bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's views of the cervical smear test: implications for nursing practice — women who have had a smear test
Authors: McKie Linda
Published: July 2003

This is the second of two papers reporting the findings of a study on the views of women with regards to the cervical smear test In the first paper (vol 18, no 6), the views of those who have not had a smear test were analysed In this paper, the views of women who have had a smear test are identified and analysed The implications of those views for nursing practice in primary health care are explored Conducted in 1989–1990, the ESRC‐funded study was located in the north‐east of England and drew respondents from two age groups living in working‐class localities Focusing upon the views of women who have had a smear test, a number of conclusions are evident (a) that a high proportion of respondents were screened opportunistically, (b) that negative views of the service concerned fear and embarrassment and the lack of, or inadequacy of, an explanation, (c) that positive aspects of the service were staff attitudes, convenience and familiarity, and (d) an understanding of the cytology process and the aetiology of cervical cancer was not linked to the level of (non) involvement in the screening service Thus the organization and delivery of the service might be reviewed However, the negative views pose a number of problems that must be further explored through primary health care work encompassing all community‐based health professionals
The role of quality assurance in future midwifery practice
Authors: Dawson Jane
Published: July 2003

Recent recommendations have been made which would give midwives a more central role in maternity care and a greater degree of independence than they currently enjoy This paper argues that midwives’ current attitudes to quality assurance are incompatible with this enhanced role Research conducted in three health districts is described, which explored the perceptions of nurses, midwives and managers towards quality assurance The findings indicate that quality assurance (in whatever form that concept is operationalized) is a demonstration of accountability For managers this accountability is primarily for the service as a whole, whilst nurses and midwives view their accountability as being owed to patients/clients The main methodology which the study identified as being used for monitoring nursing care was the development and auditing of explicit standards This approach has been actively promoted by the Royal College of Nursing, enabling nurses to regain control of the purely professional aspects of the nursing profession Midwives in the study districts showed a marked reluctance to adopt such a strategy, taking the view that as independent practitioners consensus standards would be unacceptable It is argued that this attitude is inconsistent with the basic principle that professionals are accountable for both demonstrating and developing the quality of professional practice It is further suggested that midwives currently have an opportunity to regain professional control of midwifery practice, which will be lost unless they are prepared to take responsibility for evaluating the standards for which they are accountable
A nursing model in action: the University of British Columbia experience
Authors: Thorne Sally , Jilings Carol , Ellis Donelda , Perry JoAnn
Published: July 2003

At the University of British Columbia (UBC) School of Nursing, a model building challenge in the early 1970s launched 2 decades of model development and application projects In this paper, selected creative applications will illustrate the utility of a nursing model beyond its explicit direction for clinical practice decision‐making The UBC Model for Nursing had been applied as a basis for curriculum development and teaching strategies in a baccalaureate programme as well as a foundation for nursing administrative decisions in a variety of clinical agencies
The treatment and security needs of special‐hospital patients: a nursing perspective
Authors: Burrow Stephen
Published: July 2003

Psychiatric nurses who are key workers or primary nurses within special hospitals are well placed to comment on their patients’ needs and the benefits, and shortfalls, of trying to meet these within a maximum‐security environment In this survey, nurse respondents gave information on two groups of special‐hospital clients, though they themselves were unaware of any group differentiation Those who were not seen as requiring continued care within maximum security, as judged by other team investigators, were conceptualized by the researcher as ‘leavers’ The survey revealed that in relation to those continuing to require maximum security — the ‘stayers’—‘leavers’ retained exceptionally high levels of deficits related to their potential for community reintegration Deficits in cognitive, social and life skills were as prevalent among those considered to need lower levels of security, and closer contact with the community, as those remaining within the special‐hospital service It also became clear that the effective management of special‐hospital residents demanded a necessary conflict of interests client‐centred flexibility within the constraints of secure custody There were also inconsistent features between the hospitals, as was shown in the differential provision of parole for patients Only the survey sample from Broadmoor had access to this important resource The conclusion is that, with the special hospitals’ unequivocal commitment to maintain security, not all treatment and security needs of patients are appropriately met Certain opportunities should, perhaps, be provided within new, alternative facilities
Discovery of the discharge process: a study of patient discharge from a care unit for elderly people
Authors: Jewell Sarah E
Published: July 2003

Patient discharge is not a new research topic Numerous studies have shown patients do not always receive the services they need on leaving hospital The purpose of this study was to examine the process of discharge and move away from the snapshot study of discharge outcomes Interviews were undertaken with elderly patients, their carers and the hospital and community staff involved in their care A content analysis of the data revealed a distinctive discharge process which started with admission and ended with the patient leaving hospital Discharge planning was highlighted as a separate component of this process A number of examples are examined of how vulnerable to breakdown patient discharge can be
Rust out and therapeutic reciprocity: concepts to advance the nursing care of older people
Authors: Nolan Mike , Grant Gordon
Published: July 2003

This paper considers the issue of the quality of nursing care for frail elderly patients in continuing‐care environments The continued failure to raise the standards of such care is explored and potential explanations sought It is argued that the application of models of nursing do not represent the best solution and that there is a need for a fundamental re‐appraisal of sources of job satisfaction for nurses working with such patients Using the results of an evaluation of a respite care service two concepts,‘rust out’ and ‘therapeutic reciprocity', are identified as offering the basis for future research, education and practice developments in this field
Incidence of endomycoses in autopsy material*
Authors: Tietz H.‐J. , Martin H. , Koch S.
Published: July 2003

