bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated levels of circulating adhesion molecules in patients with active pulmonary tuberculosis
Authors: MUKAE Hiroshi , ASHITANI Jun‐ichi , TOKOJIMA Masatoshi , IHI Toshihiko , KOHNO Shigeru , Matsukura Shigeru
Published: December 2004

Objective:  Recent studies have indicated the importance of cell adhesion molecules in the pathogenesis of various inflammatory lung diseases. Our study was designed to determine whether five soluble adhesion molecules including soluble L‐, E‐ and P‐selectin (sL‐, sE‐ and sP‐selectin), intercellular adhesion molecule‐1 (sICAM‐1), and vascular cell adhesion molecule‐1 (sVCAM‐1) in serum reflect the severity of active pulmonary tuberculosis (TB), and whether there is a distinct profile of these soluble molecules in this disease.

Methodology:  Using enzyme‐linked immunosorbent assays, we measured the serum levels of these five soluble adhesion molecules in 31 patients with active TB and 11 healthy volunteers.

Results:  Serum levels of sE‐selectin, sP‐selectin and sICAM‐1, but not sL‐selectin or sVCAM‐1, were significantly higher in patients with active TB than in the control subjects (P < 0.001, each). Significant correlations were detected only between serum levels of sE‐selectin and sP‐selectin, sE‐selectin and sICAM‐1, and sP‐selectin and sICAM‐1. There was a significant correlation between the Gaffky scale result (a scale assessing the number of mycobacteria bacilli present) and all of the above adhesion molecules, except for sL‐selectin. Serum levels of sE‐selectin, sL‐selectin and sICAM‐1 also correlated with the CXR radiological score. Higher levels of sL‐selectin and sICAM‐1 were detected in the serum of patients with radiological cavity formation compared to those without. The ESR, C‐reactive protein and circulating neutrophil counts all correlated significantly with sE‐selectin, sP‐selectin, sICAM‐1 and sVCAM‐1.

Conclusion:  The results suggest that there is a distinct profile of soluble adhesion molecules in active pulmonary TB and that sE‐selectin, sP‐selectin, and especially sICAM‐1 appear to be the most sensitive clinical measures of disease severity.
Novel missense mutation of the UGT1A1 gene in Thai siblings with Gilbert's syndrome
Authors: Sutomo Retno , Laosombat Vichai , Sadewa Ahmad Hamim , Yokoyama Naoki , Nakamura Hajime , Matsuo Masafumi , Nishio Hisahide
Published: December 2004

Background
: Gilbert's syndrome is a common inherited disorder of bilirubin metabolism contributing to the development of neonatal jaundice and causing recurrent jaundice after the neonatal period. In the patients with Gilbert's syndrome, mutations have been reported in the promoter and exons of the uridine diphosphate‐glucuronosyl transferase 1 (UGT1A1) gene on chromsome 2q37, which encodes bilirubin uridine diphosphate‐glucuronosyltransferase. However, the genetic basis of Gilbert's syndrome, including its inheritance trait, remains to be clarified.

Methods
: Patients 1 and 2 were Thai sisters with Gilbert's syndrome. They had a history of prolonged neonatal jaundice and showed recurrent jaundice after their infancy, while the parents showed no symptoms. To search for the mutation in the patients, all exons of the UGT1A1 gene were amplified by polymerase chain reaction (PCR) and sequenced directly. The frequency of the mutation in controls was studied by PCR‐restriction enzyme digestion method.

Results
: The patients were homozygous for a novel single transition of T to C at nucleotide position 247 (exon 1), which would predict a substitution of leucine for phenylalanine at codon 83 of the enzyme protein. No other mutation was detected in any regions except exon 1. The parents with no symptoms showed heterozygosity for the mutation. Among the 110 Japanese controls, no homozygous individuals and three heterozygous individuals for the mutation were identified, giving a mutated allele frequency of 0.0136.

Conclusions
: A novel missense mutation in the UGT1A1 gene was identified in two Thai siblings with Gilbert's syndrome. The affected family showed that homozygosity for the mutation may lead to apparent symptoms and that the syndrome was inherited as an autosomal recessive trait. The mutation does not explain a high incidence of neonatal jaundice in Japan, because it is very rare in the Japanese population.
Incidence of giardiasis among siblings in Turkey
Authors: Balcioglu I. Cüneyt , Limoncu Emin , Ertan Pelin , Yereli Kor , Özbilgin Ahmet , Onag Ali
Published: December 2004

Abstract
Background
: Giardiasis, a common infection among children, is caused by a flagellated protozoan called Giardia lamblia. It is well known to be contagious in common living places. This is an epidemiologic study investigating the incidence of giardiasis among the siblings of patients with giardiasis living in the same household.

Methods
: Stool samples of 50 patients with a G. lamblia positive sibling in the same household, and 50 patients with a G. lamblia negative sibling in the same household, were examined for giardiasis by saline‐Lugol, formalin‐ethyl acetate concentration and trichrome staining methods. Other causes of diarrhea were excluded by microbiologic laboratory tests.

Results
: Thirty‐eight per cent of siblings of G. lamblia positive patients and 8% of siblings of G. lamblia negative children were found to be positive for G. lamblia cysts and/or trophozoites. The differences between the groups were statistically significant (P < 0.001).

Conclusion
: The results suggested that the examination of G. lamblia among the siblings of patients with giardiasis both in the same age group and living in the same household should be considered.
Clinical implication of plasma natriuretic peptides in children with ventricular septal defect
Authors: Suda Kenji , Matsumura Masahiko , Matsumoto Masahiko
Published: December 2004

Abstract
Background
: There is little information available concerning plasma concentrations of B‐type natriuretic peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with atrial natriuretic peptide (ANP) in children with ventricular septal defect.

