CARBAMAZEPINE USE IN AGGRESSIVE BEHAVIOUR ASSOCIATED WITH SENILE DEMENTIA

In a randomized placebo crossover controlled study, six patients meeting DSM-III-R criteria for Alzheimer's disease and exhibiting significantly aggressive behaviour were administered carbamazepine (in doses up to 600 mg daily) and placebo, with each treatment period lasting 8 weeks. Levels of aggression as measured by the RAGE scale were significantly reduced compared with placebo (p<0.05). The results suggest that carbamazepine is an effective anti-aggressive agent in patients with dementia. Recommendations for further studies are made.     

Left Septal Atrial Tachycardias: Electrocardiographic and Electrophysiologic Characterization of a Paraseptal Focus

Left Septal Atrial Tachycardias. Objective: The objective was to characterize the electrocardiographic and electrophysiological features of focal atrial tachycardia (FAT) originating from the left septum (LS). Background: FAT is recognized to occur at predefined anatomic locations rather than randomly throughout the atria. We describe the ECG and EP features of ATs originating from the LS as an important site for apparent perinodal tachycardias. Methods: Nine patients presenting with LS FAT from a consecutive series of 384 underwent EP/RFA for symptomatic FAT. Results: The mean age was 56 ± 12 years; 7 female with symptoms for 36 ± 28 months. P wave morphology (PWM) was negative/positive in lead V1 and across the precordial leads and negative or negative/positive in inferior leads in all patients. Tachycardia was incessant in 6 out of 9 patients with a mean tachycardia cycle length 421 ± 56 milliseconds. His A was ahead of P wave in all patients (mean ?15 ± 5 milliseconds) and earlier than CS proximal (mean 4 ± 9 milliseconds). Successful acute focal ablation achieved at a mean of 31 ± 12 milliseconds ahead of P wave with no recurrences at a mean follow‐up of 30 ± 28 months. Conclusion: Although the left septum is an uncommon site for focal AT an awareness of this location for harboring foci is particularly important when mapping apparently right‐sided septal tachycardias. (J Cardiovasc Electrophysiol, Vol. 24, pp. 413‐418, April 2013)     

Free testosterone levels in umbilical‐cord blood predict infant head circumference in females

Aim Fetal androgens influence fetal growth as well as postnatal neurocognitive ability. However, to our knowledge, no published study has prospectively examined the impact of early‐life androgens on infant brain growth. We report the association between circulating fetal androgen levels, measured from umbilical‐cord blood at birth, and a proxy measure of brain growth: head circumference. Method Participants were 82 unselected female infants from a large representative birth cohort (mean gestational age 39.4wks, SD 1.7). Umbilical‐cord blood was obtained at birth and analysed for androgen concentrations (total testosterone, androstenedione, dehyrdroepiandrosterone, and its sulphated metabolite). Head circumference and two other measures of growth – weight (mean 3311.4g, SD 461.3) and length – were measured within 3 days of birth and again at approximately 1 year of age (mean age 13.1mo, SD 1.1). Results Multivariate linear regressions found an inverse association between levels of free testosterone and growth in head circumference (correlation=?.24), even when adjusting for sociodemographic/obstetric covariates and head size at birth. Growth in weight and length could not be predicted by free testosterone concentration. Interpretation This is the first report of an association between prenatal androgen levels and postnatal growth in head circumference. These findings suggest that early‐life androgens may impact brain development during infancy.     

The Renin–Angiotensin System Mediates the Effects of Stretch on Conduction Velocity,Connexin43 Expression,and Redistribution in Intact Ventricle

