Ambulatory Electrocardiography for the Detection of Pacemaker Lead Failure

The suboptimal performance of some polyurethane bipolar pacing leads has highlighted concern about the optimal method of monitoring pacemaker lead performance. Since the manifestations of premature lead failure may be initially intermittent, we hypothesized that ambulatory electrocardiography (AECG) would be a more sensitive tool for the detection of pacing lead failure compared to increased pacemaker clinic surveillance. Since the Medtronic safety alerts on the 4012, 4082, and 4004 leads, we have followed 261 patients by serial AECG and 165 patients by increased pacemaker clinic surveillance. Lead failures were identified in 75 patients: 68 in the AECG group (31 %) and 7 in the clinic group (4%, P < 0.001). Repeat AECG confirmed the lead failure in 38 (97%) of 39 patients in which it could be done. Pacing lead failure documented by AECG could be confirmed by a subsequent clinic assessment in only 15 (25%) of 60 patients evaluated (P < 0.001). The actuarial survival of the 4012 lead was significantly lower in the AECG group compared to the clinic group (56% vs 87% survival at 8 years, P < 0.002). Similar trends were observed for the 4082 and 4004 leads. AECG is a more sensitive method of surveillance for pacemaker lead function compared to pacemaker clinic assessment. AECG should be incorporated into the routine follow-up of pacemaker patients. (PAGE 1997; 20[Pt. I]:127 4-1282)     

Chemically induced or inherited myotonia?

Objective: To present a case of chemically induced myotonia occuring as a result of intentional ingestion of trifluoperazine and Defender Australia Bindi plus Clover Lawn Weeder^R (chlorophenoxy compounds present as 4-chloro-2-methylphenoxyacetic acid (MCPA) as a dimethylamine salt 15% W/V and 3,6-dichloro-2-methoxybenzoic acid (dicamba) 2.5% W/V). To discuss myotonia. Clinical features: A 38 year old man with features suggestive of dystrophia myotonica presented with severe myotonia, urinary retention and dry lips. There was no personal or known family history of this muscular disorder. Intervention: He was treated with 2mgs of intravenous benztropine mesylate, and 50 grams of activated charcoal and 150 mls of 70% sorbitol orally. An indwelling catheter was inserted. Laryngoscopy and upper gastrointestinal tract endoscopy were performed. The myotonia was managed conservatively and complete recovery occurred as evidenced by normal electromyography on day six of his admission. Conclusion: Myotonia is a rare complication of toxin ingestion. In this case, the toxins may have unmasked subclinical dystrophia myotonica or induced myotonia de novo.     

Play materials and toys in the education of young children

Woodroffe, Stella E. and Willatt, Beverley J. (1976). Aust. paediat. J., 12, 1–5. Play materials and toys in the education of young children. The paper discusses the need to consider the developmental level of the child when selecting appropriate toys and play materials that serve an educational purpose. The relevance of a number of play materials is discussed in general terms, although a range of possibilities for particular types of learning are specified in relation to some toys.
The learning is not inherent in the material but depends on the child's own cognitive processes, often assisted by an adult who is in a position to draw the child's attention to particular aspects of his encounters with his environment, and to guide the direction of his learning. For young children, a wide range of experiences will serve as a base upon which he will build his own structures. These will enable him to adapt to the requirements of learning his society will impose upon him as he grows.
Criteria are suggested for selecting toys and play materials which can serve an educative end. The reader is also reminded that materials which serve the child best are those which offer him a range of possibilities. Many of these are readily available in the home or neighbourhood and do not entail spending large sums of money, provided one uses a little imagination.     

Changing cocaine smoking rituals in the Dutch heroin addict population

Recently the use patterns, circumstances and consequences of cocaine have become of interest to both researchers and policy makers in Europe. Currently only a few studies have been conducted of the social epidemiology of cocaine. In this article, focus is placed upon the use of cocaine in one subpopulation, heroin addicts. Based mainly upon ethnographic research conducted in the city of Rotterdam it can be estimated that the prevalence of cocaine use in this population has reached a very high level. The mode of ingesting cocaine parallels that of heroin; Injecting Drug Users inject cocaine-hydrochloride, heroin smokers smoke cocaine base. This cocaine base is mainly processed by users themselves. An exception to this rule of self-processing can be found in the most marginalized addicts who do not have access to the house addresses where both heroin and cocaine-hydrochloride are sold. In this group the selling of ‘cooked cocaine’, a crack-like product, has occurred. The circumstances and potential consequences of the emergence of ‘cooked cocaine’ are discussed.     

Intraventricular haemorrhage—timing of occurrence and relationship to perinatal events

Summary. A total of 150 infants born at or before 34 weeks gestation had serial cranial ultrasound scans at age 8, 16, 24, 36, 48 h and 1 week. The overall incidence of IVH was 26%, but for infants <1500 g it was 51% and 50% of all haemorrhages were first detected in the first 8 h of life. Low-outlet forceps delivery and caesarean section offered some protection, but umbilical cord blood gas analysis did not support the hypothesis that hypoxia was causal. Respiratory distress and its complications were significantly associated with IVH. The more severe haemorrhages occurred in the less mature infants. The overall mortality in the study was 27% for the IVH group and 1.8% for the non-IVH group.