Methods
: Fifty‐nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease were enrolled. The patients’ ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were analyzed in terms of correlation with BNP and ANP.

Results
: It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 × BNP + 25 pg/mL; r= 0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r= 0.59, respectively) and mean pulmonary artery pressure (r = 0.72 and r= 0.68, respectively). In addition, plasma BNP of ≥20 pg/mL and ANP of ≥50 pg/mL identified children with mean pulmonary artery pressure of ≥20 mmHg with a sensitivity of 82% and 97%, respectively, and a specificity of 89% and 84%, respectively.

Conclusion
: Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands early intervention.
Unrelated cord blood transplantation for second hemopoietic stem cell transplantation
Authors: Isoyama Keiichi , Ohnuma Kei , Ikuta Koichiro , Toyoda Yasunori , Nakajima Fumiaki , Yamada Kouichiro , Nishihira Hirokazu ,   on behalf of the Kanagawa Cord Blood Bank
Published: December 2004

Background
: The Kanagawa Cord Blood Bank (KCBB) reports the treatment of 12 patients who received umbilical cord blood transplantation (CBT) from unrelated donors as their second hemopoietic stem cell transplantation (HSCT).

Methods
: Provided by the KCBB, between February 1997 and September 2000, 12 patients had unrelated CBT as a second HSCT. Six patients were male and six female; nine patients were in malignant, and three were in non‐malignant conditions. The median age of the patients was 7.9 years (range, 2.2−28.0), and the median bodyweight was 22.5 kg (12.0−55.0). The HLA‐A and ‐B serological and DR genotypical disparities between the patients and CBT donors were as follows: one patient was a 0‐mismatch, six were 1‐mismatches, and five were 2‐mismatches.

Results
: The median time between first and second HSCT was 14.0 months (1.0−47.0). The overall survival rate was 25.0%, three years after CBT (Kaplan−Meier estimate). Mortality after CBT as a second HSCT accounted for nine cases, six from infection and three from treatment‐related mortality other than infection.

Conclusion
: Cord blood transplantation offers the advantage of rapid availability, absence of donor risk, and possibly less HLA restriction. In these contexts, unrelated CBT should be considered as a source of HSCT for a second transplant.
Efficacy and safety of arbekacin for staphylococcal infection in the NICU
Authors: Suzuki Keiji
Published: December 2004

Abstract
Background
: This is a retrospective study on the efficacy and safety of arbekacin (ABK), an aminoglycoside antibiotic, for acquired staphylococcal infection in the neonatal intensive care nursery.

Patients and methods
: Subjects were 29 infants treated with ABK in a tertiary care neonatal center. They were 23−39 (median 28) weeks’ gestation, 530−3334 (median 930) grams at birth, and 3−157 (median 17) days of age. Diagnosis of staphylococcal infection was made by clinical signs and laboratory findings. Sensitivity of the isolated organisms to ABK was tested by the microliquid dilution method. Serum ABK level was monitored to achieve the therapeutic range during the treatment. Effectiveness was defined by improving clinical signs and laboratory findings within 3 days. Effectiveness was studied in relation to type of infection and other antibiotics administered. Auditory brainstem response and serum creatinine changes were studied for ototoxicity and nephrotoxicity assessment, respectively.

Results
: Twenty‐seven (93.1%) cases of infection were attributed to methicillin‐resistant Staphylococcus aureus (MRSA) and two (6.9%) were attributed to coagulase‐negative staphylococci (CNS). The rate of in vitro sensitivity to ABK was 85.2% for MRSA and 100.0% for CNS. The overall clinical effeciveness rate was 79.3% (23/29) with no difference associated with types of infection. Combination of ABK with sulbactam/ampicillin showed greater effectiveness (100.0%) than with other antibiotics (64.3%) (P < 0.05). There was no abnormal auditory brainstem response or serum creatinine change associated with ABK treatment.

Conclusion
: ABK is an effective and safe antibiotic for the treatment of acquired staphylococcal infection in the neonatal intensive care nursery.
Autonomic function in Kawasaki disease with myocardial infarction: Usefulness of monitoring heart rate variability
Authors: Kikuchi Yutaka , Sato Yuko , Ichihashi Kou , Shiraishi Hirohiko , Momoi Mariko Y
Published: December 2004

Background
: Despite anticoagulant therapy, many patients with Kawasaki disease and giant coronary artery aneurysm develop myocardial infarction. These patients have a high risk of sudden death, but the etiology is not clear. We studied autonomic function and the possibility of malignant ventricular arrhythmia through heart rate variability.

Methods
: We studied six Kawasaki disease patients with myocardial infarction and 16 normal controls. Heart rate variability was investigated using a 24 h electrocardiogram. We assessed the standard deviation from the mean of the normal R‐R intervals (SDNN), the proportion of adjacent R‐R intervals with a difference greater than 50 msec (pNN50) and the root‐mean square of successive R‐R differences as time−domain analysis (rMSSD). We assessed very low‐frequency power, low‐frequency power (LF), high‐frequency power (HF) and the LF/HF ratio in frequency−domain analysis.

Results
: There was no significant difference in SDNN, but there was a significant difference in pNN50 and rMSSD. Patients with Kawasaki disease showed lower HF and higher LF/HF than normal controls.

