bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective analysis of 135 renal trauma cases
Authors: SAHIN HAYRETTIN , AKAY ALI FERRUH , YILMAZ GÜLSEN , TAÇYILDIZ IBRAHIM HALIL , BIRCAN MEHMET KAMURAN
Published: May 2004

Background: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities.

Methods: One hundred and thirty‐five patients with renal injuries who had been hospitalized in the Urology and General Surgery clinics of Dicle University hospital between 1990 and 2001 were reviewed retrospectively. Patients were evaluated with regard to age, sex, cause of trauma, transport time, diagnostic methods, grade of injuries, associated organ injuries, treatments and complications.

Results: One hundred and forty‐one renal injuries were established in 135 patients. The patients were between 5 and 65 years old; 114 (84.4%) were male and 21 (15.6%) were female. The most common cause of injuries (99 patients) was penetrating injuries. The transport time to hospital after injury was approximately 116 min. Immediate laparotomy was performed in 95 hemodynamically unstable patients. Radiological investigations were carried out in the remaining 40 patients. Most of the injuries were grade 4 (28, 19.86%) or 5 (60, 42.55%). Isolated renal injury was established in only 22 of 135 patients. Nephrorrhaphy was performed in 45 of 141 kidneys. Twelve injured kidneys were managed conservatively. Nephrectomy was performed in 66 of 141 kidneys. The remaining injured kidneys were managed with different treatment methods. Twenty‐nine (21.48%) patients were lost intraoperatively or during the early postoperative period.

Conclusion: We believe that our rates of nephrectomy and mortality were high because of the long transport time, unsuitable transport type, frequent high grade and high rate of associated organ injuries.
Simple testicular cyst: A rare cause of scrotal swelling in infancy
Authors: CEYLAN HALUK , KARACA İRFAN , SARI İBRAHİM , ORTAÇ RAGIP , ÖZOKUTAN B. HAYRİ , KERVANCIOĞLU SELİM
Published: May 2004

A simple testicular cyst is a rare cause of scrotal swelling in infancy. Only 10 cases have been reported in children less than two years of age in the English literature. Pathogenesis of the lesion is unclear. Preoperative diagnosis is possible using ultrasonography (US). Testis‐sparing surgery with simple enucleation of the cyst has a favorable outcome. We report two patients with a simple testicular cyst, who were 9 and 8 months of age. The first case was referred with a presumptive diagnosis of hydrocele, and the second infant was admitted with a history of testicular swelling. Ultrasonography provided accurate preoperative diagnosis in both of the cases. The patients were successfully treated with testis‐sparing surgery with outstanding long‐term results. This unusual lesion of infancy should be considered in the differential diagnosis of a scrotal mass.
Inflammatory pseudotumor of the kidney
Authors: ISHIKAWA TOMOMOTO , FUJISAWA MASATO , TAMADA HIROSHI , INOUE TAKAAKI , SHIMATANI NOBORI
Published: May 2004

A 38‐year‐old man without prior contributory history presented complaining of a tumor in the left upper abdomen without tenderness. Suspecting renal cell carcinoma of the dark cell type, a nephrectomy was performed. Microscopic examination showed a proliferation of spindle cells containing numerous blood vessels. A diffuse infiltrate of lymphocytes and plasma cells was scattered throughout the lesion.
Multiple primary malignancies in Japanese patients with renal cell carcinoma
Authors: SATO SOSHU , SHINOHARA NOBUO , SUZUKI SHIN , HARABAYASHI TORU , KOYANAGI TOMOHIKO
Published: May 2004

Aim:  To evaluate the incidence, nature and prognosis of multiple primary malignancies involving renal cell carcinoma (RCC) in Japan.

Methods: Between 1975 and 1998, 319 patients underwent an operation for RCC at Hokkaido University, Sapporo, Japan. The incidence of other primary malignancies was determined and classified as antecedent, synchronous or subsequent. Follow‐up was obtained by thorough chart review or telephone interview, and ranged from 0 to 276 months (median 49.0 months). To analyze the influence of other primary malignancies on prognosis, overall and cause‐specific survival rates of the patients with an antecedent or synchronous malignancy were compared to the remaining patients.

Results:  Of the 319 patients there was at least one other malignancy in 38 patients (12%). Four patients had two other malignancies. The other malignancies were antecedent in 13, synchronous in 19 and subsequent in 10 patients. Twenty‐two patients had gastrointestinal cancer. In cases of antecedent or synchronous diagnosis of other primary malignancies, RCC was commonly incidental, small or low‐stage. Multivariate analysis using Cox's proportional hazards model showed that, for overall survival, the presence of other antecedent or synchronous malignancies was the second most significant prognostic factor, following the pathological stage of RCC.