Summary. From 1970 to 1993, 93 endomycoses confirmed by postmortem examination were diagnosed in the autopsy material of the Berlin Charite´, a large hospital with an average of 1,500 Hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.5%), five cryptococcoses (5.4%), one zygomycosis, one trichosporosis and one coccidioidomycosis. This corresponded to 0.7% of the 13,275 deceased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis: 11 candidoses (39.3%), 10 aspergilloses (35.7%) five cryptococcosis (17.8%), one trichosporosis and one coccidioidomycosis. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. The observations made in the present paper underscore the importance of clinical autopsy in endomycoses.
Clinical significance of lipoprotein(a) in carotid plaque types and ischemic stroke in the elderly
Authors: Iwamoto Toshihiko , Feng Yi , Shinozaki Kazushi , Koyama Shun‐ichi , Oyama Tetsuo , Takasaki Masaru
Published: July 2003

Background:  The relationship between lipoprotein(a) (Lp(a)) and ischemic stroke is still controversial in the elderly. The purpose of the present paper was to evaluate the significance of Lp(a) in the development of extracranial carotid lesions and ischemic stroke.

Methods:  A total of 371 elderly subjects, studied with carotid ultrasonography (US) and brain computed tomography (CT), was stratified into two groups according to serum Lp(a) levels: the normal Lp(a) and high Lp(a) (>40 mg/dL) groups. Carotid plaques were divided into three types based on the US echogenicity: hypoechoic, hyperechoic, and heterogeneous plaques. Low‐density areas (LDA) on brain CT images were classified into three groups depending on their distribution: basal ganglionic, cortical and only leuko‐araiosis types.

Results:  The incidence of bilateral carotid lesions and the ratios of hypoechoic and heterogeneous plaques were significantly higher in the high Lp(a) group than in the normal Lp(a) group. Both the mean height and length of plaque were also greater in the high Lp(a) group. Mean Lp(a) levels were significantly elevated in cases with hypoechoic and heterogeneous types, compared to the cases without lesions. Higher mean Lp(a) levels were seen in cases with any kind of LDA than in normal subjects on CT, but there was no significant difference in the incidence of each LDA between the two groups.

Conclusions  These findings indicate that serum Lp(a) is strongly related to carotid lesions, especially hypoechoic and heterogeneous plaque types, in Japanese elderly patients. This suggests that Lp(a) could promote the formation of lipid‐rich atheromatous plaque with intraplaque hemorrhage or superimposed thrombi. Serum Lp(a) also seemed to be a risk for all types of LDA.
Improved reversal learning and altered fear conditioning in transgenic mice with regionally restricted p25 expression
Authors: Angelo Marco , Plattner Florian , Irvine Elaine E. , Giese K. Peter
Published: July 2003

Cleavage of the cyclin‐dependent kinase 5 activator p35 generates the protein fragment p25, which accumulates in the forebrain of patients with Alzheimer's disease. Although p25 expression has been suggested to affect learning and memory, this hypothesis has not been tested to date. To investigate the role of p25 in hippocampus‐dependent learning and memory we have generated transgenic mice expressing p25 preferentially in postnatal forebrain. p25 expression was highest in hippocampus where it averaged approximately 33% of endogenous p35 expression. This low level of p25 expression did not seem to result in hyperphosphorylation of tau, but increased the phosphorylation of neurofilament M and enhanced the expression of tau protein. These molecular changes did not correlate with neurodegeneration or motor abnormalities. In the Morris water maze the p25 mutants were normal in learning an initial platform location, but surprisingly reversal learning was improved when the platform position was changed. The p25 mutants were normal in contextual fear conditioning. However, when trained with a tone presentation the mutants showed reduced contextual conditioning and enhanced tone fear conditioning. We conclude that low p25 expression has pleiotropic effects on learning and memory. As p25 expression can improve learning and memory, p25 formation could be a compensatory mechanism for learning and memory deficits in Alzheimer's disease.
Enabling role of adenosine A1receptors in adenosine A2Areceptor‐mediated striatal expression ofc‐fos
Authors: Karcz‐Kubicha Marzena , Quarta Davide , Hope Bruce T. , Antoniou Katerina , E. Müller Christa. , Morales Marisela , Schindler Charles W. , Goldberg Steven R. , Ferré Sergi
Published: July 2003