Conclusion
: Our findings suggest that patients with Kawasaki disease and myocardial infarction show decreased vagal activity, which could cause malignant arrhythmia.
Impedance Cardiography for Atrioventricular Interval Optimization During Permanent Left Ventricular Pacing
Authors: TSE HUNG‐FAT , YU CANNAS , PARK EULJOON , LAU CHU‐PAK
Published: December 2004

TSE, H‐F., et al.: Impedance Cardiography for Atrioventricular Interval Optimization During Permanent Left Ventricular Pacing.
Left ventricular (LV) pacing is increasingly used in the management of congestive heart failure. Optimization of the atrioventricular (AV) interval is essential to maximize the hemodynamic benefits of this therapy. Although Doppler echocardiography (echo) is the most widely used method, it is time‐consuming, expensive, and operator‐dependent. We examined the value of an impedance cardiography (IC)‐based method of cardiac output (CO) measurement to optimize the AV interval in 5 men and 1 woman (mean age

= 72 ± 11

years) during permanent LV pacing with a 4.8 Fr unipolar coronary sinus pacing lead. Simultaneous measurements of CO by IC and echo were performed at AV intervals of 50, 80, 110, 150, 180, and 225 ms during DDD pacing at 85 beats/min. The optimal AV interval varied between 110 and 180 ms. In 5 of 6 patients (83%), the optimal AV interval by echo and IC was identical. While CO measurements were higher with IC than with echo (

6.1 ± 0.4 L/min

vs 4.7 ± 0.3 L/min, P < 0.05), CO measurements by IC and echo were closely correlated

r = 0.67

, P < 0.001). In conclusion, our initial experience suggests that IC is a reliable method of AV interval optimization during LV pacing. IC and echo measurements of CO during LV pacing were closely correlated. (PACE 2003; 26[Pt. II]:189–191)
Optical Mapping Technique Applied to Biventricular Pacing:
Authors: GARRIGUE STEPHANE , REUTER SYLVAIN , EFIMOV IGOR R. , MAZGALEV TODOR N. , JAÏS PIERRE , HAÏSSAGUERRE MICHEL , CLEMENTY JACQUES
Published: December 2004

GARRIGUE, S., et al.: Optical Mapping Technique Applied to Biventricular Pacing: Potential Mechanisms of Ventricular Arrhythmias Occurrence.
Although it has been suggested that multisite ventricular pacing alleviates heart failure by restoring ventricular electrical synchronization, the respective roles of voltage output, interventricular delay, and pacing sites in the development of ventricular arrhythmias occurrence have not been studied during biventricular pacing or LV pacing. Voltage‐sensitive dye was used in eight ischemic Langerdorff‐perfused guinea pig hearts to measure ventricular activation times and examine conduction patterns during multisite pacing from three RV and four LV sites. The hearts were stained with di‐4‐ANEPPS and mapped with a

16 × 16

photodiode array at a resolution of 625 μm per diode. Isochronal maps of RV and LV activation were plotted. Ischemia was produced by gradually halving the perfusion output over 5 minutes. Pacing the RV apex and the base of the LV anterior wall was associated with the most homogeneous and rapid activation pattern (

28 ± 9

vs

41 ± 12

ms with the other configurations, P < 0.01), and no inducible arrhythmia. In six hearts, ventricular tachycardia could be induced when pacing from the right and left free walls with 20 ms of interventricular delay, at six times the pacing threshold output. In four hearts, simultaneous RV and LV pacing at high voltage output induced ventricular fibrillation with complex three‐dimensional propagation patterns, independently of the pacing sites. During biventricular pacing with ischemia, pacing at high voltage output with a long interventricular delay is likely to induce ventricular arrhythmias, particularly when left and right pacing results in a conduction pattern orthogonal to the ventricular myocardial fibers orientation. PACE 2003; 26[Pt. II]:197–205)
Impact of Adaptive Rate Pacing Controlled by a Right Ventricular Impedance Sensor on Cardiac Output in Response to Exercise
Authors: COOK LINNEA , HAMILTON DAWN , BUSSE EDWARD , TSANG JOHN , GARBE GEORGE , WOJCIK WADYSLAW , HAENNEL ROBERT
Published: December 2004

COOK, L., et al.: Impact of Adaptive Rate Pacing Controlled by a Right Ventricular Impedance Sensor on Cardiac Output in Response to Exercise.
This study examined the effects of adaptive rate pacing controlled by closed‐loop right ventricular impedance sensing on exercise hemodynamics. Twelve patients in whom Biotronik INOS2+ pacemakers had been implanted 4–6 weeks earlier participated in the study. All patients completed two graded, symptom‐limited exercise tests. The pacemaker was programmed to DDDR with an upper rate limit of 75–85% of the age‐predicted maximum heart rate and a lower rate limit of 45–60 ppm. Heart rate was recorded continuously. An average of 5 beats during the last 10 seconds of each exercise stage was used in the analysis. Oxygen uptake (VO2) was measured using open circuit spirometry. The VO2 values from the final 15 seconds of each exercise stage were used for analysis. Stroke volume and cardiac output were measured during the last minute of each stage using impedance cardiography. The test‐retest reliability of heart rate and cardiac output responses to graded exercise was assessed using repeated measures analysis of variance, for which the reliability coefficients were r = 0.993 and r = 0.954, respectively (P < 0.01). There were significant correlations (P < 0.01) between VO2 and heart rate and between VO2 and cardiac output, with correlation coefficients of r = 0.907 and r = 0.824, respectively. This method of adaptive rate pacing produced reliable, positive hemodynamic responses to graded exercise on a test‐retest basis. (PACE 2003; 26:[Pt. II]:244–247)
Angiotensin‐Converting Enzyme and Endothelial Nitric Oxide Synthase Polymorphisms in Patients with Atrial Fibrillation
Authors: GENSINI FRANCESCA , PADELETTI LUIGI , FATINI CINZIA , STICCHI ELENA , FRANCO GENSINI GIAN , MICHELUCCI ANTONIO
Published: December 2004

