Catheter-Assisted Vein Sclerotherapy: A New Approach for Sclerotherapy of the Greater Saphenous Vein with a Double-Lumen Balloon Catheter

OBJECTIVE: We sought to optimize sclerotherapy of the greater saphenous vein (GSV) by targeted application of foamed sclerosant by using a catheter. METHODS: We designed a new double-lumen catheter that is inserted into the GSV. Via one lumen, a balloon at the tip of the catheter can be inflated to stop the blood flow. Via the second lumen, the sclerosing agent can be injected and aspirated. This method enabled us to perform a targeted application of the sclerosing agent [catheter-assisted vein sclerotherapy (KAVS)]. In an open study, outpatients suffering from varicosis of the GSV received a foam sclerotherapy under ultrasound guidance, using the newly developed KAVS catheter. RESULTS: Thirty patients with an insufficiency (reflux) of the GSV were treated with the newly developed KAVS method using foamed polidocanol. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90%), we found a closure of the GSV at control visits 6 weeks, 3 months, and 6 months after treatment. CONCLUSIONS: The KAVS method represents a feasible approach for sclerotherapy of the GSV. The efficiency and treatment modalities need to be explored in further studies.     

A Latent Atrioventricular Decrementally Conducting Accessory Pathway Mimicking a Bystander Nodoventricular Fiber

A 41‐year‐old woman with recurrent wide‐QRS tachycardia is reported. Electrophysiologic findings were consistent with the diagnosis of a preexcited atrioventricular nodal reentrant tachycardia due to a bystander nodo‐ventricular fiber. However, slow pathway ablation did not preclude tachycardia recurrence. A second electrophysiology study shed light on the correct mechanism and eventually a successful ablation was achieved. (PACE 2010; e76–e80)     

Receptor Binding Affinities and Biological Activities of Linear and Cyclic Melanocortins in B16 Murine Melanoma Cells Expressing the Native MC1 Receptor

Cyclic α-melanocyte-stimulating hormone (α-MSH) analogues produced by disulphide bridging (e.g. [Cys⁴,Cys¹⁰]α-MSH) are known to be almost equipotent to the native hormone in amphibian skin bioassays and as a consequence have been proposed as a paradigm for the active conformation of native MSH at the pigment cell MC1 receptor. However this proposal has been somewhat speculative as there is no published data comparing biological activity of cyclic MSH analogues with data on receptor binding. This study addresses this problem by comparing tyrosinase stimulatory activity with their receptor binding affinity in B16 murine melanoma cells expressing the native MC1 melanocortin receptor. Cyclic [Cys⁴,Cys¹⁰] α-MSH showed almost the same affinity for the MC1 receptor as α-MSH, but the linear analogue [Cys⁴,Cys¹⁰]α-MSH bound less strongly. Both had biological activities similar to that of the natural ligand. Introduction of D-Phe into the ring in position 7 increased both affinity and activity of the cyclic compound. The study suggests that the intrinsic efficacy of cyclic [Cys⁴,Cys¹⁰]α-MSH analogues is similar to native α-MSH. Our studies support the proposal that the cyclic structure serves as a good model for the active conformation of linear α-MSH.     

Catheter Ablation of Scar‐Related Ventricular Tachycardia in Patients with Electrical Storm Using Remote Magnetic Catheter Navigation

Background: A remote magnetic navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip catheter has not been evaluated in large series of patients. Objective: To evaluate acute and long‐term efficiency of the newly available irrigated tip magnetic catheter for radiofrequency (RF) ablation of scar‐related ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip catheter. Results: Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1–6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210–660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow‐up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them. Conclusions: Irrigated ablation of scar‐related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure. (PACE 2010; 1312–1318)     

SUB-POPULATIONS OF ALCOHOL-DEPENDENT PATIENTS: DIFFERENCES IN PSYCHOLOGICAL FUNCTIONING BETWEEN HIGH- AND LOW-FREQUENCY ALCOHOL CONSUMERS