Conclusions: In Japanese patients with RCC, the incidence of other primary malignancies was not uncommon and these malignancies contributed to the prognosis of these patients. Therefore, the malignant potential of individual tumors should be paid careful attention in the management of these patients.
A pilot study evaluating a new questionnaire for prostatic symptom scoring, the SPSS, and its sensitivity as constructed to objective measures of outflow obstruction
Authors: YANO MASATAKA , KITAHARA SATOSHI , YASUDA KOSAKU , YAMANISHI TOMONORI , NAKAI HIDEO , YANAGISAWA RYOUZO , MOROZUMI MAKOTO , HOMMA YUKIO
Published: May 2004

Aim: To evaluate the extent to which our newly developed questionnaire, the Saitama Prostate Symptom Score (SPSS), for prostatic symptom scoring reflects objective findings in benign prostatic hyperplasia (clinical BPH) and to compare it with the International Prostate Symptom Score (IPSS) with regard to diagnostic sensitivity in clinical BPH.

Methods: In this study, both the SPSS and the IPSS were self‐administered by patients. Free uroflowmetry, a pressure‐flow study and the measurement of prostatic volume were carried out.

Results: There was no significant correlation between the results of the IPSS questionnaire and the urethral obstruction grade estimated by Schaefer or Abrams‐Griffiths nomograms. The total score of the SPSS was correlated with these nomograms (P = 0.0487 and P = 0.0413, respectively). There was no significant correlation between the results of the IPSS questionnaire and the total volume or transition zone volume of the prostate, whereas the total score of the SPSS correlated with the total volume of the gland and transition zone volume (P = 0.0044 and P= 0.0051, respectively).

Conclusion: This study revealed the SPSS to correlate with objective findings satisfactorily. However, there are still several aspects of the SPSS which need to be improved upon, and the questionnaire should be studied in larger numbers of patients suffering from lower urinary tract symptoms.
Retrospective study on stage B prostate cancer in the Hokuriku District, Japan
Authors: EGAWA MASAYUKI , MISAKI TOSHIMITSU , IMAO TETSUYA , YOKOYAMA OSAMU , FUSE HIDEKI , SUZUKI KOUJI , NAMIKI MIKIO
Published: May 2004

Background: The present study was conducted to investigate how patients with clinically localized prostate cancer were treated in the Hokuriku District, Japan.

Methods
:
Medical records of 536 patients with stage B prostate cancer were retrospectively reviewed. The patients were diagnosed and treated at four university hospitals and 32 collaborating hospitals in the Hokuriku District.

Results: Because their medical records were incomplete and/or they not available for follow up, 79 cases were excluded from this study. Conservative treatment with hormone therapy was used for 248 cases. Radical prostatectomy was performed in 199 cases, only 27 of whom underwent surgical monotherapy. There was no significant difference in disease‐specific survival rates between the hormone (69.0%) and surgery group (83.2%) after 110 months. Results of the analysis of disease‐specific survival rates according to histologic grade showed that patients with poorly differentiated cancers treated with hormone therapy were the only subset with significant differences when compared against the other patients.

Conclusion: The value of prostatectomy alone or added was marginal in terms of survival. Only patients with poorly differentiated cancer might benefit from prostatectomy.
Long‐term outcome of postoperative interferon‐α adjuvant therapy for non‐metastatic renal cell carcinoma
Authors: GOTOH AKINOBU , SHIRAKAWA TOSHIRO , HINATA NOBUYUKI , WADA YOSHITAKA , HARA ISAO , FUJISAWA MASATO , KAWABATA GAKU , OKADA HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO
Published: May 2004

Aim: To investigate the long‐term efficacy of postoperative interferon‐α (IFN‐α) adjuvant therapy in preventing recurrence in non‐metastatic renal cell carcinoma treated with radical nephrectomy and to identify related prognostic markers.

Methods: Long‐term follow‐up was conducted to study rates of survival and non‐recurrence in 88 subjects following radical nephrectomy for non‐metastatic disease.

Results: The overall survival rate was 90% at 5 years and 88% at 10, with corresponding non‐recurrence rates of 81% and 74%. Survival rates reviewed by preadministration pT stage showed a falling tendency from T1 through to T3 in line with pathological progression; when cases at stage pT1b or below were compared with those at stage pT2 or above, the latter showed a tendency to lower survival rates (P = 0.0966, Breslow‐Gehan‐Wilcoxon). Similarly, non‐recurrence rates tended to fall in line with pathological progression, with a significant difference found in the comparison of cases at stage pT1b or below with those at stage pT2 or above (P = 0.0265, log–rank, Mantel‐Cox). Duration of IFN‐α administration showed a tendency to positive correlation with long‐term survival (P = 0.3765, Breslow‐Gehan‐Wilcoxon). Non‐recurrence rate was not found to differ according to duration of administration. Comparison of groups with normal and abnormal preadministration immunosuppressive acidic protein values showed that the normal group tended to have higher rates of survival and non‐recurrence (P = 0.3371, Breslow‐Gehan‐Wilcoxon).