GENSINI, F., et al.; Angiotensin‐Converting Enzyme and Endothelial Nitric Oxide Synthase Polymorphisms in Patients with Atrial Fibrillation.
Experimental studies have shown a significant increase in angiotensin‐converting enzyme (ACE) expression in atrial tissue of AF patients. ACE regulates the synthesis of endothelial nitric oxide (NO), which modulates autonomic nervous activity involved in the development of AF. The aim of the study was to evaluate the prevalence of ACE insertion/deletion and endothelial NO synthase (eNOS) T‐786C, G894T, and 4a/4b polymorphisms in 148 patients with persistent AF, compared with 210 control subjects. ACE insertion/deletion polymorphism genotype distribution and allele frequency were significantly different between patients and controls (

P < 0.0001

and

P < 0.0001

, respectively). ACE DD genotype was significantly associated with the risk of AF

(OR DD/ID + II = 3.24, P < 0.0001)

. Analysis of eNOS polymorphisms showed no significant difference in genotype distribution and allele frequency between patients and controls. The results suggest a possible role of ACE DD genotype as a predisposing factor to AF and a pathophysiological mechanism of ACE inhibition in reducing the incidence of AF in patients with left ventricular dysfunction. (PACE 2003; 26[Pt. II]:295–298)
Analysis of the Corrected QT Before the Onset of Nonsustained Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy
Authors: BARANOWSKI RAFAŁ , CHOJNOWSKA LIDIA , MICHALAK EWA , ORŁOWSKA‐BARANOWSKA EWA
Published: December 2004

BARANOWSKI, R., et al.: Analysis of the Corrected QT Before the Onset of Nonsustained Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy.
This study examined ventricular repolarization before the onset of 37 episodes of nonsustained ventricular tachycardia (NSVT) in 26 untreated patients with hypertrophic cardiomyopathy (HCM). Fourteen episodes were recorded in patients with a history of cardiac arrest or patients who died suddenly during follow‐up. The QT interval was measured beat‐by‐beat on 24‐hour ambulatory electrocardiograms. Mean 24‐hour, hourly QTc and QTc of the last 10 beats prior to NSVT, consisted of 4–50 cycles (mean

9 ± 10

), at the fastest rates of 100–175 beats/min (mean 122 ± 22) were analyzed. NSVT was more prevalent during nighttime (23 episodes), than during daytime (14 episodes,

P < 0.05

). No significant differences were observed between mean 24‐hour, mean hourly QTc during the hour with NSVT, and QTc of the last 10 cycles prior to onset of NSVT. QTc was significantly longer in patients with a history of sudden cardiac death (SCD) or who died suddenly during follow‐up than in survivors. The 24‐hour QT variability was higher in nonsurvivors than in survivors (

‐39 ± 6

vs

33 ± 6 ms, P = 0.03

). Episodes of NSVT in untreated patients with hypertrophic cardiomyopathy were more frequent during the nighttime. The 24‐hour QT variability was higher in nonsurvivors than in survivors. (PACE 2003; 26[Pt. II]:387–389)
Phantom Validation of Multichannel Magnetocardiography Source Localization
Authors: FENICI RICCARDO , BRISINDA DONATELLA , NENONEN JUKKA , FENICI PETER
Published: December 2004

FENICI, R., et al.: Phantom Validation of Multichannel Magnetocardiography Source Localization.
Multichannel magnetocardiography (MMCG) is used clinically for noninvasive localization of the site of origin of cardiac arrhythmias. However, its accuracy in unshielded environments is still unknown. The aim of this study was to test the accuracy of three‐dimensional localization of intracardiac sources by means of MMCG in an unshielded catheterization laboratory using a saline‐filled phantom, together with a nonmagnetic catheter designed for multiple monophasic action potential recordings in a clinical setting. A nine‐channel direct current superconducting quantum interference device (DC‐SQUID) system (sensitivity fT/Hz0.5) was used for MMCG from 36 points in a measuring area of 20 × 20 cm. The artificial sources to be localized were dipoles embedded in the distal end of the catheter, placed 12 cm below the sensor's plane. Equivalent current dipoles, effective magnetic dipoles, and distributed currents models were used for the inverse solution. The localization error was estimated as the three‐dimensional difference between the physical position of the tip of the catheter and the three‐dimensional localization of the dipoles derived by means of the inverse solution calculated from MMCG data. The reproducibility was tested by repeating the MMCG after repositioning the phantom and the measurement system. The average location error of the catheter dipole was

9 ± 4 mm

and was due primarily to imprecise depth estimation. Localization was reproducible within 0.73 mm. The distributed currents model provided an accurate image of current distribution centered over the catheter tip. The authors conclude that MMCG estimation is accurate enough to guarantee proper localization of cardiac dipolar sources even in an unshielded clinical electrophysiological laboratory. (PACE 2003; 26[Pt. II]:426–430)
Can Simple Doppler Measurements Estimate Interatrial Conduction Time?
Authors: COZMA DRAGOS , KALIFA JEROME , PESCARIU SORIN , LIGHEZAN DANIEL , STIUBEI MARCEL , LUCA CONSTANTIN TUDOR , DEHARO JEAN‐CLAUDE , DJIANE PIERRE , DRAGULESCU STEFAN‐IOSIF
Published: December 2004