The purpose of the present study was to examine the processesunderlying relapse to drinking using objective biological validationof self-reported recent alcohol consumption, using the ratioof 5-hydroxytryptophol to 5-hydroxyindol-3-ylacetic acid (5-HTOL/5-HIAA),a new biological marker to detect single episodes of drinking,in a sample of 38 male alcohol-dependent patients (DSM-III-R)who were assessed prospectively in terms of their clinical symptomatologyover a 6-month treatment period. Results showed that nearlyall patients obtained positive 5-HTOL/5-HIAA samples duringthe course of treatment. However, upon closer inspection, resultsrevealed a bimodal distribution for alcohol intake with highand low frequency of consumption episodes. Results showed thathigh frequency consumers obtained higher ratings of clinicalsymptoms as measured by the Comprehensive PsychopathologicalRating Scale (CPRS) and by the St Göran's Semi-structuredInterview (SGSI) compared to low frequency alcohol consumerson symptoms of inner tension, lack of initiative, risk of relapse(as rated by therapists and as rated by patients themselves),dysphoria, negative craving for alcohol, and positive cravingfor alcohol. The present results provided evidence for the existenceof two sub-populations of alcoholics, those who have frequentlapses and those who have low frequency of sporadic lapses.Further, these two sub-populations were shown to differ withrespect to overall psychological functioning, and craving foralcohol. In conclusion, the present findings have importanttreatment implications in that reliable identification of patients'consumption patterns using biological markers would allow forthe design of individually tailored treatment needs.     

Dose reduction of asparaginase under pharmacokinetic and pharmacodynamic control during induction therapy in children with acute lymphoblastic leukaemia

The enzyme asparaginase is an important element in the therapy of acute lymphoblastic leukaemia (ALL). The usual asparaginase dose as prescribed in the ALL-BFM-86/90 treatment protocol for the therapy of ALL is 10 000 IU/m² at 3 d intervals and had been developed on the basis of the E. coli asparaginase preparation Crasnitin^TM from the Bayer company. Using the described schedule the E. coli asparaginase preparation from the Medac company shows significantly higher biological activity than the Bayer preparation. These findings prompted an attempt to reduce the dose of the Asparaginase medac^TM under careful pharmacokinetic and pharmacodynamic monitoring. At the first step of dose reduction in ALL treatment protocol I, 11 children received 5000 IU/m² of Asparaginase medac^TM. Another 15 children were given 2500 IU/m² of the enzyme at the second step of dose reduction. Prior to each asparaginase dose, blood samples were taken to determine amino acids and trough enzyme activity. Concurrent with the asparaginase monitoring, the coagulation parameters were measured. 96% of samples from the first step of dose reduction (5000 IU/m² every third day) showed complete L-asparagine depletion (<0.1 μM ), the median trough enzyme acitivity was 265 IU/l. At the second step of dose reduction (2500 IU/m²) complete L-asparagine depletion was seen in 97% of samples, and the median trough enzyme acitivity was 102 IU/l. Cerebrospinal fluid (CSF) depletion was complete in all samples tested (11/11). We concluded that an Asparaginase medac^TM dose reduced from the usual 10000 IU/m² down to 5000 IU/m² or 2500 IU/m², applied at 3 d intervals, was sufficient to achieve complete L-asparagine depletion in serum. Changes of the fibrinogen levels was significantly less pronounced in the group on 2500 IU.     

'Healthy Living is Fun' A creative way of health education

‘Healthy living is fun’ is a health education programmefor pupils aged 8–10 years. It consists of a curriculumcovering seven health topics, and was developed by a team ofa physician and teachers. The programme follows an integrated,cognitive concept of health education. By a creative approachthe pupils learn to appreciate their body and, consequently,to avoid risk factors. A prospective evaluation study is beingcarried out in cooperation with the German Institute for HighBlood Pressure Research, Heidelberg, Federal Republic of Germany.     

