Use of Telemetered Electrograms in the Assessment of Normal Pacemaker Function

The facility of direct real-time endocardial electrogram recording offered by newer pacemaker models can be helpful in the assessment of normal pacemaker function. Confirmation of the main hallmarks of sensing (amplitude, slew rate, and timing of the electrogram) can be achieved. Assessment of pacing capture also can be made; techniques for further analysis using external signal averaging can enhance this. The measurement of atrial and ventricular electrograms by telemetry has led to alterations in the protocol used at implantation to allow for the input impedance of the sensing circuit of the pacemaker. Accurate measurements of retrograde VA conduction times and confirmation of normal upper rate limit behavior of ODD pacemakers can be achieved simply and reliably using telemetered electrograms from the permanent pacemaker system.     

Phenylketonuria and anorexia nervosa

ABSTRACT. A girl with phenylketonuria and mild mental retardation developed a behaviour disorder and anorexia nervosa at the age of 14. The anorexic symptoms disappeared at the age of 20, but the behaviour disorder worsened, leading to compulsory detention in a psychiatric hospital. Serum phenylalanine levels may have influenced the course of the disorder.     

Variation in Mortality from Ischaemic Heart Disease between England and Scotland

A Comparison of mortality from ischaemic heart disease underthe age of 60 for 1980 to 1981 between the Grampian Health Boardand the North Staffordshire Health Authority has been made.A total of 993 deaths was notified by death certificate fromthe two areas of similar population of which 434 were from Grampianand 559 from North Staffordshire. After examination of generalpractitioner and hospital case notes, autopsy reports and deathcertificates, nearly all (532) of the North Staffordshire deathswere accepted as being due to ischaemic heart disease but onlythree-fifths (263) of the Grampian deaths could be begin besubstantiated as there was inadequate information for the remainder.Deaths from ischaemic heart disease seem apparently to be twofoldgreater in North Staffordshire than Grampian but much of thisdiscrepancy could be attributed to a widely different autopsyrate and to unavailability of case notes. Experience of thissurvey suggests that the results of other epidemiological investigationsmay be equally or even more unreliable.     

Positive health--some lay perspectives

Sixty members of a general population (comprising a conveniencesample stratified for age and sex) underwent tape-recorded interviewsto discover what they thought were the signs and determinantsof good health. They were asked to identify the healthiest personthey knew, how they knew the person was healthy, and what made(or kept) the person healthy. The responses were transcribed and analysed independently. Theyounger people identified as healthy tended to be male, andthe older people so identified, female. The respondents reportedthe signs of health to include general appearance, posture,movement, activity and facial appearance, particularly the skinand. eyes. But they also said that diet and exercise, as wellas not smoking, and alcohol in moderation, were signs of health. Diet and exercise were also identified as important contributorsto good health, although vigorous physical exercise is not afeature of this community. Overweight was not often mentioned,although objectively this is a community with a weight problem.A positive mental attitude and engaging in pleasurable activitieswere also identified as important contributors to health. From this evidence, changes in diet and the pursuit of pleasurableactivities, particularly those involving aerobic exercise, appearto represent the most attractive options for health promotionactivities designed to enhance positive health in this community.     

The surfaces of the parasitic nematodes Trichinella spiralis and Toxocara canis differ in the binding of post-C3 components of human complement by the alternative pathway

The binding of human complement components C3, C5 and C9 to the surface of the infective larvae of the nematode parasites Toxocara canis and Trichinella spiralis, by the alternative pathway, was examined by direct and indirect immunofluorescence on the intact parasites. This showed that although C3 bound to both nematodes, they differed markedly in the binding of C5 and C9; C5 bound only minimally to T. spiralis, and C9 binding to this parasite was barely detectable. In contrast, both early and late components bound to T. canis to a high density, comparable to, or in excess of, the binding of these components to the infective larvae of the trematode Schistosoma mansoni. The lack of binding of the post-C3 components to T. spiralis did not correlate with enhanced binding of the control protein, Factor H.     

Rescue and Adjunctive Directional Coronary Atherectomy

Conventional coronary balloon angioplasty is complicated by abrupt arterial occlusion in 4%-8% of cases and remains the most important and feared acute problem with this procedure. This review discusses the significance and various treatment options for abrupt occlusion, focusing particularly on the potential use of directional coronary atherectomy to treat significant coronary arterial dissections complicating conventional angioplasty. The use of adjunctive atherectomy for the treatment of suboptimal coronary angioplasty results without dissection is also discussed. (J Interven Cardiol 1996;9:129–134)     

Stage-specific surface antigens of the cattle lungworm Dictyocaulus viviparus

Immunofluorescence on live Dictyocaulus viviparus parasites revealed a significant antibody response by vaccinated and patently infected bovine hosts to the sheath of infective larvae (L3), a structure which is generally thought to be shed from the parasite surface prior to invasion of host tissue. In contrast, surface-exposed antigens of the adult, egg and pulmonary L1 stages were recognized only by serum antibody from calves exposed to a patent lungworm infection. Radioiodination of sheathed L3 identified a restricted set of components while a more complex pattern of labelled material was observed with adult parasites. Many more components of adult worms were labelled by the Bolton-Hunter than by the lodogen reagent, probably reflecting the more penetrative labelling propensities of the former. Stage-specificity of surface-associated antigens of adult parasites was demonstrated by their immunoprecipitation by antibody from patently-infected, but not from vaccinated, calves. There was no in vitro release of the major iodinatable surface-associated antigens of adult parasites nor any binding of antibody raised against adult excretory-secretory (ES) products to the surface of living adult worms, suggesting that surface components do not contribute to adult ES products in this species. Antibody responses to the surface of adults. L1 and eggs were specific to patently-infected animals and may provide a useful indicator of exposure to patent infection.     

COMBINATION THERAPY WITH GOLD AND HYDROXYCHLOROQUINE IN RHEUMATOID ARTHRITIS: A PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED STUDY

We studied combination therapy with two slow-acting antirheumaticdrugs given concurrently in active rheumatoid arthritis (RA).A 12-month prospective randomized controlled trial comparedgold and hydroxychloroquine in 52 patients to gold and placeboin 49. The patients continued to receive non-steroidal anti-inflammatorydrugs and analgesics. They were selected from three rheumatologycentres in the West Midlands. Combination therapy led to a greaternumber of withdrawals due to adverse reactions (18 cases comparedto 10 receiving gold/placebo). Patients completing 12 months'therapy (27 taking gold/ hydroxychloroquine and 32 on gold/placebo)were compared using five clinical, seven laboratory, and oneradiological measure. All 13 variables favoured gold/hydroxychloroquinewith an overall advantage of 20–25% for the combination.This only reached statistical significance (at the 1% level)for C-reactive protein. An overall disease activity index wasbetter at 12 months (at the 5% level) and showed a more rapidresponse with gold/hydroxychloroquine. This is the first randomizedprospective placebo-controlled trial to show a significant advantagefrom a combination of two slow-acting drugs. There are manydifferent ways of giving such combinations and we consider theseshould be explored to maximize the effectiveness of treatmentfor RA. KEY WORDS: Rheumatoid arthritis, Treatment, Antimalarials, Sodium aurothiomalate