COZMA, D., et al.: Can Simple Doppler Measurements Estimate Interatrial Conduction Time?
Prolongation of the interatrial conduction time (ia‐CT) is considered an important factor in the pathophysiology of atrial fibrillation (AF) and as a criterion to perform multisite atrial pacing. Measurement of ia‐CT requires an electrophysiologic study. The aim of this study was to compare echocardiographic with electrophysiologic measurements to determine if they are correlated. Methods and Results: The study included 32 consecutive patients who underwent electrophysiologic studies. We measured ia‐CT between the high right atrium and the distal coronary sinus. In all patients we measured P wave duration, left atrial diameter and area, and ia‐CT by Doppler echocardiography was measured as the difference in time intervals between the QRS onset and the tricuspid A wave, and the QRS onset and the mitral A wave (DT). Ia‐CT was statistically correlated with DT
(r = 0.79, P < 0.0001)
, but not with P wave duration or left atrial dimensions. Conclusions: Measurement DT may be reliable to estimate ia‐CT without invasive procedure. Accordingly, DT could be used as a simple selection criterion when considering patients for atrial resynchronization therapy. (PACE 2003; 26[Pt. II]:436–439)
Evaluation of a Dual Chamber Implantable Cardioverter Defibrillator for the Treatment of Atrial and Ventricular Arrhythmias
Authors: BORIANI GIUSEPPE , WOLLMANN CHRISTIAN , BIFFI MAURO , KÜHL MARTIN , SCHUCHERT ANDREAS , SPERZEL JOHANNES , STILLER SASCHA , GASPARINI GIANNI , BÖCKER DIRK
Published: December 2004

BORIANI, G., et al.: Evaluation of a Dual Chamber Implantable Cardioverter Defibrillator for the Treatment of Atrial and Ventricular Arrhythmias.
Eighty‐nine patients with a documented history of atrial tachyarrhythmias or fibrillation (AF) received a cardioverter defibrillator designed to selectively differentiate and treat atrial and ventricular arrhythmias. Twenty‐two patients received a coronary sinus lead and, therefore, could use a separate shock vector for selective treatment of atrial tachyarrhythmias/AF. The device is designed to treat tachyarrhythmias with antitachycardia pacing (ATP) and/or shock therapy using an atrial and/or a ventricular shock vector. Patients underwent induction and shock termination of atrial or dual tachyarrhythmias (AF/VF) to verify proper device function and to measure the arrhythmia detection time with enhancements and preventive algorithms programmed On and Off, respectively. Detection time for 329 VF inductions was

2.41 ± 0.64  seconds

with enhancements On and

2.29 ± 0.47

with enhancements Off (NS). At implant or predischarge, 283 AF and/or AF/VF (121 atrial and 162 atrial/ventricular fibrillation) were induced. Shock conversion efficacy was 89.8% with AF conversion energies ranging from 0.9 to 27 J. Thirteen of the 23 patients had atrial shock conversions using the separate shock vector with an average conversion energy of

1.9 ± 1.4  J

. (range 0.5–5 J). During follow‐up the efficacy of ATP on atrial tachyarrhythmias was 59% and the efficacy of delivered shocks on AF was 85%. This new dual chamber cardioverter defibrillator appropriately detected and classified atrial arrhythmias, and shock therapy for AF was highly effective. The detection algorithm differentiated atrial tachyarrhythmia/AF and did not delay VF detection. The separate shock vector converted induced AF with energies ranging from 0.6 to 5 J. (PACE 2003; 26[Pt. II]:461–465)
Transfemoral Pediatric Permanent Pacing:
Authors: COSTA ROBERTO , FILHO MARTINO MARTINELLI , TAMAKI WAGNER TETSUJI , CREVELARI ELIZABETH SARTORIO , NISHIOKA SILVANA D'ÓRIO , MOREIRA LUIZ FELIPE PINHO , OLIVEIRA SÉRGIO ALMEIDA
Published: December 2004

COSTA, R., et al.: Transfemoral Pediatric Permanent Pacing: Long‐term Results.
The femoral vein has been used as an alternative conduit to implant pacemakers in children of any weight. Such method associates endocardial pacing and good cosmetics. The aim of this study was to evaluate prospectively, since 1981, the long‐term follow‐up of 99 children, from newborn to 13 years old (average

= 4.1 ± 3.6

years, 56 girls), who underwent the implantation of pacemakers via the femoral vein. Atrioventricular block was present in 88% of patients, of congenital etiology in 39% and postoperative in 54%. Single chamber pacemakers were implanted in 92% of patients. During a mean follow‐up of 5.3 ± 5.0 years (maximum

= 18.2

years), 5 patients died of cardiac causes, 4 of infection, 2 suddenly, and 3 of unknown causes. The 5‐, 10‐ and 15‐year actuarial survival rates were 83.7%, 75.7%, and 75.7%, respectively. Transfemoral leads were used for a mean of 48.9 ± 44.0 months. Reasons for lead explantations were pacing failure in five patients, infection in eight, and elective in nine. The 2‐, 5‐ and 10‐year actuarial survivals of transfemoral leads were 87.6%, 73.8%, and 31.8%, respectively. The mean lead survival was 97 months. Overall, 105 reoperations were performed, 38 for battery depletion, 24 for body growth, 14 for infection or pocket revisions, and 27 for miscellaneous reasons. In conclusion, the durability and overall long‐term performance of transfemoral leads were excellent. (PACE 2003; 26[Pt.II:487–491)
Use of a Modified, Commercially Available Temporary Pacemaker for R Wave Synchronized Atrial Pacing in Postoperative Junctional Ectopic Tachycardia
Authors: JANOUS̆EK JAN , VOJTOVIC̆ PAVEL , ANTONÍN GEBAUER ROMAN
Published: December 2004