When striatal neurons are strongly activated they produce adenosine, which activates nearby adenosine A1receptors (A1Rs) and adenosine A2Areceptors (A2ARs). Although the effects of A1R or A2AR activation on neural activity in the striatum have been examined separately, the effects of coactivating both receptors has not been investigated. Using c‐Fos immunohistochemistry as an indicator of neural activity, we examined the effects of coactivation of A1Rs and A2ARs on neural activity and their mechanism of interaction in the caudate‐putamen, nucleus accumbens (NAc) and prefrontal cortex in rats. Administration of a motor‐depressant dose of the A2AR agonist CGS 21680 (0.5 mg/kg i.p.) did not significantly inducec‐fosexpression in any of these brain regions. Administration of a motor‐depressant dose of the A1R agonist CPA (0.3 mg/kg, i.p.) produced a small but significant induction ofc‐fosexpression only in the shell of the NAc. Coadministration of CGS 21680 and CPA produced a synergistic induction ofc‐fosexpression in the caudate‐putamen, cingulate cortex, and especially the NAc. In the shell of the NAc administration of CPA significantly decreased extracellular dopamine levels measured byin vivomicrodialysis and blocked CGS 21680‐induced increases in dopamine levels. Because it has been previously shown that activation of dopamine D2receptors (D2Rs) by endogenous dopamine blocks A2AR‐mediatedc‐fosexpression, it is hypothesized that the enabling role of A1Rs in A2AR‐mediated striatalc‐fosexpression is related to the A1R‐mediated inhibition of dopamine release.
Task‐dependent intermanual coupling of 8‐Hz discontinuities during slow finger movements
Authors: Evans Clary M. B. , Baker Stuart N.
Published: July 2003

During slow finger movements, small discontinuities are visible at approximately 8–10 Hz. We have recorded from eight normal subjects whilst they performed index finger flexion–extension movements with the left and right hand. Movements were either performed in‐phase (both fingers flexing or extending together), or anti‐phase (flexion on one side coinciding with extension on the other). Coherence calculated between left and right finger velocity was significantly above zero at approximately 8 Hz for the in‐phase condition, but was significantly smaller for anti‐phase movements (mean coherence across all subjects at 8.7 Hz was 0.031 for in‐phase, 0.010 for anti‐phase). We also calculated a ‘phase coherence’ measure which, unlike conventional coherence analysis, was sensitive only to phase synchronization and not to amplitude co‐variations. For the in‐phase task, phase coherence values were smaller than coherence, but still significantly different from zero around 8 Hz; for the anti‐phase task, phase coherence was not significant in this band. Measures calculated from EMG recordings yielded similar conclusions to those using finger velocity, indicating that the results were not simply due to mechanical cross‐talk. Neural oscillators generating approximately 8‐Hz movement discontinuities on each side of the body are therefore selectively coupled during the in‐phase task. A wavelet‐based analysis further suggested that intermanual coupling modulated during in‐phase task performance; coupling was maximal at the start and the end of a movement. We conclude that the systems producing approximately 8‐Hz movement discontinuities and those responsible for intermanual coupling are likely to share common neural elements.
Cell type‐dependent expression of HCN1 in the main olfactory bulb
Authors: Holderith Noémi B. , Shigemoto Ryuichi , Nusser Zoltan
Published: July 2003

In many brain regions, hyperpolarization‐activated cationic currents (Ih) are involved in the generation of rhythmic activities, but the role of Ih in olfactory oscillations remains unclear. Knowledge of the cellular and subcellular distributions of hyperpolarization‐activated and cyclic nucleotide‐gated channel (HCN) subunits is necessary for understanding the role of Ih in olfactory network activities. Using light microscopic immunocytochemistry, we demonstrate strong HCN1 labelling of the glomerular layer and moderate staining of granule cell, internal and external plexiform layers of the rat main olfactory bulb. In the glomerular layer, among many unlabelled neurons, two distinct subpopulations of juxtaglomerular cells are labelled. Approximately 10% of the juxtaglomerular cells strongly express HCN1. These small diameter cells are immunoreactive for GABA and comprise a subpopulation of periglomerular cells. An additional subset of juxtaglomerular cells (≈ 1%) expresses low levels of HCN1. They are large in diameter, GABA immunonegative but immunopositive for vesicular glutamate transporter 2, characterizing them as external tufted cells. Quantitative immunogold localization revealed that the somatic plasma membranes of periglomerular cells contain approximately four times more HCN1 labelling than those of external tufted cells. Unlike in cortical pyramidal cells, immunogold density for HCN1 does not significantly differ in somatic and dendritic plasma membranes of external tufted cells, indicating that post‐synaptic potentials arriving at proximal and distal dendrites are modulated by the same density of Ih. Our results demonstrate a cell type‐dependent expression of HCN1 in the olfactory bulb and predict a differential contribution of distinct juxtaglomerular cell types to network oscillations.
Repeated withdrawal from ethanol impairs acquisition but not expression of conditioned fear
Authors: Ripley T. L. , O'Shea M. , Stephens D. N.
Published: July 2003

Repeated withdrawal from ethanol impairs acquisition of conditioned fear [Stephens, D.N., Brown, G., Duka, T. & Ripley, T.L. (2001) Eur. J. Neurosci., 14, 2023–2031]. This study further examined the effect of repeated withdrawal from ethanol on the expression and acquisition of fear conditioning. Following training, presentation of a cue associated with footshock (CS+) resulted in a suppression of operant responding for food reinforcement. In different groups, shock thresholds were manipulated to give weak or severe behavioural suppression. Rats were subsequently chronically treated with ethanol‐containing liquid diet either continuously (single withdrawal) or with three withdrawal periods (repeated withdrawal). Ethanol treatment and withdrawal had no effect on conditioned suppression of responding tested 2 weeks after the final withdrawal, at either shock intensity. Nevertheless, extinction of conditioned fear was impaired in the repeated withdrawal group exposed to the higher shock intensity. In the high intensity group, the stimulus–shock association was then reversed, so that the previously neutral conditioned stimulus (CS–) became the CS+. Acquisition of suppression to the new CS+ was significantly less in the animals previously given repeated experience of withdrawal, confirming our previous finding. Thus, repeated withdrawal from ethanol lead to disruption in the acquisition of fear conditioning but had no effect on retrieval of an association formed prior to the ethanol‐withdrawal experiences.
Visual receptive field properties of neurons in the caudate nucleus
Authors: Nagy Attila , Eördegh Gabriella , Norita Masao , Benedek György
Published: July 2003

