Monitoring of central venous dual-lumen catheter placement in haemodialysis: improvement of a technique for the practising nephrologist

Mismanagement in the placement of central venous catheter (CVC)may occur in up to 20% of cases. The catheter can be inadvertentlyplaced in the contralateral brachiocephalic vein, the ipsi orcontralateral internal jugular vein, and usually a thoracicradiograph is necessary to evaluate its location. We proposea technique first described by Serafini et al. to establishthe position of a CVC by endocavitary electrocardiography (EC-ECG)and its employment in a large number of uraemic patients requiringhaemodialysis. This technique uses the tip of the CVC as referencelead in a standard electrocardiograph. The best employment ofthis technique has been obtained by echotomographic visualizationof the internal jugular vein executed just before transcutaneouspuncture of the vessel. For 13 months we have successfully appliedthis technique in CVC placement in 81 patients requiring haemodialysis.In our opinion this method is a safe and simple technique thatavoids the need for thoracic radiographs and time lost waitingfor radiographs that prolong the start of the haemodialysissession. According to our experience, we confirm that the EC-ECGtechnique provides a method for ensuring compliance with Foodand Drug Administration guidelines regarding catheter tip locationin uraemic patients.     

Electrocardiographic signs of hypertrophy in Fabry disease-associated hypertrophic cardiomyopathy

Aims : Fabry disease results from deficient activity of the lysosomal enzyme α-galactosidase A. Progressive accumulation of the major substrates leads, in both men and women, to progressive hypertrophic cardiomyopathy. We aimed to evaluate the utility of different electrocardiographic (ECG) parameters for assessing the degree and severity of hypertrophic cardiomyopathy in patients with Fabry disease. Methods : A total of 166 ECGs of 94 hemi- and heterozygous patients with Fabry disease were analysed and compared with echocardiographic-estimated left ventricular mass (LVM). Results : There was a significant ( p > 0.0001) correlation between QRS duration (R²= 0.59), 12-lead amplitude/duration product (R²= 0.61), Sokolow-Lyon voltage/duration product (R²= 0.52) and LVM. Analysis of receiver operating characteristics revealed that the 12-lead amplitude/duration product had the highest sensitivity-specificity relationship ( p > 0.01 compared with the Cornell index).
Conclusion : In general, ECG signs of left ventricular hypertrophy correlated well with LVM as revealed by echocardiography. Of the parameters studied, the 12-lead amplitude/duration product was the most successful at describing the severity of cardiac involvement in Fabry disease. These data suggest that ECG parameters have potential for use as a simple and cost-effective means of screening for hypertrophic cardiomyopathy in patients with Fabry disease.     

Isolated cardiac manifestations in Fabry disease: the UK experience

Cardiac abnormalities are common in patients with Fabry disease, and may be the only clinical manifestation of the disease in some patients. At St George's Hospital Medical School, a national referral centre for hypertrophic cardiomyopathy in the UK, a study of 153 consecutively referred male patients revealed that 4% had Fabry disease. This increased to 6% in patients over 40 years of age. All these patients had electrocardiographic (ECG) abnormalities, most of which were consistent with those found in patients with classic Fabry disease: left ventricular hypertrophy, repolarization abnormalities and a prolonged QRS complex. A study of heterozygote females with Fabry disease also showed ECG and echocardiographic abnormalities in most patients.
Conclusions : Fabry disease should be considered in the differential diagnosis of otherwise unexplained cardiac disease.     

One-year treatment of chronic urticaria with mizolastine: efficacy and safety

AIM: To assess the long-term safety and efficacy of the H1-receptor antagonist mizolastine in the symptomatic treatment of chronic urticaria (CU). BACKGROUND: Mizolastine is a novel second generation antihistamine with additional anti-inflammatory properties which has been shown to be effective in this condition as well as in allergic rhinitis. As the drug is used for chronic treatment, a detailed study of its efficacy and safety over a prolonged period was warranted. METHODS: This open label multicentre trial recruited 211 patients suffering from CU (67% female; mean age 40+/-13 years), with > or = 1 episode/week if untreated. After a 7-day placebo run-in period, patients received mizolastine (10 or 15 mg) for 12 months. Efficacy was assessed by the patient using daily diary cards and overall condition evaluation at study visits. Clinicians also assessed the same parameters at each visit, and gave a global assessment at study termination. Safety was assessed by monitoring adverse events and laboratory parameters. Cardiac safety was monitored every 4 months using 12-lead ECGs, with particular attention to QT intervals. RESULTS: The trial was completed by 127 patients. Mizolastine reduced overall discomfort from the second week of therapy, and reduced itching and the number and size of wheals, as assessed by the patients. The clinician's assessment of the proportion of patients with > 10 wheals decreased from 42% to 28% after 2 months. Clinical assessment also indicated that itch intensity and angioedema were improved by mizolastine, and the improvement was sustained throughout the trial. The investigators estimated that 70% of patients benefited from therapy. There were no drug-related serious adverse events during the study. The cardiac repolarization assessed according to the QTc intervals was not modified during prolonged administration. CONCLUSION: Mizolastine improves CU symptoms, and these improvements are sustained over 12 months with no loss of drug sensitivity. No specific side-effects are associated with its long-term use in the current study.