Entrapment of a Pacing Lead within a Chiari Network: Utility of Intracardiac Echo and a Laser Sheath

Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal.     

PREVALENCE AND CORRELATES OF DSM-IV AND ICD-10 ALCOHOL DEPENDENCE: 1990 US NATIONAL ALCOHOL SURVEY

This paper describes DSM-IV and ICD-10 alcohol dependence prevalencerates and sociodemographic and drinking correlates. The sampleunder analysis (n = 2058) constitutes a multicluster probabilitysample of the US adult household population. The study responserate is 71%. The prevalence rate for current (past 12 month)DSM-IV alcohol dependence is 3.9%, and for current ICD-10 itis 5.5%. Agreement between DSM-IV and ICD-10 on whether respondentsare dependent or not is less than optimal (Kappa = 0.67). Thepredictors of ICD-10 alcohol dependence are the frequency ofdrinking five or more drinks on occasion and age (inverse relationship).For DSM-IV alcohol dependence the correlates are drinking fiveor more drinks on occasion, being unemployed and age (also aninverse relationship). Differences in results underline theimportance of understanding the variations among DSM-IV andICD-10 criteria for alcohol dependence and the implicationsof these differences for epidemiological research. The highprevalence of dependence among young men may be the result ofrecognizing consequences of episodic heavy drinking as signsof alcohol dependence.     

SUPRANORMAL FSH RESPONSE TO GONADOTROPHIN-RELEASING HORMONE IN OLIGOSPERMIC MEN WITH A NORMAL BASAL SERUM FSH CONCENTRATION

Twenty-six men with severe oligospermia (sperm density less than 10 X 10(6)/ml, but greater than O), but normal serum concentration of FSH, as well as normal serum concentrations of LH and testosterone, were given a 250 microgram i.v. bolus dose of synthetic gonadotrophin releasing hormone (LHRH). The serum FSH and LH responses were compared to those of a group of normal men and a group of men with oligospermia or azoospermia and elevated basal serum FSH concentration. The mean FSH response to LHRH of the men with oligospermia but normal basal serum FSH concentration was 911 miu min/ml, nearly three times that of the normal men, 322 miu min/ml (P less than 0.001), though not so great as that of the men with oligo/azoospermia and elevated basal FSH concentration (2890 miu min/ml). Ten of the twenty-six men with oligospermia and normal basal serum FSH had a supranormal FSH response to LHRH. The mean LH response to LHRH of the men with oligospermia and normal basal serum FSH levels was not significantly different from that of the normal men. We conclude that LHRH stimulation can often elicit a deficiency of feedback inhibition of FSH secretion not readily recognizable by measurement of the basal serum FSH concentration.