusions regarding the potential benefit of CRT in this patient population.     

A Report Using a Hybrid ICD System: The Need for Compatibility Among Implanted Defibrillator Components

The successful implantation of an ICD system with hardware from three different manufacturers is described. This case exemplifies the need for compatibility of components among different manufacturers. This is most relevant at a time when rapidly changing technology and hardware availability may require a mixing, by informed practitioners, of ICD system components. The parallel to the development of the uniform IS-1 standard for bradycardia devices is made.     

Serial Measures of Sinoatrial and Atrioventricular Nodal Function in Ambulatory Patients

We hypothesized that the outpatient assessment of SA and AV nodal (SAN, AVN) function could be a useful tool to determine the effectiveness of drugs and other treatments. We sought to examine the reproducibility, safety and ease of acquiring serial measurements of these parameters. Ten patients with permanent pacemakers underwent low current chest wall stimulation while their device was programmed to unipolar atrial triggered mode. Measurements at multiple conditioning drive train frequencies were obtained for: sinus nodal recovery time (SNRT); corrected sinus nodal recovery time (CSNRT); SA conduction time (SACT); AVN block cycle length (AVNBCL); and AVN effective refractory period (AVNERP). AVN function curves were also constructed. All studies were repeated after 2 weeks. Measures of sinus nodal and AVN function did not show significant differences between the two studies. The following coefficients of correlation were obtained: SNRT800, r = 0.79; CSNRT800, r = 0.71; SNRT600, r = 0.71; CSNRT600, r = 0.44; SACT, r = 0.75; AVNBCL, r = 0.98; AVNERP800, r = 0.55; and AVNERP600, r = 0.99. A VN function curves did not significantly differ between week 1 versus week 2 at conditioning drive trains of either 800 ms or 600 ms. These data suggest that serial noninvasive electrophysiological measures of AVN and SAN function are reproducible over 2 weeks. Using data in this study, estimates of the sample size necessary for the evaluation of the effects of investigational drugs on the SAN and AVN in future studies are possible.     

Mercuric chloride induced autoimmune disease in Brown-Norway rats: sequential search for anti-basement membrane antibodies and circulating immune complexes

Mercuric chloride induces in the Brown-Norway rat a biphasic autoimmune disease characterized initially by linear IgG deposits along the glomerular basement membrane followed later by granular IgG deposition. In the present study, anti-glomerular basement membrane antibodies and immune complex-like material were sequentially assessed in serial serum samples. Both were transiently found at the same period. Glomerular linear IgG deposits were present on day 11 but circulating anti-glomerular basement membrane antibodies were only found later on day 16. Circulating immune complexes were first detectable on day 8 before the earliest granular IgG deposits were first observed in the spleen vessels on day 16. The disappearance of circulating anti-glomerular basement membrane antibodies and of circulating immune complexes, although HgCl2 injections were pursued, is in agreement with the self-limited character of mercuric chloride induced autoimmune disease and suggests the induction of immunosuppressive mechanisms.     

Plasma lipids in kidney transplanted children and adolescents: influence of pubertal development, dietary intake and steroid therapy

Abstract. Plasma triglycerides and/or cholesterol were significantly increased in twenty-four of thirty kidney transplanted children and adolescents with stable renal function, at least one year after the last rejection crisis who received low dose prednisone therapy. The cholesterol increment was related to both low density and high density lipoproteins. However, similar to findings in adult allograft recipients, these increases were very variable: six subjects had normal levels, eight had increased triglycerides, five increased triglycerides and cholesterol, and eleven increased cholesterol. No influence of renal function was found in this series of patients all of whom had plasma creatinine below 160 μmol/1. Subjects who had achieved sexual development had lower cholesterol values. An insignificant difference was observed between patients receiving daily and alternate-day steroid therapy, but a significant negative correlation was found between plasma triglycerides and fractional urinary excretion of 17 OH corticosteroids in the first 6 h after an oral dose of prednisone. Finally, no correlation was found between energy intake and triglycerides; but a significant correlation was observed between protein intake and plasma cholesterol.
In conclusion, some patients show a high level of triglycerides and/or cholesterol after renal transplantation, possibly due to a different individual response to steroid therapy.     

Assistant Programming Software: A New Tool for an Improved Programming of Pacemakers

LASCAULT, G., ET AL.: Assistant Programming Software: A New Tool for an Improved Programming of Pacemakers. Programming the new DDD pacemakers is becoming increasingly difficult. One must take into, account the pacemaker's complexity, the fact that some parameters are linked to others, and the clinical profile of the patient. This difficult problem will lead to the design of software to assist programming, which will help the implanting physicians in choosing adequate programmed settings adapted to the functioning of the device and to the physiology and pathology of the patient. These programming aides should meet certain basic requirements to make them safe, efficient, and easy to use. One such system designed by ELA Médical, "Programming Assistant" is herein described. The preliminary results of an initial study on the acceptance of this programming aide among physicians involved in cardiac pacing are given and discussed.     

Serological diagnosis of bullous pemphigoid (BP): comparison of the sensitivity of indirect immunofluorescence on salt-split to immunoblotting

Specialized immunological assays are required for the accurate diagnosis of bullous dermatoses such as bullous pemphigoid (BP), epidermolysis bullosa acquisita and bullous lupus erythematosus. The aim of this study was to analyse and compare the sensitivity of indirect immunofluorescence (IF) on salt-split skin and immunoblotting for the detection of circulating autoantibodies in BP. Of the BP patients selected for the study, 74/79 (94%) had circulating autoantibodies detected by at least one of the two methods. Both methods had comparable sensitivity and detected BP-specific autoantibodies in 82-85% of the patients. Because 20% of the patients were found to be positive by only one of the methods, both methods should be used in the diagnosis of BP. Indirect IF on salt-split skin is easier to perform and is preferable in routine analysis, but Western blotting may be used as a complementary assay with sera showing no reactivity on salt-split skin.