Randomized Comparison of Efficacy of Cooled Tip Catheter Ablation of Atrial Flutter: Anatomic Versus Electrophysiological Complete Isthmus Block

There is a subset of patients with failed ablation of the cavotricuspid isthmus (CTI) using standard catheters and with 10% of the patients having recurrences. The purpose of this study was to compare the cooled and standard ablation with regard to acute successful electrophysiological achievement of bidirectional isthmus block and the subacute anatomic characteristics of the lesions. This randomized, experimental study compares the effects of ablation on the isthmus using a cooled catheter with those of a standard ablation catheter in 16 pigs. In 12 animals, CTI block was achieved after ablation (8/8 cooled and 4/8 standard). In two animals, it was not possible to achieve complete isthmus block and two had persistent slow conduction (all four using the standard catheter). After 1 week, the animals were slaughtered. The size of the lesion was greater with the irrigated tip catheters. Transmural lesions were found in 14 animals. A complete line of anatomic isthmus block was not documented after thefirst line in six animals, four with the standard and two with the cooled catheter. A conduction block was never present across gaps > or = 5 mm. In conclusion cooled catheters achieved a complete line of electrophysiological and anatomical block in a significantly higher percentage than the standard catheters.     

Abnormal sperm morphology and other semen parameters related to the outcome of the hamster oocyte human sperm penetration assay

A new method for evaluation of sperm morphology using strict criteria is currently used in the andrology laboratory at the Eastern Virginia Medical School. A prospective study was designed to evaluate the following semen parameters in samples of all patients over a set period of time: sperm concentration and motility, and normal sperm morphology. These factors were correlated with results of the hamster zona-free oocyte/human sperm penetration assay (SPA). One hundred patients with a sperm concentration ranging from 2 to 219 X 10(6)/ml, a motile sperm fraction ranging from 6.9 to 87%, and normal sperm morphology ranging from 1 to 39%, were evaluated. The statistical analysis system general linear model was used to judge the influence of the different variables. There was a statistically significant relationship between the per cent of sperm with normal morphology and penetration rate in the SPA (P = 0.001). Outcome of the SPA was also correlated with in vitro fertilization, retrospectively, in 84 patients. Thirty-eight patients had an SPA less than 10%, with no fertilization in vitro in 13 patients (33.3%) and fertilization in 25 (66.7%). Forty-five had an SPA greater than 10% with fertilization in 37 (82.2%) and no fertilization in eight (17.8%) patients.     

Culprit-Only or Multivessel Percutaneous Coronary Stenting in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: One-Year Follow-Up

Objective: To investigate the major cardiac events at 1-year follow-up of multivessel versus culprit-vessel stenting in patients presenting with non-ST elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD).
Introduction: Percutaneous coronary intervention is a standard revascularization strategy for patients with NSTE-ACS. However, when these patients have MVD it is not clear whether multivessel (MVR) is superior to culprit-vessel revascularization (CVR).
Methods: We screened 1,100 consecutive patients with NSTE-ACS from an institutional database. Comparisons of 1-year outcomes between multivessel and culprit-vessel revascularized patients were made. The primary outcome was the composite (MACE) of death, myocardial infarction (MI), or any revascularization. Secondary end-points were the components of the composite end-point. Regression analysis was performed to detect predictors of MACE.
Results: A total of 609 patients were considered for this analysis: 204 (33.5%) and 405 (66.5%) had MVR and CVR treatment, respectively. The strategy adopted was based on a clinical decision. The incidence of MACE was lower in MVR (9.45% vs. 16.34%, P = 0.02) with lower revascularization rate (7.46% vs. 13.86%, P = 0.04) than in CVR. There was no difference in death (1.99% vs. 1.98%, P = 0.8) nor death/MI (2.49% vs. 3.22%, P = 0.8) between MVR and CVR, respectively. Multivariate analysis showed CVR as the only independent predictor of improved MACE (OR 0.66, CI95% 1.12–3.47, P = 0.01).
Conclusion: Multivessel stenting in patients with NSTE-ACS and multivessel disease using a clinical decision of treatment is associated with lower rate of MACE driven by lower repeat revascularization, compared with culprit-vessel stenting, without difference in rates of death or MI.     

Which policy for caesarian sections in Brazil? An analysis of trends and consequences

This paper analyses the incidence of caesarian sections (C-sections)in Brazil. In the last decade, it has reached an extremely highlevel, higher than in any other country in the world. Socioeconomicand regional differences are established, using available nationaldata on the caesarian section rate, which is higher in moreprosperous regions and among wealthier women. The different factors influencing this high incidence, includingsociocultural, obstetric care organization and legal and institutionalconsiderations are analysed. Special attention is given to theproblem of female surgical sterilization, which is not officiallyaccepted in the country, but is performed during a C-sectionwith no other maternal or foetal indication. Consequences relatingto maternal and perinatal morbidity and mortality, populationfertility and the cost of health services are discussed. Interventionsto reverse this trend toward higher caesarian section ratesare proposed.     

The Feeding of Premature Infants

The operating of a Premature Center, installed in a children's hospital, which forms part of a Medical Unit together with a large Maternity Unit, is described. The feeding routine used in 311 prematures admitted in a 7-month period is studied. Schenistically this routine is the following: initial complete fasting period during the first 24 hours of life, followed by small fractionated feeds, 8 or 10 a day, of either skimmed or half skimmed breast milk, with added amounts of amino acids after the 9th day. The feeds are gradually increased in volume and decreased in frequency, so that by the third week the prematures only receive 5 meals in the 24-hour period. The calorie intake during the first week is under 70 calories per kg and afterwards never exceeds 100 or 115. To replace human milk, babeurre at greater dilutions than usual is used, a preparation that supplies 53 calories for every 100 cc, and is composed of 3 g of protein, 0.8 g of fat and 9.5 g of carbohydrates per cent. After the third week, 300 cc of this formula, with added aminoacids is given. Thus the premature receives 4 to 6 g of protein, 1.5 to 3 g of fat, and 16 to 30 g of carbohydrates per kg per day.
The results obtained are analyzed, revealing a 39.3 per cent death rate, which, although high, is lower than those registered for a similar group in the different maternity hospitals of this country. This high figure is explained, besides the fact that admission is restricted to prematures under 2000 g at birth (accepting only complicated prematures over this weight), by the unfavourable general condition of these prematures on arrival. Of the survivors, 65 per cent adjust themselves to Holt's schematic curves.