A trial of relapse prevention with severely dependent male problem drinkers

Over the last two decades, relapse prevention has emerged as a major focus of the treatment of drug problems. Few studies have demonstrated any impact on generally high relapse rates. In this paper the outcome of a controlled trial of a relapse prevention programme with male problem drinkers (n=60) attending an Alcohol Treatment Unit is reported. Subjects who met the inclusion criteria were allocated to a relapse prevention (n=20) procedure or a discussion (n=20) or no-additional treatment (n=20) control procedure. Subjects were followed-up at 6 and 12 months by the first author. The relapse prevention programme was associated with significantly greater increases in pre- and post-treatment self-efficacy compared to the discussion control group and significantly greater probability of total abstinence than all controls over the first 6-month follow up. In addition, the relapse prevention programme was associated with significantly longer survival time to an initial lapse and relapse than the controls. At 12-month follow-up, treatment effects had been eroded. It was concluded that the relapse prevention programme was an effective treatment in the short term and that longer-term impact may require greater focus on maintenance factors, such as the individual's environment.     

Catheter Ablation of Recurrent Scar-Related Ventricular Tachycardia Using Electroanatomical Mapping and Irrigated Ablation Technology: Results of the Prospective Multicenter Euro-VT-Study

Catheter Ablation of Ventricular Tachycardia.   Introduction: Ventricular tachycardia (VT) late after myocardial infarction is an important contributor to morbidity and mortality. This prospective multicenter study assessed the efficacy and safety of electroanatomical mapping in combination with open-saline irrigated ablation technology for ablation of chronic recurrent mappable and unmappable VT in remote myocardial infarction.
Methods and Results: In 8 European institutions, 63 patients (89% males) were enrolled in the study. All patients had remote myocardial infarction and presented with a median number of 17 (range 1–380) VTs in the preceding 6 months. Incessant VT was present in 14 patients (22%). Left ventricular ejection fraction measured 30 ± 13%. A mean of 3 VTs were targeted per patient and 22% of all patients had only unmappable VT. The mean follow-up period was 12 ± 3 months. A total of 164 VTs were targeted during catheter ablation. Ablation was acutely successful in 51 patients (81%). One patient (1.5%) experienced a major complication with degeneration of VT into ventricular fibrillation necessitating cardiopulmonary resuscitation maneuvers. However, no death occurred acutely or within the first 30 days after catheter ablation. During the follow-up, 19 of the initially successful ablated patients (37%) and 31 of all ablated patients (49%) developed some type of VT recurrence.
Conclusions: The results of this multicenter study demonstrate the high acute success rate and a low complication rate of irrigated tip catheter ablation of all clinical relevant VTs in remote myocardial infarction. However, during the follow-up a relevant number of recurrences occurred. (J Cardiovasc Electrophysiol, Vol. 21, pp. 47–53, January 2010)     

ADH and ALDH genotype profiles in Caucasians with alcohol-related problems and controls

Eighty-two Caucasian patients receiving treatment for alcohol-related problems and eighty four controls were DNA typed for variants in the alcohol dehydrogenase (ADH₂ and ADH₃) and mitochondrial aldehyde dehydrogenase (ALDHJ gene loci. No association was observed between individual, or combined gene frequencies and the presence of alcohol-related problems.     

Natural Killer Cell Cytotoxicity and Antibody-Dependent Cellular Cytotoxicity to Herpes Simplex Virus-Infected Cells in Human Pregnancy

ABSTRACT: Natural killer cell (NKC) cytotoxicity and antibody-dependent cellular cytotoxicity (ADCC) represent the ability of human leukocyte effector cells to destroy target cells in the absence and presence of antibody, respectively. Since these immune systems play a pivotal role in the body's primary lines of defense against a variety of pathogens including herpes simplex virus (HSV), a study was undertaken to evaluate the influence of pregnancy on these systems. Eleven uncomplicated gravidas were followed serially through each trimester and compared to 11 nonpregnant female controls. Mononuclear cells were acquired by Ficoll-Hypaque centrifugation of heparinized blood. Chang liver cells infected with HSV-I were utilized as target cells in a ⁵¹Cr release assay. Mean NKC values in the pregnant patients were uniformly lower than in the controls. No similar decreases in ADCC activity were observed in a comparison between the two study populations. These data support previous observations suggesting that pregnancy represents a relatively immunocompromised state. Differences apparently exist between NKC and ADCC effector cell populations with regard to the influence of pregnancy. Although these physiologic alterations in immunoregulation may help support the fetoplacental allograph, detrimental conditions may exist regarding susceptibility to various pathogens such as HSV.     

Is the Automatic Atrial Defibrillator a Promising Approach?

Automatic Atrial Defibrillator. Atrial fibrillation is a common arrhythmia, accounting for more consumption of medical resources than any other arrhythmia. The impact of the disease results from the combination of a loss of atrial contraction, and atrial control over cardiac rate. Studies in animals demonstrated the basic feasibility of atrial defibrillation using electrodes passed intravenously. Subsequent studies in patients confirmed that low-energy shocks were effective in converting atrial fibrillation and were safe if delivered synchronous to the R wave in the absence of a short preceding RR interval. Preliminary experience suggests that a small implanted device might provide beneficial therapy for patients with recurring episodes of persistent, drug-refractory, atrial fibrillation.     

Use of the Pill Electrode for Transesophageal Atrial Pacing

The pill electrode, which was developed for esophageal electrocardiography, has found application in transesophageal atrial pacing during procedures such as conversion of tachycardia, electrophysiologic measurement, and acceleration of heart rate to produce stress during cardiac imaging studies. This paper presents theoretical studies that examine the relationship of interelectrode distance, current level, and pulse duration to the achievement of successful capture. Theoretical results agree with our clinical findings, i.e., current levels of 25 mA are effective to sustain capture; increased pulse duration reduces current requirements; and close bipolar spacing combines efficacy with safety. Results of animal studies performed to assess the extent of esophageal burn injury reveal that current levels in excess of 75 mA are required to produce lesions in short-term (under 30 minutes) pacing, and greater than 60 mA in long-term (4 hours) pacing. These results are based on experiments using a pulse duration of 2 ms, and the current levels that produce injury will be considerably lower if longer pulse durations are used. Typical current levels and pulse durations for successful capture are presented for 46 subjects in several new clinical applications. Termination of tachycardia, basic electrophysiologic measurements, and controlled acceleration of heart rate can be performed noninvasively with this technique.     

OBSERVATIONS ON SCANNING ELECTRON MICROSCOPY OF HYDROPHILIC CONTACT LENSES

Hydrated hydrophilic lenses, Bionite and Hydron, were prepared for scanning electron microscopy by air drying and freeze drying techniques. Air dried lenses shrank more on dehydration (with more distortion to overall lens shape) than freeze dried lenses. The surfaces of both types of lens, worn and unworn, demonstrated grooves and ridges which appear to serve as anchoring sites for debris associated with wearing the lens. On worn lenses, structures suspected to be micro-organisms were observed amidst the debris. The lens surfaces did not exhibit a porous architecture, and no pores were observed with magnifications to 30,000x.