Visual single‐unit activity was recorded in the caudate nucleus of halothane‐anaesthetized, immobilized, artificially respirated cats. Visually sensitive neurons were found in the dorsolateral part of the caudate body. A majority of the units responded optimally to small spot‐like stimuli moving with velocities between 30 and 120 °/s. The receptive field of these units is large: it covers a major part of both the contra‐ and ipsilateral visual hemifields. No signs of retinotopy were observed. Most of the neurons display directional selectivity and are narrowly tuned to the direction of the moving stimulus. These physiological properties are consistent with recent morphological results that reveal multiple connections of the caudate nucleus with the superior colliculus through tecto‐extrageniculo‐thalamic pathways in the mammalian brain.
Unilateral dorsal column and rubrospinal tract injuries affect overground locomotion in the unrestrained rat
Authors: Webb Aubrey A. , Muir Gillian D.
Published: July 2003

The purpose of this study was to determine the importance of the rubrospinal pathway and the ascending components of the dorsal column for overground locomotion in adult, unrestrained rats. The dorsal column (excluding the corticospinal tract), the rubrospinal tract or both were damaged unilaterally in rats at the level of the upper cervical spinal cord. Behavioural analysis consisted of skilled locomotion (an evaluation of footslips during ladder walking), a paw usage task and the assessment of ground reaction forces during unrestrained locomotion. All lesioned animals used the forepaw ipsilateral to the lesions less while rearing. Animals with dorsal column injuries used the forelimb contralateral to the spinal injury significantly more while rearing compared with uninjured animals. All lesioned animals produced more footfalls while crossing the ladder compared with uninjured animals. All injuries, regardless of the pathway affected, resulted in significant alterations in body weight support and reduced braking forces from the forelimb ipsilateral to the injury during overground locomotion. Animals typically bore less weight on the hindlimb ipsilateral to the lesion compared with the hindlimb contralateral to the spinal injury. Taken together with previously published work, our data indicate that the rubrospinal and dorsal column pathways are important for forelimb support while rearing and for skilled locomotion. Additionally, the ascending dorsal column pathways and the rubrospinal tract play a role during flat surface overground locomotion and combined damage to these pathways does not alter the acquired gait.
Identification of circadian brain photoreceptors mediating photic entrainment of behavioural rhythms in lizards
Authors: Pasqualetti Massimo , Bertolucci Cristiano , Ori Michela , Innocenti Augusto , Magnone Maria C. , De Grip Willem J. , Nardi Irma , Foà Augusto
Published: July 2003

We have shown previously that in ruin lizards (Podarcis sicula) the ablation of all known photoreceptive structures (lateral eyes, pineal and parietal eye) in the same individual animal does not prevent entrainment of their circadian locomotor rhythms to light. The present study was aimed at identifying the circadian brain photoreceptors mediating entrainment. For this purpose, we looked for opsin expression in the brain by means of immunocytochemistry. Using anti‐cone‐opsin antiserum CERN 874 we have localized photoreceptors in the periventricular area of hypothalamus, near the third cerebral ventricle. We also cloned a brain opsin cDNA that, on the basis of the deduced amino acid sequence, appears to belong to the RH2 class of cone‐opsins. We named the cloned cone‐opsin Ps‐RH2. To examine whether brain cone‐opsins mediate photic entrainment of circadian locomotor rhythms, we performed post‐transcriptional inactivation experiments by injecting an expression eukaryotic vector transcribing the antisense cone‐opsin Ps‐RH2 mRNA in the third cerebral ventricle of pinealectomized–retinectomized lizards previously entrained to a light–dark (LD) cycle. Injections of the antisense construct abolished photic entrainment of circadian locomotor rhythms of pinealectomized–retinectomized lizards to the LD cycle for 6–9 days. CERN 874 completely failed to label cells within the periventricular area of hypothalamus of brains injected with antisense construct. Thus, abolishment of photic entrainment is due to inactivation of endogenous brain cone‐opsins mRNA. The present results demonstrate for the first time in a vertebrate that brain cone‐opsins are part of a true circadian brain photoreceptor participating in photic entrainment of behavioural rhythms.
Subcellular distribution of L‐type Ca2+ channels responsible for plateau potentials in motoneurons from the lumbar spinal cord of the turtle
Authors: Simon Magda , Perrier Jean‐François , Hounsgaard Jørn
Published: July 2003

