A New Acceleration Driven Pacemaker: Rate Modulation Versus Normal Sinus Rhythm—Comparison During Treadmill Exercise

The pocing rate response of a new acceleration driven pulse generator (SWING 100, SORIN BIOMEDICA) was compared with simultaneous normal sinus rhythm (NSR) during two different treadmill exercises. This pacemaker has a gravitational acceleration sensor able to discriminate between physical activities and vibrations. Six healthy volunteers (three male, three female; aged 21.7 ± 4,3 years), with the pacemaker strapped to their right infraclavicular area, performed each test three times with different rise response curve (RRC) each time: fast, normal, and slow. The fall response curve used was the same as the rising one during each test. Pacing rates were recorded using the VEGA analyzer (SORIN BIOMEDICA) and compared with simultaneous NSR recorded by a 7-channel ECG recorder (MINGOGRAF 7, SIEMENS), During all tests immediate (within seconds) rapid increase in pacemaker rate was seen up to about 60 seconds, then a slower increase followed thereafter. The mean correlation between pacing rates and NSR during the Bruce tests were 0.7941 ± 0.10, 0.8562 ± 0.14, and 0.8292 ± 0.07; during the discontinous tests 0.7292 ± 0.16, 0.7233 ± 0.10, and 0.7480 ± 0.11 for fast, normal, and slow RRC, respectively. Each 30 seconds, nonsignificant differences were present between pacing rate and NSR during all the discontinuous tests; similar responses were observed only during the first two stages of Bruce tests after which NSR was significantly higher than pacemaker rates. The speed of rise to upper rate was the main difference between the different programs (fast, normal, and slow). The discontinuous tests showed that the pacemaker responds more to speed than to grade. In conclusion, the Swing pacemaker is easy to use and program, fast, reliable, and is able to mimic the normal sinus behavior especially during discontinuous activities.     

Dentists' involvement in identification and reporting of child physical abuse: Jordan as a case study

Objectives.  The objectives of this study were to assess the knowledge, attitude, and experience among Jordanian dentists regarding child abuse, and to explore the factors that affect their hesitation to report any suspected cases.
Materials and methods.  A self-administered structured questionnaire was sent randomly to 500 Jordanian dentists. It investigated dentists' knowledge, attitude, and experience in recognizing and reporting child abuse cases. It also investigated several factors associated with dentists' hesitation to report suspected cases of child physical abuse.
Results.  The response rate was 68%. More dentists were aware of their ethical obligations (80%) than their legal responsibilities (71%) to report child abuse cases. One-third of the dentists knew where to report suspected cases. Although 42% of dentists suspected cases of child abuse, only 20% of them reported these cases. The most frequently cited reasons for hesitation to report such cases were lack of history (76%), uncertainty about diagnosis (73%), and possible consequences on the child (66%). Reporting was significantly associated with suspicion of child abuse cases, as well as the belief of legal responsibilities.
Conclusion.  There was a low reporting rate of child abuse among Jordanian dentists. They lack the adequate knowledge about recognition and reporting issues of suspected cases.     

A PROSPECTIVE, RANDOMIZED 1-YEAR CLINICAL TRIAL COMPARING TRANSURETHRAL NEEDLE ABLATION TO TRANSURETHRAL RESECTION OF THE PROSTATE FOR THE TREATMENT OF SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

Purpose

We assess the 1-year efficacy and safety of transurethral needle ablation of the prostate compared to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH).

Materials and Methods

A prospective, randomized clinical trial of 121 men 50 years old or older with symptomatic BPH was performed at 7 medical centers across the United States. Of the men 65 (54%) were treated with transurethral needle ablation of the prostate and 56 (46%) underwent transurethral resection of the prostate. Mean and percentage changes from baseline and between cohorts for American Urological Association (AUA) symptom score, AUA bother score, quality of life score, peak urinary flow rate and post-void residual urine volume were measured at 1, 3, 6 and 12 months following treatment. Length of procedure, hospitalization, type of anesthesia, post-procedure catheterization, side effects and sexual function were compared.

Results

Transurethral needle ablation and resection resulted in a statistically significant improvement in AUA symptom, bother and quality of life scores, peak urinary flow rate and post-void residual. At 1-year followup, needle ablation and resection were equally effective in enhancing quality of life. Needle ablation had less effect on sexual function, with resection being associated with a greater incidence of retrograde ejaculation. Needle ablation could be performed as an outpatient procedure with local anesthesia while resection required anesthesia and hospitalization. Needle ablation was associated with markedly fewer side effects than resection.

Conclusions

Compared to transurethral resection of the prostate, transurethral needle ablation of the prostate is an efficacious, minimally invasive treatment for symptomatic BPH that is associated with few side effects.     

Obsessive Compulsive Disorder in a Patient with Twiddler's Syndrome

Twiddler's or twist syndrome is the twisting of pulse generators around themselves. It may result from mechanical manipulation that can induce the malfunction of the device. In this case, twiddler's syndrome resulted from compulsive checking of the device. The implantable cardioverter‐defibrillator (ICD) triggered the development of an obsessive compulsive disorder (OCD). Two invasive procedures were required to replace the ICD. Psychiatric intervention prevented the recurrence of twiddler's syndrome in this patient for more than 2 years. We believe that preimplant psychiatric assessment should be the rule.     

EOSINOPHILIC FASCIITIS WITHOUT PERIPHERAL EOSINOPHILLA PRESENTING AS PYREXIA OF UNKNOWN ORIGIN

Eosinophilic fasciitis is a syndrome usually characterized bylimb and joint pain, a raised sedimentation rate, hypergammaglobulinaemia,subcutaneous fasciitis and peripheral as well as tissue eosinophilia. We present a case with a positive tissue diagnosis, but whopresented predominantly with marked nocturnal sweating and pyrexia. KEY WORDS: Fever, Night sweats, Muscle, Scleroderma     

鼻内镜下综合治疗慢性泪囊炎

目的：观察鼻内镜下三种不同方法治疗慢性泪囊炎所需的手术时间、出血量及效果。方法：98例慢性泪囊炎分为三组,A组28例（31眼）在鼻内镜下应用膨胀海绵行鼻腔泪囊吻合造口术（置管）,B组33例（35眼）鼻内镜下应用银夹、膨胀海绵行鼻腔泪囊造口术（不置管）,C组37例（40眼）在鼻内镜下联合应用眼光导纤维、电刀、丝裂霉素C（mitomycin C,MMC）、耳脑胶及明胶海绵行鼻腔泪囊造口术（不置管）,三组所需的手术时间、出血量及疗效进行对比分析。结果：平均手术时间、平均出血量及有效率（6个月、12个月）分别是A组、B组、C组。结论：鼻内镜下联合应用内光导纤维引导,电刀、丝裂霉素c和耳脑胶及明胶海绵行鼻腔泪囊造口术,能减少手术时间,出血少,疗效好、复发率低,是一种操作简单、安全可靠、经济、快速、实用、疗效好的方法。