JANOUS̆EK, J., et al.: Use of a Modified, Commercially Available Temporary Pacemaker for R Wave Synchronized Atrial Pacing in Postoperative Junctional Ectopic Tachycardia.
Junctional ectopic tachycardia (JET) is a life‐threatening arrhythmia frequently seen after surgical correction of congenital heart defects. This study evaluates the use of a modified, commercially available temporary dual chamber pacemaker used to reestablish AV synchrony by R wave synchronized atrial pacing, a technique not routinely applied because of a lack of appropriate equipment. Ten consecutive children with postoperative JET (median maximum heart rate 185, range 130–240 beats/min) age 0.3–45 (median 5.2) months were studied. R wave synchronized atrial pacing was performed using the VAT mode with inverse connection of the pacing wires (effectively AVT mode), short postventricular atrial refractory period (100 ms), and long AV (effectively VA) delay. AV delay was adjusted to achieve maximum increase in arterial pressure by optimal AV resynchronization. Pacing was successfully applied in all patients for a median period of 29 (range 10–96) hours until tachycardia cessation and led to an immediate increase in systolic, mean, and pulse pressure by

8.9 ± 3.2 (P < 0.001), 8.1 ± 4.0 (P < 0.001)

, and

11.9 ± 7.8% (P < 0.005)
, respectively. Two patients developed pacemaker‐mediated tachycardia, which could be easily stopped by AV (effectively VA) delay prolongation. Atrial flutter was induced in one patient by asynchronous atrial pacing during the VAT (effectively AVT) mode and managed by overdrive pacing. In conclusion, R wave synchronized atrial pacing could be easily performed using a modified, commercially available temporary dual chamber pacemaker. Significant hemodynamic benefit was achieved due to optimal AV resynchronization at intrinsic heart rate and spontaneous ventricular activation sequence. R wave synchronized atrial pacing should be included in the standard management protocol of postoperative JET. (PACE 2003; 26[Pt. I]:579–586)
Paced QT Dispersion and QT Morphology After Radiofrequency Atrioventricular Junction Ablation:
Authors: RAJ SATISH R. , GILLIS ANNE M. , MITCHELL L. BRENT , WYSE D. GEORGE , SHELDON ROBERT S. , EXNER DEREK V. , MORCK MARGARET , DUFF HENRY J.
Published: December 2004

RAJ, S.R., et al.: Paced QT Dispersion and QT Morphology After Radiofrequency Atrioventricular Junction Ablation: Impact of Left Ventricular Function.
Catheter ablation of the atrioventricular junction (AVJ) is a widely accepted treatment for drug refractory atrial fibrillation. Unfortunately, there have been some reports of pause dependent ventricular arrhythmias associated with QT interval prolongation, mainly in patients with reduced LV function. The present investigation evaluates the association of LV function with QT dispersion in response to a sudden rate drop. ECGs were recorded on 20 patients (13 with normal LV function) on the day following AVJ ablation while paced at a range of ventricular rates (40–120 beats/min), and during a sudden drop from 80 to 40 beats/min. The maximum QT interval (QTmax), minimum QT interval (QTmin), and QT interval dispersion (QTdisp) were compared. In both groups, the QTmax and QTmin increased at slower paced heart rates while the QTdisp did not change. In response to a sudden rate drop from 80 to 40 beats/min, the QTmax increased in both groups of LV function (trend), while the QTmin increased in those with normal LV function

(24 ± 22 ms)
, but not in those with reduced LV function(0 ± 14 ms; P = 0.01). Consequently, the QTdisp increased significantly in those with reduced LV function(31 ± 23 ms)but not in normal LV function(−5 ± 29 ms; P = 0.01). Morphological QTU changes developed following the sudden rate drop in 67% of the reduced LV versus 8% of the normalLV (P = 0.02)function groups. Following AVJ ablation, QTdisp increased during a sudden rate drop in patients with reduced LV function, but not in patients with normal LV function. (PACE 2003; 26:662‐–668)
Relationship Among the Severity of Sleep Apnea Syndrome, Cardiac Arrhythmias, and Autonomic Imbalance
Authors: ROCHE FRÉDÉRIC , THANH XUONG ALAIN NGUYEN , COURT‐FORTUNE ISABELLE , COSTES FRÉDÉRIC , PICHOT VINCENT , DUVERNEY DAVID , VERGNON JEAN‐MICHEL , GASPOZ JEAN‐MICHEL , BARTHÉLÉMY JEAN‐CLAUDE
Published: December 2004

ROCHE, F., et al.: Relationship Among the Severity of Sleep Apnea Syndrome, Cardiac Arrhythmias, and Autonomic Imbalance.
The relationship between obstructive sleep apnea syndrome (OSAS), cardiac arrhythmias, and conduction disturbances in adults remains controversial. Early studies showed a higher prevalence than more recent and designed epidemiological studies. To clarify the actual prevalence of cardiac arrhythmias and conduction disturbances in patients referred for assessment of OSAS, a prospective cohort study was conducted: 147 consecutive patients (103 men; mean age of

54.5 ± 10.7

years) underwent time‐synchronized polysomnography and ECG Holter monitoring. OSAS was diagnosed in 66 (44.9%) of them based on an apnea hypopnea index (AHI) ≥10. Prevalence of heart failure, of prior myocardial infarction, of hypertension, and of ventricular arrhythmias were similar in patients with or without OSAS. Nocturnal paroxysmal asystole was significantly more prevalent in OSAS patients