L‐type calcium channels mediate the persistent inward current underlying plateau potentials in spinal motoneurons. Electrophysiological analysis shows that plateau potentials are generated by a persistent inward current mediated by low threshold L‐type calcium channels located in the dendrites. As motoneurons express L‐type calcium channels of the CaV1.2 and CaV1.3 subtypes, we have investigated the subcellular distribution of these channels using antibody labelling. The plateau generating a persistent inward current is modulated by the activation of metabotropic receptors. For this reason, we also examined the relationship between CaV1.2 and CaV1.3 subunits in motoneurons and presynaptic terminals labelled with antibodies against synapsin 1a. Motoneurons in the spinal cord of the adult turtle were identified as large neurons, immunopositive for choline acetyltransferase, located in the ventral horn. In these neurons, CaV1.2 subunits were present in the cell bodies and axons. Patches of CaV1.3 subunits were seen in association with the cell membrane of the somata and both the proximal and distal dendrites. Double labelling with an antibody against synapsin 1a showed that CaV1.3 subunits, but not CaV1.2 subunits, were always located at synaptic sites. The distribution of CaV1.2 and CaV1.3 strongly suggests that the persistent inward current underlying plateau potentials in spinal motoneurons is mediated by CaV1.3 and not by CaV1.2. Our findings also show that CaV1.3 may be located in the somatic and dendritic membrane adjacent to particular presynaptic terminals.
Closed‐Loop Stimulation Using Intracardiac Impedance as a Sensor Principle: Correlation of Right Ventricular dP/dtmax and Intracardiac Impedance During Dobutamine Stress Test
Authors: OSSWALD S. , CRON T. , GRÄDEL C. , HILTI P. , LIPPERT M. , STRÖBEL J. , SCHALDACH M. , BUSER P. , PFISTERER M.
Published: July 2003

OSSWALD, S., et al.: Closed‐Loop Stimulation Using Intracardiac Impedance as a Sensor Principle: Correlation of Right Ventricular dP/dtmax and Intracardiac Impedance During Dobutamine Stress Test. Changes of the unipolar right ventricular impedance during the cardiac cycle are related to the changing content of blood (low impedance) and tissue (high impedance) around the tip of the pacing electrode. During myocardial contraction, the impedance continuously increases reaching its maximum in late systole. This impedance increase is thought to correlate with right ventricular contractility, and thus, with the inotropic state of the heart. In the new Inos2 DDDR pacemaker, integrated information from the changing ventricular impedance (VIMP) is used for closed‐loop regulation of the rate response. The aim of this study was to analyze the effect of increasing dobutamine challenge on RV contractility and the measured impedance signals. In 12 patients (10 men, 68 ± 12 years) undergoing implantation of an Inos2 DDDR pacemaker (Biotronik), a right ventricular pigtail catheter was inserted for continuous measurements of RV‐dP/dtmax and simultaneous VIMP signals during intrinsic and ventricular paced rhythm. Then, a stress test with a stepwise increase of intravenous dobutamine (5–20 μg/kg per min) was performed. To assess the relationship between RV contractility and measured sensor signals, normalized values of dP/dtmax and VIMP were compared by linear regression. There was a strong and highly significant correlation between dP/dtmax and VIMP for ventricular paced (r2= 0.93) and intrinsic rhythm (r2= 0.92), although the morphologies of the original impedance curves differed quite substantially between paced and intrinsic rhythm in the same patient. Furthermore, VIMP correlated well with sinus rate (r2= 0.82), although there were at least four patients with documented chronotropic incompetence. We conclude, that for intrinsic and ventricular paced rhythms sensor signals derived from right ventricular unipolar impedance curves closely correlate with dP/dtmax, and thus, with a surrogate of right ventricular contractility during dobutamine stress testing. Our results suggest that “inotropy‐sensing” via measurement of intracardiac impedance is highly accurate and seems to be a promising sensor principle for physiological rate adaptation in a closed‐loop pacing system.
Heart Rhythm During Syncope and Presyncope: Results of Implantable Loop Recorders
Authors: NIEROP PETER R. , VAN MECHELEN ROB , VAN ELSÄCKER ANDRÉ , LUIJTEN RONALD H.M. , ELHENDY ABDOU
Published: July 2003

NIEROP, P.R., et al.: Heart Rhythm During Syncope and Presyncope: Results of Implantable Loop Recorders. Ambulatory ECG monitoring in patients with recurrent syncope is nondiagnostic in the majority of cases. Recently, an ECG implantable loop recorder (ILR) has been introduced. The ILR performs continuous ECG monitoring over a period of at least 14 months. From February 1997 to September 1999, 35 patients underwent implantation of an ILR. During a mean follow‐up of 11 ± 8 months, 24 (69%) patients had recurrent syncope or presyncope events. Four (11%) patients were not capable of activating the ILR to save the event. A symptom‐rhythm correlation could be studied in 20 (83%) of 24 patients. Forty of 44 recurrences were captured by the ILR. There were 14 (40%) patients with at least one syncopal episode. An arrhythmic cause for syncope was found in eight of them (bradycardia in four and tachycardia in four). In the other six patients the heart rhythm was normal. In 17 (49%) patients with 1‐year follow‐up, the mean syncope event rate 12 months before ILR implantation was 4.7 ± 2.4, whereas the mean syncope event rate 12 months after ILR implantation was 1.3 ± 0.7 (P < 0.01). Resolution of symptoms was observed in 6 (17%) patients. These patients were significantly younger than patients without resolution (50 ± 18 vs 69 ± 14 years, p < 0.01) and five were women. Three (9%) patients died during follow‐up, all of them were noncompliant during their follow‐up. In conclusion, the ILR made symptom—rhythm correlation possible in 83% of patients with recurrent syncope. Syncope recurrences decreased significantly after implantation of the device, especially in the younger patients. Noncompliant patients had a high mortality rate.
Long‐Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators
Authors: UNTERBERG CHRISTINA , STEVENS JENS , VOLLMANN DIRK , HASENFUß G. , BUCHWALD ARND B.
Published: July 2003

