Refractory anaemia with excess of blasts terminating as Ph1 negative chronic myeloid leukaemia

A case of refractory anaemia with excess of blasts (RAEB) terminating with clinical and haematological picture of Ph¹ negative chronic myeloid leukaemia (CML) is reported. It is suggested that the same abnormal clone of cells is responsible for the initial picture of the RAEB and the terminal CML picture.     

Hybrid Pharmacologic and Ablative Therapy: A Novel and Effective Approach for the Management of Atrial Fibrillation

Hybrid Therapy for Atrial Fibrillation. Introduction: Maintenance of sinus rhythm in patients with recurrent atrial fibrillation is often difficult to achieve with pharmacologic therapy. Complex catheter ablative procedures are being developed, but efficacy and safety issues remain to be clarified. We hypothesized that combined pharmacologic and simple ablative therapies in a targeted subset of patients will improve success in the treatment of atrial fibrillation. Methods and Results: We identified 13 patients (mean age 61.5 ± 16.2 years) with atrial fibrillation who converted to electrocardiographic atrial flutter during antiarrhythmic drug treatment. Surface ECG suggested “typical” atrial flutter in 11 patients and “atypical” atrial flutter in 2. Intracardiac mapping and entrainment studies revealed 9 patients had counter-clockwise isthmus-dependent atrial flutter, and the remaining 4 had complex activation patterns, suggesting the presence of multiple wavefronts. All 9 patients with typical atrial flutter underwent successful ablation. None of the 4 patients with complex activation patterns had successful ablation. Patients were followed for recurrences of atrial arrhythmias via clinic visits, record review, and interviews. In patients who underwent successful ablation and continued on antiarrhythmic drugs, 88.9% remain in sinus rhythm after a mean follow-up of 14.3 ± 6.9 months (range 1 to 28). Conclusion: In patients who experience conversion of atrial fibrillation to atrial flutter during antiarrhythmic drug treatment, ablation and continuation of pharmacologic therapy is a safe and effective means of achieving and maintaining sinus rhythm.     

Nonuniform Anisotropy is Responsible for Age-Related Slowing of Atrioventricular Nodal Reentrant Tachycardia

Age-Related Slowing of AVNRT. Introduction : AV nodal reentrant tachycardia cycle length has been shown to he longer in the elderly population. Microfibrosis associated with aging producing nonuniform anisotropic conduction or changes in membrane ionic properties could explain this finding.
Methods and Results : Forty-five patients (33 women and 12 men) with typical AV nodal reentrant tachycardia were studied to analyze the effects of age on electrophysiologic characteristics of the tachycardia using high-density catheter mapping of the triangle of Koch. We classified patients into group A (age ≤ 45 years, mean [± SD] 32.7 ± 8.8, n = 27) and group B (age > 45 years, mean [± SD] 61.1 ± 10.2, n =18). Retrograde atrial activation was recorded during tachycardia by means of a 2-mm decapolar catheter at the His bundle, a quadripolar catheter at the high right atrium, a multipolar catheter (6 to 10 poles) in the coronary sinus, and a deflectable quadripolar catheter at the posterior triangle of Koch. The AH interval at the AV junction as well as HA intervals at several atrial sites were measured during tachycardia. HA intervals at all atrial recording sites except in the posterior triangle of Koch were significantly longer in group B, as well as the tachycardia cycle length (362 vs 329 msec, P = 0.01). The mean AH interval was prolonged by 24 msec in group B, but this difference did not reach statistical significance. A sequential pattern of retrograde atrial activation during tachycardia was more frequently recorded in group B.
Conclusions : Since the delayed activation to the atrium was heterogeneous, transverse nonuniform anisotropic conduction is a likely explanation of these age-related modifications of AV nodal reentrant tachycardia characteristics.     

Suppressor T cells and soluble suppressor factors in allergy: effect of immunotherapy

Suppressor-cell activity of Concanavalin-A-stimulated lymphocytes was studied in allergic patients by inhibition of one-way mixed lymphocyte culture reactions before and after allergy immunotherapy. This activity was compared with twelve healthy controls. In preliminary experiments, six out of eight allergic patients had no detectable T suppressor activity. In the second prospective group, eight out of eleven patients had much reduced suppressor-cell activity before immunotherapy, and seven out of eleven patients had much reduced activity after immunotherapy. The data suggest that non-specific T suppressor-cell activity is reduced in allergic patients but immunotherapy does not restore such activity.     

BACK TO FRONT? EXAMINING RESEARCH PRIORITIES IN RHEUMATOLOGY

‘Arthrosis and back troubles together account for at leasta third of all rheumatic suffering, and they are much the commonestrheumatological causes of impairment and disability. In contrastto the inflammatory arthropathies, one cannot help but be struckby the fact that research endeavour has not been commensuratewith the burden that has to be endured.’[1]     

Corrected QT interval in relation to the severity of diabetic autonomic neuropathy

The aim of this study was to investigate to what extent the existence of objective signs of diabetic autonomic neuropathy affects the corrected QT interval (QTc) in diabetic subjects. A total of 105 diabetic subjects (type 1, n  = 53; type 2, n  = 52) as well as 40 matched (by age and sex) control subjects were studied. All subjects underwent the battery of five Ewing tests. Autonomic neuropathy was diagnosed if two of the five tests were abnormal. In addition, the result of each test was considered as normal (grade = 0), borderline (grade = 1) or abnormal (grade = 2), and on the basis of the sum of the scores we calculated a total score for autonomic neuropathy. The QTc interval was measured at rest, and a value > 440 ms was considered abnormal. The QTc interval was significantly more prolonged in diabetic persons with autonomic neuropathy than in those without neutopathy and in control subjects: 408.4 ± 24.2 ms vs. 394.6 ± 27.9 ms and 393.6 ± 25.5 ms respectively ( P  = 0.001). Furthermore, multivariate analysis controlling for age, sex, systolic and diastolic blood pressure, body mass index (BMI), waist–hip ratio (WHR), smoking, type and duration of diabetes, type of treatment, HBA_1c and total score of autonomic neuropathy eliminated the role of all these factors as potential confounders except for the total score of autonomic neuropathy, which was found to affect QTc interval independently and significantly ( P  = 0.012). In summary, the present study confirmed the well-known relation between autonomic neuropathy and QTc interval; in addition, it showed that QTc prolongation is associated with major degrees of autonomic neuropathy.     

The increase in illegal private duty nurses in public Greek hospitals

fouka g., plakas s., papageorgiou d., mantzorou m., kalemikerakis i. & vardaki z. (2013) Journal of Nursing Management  21 , 633–637 The increase in illegal private duty nurses in public Greek hospitals Aim To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. Background Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. Evaluation Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. Key issues Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. Conclusions It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. Implications for nursing management Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.     

Effects of propofol and thiopentone on polymorphonuclear leukocyte functions in vitro

Anaesthetic agents may impair host defense mechanisms including polymorphonuclear leukocyte (PMNL) function.
We have studied the effects of thiopentone and propofol in low (thiopentone 10 mg/L, propofol 2 mg/1) and high (thiopentone 40 mg/L, propofol 6 mg/L) clinically relevant concentrations on PMNL adherence, chemotaxis, phagocytosis and killing in vitro.
The results demonstrated that thiopentone in both concentrations significantly decreases all PMNL functions tested and had a direct influence on the PMNLs in terms of their chemotactic response. In contrast, propofol decreases significantly only PMNL chemotaxis but not adherence, phagocytosis and killing. The effect of propofol was not attributable to the lipid carrier vehicle, as Intralipid with same formulation had no effect on PMNL function.