(10.6 vs 1.2%; P < 0.02)

and the number of episodes of bradycardia and pauses increased with the severity of the syndrome. Almost all bradycardic events occurred in patients with severe OSAS (AHI > 30), prolonged periods of arterial oxyhemoglobin desaturation, and low diurnal awake PaO2. Moreover, using heart rate variability analysis, nocturnal sinusal dysfunction contrasted with a blunted diurnal parasympathetic modulation of the sinus node. Frequent nocturnal nonsustained supraventricular tachycardias were predominantly found in patients with severe sleep related breathing disorders; however, an increased risk of ventricular arrhythmias was not found. Under continuous positive airway pressure treatment, the 1‐year follow‐up of OSAS patients with nocturnal pauses did not reveal any arrhythmic event justifying a specific intervention. (PACE 2003; 26:669–677)
Pacemaker Diagnostics:
Authors: POLLAK WAYNE M. , SIMMONS JEFFERY D. , INTERIAN ALBERTO , CASTELLANOS AGUSTIN , MYERBURG ROBERT J. , MITRANI RAUL D.
Published: December 2004

POLLAK, W.M.,

et al

.: Pacemaker Diagnostics: A Critical Appraisal of Current Technology.
Diagnostic information retrieved from a pacemaker offers the ability to improve patient care. Pacemaker diagnostic data provides information regarding pacemaker function and activity, lead function, arrhythmia occurrence, and data to aid in optimal pacemaker programming. Current pacemakers incorporate greater storage capabilities, more efficient means of storing and presenting data between follow‐up visits, and more options for programming diagnostic functions and algorithms. The cardiac rhythm of the paced patient can be evaluated via real‐time intracardiac electrograms at interrogation, surface electrocardiograms, ambulatory electrocardiograms, and by pacemaker stored diagnostic function that may include stored intracardiac electrograms. This article focuses on the various methods of obtaining diagnostic information regarding pacemaker activity, pacemaker function, and diagnostic information on cardiac arrhythmias. The current clinical applicability and limitations of these methods and the use of stored diagnostic data in the clinical follow‐up and study of patients with pacemakers is discussed. (PACE 2003; 26[Pt. I]:76–98)
Long QT Syndrome:
Authors: MILLER RICHARD F. , HALEY MICHAEL W. , LITTMANN LASZLO
Published: December 2004

MILLER, R.F.,

et al

.: Long QT Syndrome: First and Fatal Events Provoked by Hemodialysis.
Long QT syndrome (LQTS) involves both congenital and acquired predispositions toward the characteristic torsades de pointes (TP) ventricular arrhythmia. Congenital long QT syndrome generally manifests with TP, syncope, or sudden death early in life. This is a documented case of previously undiagnosed congenital LQTS in a 48‐year‐old woman where the first and fatal episodes of TP were provoked by hemodialysis. (PACE 2003; 26[Pt. I]:103–104)
Venospasm in Contrast Venography‐Guided Axillary Vein Puncture for Pacemaker Lead Implantation
Authors: CHAN NGAI‐YIN , LEUNG WAI‐SUEN
Published: December 2004

CHAN, N.‐Y., et al.: Venospasm in Contrast Venography‐Guided Axillary Vein Puncture for Pacemaker Lead Implantation.
Venospasm is a recognized complication in right heart catheterization and the reported incidence is 2%. Contrast venography guided axillary vein puncture was a recently described technique for pacemaker lead implantation. This report describes a case of venospasm of the axillary vein during pacemaker implantation. (PACE 2003; 26[Pt. I]:112–113)
The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study
Authors: Gulhas Nurcin , Durmus Mahmut , Demirbilek Semra , Togal Turkan , Ozturk Erdogan , Ersoy M. Ozcan
Published: December 2004

Background: Laryngospasm is the most common cause of upper airway obstruction after tracheal extubation. Magnesium has a central nervous system depressant property, which contributes to the depth of anaesthesia. It also has calcium antagonist properties, which provide muscle relaxation. In this study, we aimed to determine the effect of magnesium on preventing laryngospasm.

Methods: After approval of the Ethics Committee and informed parental consent, 40 patients, ASA I–II, aged 3–12 years, who were scheduled for tonsillectomy or/and adenoidectomy, were randomly divided into two groups. Anaesthesia was induced with sevoflurane, lidocaine 1 mg·kg−1, alfentanil 10 µg·kg−1, vecuronium 0.1 mg·kg−1 and maintained with sevoflurane 2% and 60% nitrous oxide in oxygen. After intubation, patients in group I received 15 mg·kg−1 magnesium in 30 ml 0.9% NaCl over 20 min. Patients in group II received 0.9% NaCl alone in the same volume. After reversal of neuromuscular blockade, all patients were extubated at a very deep plane of anaesthesia. The incidence of laryngospasm was determined until the time of discharge from the postanaesthesia care unit.

Results: Although laryngospasm was not observed in group I, it was observed in five patients in group II (25%). The incidence of laryngospasm in group II was significantly higher than group I. The plasma magnesium concentrations were significantly higher in group I than group II.