UNTERBERG, C., et al.: Long‐Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators. Inappropriate therapy by ICDs due to SVTs is an important problem. A third generation ICD with a new detection criterion (“EGM width criterion”) for differentiation of SVTs and VTs by measuring the width of the intracardiac EGM was studied in 47 patients. A wide EGM was defined as the longest measured EGM plus 4–12 ms (programmed as EGM width threshold). EGM width detection function was programmed to the “Passive” mode so that no therapy was withheld. During a follow‐up of 29.9 ± 8.3 (12–45) months, 489 spontaneous episodes were analyzed. SVTs occurred in ten patients with 305 episodes; 301 were correctly classified by use of the new detection criterion. In four patients four episodes were incorrectly detected as wide QRS tachycardias. Thus specificity for SVT was 98.7% (on a per episode basis) and 60% on a per patient basis. Of 184 VTs in 23 patients, 118 episodes were correctly classified (19 patients), however, in 4 patients 66 VTs were falsely detected as SVTs, 62 (94%) of which occurred in 1 patient with complete left BBB and continuously increasing QRS width in 12‐lead surface ECGs. Overall sensitivity (on a per episode basis) for VT detection was 64.1% and 96.7% in patients with stable width of the QRS complex in a 12‐lead surface ECG. These data show that this criterion is not superior to data on rate dependent detection criteria and furthermore not applicable in patients with complete BBB.
Autonomic Nervous System‐Controlled Cardiac Pacing: A Comparison Between Intracardiac Impedance Signal and Muscle Sympathetic Nerve Activity
Authors: BINGGELI CHRISTIAN , DURU FIRAT , CORTI ROBERTO , SUDANO ISABELLA , SPIEKER LUKAS E. , TURINA ANDREAS , WESTERMANN PATRICK , OSTERMEIER MARTIN , RAHN MARIETTE , LÜSCHER THOMAS F. , NOLL GEORG , CANDINAS RETO
Published: July 2003

BINGGELI, C., et al.: Autonomic Nervous System‐Controlled Cardiac Pacing: A Comparison Between Intracardiac Impedance Signal and and Muscle Sympathetic Nerve Activity. A recently introduced rate responsive cardiac pacing system is based on information derived from the intracardiac impedance signal containing information on the inotropic state of the ventricle. This study compared the inotropic state index (ISI) with muscle sympathetic activity (MSA), both being modulated by the autonomic nervous system. Nine patients (66 ± 3 years, mean ± SEM) with Inos2DR pacemakers were included. Each patient was studied at rest and during cold pressor test (CPT). Microneurography of the peroneal nerve was performed to measure MSA continuously, which was digitally stored along with continuous surface ECG and blood pressure. The intracardiac impedance signal was transmitted by the pacemaker and stored simultaneously. Linear correlation between ISI and MSA was calculated for the period of the CPT. During CPT, mean systolic blood pressure increased from 122 ± 4 to 149 ± 6 mmHg (P < 0.0001), diastolic blood pressure increased from 74 ± 8 to 86 ± 4 mmHg(P = 0.02), and intrinsic heart rate increased from 69 ± 7 to 75 ± 7 beats/mill (P = 0.019). ISI increased by 21 ± 7% (P = 0.018), MSA by 26 ± 6% (P = 0.004). ISI and MSA were positively correlated during the CPT in eight of nine patients (R2 = 0.86–0.99, P < 0.0001). Negative correlation was found in one patient (R2 = 0.94). This study demonstrates parallel increases of the ISI and MSA during CPT. ISI and MSA showed a close linear relationship during provoked changes of sympathetic activity. These results provide further evidence that the sympathetic nervous system is responsible for the observed ISI changes.
Determination of Pacing Capture in Implantable Defibrillators: Benefit of Evoked Response Detection Using RV Coil to Can Vector
Authors: SPLETT VINCENT , TRUSTY JANE M. , HAYES DAVID L. , FRIEDMAN PAUL A.
Published: July 2003

SPLETT, V., et al.: Determination of Pacing Capture in Implantable Defibrillators: Benefit of Evoked Response Detection Using RV Coil to Can Vector. Automatic detection of capture in ICDs would be useful for ensuring normal pacing function and lead integrity and may increase device longevity. Evoked response detection can be difficult due to postpace polarization. Polarization on the RV coil to can vector, however, should be absent when pacing with a true bipolar lead (pace tip to ring). Polarization on the RV coil to can vector should be low in an integrated bipolar lead due to the large surface area of the coil. Ventricular‐paced responses were prospectively recorded in 20 patients during ICD implantation or replacement. Capture and loss of capture responses were noted during threshold searches with electrograms recorded between the RV coil and can. A detector was designed to discriminate between capture and noncapture‐paced responses using data from the first 11 patients and validated on the remaining 9. The detector had a sensitivity of 99.9% (detected capture on capture beats), and had a specificity of 100% (detected no capture on noncapture beats) for all lead configurations. There was no measurable polarization with true bipolar leads. In integrated bipolar leads, maximum polarization ranged from 0.0 to 16.7mV. In conclusion, paced evoked responses can be detected in ICDs using the RV coil to can vector using standard pacing waveforms. Special polarization reducing pacing waveforms are not required. These observations could be used to design ICDs with automatic pacing threshold detection.
Clinical Predictors and Efficacy of Antitachycardia Pacing in Patients with Implantable Cardioverter Defibrillators: The Importance of the Patient's Sex
Authors: PETERS ROBERT W. , ZHANG XIAOZHENG , GOLD MICHAEL R.
Published: July 2003

