A Survey of Stress at Work

A survey was carried out among members of the Society of OccupationalMedicine on their assessment of stress-related illness in industry.It was found that medical officers in organizations estimatedthat over 45 per cent of their managers suffered from some formof psychosocial stress (e.g anxiety, psychosomatic illness,depression), ‘to some or a ereat extent’. Professor C. L. Cooper, University of Manchester Institute of Science and Technology, P.O. Box 88, Manchester M60 1QD.     

A Population-based Study of Toenail Onychomycosis in Israeli Children

Abstract:   Onychomycosis is widespread in the adult population, but considered to be rare in children. A number of studies in recent years show a rise in the prevalence of toenail onychomycosis in children. Of these, only a few were population-based. Here, we present a comprehensive cross-sectional population-based survey of toenail onychomycosis in primary school children in Israel. The survey included 1148 children, 598 boys, and 550 girls aged 5 to 14 from primary schools in the Jerusalem vicinity. Each child underwent a physical examination and completed a personal questionnaire, which provided background information of predisposing factors. The survey shows a prevalence of 0.87% of toenail onychomycosis. Although this figure is too small for statistical analysis, some important conclusions could be drawn: prevalence increased with age: boy/girl ratio was 2.2; the dominant etiologic agent was Trichophyton rubrum followed by Trichophyton mentagrophytes and Candida albicans . Infections were probably transferred from adults via the environment to children. Infected children came from different socio-economic backgrounds. This condition should be considered in the differential diagnosis of nail diseases in children.     

Childhood Discoid Lupus in Identical Twins

Abstract: We report the exceptional case of 11‐year‐old identical male twins who both developed discoid lupus erythematosus lesions. Although systemic lupus erythematosus has often been reported in identical twins, discoid lupus erythematosus has only ocassionaly been described, with only one other case in twin children, as far as we are aware.     

Blood Polyamines in the Rat

The physiological concentrations of polyamines in plasma, serum and red blood cells were determined in male Wistar rats, using HPLC with fluorometric detection. The analysis of the metabolic ratio between polyamines and the frontal cortex/plasma relationship for putrescine, spermidine and spermine, suggest the existence of common mechanisms in the regulation of spermidine in blood and brain.     

A Survey of Stress at Work

A survey was carried out among members of the Society of OccupationalMedicine on their assessment of stress-related illness in industry.It was found that medical officers in organizations estimatedthat over 45 per cent of their managers suffered from some formof psychosocial stress (e.g anxiety, psychosomatic illness,depression), ‘to some or a ereat extent’. Professor C. L. Cooper, University of Manchester Institute of Science and Technology, P.O. Box 88, Manchester M60 1QD.     

Cryoballoon Versus Radiofrequency for Pulmonary Vein Re‐Isolation After a Failed Initial Ablation Procedure in Patients with Paroxysmal Atrial Fibrillation

Cryoballoon versus Radiofrequency Ablation . Aim: Catheter ablation of paroxysmal atrial fibrillation (PAF) is associated with an important risk of early and late recurrence, necessitating repeat ablation procedures. The aim of this prospective randomized patient‐blind study was to compare the efficacy and safety of cryoballoon (Cryo) versus radiofrequency (RF) ablation of PAF after failed initial RF ablation procedure. Methods: Patients with a history of symptomatic PAF after a previous failed first RF ablation procedure were eligible for this study. Patients were randomized to Cryo or RF redo ablation. The primary endpoint of the study was recurrence of atrial tachyarrhythmia, including AF and left atrial flutter/tachycardia, after a second ablation procedure at 1 year of follow‐up. All patients were implanted with a cardiac monitor (Reveal XT, Medtronic) to continuously track the cardiac rhythm. Patients with an AF burden (AF%) ≤ 0.5% were considered AF‐free (Responders), while those with an AF% > 0.5% were classified as patients with AF recurrences (non‐Responders). Results: Eighty patients with AF recurrences after a first RF pulmonary vein isolation (PVI) were randomized to Cryo (N = 40) or to RF (N = 40). Electrical potentials were recorded in 77 mapped PVs (1.9 ± 0.8 per patient) in Cryo Group and 72 PVs (1.7 ± 0.8 per patient) in RF Group (P = 0.62), all of which were targeted. In Cryo group, 68 (88%) of the 77 PVs were re‐isolated using only Cryo technique; the remaining 9 PVs were re‐isolated using RF. In RF group, all 72 PVs were successfully re‐isolated (P = 0.003 vs Cryo). By intention‐to‐treat, 23 (58%) RF patients were AF‐free vs 17 (43%) Cryo patients on no antiarrhythmic drugs at 1 year (P = 0.06). Three patients had temporary phrenic nerve paralysis in the Cryo group; the RF group had no complications. Of the 29 patients who had only Cryo PVI without any RF ablation, 11 (38%) were AF‐free vs 20 (59%) of the 34 patients who had RF only (P = 0.021). Conclusion: When patients require a redo pulmonary vein isolation ablation procedure for recurrent PAF, RF appears to be the preferred energy source relative to Cryo. (J Cardiovasc Electrophysiol, Vol. 24, pp. 274‐279, March 2013)     

Plasma somatomedin-C levels in psoriasis

We have measured plasma levels of somatomedin-C, one of the principal mediators of growth hormone action, in 25 patients with plaque-type psoriasis of varying severity and compared these levels with those found in healthy controls. Plasma somatomedin-C levels were not elevated in the psoriatic patients regardless of the severity of their disease, suggesting that in these patients growth hormone secretion is within normal limits.     

A Multicenter Experience with a Bipolar Tined Polyurethane Ventricular Lead

A multicenter study was undertaken to determine the failure rate of a specific polyurethane bipolar tined pacing lead, the Medtronic 4012 pacing lead. Six centers in the United States and Canada implanted 1,190 Medtronic 4012 pacing leads. The study was designed to determine the probability and clinical manifestations of lead failure. Only failures compatible with an insulation problem were included. The probability of a 4012 lead failure by Kaplan-Meier analysis was 20.9% at 6 years after implantation. Failures were manifested as sensing abnormalities, failure to capture, early battery depletion, and significant decrease in measured impedance compared with the previous impedance measurements. Of the 95 definite lead failures, 16 (16.8%) were associated with symptoms similar to those experienced before pacemaker placement. The observed failure rate is unacceptable, and strong consideration should be given to replacing the 4012 pacing lead in pacemaker-dependent patients and closely monitoring nondependent patients.