The Effects of Intravenous Mexiletine on Spectra of the Signal-Averaged ECG

This study examined the effects of intravenous mexiletine on the time-domain and spectrotemporal signal-averaged ECG (SAECG). SAECGs were recorded in 60 postmyocardial infarction (MI) patients with more than 100 premature ventricular beats per hour, before and after a constant infusion of mexiletine, 7 mg/ kg, given over 1 hour. Spectrotemporal analysis was done on a fixed analyzed signal duration of QRS complex and ST segment of X, Y, and Z leads using a temporal window of rectangular type, measuring the signal content between 10–120 Hz. Intravenous mexiletine produced no significant change in the mean values of any of the time-domain variables. However, mexiletine either increased or decreased the power density spectrum (PDS) and PDS ratio (40–120 Hz/25–120 Hz) of the SAECG. and in rare cases only did it not alter the spectra of the SAECG. When PDS ratio in lead Z decreased after mexiletine, it was usually higher at baseline in comparison with that when the PDS ratio increased, or vice versa. When the treatment with mexiletine was effective, PDS increased in comparison with that when the drug was ineffective, or vice versa. Not all ranges (10–120 Hz) of spectra of the SAECG, but only certain frequency bands (25–40 Hz in lead Z,P = 0.0253; 40–55 Hz in lead Y, P = 0.0096; 55–70 Hz in Xlead, P = 0.0018; and in lead Z, P = 0.0002; 70–85 Hz in lead X, P = 0.0025; and in lead Z, P = 0.0075, 85–100 Hz in lead X, P = 0.0033) were associated with mexiletine efficacy. However, PDS ratio changes after mexiletine did not correlate with drug efficacy as measured by Holter monitoring. These results might provide a new understanding relative to the role and impact of mexiletine therapy in post-MI patients.     

Risk factors of institutionalization in an elderly disabled population

Due to increased life expectancy and demographic ageing an increasingnumber of elderly people have to spend the eve of their lifein institutional settings, which is often associated with adversepsychosocial and financial consequences. The purpose of thisprospective study is to assess the extent and determinants ofinstitutionalization in a population sample of severely disabledelderly people from south Germany. The study population includedall non-institutionalized persons in a defined region who metthe criteria of permanent nursing dependency set by the Germanstatutory health insurance system. Study participants were recruitedin 1991–1993 and followed for a mean of 1.7 years. Rateratios of Institutionalization for potential risk factors werecalculated using Cox's proportional hazards model. Out of 1,583study participants 159 aged 60 years or older were admittedto a nursing home during the follow-up period. Old age, femalegender, living In urban compared to rural areas, professionalprovider of nursing care compared to family members as maincare givers and cognitive impairments independently increasedthe rate of institutionalization In multivariable analysis.There was no relationship between limitations in basic activitiesof daily living and the rate of institutionalization. Theseempirical data extend the scarce database in Germany, whichis needed for further planning of nursing care facilities inthe community in order to improve the situation of disabledpeople, in particular to prevent nursing home admission.     

Expression of intercellular adhesion molecule 1 (ICAM-1) in childhood acute lymphoblastic leukaemia: correlation with clinical features and outcome

To investigate whether expression of intercellular adhesion molecule 1 (ICAM-1, CD54) in childhood acute lymphoblastic leukaemia (ALL) has an impact on the biological behaviour of the disease, we evaluated 751 children of the ALL-BFM 90 trial with B-cell precursor- ( n  = 6777) or T-cell-ALL ( n  = 74) for CD54 expression within immunological subgroups, its correlation to certain clinical features, and therapy outcome.
The highest percentage of patients expressing CD54 was found in common- and pre-B-ALL (76.1% and 61.4%, respectively). There was intermediate expression in pre-pre-B-ALL (47.8%), and the lowest expression was detected in T-ALL (12.2%).
A significant positive correlation could be demonstrated between low CD54 expression (< 20% stained blasts) and high peripheral leucocyte counts, central nervous system (CNS) involvement, and splenomegaly at the time of diagnosis ( P  < 0.01). In addition, CD54 expression was a favourable but not independent prognostic factor. Event-free survival estimate at 4.5 years was 86% for CD54⁺ patients ( n  = 463), compared with 78% for CD54⁻ patients ( n  = 241) ( P  < 0.01). These findings demonstrate that CD54 expression has an impact on dissemination patterns and outcome of childhood ALL, and emphasizes the potential relevance of adhesion mechanisms in influencing clinical characteristics and prognosis of haematological malignancies.