PETERS, R.W., et al.: Clinical Predictors and Efficacy of Antitachycardia Pacing in Patients with Implantable Cardioverter Defibrillators: The Importance of the Patient's Sex. The ICD has become accepted as primary therapy for malignant ventricular arrhythmias. The incorporation of antitachycardia pacing into ICDs has provided a better tolerated alternative to shocks but has the potential disadvantage of delaying definitive therapy. Accordingly, we sought to delineate the characteristics of patients likely to experience unsuccessful termination of pacing and to identify ineffective pacing strategies. Of 519 patients who received ICDs, 11 clinical and tachycardia characteristics in the 162 who received antitachycardia pacing therapy for sustained ventricular arrhythmias were evaluated. Tachycardia episodes were grouped according to outcome of pacing (successful, unsuccessful, acceleration). Of 1,946 episodes, 1,502 (77.2%) were successfully reverted with pacing, 322 (16.5%) were unsuccessful, and 121 (6.2%) were accelerated. Antitachycardia pacing was less successful in women, patients with a history of myocardial infarction, those with more severe left ventricular dysfunction, those who received antiarrhythmic drugs, and those programmed to ramp pacing. Tachycardia acceleration was inversely related to tachycardia cycle length and was more frequent in patients programmed to more aggressive ramp pacing protocols. Women had an almost threefold incidence of tachycardia acceleration compared with men (14% vs 5%, P < 0.001). Antitachycardia pacing is generally successful in terminating ventricular tachycardia and has a low incidence of tachycardia acceleration. Caution should be used with rapid tachycardias and aggressive ramp pacing protocols because of an increased risk of acceleration. Antitachycardia pacing appears less successful and has a higher incidence of complications in women.
Brugada Syndrome: A Case Report of Monomorphic Ventricular Tachycardia
Authors: BOERSMA LUCAS V.A. , JAARSMA WYBREN , JESSURUN EMILE R. , VAN HEMEL NORBERT H.M. , WEVER ERIC F.D.
Published: July 2003

BOERSMA, L.V.A., et al.: Brugada Syndrome: Monomorphic Ventricular Tachycardia. A 56‐year‐old woman without structural heart disease had an ECG typical of Brugada syndrome. Syncope occurred due to monomorphic VT with left bundle branch block (LBBB) morphology. At electrophysiological study, VT with the same morphology was inducible.
Spatial Aspects of Ventricular Repolarization in Postinfarction Patients
Authors: DILAVERIS POLYCHRONIS , GIALAFOS ELIAS , PANTAZIS ANTONIOS , SYNETOS ANDREAS , TRIPOSKIADIS FILIPPOS , STAMATELOPOULOS STAMATIOS , GIALAFOS JOHN
Published: July 2003

DILAVERIS, P., et al.: Spatial Aspects of Ventricular Repolarization in Postinfarction Patients. QT dispersion has been proposed to reflect the heterogeneity of ventricular repolarization, but a poor reproducibility limits its clinical usefulness. Spatial vectorcardiographic descriptors constitute a novel approach to quantify ventricular repolarization. To test the ability of vectorcardiographic descriptors to discriminate among different subsets of postinfarction patients, 50 consecutively recruited patients with acute MI, 50 patients with history of an old (> 6 months) MI, and 50 healthy controls were evaluated. The maximum and minimum QT and JT intervals and QT and JT dispersion were manually measured from a digitally recorded 12‐lead ECG. X, Y, and Z leads were reconstructed from the 12‐lead ECG. The amplitude of the maximum spatial T vector (spatial T amplitude), the angle between the maximum spatial QRS and T vectors (spatial QRS‐T angle), and the frontal plane QRS‐T angle were automatically calculated. The spatial T amplitude and the spatial QRS‐T angle did not differ between patients with a recent and those with an old MI (P = 1). QT dispersion was significantly lower in patients with an old MI than in patients with a recent one (P = 0.002). The spatial repolarization descriptors showed better short‐term reproducibility than the dispersion indices. In conclusion, the spatial T amplitude and the spatial QRS‐T angle are accurate measures of ventricular repolarization that do not differ between patients with recent and those with old MI. The different QT dispersion values observed in this study between the two post‐MI groups should be considered cautiously because of the low accuracy of the manual measurements.
The Effects of Aging on AV Nodal Recovery Properties
Authors: KUO CHI‐TAI , WU JING‐MING , LIN KUO‐HONG , YOUNG MING‐LON
Published: July 2003