Conclusions: We found a significant decrease in the incidence of laryngospasm in paediatric patients receiving magnesium. It is suggested that the use of intravenous magnesium intraoperatively may prevent laryngospasm.
Ventilatory effects of morphine infusions in cyanotic versus acyanotic infants after thoracotomy
Authors: Lynn Anne M. , Nespeca Mary Kay , Bratton Susan L. , Shen Danny D.
Published: December 2004

Background: Previous studies show that the age of an infant affects morphine clearance but that ventilatory effects from morphine infusions are similar at the same morphine steady‐state concentration in infants and children after surgery. The presence of cyanotic heart disease in infants receiving postoperative morphine infusions was studied for its potential effect on ventilatory effort.

Methods: Twenty infants under 90 days of age (10 cyanotic, 10 acyanotic) received morphine intravenous infusions following thoracotomy. PaCO2 during spontaneous breathing, CO2 rebreathing trials during morphine infusions and time to wean from assisted mechanical ventilation after decreasing infusion rates were compared. Analgesia scoring in the first postoperative 24 h was also compared between cyanotic and acyanotic infants.

Results: PaCO2 during spontaneous breathing and CO2 response curve slopes were not different between groups. The time to wean from assisted mechanical ventilation after decreasing morphine infusion rates was not statistically different (median 6.9 h versus 5.8 h in cyanotic and acyanotic, respectively). Median morphine concentrations were higher in cyanotic infants at the time of ventilatory testing (32 versus 20.5 ng·ml−1 in cyanotic versus acyanotic infants, respectively, P = NS). Both groups had good pain relief. Steady‐state morphine clearance rates showed two‐ to three‐fold variability between infants. They were not statistically different in cyanotic versus acyanotic infants but tended to be lower in the cyanotic. Morphine clearance increased significantly with increasing age.

Conclusions: Morphine i.v. infusions given to infants following thoracotomy show the same ventilatory effects in infants with cyanotic heart disease as in acyanotic infants. Age is the more important determinant of morphine response by its effect on morphine clearance than cyanosis in infants aged less than 3 months.
Position dependent ventricular tachycardia in two children with peripherally inserted central catheters (PICCs)
Authors: Hacking Matthew B. , Brown Johanna , Chisholm David G.
Published: December 2004

Summary We report two cases of ventricular tachycardia (VT) in children following the insertion of peripherally inserted central catheters (PICCs). These children had additional procedures requiring turning into the left lateral position after PICC insertion. In both cases sustained VT occurred after turning and flexion of the arm with the PICC. VT was terminated in both cases by withdrawing the catheter.
Anaesthetic management of the child with sickle cell disease
Authors: Marchant Warwick A. , Walker Isabeau
Published: December 2004

Summary Sickle cell disease (SCD) is a relatively common inherited disorder of haemoglobin with significant morbidity and mortality. This review describes the epidemiology and pathophysiology of the disease, and discusses the clinical manifestations found in children with SCD. A discussion of the evidence concerning the perioperative management of such children is presented.
Use of remifentanil in an infant with surgically repaired Shone's syndrome
Authors: Tsiotou A.G. , Matsota P. , Kouptsova E. , Papageorgiou‐Brousta M.
Published: December 2004

We describe the use of remifentanil in an infant with a partially repaired Shone's syndrome who required tendon lengthening because of congenital clubfoot. Remifentanil has unique properties, making it a potentially useful and predictable agent for infants with significant comorbidity.
Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate®) in two extremely low birth weight newborns
Authors: Filippi Luca , Cecchi Alessandra , Dani Carlo , Bertini Giovanna , Pezzati Marco , Rubaltelli Firmino F.
Published: December 2004

Hyperkalaemia is a life‐threatening electrolyte disorder that can occur in the first week of life in almost 50% of preterm infants with a birth weight less than 1000 g [extremely low birth weight (ELBW)]. Serum potassium values higher than 7 mmol·l−1 are associated with cardiac arrhythmias and an increased incidence of intraventricular haemorrhage and periventricular leucomalacia. Therapeutic options to treat this dangerous imbalance comprise calcium gluconate, insulin plus glucose, albuterol/salbutamol inhalation. Administration of cation‐exchange resin such as sodium polystyrene sulphonate (Kayexalate®) is effective in lowering plasma potassium, although complications following oral or rectal administration are reported in newborns. We describe two ELBW infants affected by hyperkalaemia, treated with Kayexalate, who developed serious hypernatraemia, that has never been reported before in preterm infants.
Gastric insufflation pressure, air leakage and respiratory mechanics in the use of the laryngeal mask airway (LMATM)in children
Authors: Wahlen B.M. , Heinrichs W. , Latorre F.
Published: December 2004

Background : The objective of the present study was to evaluate the prelaryngeal position of the laryngeal mask airway (LMATM) in children, and to determine the influence of mask positioning on gastric insufflation and oropharyngeal air leakage.

Methods : A total of 100 children, 3–11 years old, scheduled for surgical procedures in the supine position under general anaesthesia were studied. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 30 cmH2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using a flexible bronchoscope.

Results : The insertion of the LMA with a clinically satisfactory position was achieved in all patients at the first attempt. Gastric air insufflation occurred in five of 49 patients with malpositioned LMA. No incident of gastric air insufflation was observed in 51 patients with correctly positioned LMA. The minimum inspiratory pressure leading to mask leakage was 17 cmH2O for incorrectly positioned LMA, and 25 cmH2O for correctly positioned LMA. Clinically unrecognized LMA malposition was associated with a significantly increased incidence of either oropharyngeal leakage (r = 0.59; P = 0.0001) or gastric insufflation (r = 0.25; P = 0.01).

Conclusions : Clinically undetected LMA malpositioning is a significant risk factor for gastric air insufflation in children between 3 and 11 years, undergoing positive pressure ventilation, especially at inspiratory airway pressures above 17 cmH2O.