Anomalous "VVI" Pacing of a Dual Chamber Pacemaker When Programmed in DDI(R) Mode

We describe the case of a dual chamber rate responsive pacemaker (Relay, model 294-03, Intermedics, Angleton, TX, USA) implanted in a 68-year-old male for sick sinus syndrome, which was not working properly when programmed in the DDIR mode, thus determining occasionally a sort of "VVI" pacing. However, the pacemaker performed well when programmed in the DDDR mode. We discovered that this was not a malfunction of a single device but rather a general behavior of this family of Intermedics dual chamber pacemakers (also not rate responsive), caused by a software problem.     

Renal water and sodium handling in compensated liver cirrhosis: mechanism of the impaired natriuresis after saline loading

The present study was attempted to evaluate sodium and water balance in compensated liver cirrhosis. Renal sodium and water handling was studied in six cirrhotic patients without ascites and/or oedema and in six controls before and after saline loading. Fractional sodium reabsorption at the various nephron sites (proximal, diluting and distal) was evaluated by means of clearance techniques during maximal water diuresis and hypotonic saline infusion. Compensated cirrhotic patients showed a normal baseline sodium and water balance but a blunted natriuretic response when saline loaded (urinary sodium excretion after saline load = 338 +/- 290 compared to 933 +/- 504 mumol min-1 of controls; P less than 0.05). The impaired natriuresis was found to be related to an increased reabsorption of sodium in the proximal tubule (proximal fractional sodium reabsorption = 88.4 +/- 3.8 compared to 81.7 +/- 4.3% of controls; P less than 0.05). These findings confirm the hypothesis that renal sodium handling abnormalities might precede ascites formation. Additional studies, however, are necessary to further define renal factors mediating the increased reabsorption of sodium in compensated liver cirrhosis.     

Red Cell Enzymes and Intermediates in AGA Term Newborns, AGA Preterm Newborns and SGA Term Newborns

ABSTRACT. Red cell enzyme activities and 2,3-diphosphoglycerate and adenosine-triphosphate levels in cord blood of three groups of newborn infants were studied. The groups were classified according to birthweight in relation to intrauterine growth and gestational age. Only phos-phofructokinase, glyceraldehyde-3-phosphate dehydrogenase and enolase activity values differed significantly among the groups. The activity of phosphofructokinase was lower in small-for-date term infants (TSGA) and preterm adequate for gestational age (PTAGA) in comparison to term infants adequate for gestational age (TAGA). Glyceraldehyde-3-phosphate dehydrogenase activity was higher in TAGA, in comparison to PTAGA, with no other difference among the groups. Enolase activity was found to be higher in TSGA compared to TAGA and higher in PTAGA compared to TAGA. No differences were found between PTAGA and TSGA.     

Some Innovations in the Technic of the One-second Needle Biopsy of the Liver

The one-second liver biopsy technic, published about 18 years ago, has undergone, in the course of the years, some minor modifications, suggested by the practical experience and by the critical evaluation of published and unpublished complications. Some instrumental innovations are described. A new design skin perforator and a penetration limiter are proposed. The clinical use of biopsy needles of different size is discussed. Moreover, the importance of some technical aspects of the practical execution of the biopsy, which are frequently neglected, is pointed out. Finally, the biopsy technic, in its up-to-date version is summarized and the opportunity of a further trial to confirm the validity of the innovations suggested is emphasized.