Effect of Stretch on Conduction and Cx43 . Introduction: In disease states such as heart failure, myocardial infarction, and hypertrophy, changes in the expression and location of Connexin43 (Cx43) occur (Cx43 remodeling), and may predispose to arrhythmias. Stretch may be an important stimulus to Cx43 remodeling; however, it has only been investigated in neonatal cell cultures, which have different physiological properties than adult myocytes. We hypothesized that localized stretch in vivo causes Cx43 remodeling, with associated changes in conduction, mediated by the renin–angiotensin system (RAS). Methods and Results: In an open‐chest canine model, a device was used to stretch part of the right ventricle (RV) by 22% for 6 hours. Activation mapping using a 312‐electrode array was performed before and after stretch. Regional stretch did not change longitudinal conduction velocity (post‐stretch vs baseline: 51.5 ± 5.2 vs 55.3 ± 8.1 cm/s, P = 0.24, n = 11), but significantly reduced transverse conduction velocity (28.7 ± 2.5 vs 35.4 ± 5.4 cm/s, P < 0.01). It also reduced total Cx43 expression, by Western blotting, compared with nonstretched RV of the same animal (86.1 ± 32.2 vs 100 ± 19.4%, P < 0.02, n = 11). Cx43 labeling redistributed to the lateral cell borders. Stretch caused a small but significant increase in the proportion of the dephosphorylated form of Cx43 (stretch 9.95 ± 1.4% vs control 8.74 ± 1.2%, P < 0.05). Olmesartan, an angiotensin II blocker, prevented the stretch‐induced changes in Cx43 levels, localization, and conduction. Conclusion: Myocardial stretch in vivo has opposite effects to that in neonatal myocytes in vitro. Stretch in vivo causes conduction changes associated with Cx43 remodeling that are likely caused by local stretch‐induced activation of the RAS. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1276‐1283, November 2010)     

Predictors of Mortality in Patients with Lower Extremity Peripheral Arterial Disease: 5‐Year Follow‐up

Background: Peripheral arterial disease (PAD) is associated with increased mortality. Lower extremity (LE) revascularization improves symptoms, but less is known about long‐term survival benefits of LE arterial revascularization. Methods: Two hundred and eighty‐three patients with an ankle brachial index (ABI) ≤0.9 were identified at the Veterans Administration Hospital, Danville, Illinois, and rates of LE arterial revascularization and all‐cause mortality were measured at 5 years. Results: Of 283 patients identified, 42 (15%) underwent LE revascularization including 39 surgical procedures and 18 percutaneous interventions for symptomatic PAD. Eleven (26%) patients underwent repeat procedures over the 5 years of follow‐up. Those undergoing revascularization were more often Caucasian (95% vs. 79%, P = 0.01) and had lower ABIs (ABI ≤ 0.4, 45% vs. 17%, P = <0.001). At 44 ± 19 months follow‐up, there were fewer deaths in patients that underwent revascularization compared to patients who did not undergo revascularization; 10/42 (24%) versus 107/241 (44%) patients, P = 0.012. In a multivariate model LE arterial revascularization was associated with a trend toward lower all‐cause mortality (HR 0.51 [95% CI 0.26–1.02], P = 0.056). Independent predictors of mortality were age ≥65 years (HR 2.42 [95% CI 1.52–3.85], P < 0.001), history of coronary artery disease (HR 1.67 [95% CI 1.13–2.46], P = 0.010), chronic kidney disease (HR 1.75 [95% CI 1.15–2.67], P = 0.010), and an ABI ≤ 0.4 (HR 1.88 [95% CI 1.19–2.96], P = 0.006). Conclusion: Few patients at this center with LE‐PAD underwent arterial revascularization. After adjusting for baseline differences, there is a trend toward lower 5‐year mortality in those undergoing LE arterial revascularization when compared to those who do not.     

Torsion of accessory fallopian tube: Ultrasound findings in two premenarchal girls

The ultrasound findings of two cases of fallopian tube duplication, both of which had undergone torsion, are described. Two premenarchal girls were examined with ultrasound because of clinical evidence of pelvic pathology. Both were found to have complex cystic structures that on surgery and subsequent pathological examination were shown to be twisted accessory fallopian tubes. Accessory fallopian tubes have been reported to occur in 6–13% of selected patient groups. To our knowledge, torsion of an accessory tube has not been reported in the literature.     

Tinnitus in pregnancy

The presence of tinnitus in pregnancy was investigated by a postal questionnaire survey. A group of pregnant women attending the ante-natal clinic and a control group of non-pregnant members of the nursing staff at the Royal United Hospital in Bath were studied. The prevalence of tinnitus in the pregnant and non-pregnant women was compared. Both groups were similar in age, previous noise exposure and the presence of ear disease or operations. Twenty-five per cent of the pregnant women reported tinnitus compared with 11% of the control group. Chi-square analysis of this data gives a value of χ²= 4.07, d.f. = 1, P < 0.05. The result of our survey shows that there is a significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant control group. This association has not been previously reported.