KUO, C.‐T., et al.: The Effects of Aging on AV Nodal Recovery Properties. The purpose of this study was to assess the changes of AV nodal recovery properties with aging. Although in children and young adults it was found that there were age dependent changes in their AV nodal recovery properties, in the older population this information was not available. In 92 subjects (aged 16–92 years) without AV nodal disease or dual AV nodal pathway physiology, their AV nodal recovery curves were studied by delivering premature atrial extrastimuli coupled to basic atrial beats during cardiac electrophysiological study. Data were analyzed using linear regression and curve‐fitting techniques. Patients were grouped by age, group I < 40 years (n = 33), group II 40–59 years (n = 26), and group III > 60 years (n = 33). The results showed that the AV nodal recovery curve did not change significantly in the aging process except that the AV nodal effective refractory period had a positive correlation with increasing age. The latter was significantly increased in group III when compared to group I or group II. For this parameter, when patients whose AV nodal refractory period was limited by the atrial refractory period were excluded, there was still a statistically significant increase in group III compared to group II (P < 0.05): group I (n = 27): 202 ± 42 ms; group II (n =17): 197 ± 26 ms; and group III (n = 17): 224 ± 46 ms. The results suggest that the AV nodal recovery curve remains unchanged once it reaches adulthood, with the exception that the nodal effective refractory period becomes slightly longer after age 60.
Is Sinus Node Modification Appropriate for Inappropriate Sinus Tachycardia with Features of Postural Orthostatic Tachycardia Syndrome?
Authors: SHEN WIN‐KUANG , LOW PHILLIP A. , JAHANGIR ARSHAD , MUNGER THOMAS M. , FRIEDMAN PAUL A. , OSBORN MICHAEL J. , STANTON MARSHALL S. , PACKER DOUGLAS L. , REA ROBERT F. , HAMMILL STEPHEN C.
Published: July 2003

SHEN,W.‐K., et al.: Is Sinus Node Modification Appropriate for Inappropriate Sinus Tachycardia with Features of Postural Orthostatic Tachycardia Syndrome? Inappropriate sinus tachycardia and postural orthostatic tachycardia are ill‐defined syndromes with overlapping features. Although sinus node modification has been reported to effectively slow the sinus rate, long‐term clinical response has not been adequately assessed. Furthermore, whether patients with postural orthostatic tachycardia would benefit from sinus node modification is unknown. The study prospectively assessed the short‐ and long‐term clinical outcomes of seven consecutive female patients with postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia who were treated with sinus node modification. The study was conducted in a tertiary care center. The electrophysiological and clinical responses were prospectively assessed as defined by autonomic function testing, including Valsalva maneuver, deep breathing, tilt table testing, and quantitative sudomotor axonal reflex testing. Among the study population (mean age was 41 ± 6 years), 5 (71%) patients had successful sinus node modification. At baseline, heart rates were 101 ± 12 beats/min before modification and 77 ± 9 beats/min after modification (P = 0.001). With isoproterenol, heart rates were 136 ± 9 and 105 ± 12 beats/min (P = 0.002) before and after modification, respectively. The mean heart rate during 24‐hour Holter monitoring was also significantly reduced: 96 ± 9 and 72 ± 6 beats/min (P = 0.005) before and after modification, respectively. Despite the significant reduction in heart rate, autonomic symptom score index (based on ten categories of clinical symptoms) was unchanged before (15.6 ± 4.1) and after (14.6 ± 3.6) sinus node modification (P = 0.38). Sinus rate can be effectively slowed by sinus node modification. Clinical symptoms are not significantly improved after sinus node modification in patients with inappropriate sinus tachycardia and postural orthostatic tachycardia. A primary subtle autonomic disregulation is frequently present in this population. Sinus node modification is not recommended in this patient population.
Dysfunction of Phrenic Pacemakers Induced by Metallic Rescue Blankets
Authors: BOISSEL NICOLAS , VÄÄNÄNEN LUKKA , MICHOUX JOËL , STRAUS CHRISTIAN , FARTOUKH MURIEL , DERENNE JEAN‐PHILIPPE , TALONEN PASI P. , SIMILOWSKI THOMAS
Published: July 2003

BOISSEL, N., et al.: Dysfunction of Phrenic Pacemakers Induced by Metallic Rescue Blankets. Phrenic pacing can restore diaphragmatic contractions in patients with central respiratory paralysis. It relies on radiofrequency transmission of energy from an external unit to implanted receivers through circular coil antennas. The case of a patient is reported in whom severe hypoventilation occurred following the use of a metallic rescue blanket. The phenomenon was confirmed in two subsequent patients and during benchmark tests. Possible mechanisms include reflection and diffusion of high frequency waves by a Faradaylike effect. Patients with implanted devices relying on telemetric control or powering, and their care givers, should be warned against the use of metallic rescue sheets.
Termination of Pacemaker Endless Loop Tachycardia by an Atrial Extrasystole
Authors: BAROLD S. SERGE
Published: July 2003

BAROLD, S.S., et al.: Termination of Pacemaker Endless Loop Tachycardia by an Atrial Extrasystole. This article documents the termination of a pacemaker endless loop tachycardia by a critically timed atrial extrasystole. Although predictable electrophysiologically, this mode of termination has not been previously reported. The observation is conceptually important because it provides the final link in establishing the similarity of endless loop tachycardia and spontaneous reentrant AV nodal or junctional tachycardias in terms of initiation and termination by single atrial or ventricular extrasystoles.