Prediction of Arrhythmic Events After Acute Myocardial Infarction Using Two Methods for Late Potentials Recording

One hundred consecutive patients recovering from an acute myocardiai infarction underwent, prior to home discharge, signal-averaged electrocardiography (ECG), left ventriculography. and 24-hour Holter ECG recording. The signal-averaged ECG was recorded and analyzed using two procedures: the orthogonal bipolar XYZ lead configuration with a bidirectional filter: and a precordial unipolar lead configuration with a uonrecursive digital filter. An abnormal signal-averaged ECG was seen in 40% of patients with the XYZ system and in 30% of patients in the precordial method, abnormal ejection fraction (< 40%) in 24% of patients and high grade ectopy activity in 22%. During the 24-month follow-up period, 12 patients (12%) had an arrhythmic event defined as either sudden death (11 patients) or sustained ventricular tachycardia (1 patient). Neither the signal-averaged ECG with the XYZ configuration, the abnormal ejection fraction, nor the high grade ectopy were able to statistically predict a higher arrhythmic event rate. The signal-averaged ECG with the precordial configuration was able to statistically predict a higher arrhythmic event rate, P < 0.03; odds ratio = 3.96. The combination of the orthogonal XYZ configuration signal-averaged ECG with the ejection fraction (P < 0.01, odds ralio = 7.33), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio = 6.17) was able to predict a higher arrhythmic event rate. The combination of the precordial configuration signal-averaged ECG with the ejection fraction (P < 0.002, odds ratio = 14.4), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio =10) was able to better predict a higher arrhythmic event rate. The combination of a normal or abnormal signal-averaged ECG and ejection fraction gave a sensitivity, specificity, positive, or negative value prediction of arrhythmic events of 60%, 90.6%, 37.5%, and 96%, respectively. It must be emphasized that the number of arrhythmic events during the 2-year follow-up was small and further study is required to determine the true predictive value of each method for arrhythmic events.     

Long‐term follow up of root canal treated primary molars

International Journal of Paediatric Dentistry 2010; 20: 207–213 Background. Root canal treatment (RCT) is commonly performed to preserve primary molars with an infected or necrotic pulp. Aim. This study evaluates the long‐term effects of RCT in primary molars on the development and eruption of their permanent successors. Methods. This is a retrospective study of treatment of pulpectomised primary molars in a public dental clinic. All teeth were treated by the same operator using the same material (Endoflas F.S.) and the same method. Records of 194 patients with 242 pulpectomised primary molars (124 in 97 boys and 118 in 97 girls) met the inclusion criteria. The children’s age at the time of treatment ranged from 5 to 11 years (mean 6.72). Follow‐up time ranged from 6 to 113 months (mean 33.5). Results. Eight (3.3%) of the 242 primary molars presented a new radiolucent defect or enlargement of existing periapical radiolucency. Of the 106 molars followed until eruption of the permanent successor, none had radiographic pathological signs. Of 17 permanent teeth evaluated clinically, three were erupted into a rotated alignment, and one premolar presented hypocalcified defect in the enamel. Conclusions. Failure of root canal treatment in primary molars may be evident from development of new radiolucent defects or enlargement of existing defects. No relationship was found between RCT in the primary molars and the appearance of enamel defects or the ectopic eruption of following permanent teeth.     

A Common Color Flow Doppler Finding in the Mitral Regurgitation of Acute Rheumatic Fever

Between October 1986 and May 1991, 19 patients with acute rheumatic fever who were hospitalized in the Department of Pediatrics at Soroka Medical Center underwent echocardiographic color flow Doppler examination. Five patients had an echocardiographic picture of mitral valve prolapse, with or without leaflet thickening, and one had a flail anterior leaflet. Six had mitral valve thickening without prolapse, and seven patients had an echocardiographically normal appearing mitral valve. All 19 patients had a posterolaterally directed jet of mitral regurgitation demonstrated on color flow Doppler. All patients had echocardiographically normal aortic valves. However, mild aortic regurgitation was noted in eight of them. The posterolateral jet of mitral insufficiency in acute rheumatic fever may be the most common echo-Doppler finding in this condition. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Summary and Conclusions