Conclusions: Immunosuppressive acidic protein values appear to be a useful predictive marker for recurrence. A randomized trial, examining long‐term outcome according to tumor stage and variables such as duration of administration, dose, administration time, and dosing schedule is required.
Care and Justice in the Global Context
Authors: Held Virginia
Published: May 2004

Abstract.  Morality is often dismissed as irrelevant in what is seen as the global anarchy of rival states each pursuing its national interest. When morality is invoked, it is usually the morality of justice with its associated moral conceptions of individual rights, equality, and universal law. In the area of moral theory, an alternative moral approach, the ethics of care, has been developed in recent years. It is beginning to influence how some see their global responsibilities.
Hegel and Hobbes on Institutions and Collective Actions
Authors: Lagerspetz Eerik
Published: May 2004

Abstract.  Georg Wilhelm Friedrich Hegel is usually, and rightly, considered the foremost representative of the organistic conception of society. It is only natural to think that his view has nothing in common with the kind of individualistic outlook that dominates our legal and political thinking, and that I myself have tried to defend. I try to show why certain insights of Hegel are potentially important even for individualistic legal and political theories. First, I explicate some of the problems he struggled with, and compare his views with those of Thomas Hobbes. Next, I try to link his views to the modern theories of institutions and of collective action. The antidemocratic ideology expressed in the main works of Hobbes and Hegel is clearly outmoded. Nevertheless, in their criticism of popular sovereignty, they posed some important questions. First, how do collectives like the People exist? Second, what do we mean by saying that collectives perform actions? It seems that, in order to perform an action, an entity ought to possess will. But what does it mean that a collective has a will?
Voting Procedures for Complex Collective Decisions. An Epistemic Perspective
Authors: Bovens Luc , Rabinowicz Wlodek
Published: May 2004

Abstract. In addressing a complex issue that is decomposable into several sub‐questions, a committee can use different voting procedures: Either it can let the committee members vote on each sub‐question and then use the outcomes as premises for its conclusion on the main issue (premise based‐procedure,pbp), or it can let the members directly vote on the conclusion (conclusion‐based procedure,cbp). The procedures can lead to different results, but which of them is a better truth‐tracker? On the basis of Condorcet's jury theorem, we show that the pbp is clearly superior if the objective is to reach truth for the right (= correct) reasons. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be cases in which using the cbp turns out to be more reliable, even though, for the most part, the pbp will retain its superiority. In that connection, we also consider the truth‐tracking potential of a “sophisticated” variant of the pbp, which is sensitive to the size of the majorities supporting each of the premises.
Managed Care and Preventable Hospitalization among Medicaid Adults
Authors: Basu Jayasree , Friedman Bernard , Burstin Helen
Published: May 2004

Objective. The study examines the association between managed care enrollment and preventable hospitalization patterns of adult Medicaid enrollees hospitalized in four states.

Data Sources/Study Setting. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) database of the Agency for Healthcare Research and Quality (AHRQ) for New York (NY), Pennsylvania (PA), Wisconsin (WI), and Tennessee (TN) residents in the age group 20–64 hospitalized in those states, linked to the Area Resource File (ARF) and American Hospital Association (AHA) survey files for 1997.

Study Design. The study uses separate logistic models for each state comparing preventable admissions with marker admissions (urgent, insensitive to primary care). The model controls for socioeconomic and demographic variables, and severity of illness.

Principal Findings. Consistently in different states, private health maintenance organization (HMO) enrollment was associated with fewer preventable admissions than marker admissions, compared to private fee‐for‐service (FFS). However, Medicaid managed care enrollment was not associated with a reduction in preventable admissions, compared to Medicaid FFS.

Conclusions. Our analysis suggests that the preventable hospitalization pattern for private HMO enrollees differs significantly from that for commercial FFS enrollees. However, little difference is found between Medicaid HMO enrollees and Medicaid FFS patients. The findings did not vary by the level of Medicaid managed care penetration in the study states.
The Prevention Index: Using Technology to Improve Quality Assessment
Authors: Vogt Thomas M. , Aickin Mikel , Ahmed Faruque , Schmidt Mark
Published: May 2004

Objective. To improve quality of care assessment for preventive medical services and reduce assessment costs through development of a comprehensive prevention quality assessment methodology based on electronic medical records (EMRs).

Data Sources. Random sample of 775 adult and 201 child members of a large nonprofit managed care system.

Study Design. Problems with current, labor‐intensive quality measures were identified and remedied using EMR capabilities. The Prevention Index (PI) was modeled by assessing five‐year patterns of delivery of 24 prevention services to adult and child health maintenance organization (HMO) members and comparing those services to consensus recommendations and to selected Health Plan Employer Data and Information Set (HEDIS) scores for the HMO.

Data Collection. Comprehensive chart reviews of 976 randomly selected members of a large managed care system were used to model the Prevention Index.

Principal Findings. Current approaches to prevention quality assessment have serious limitations. The PI eliminates these limitations and can summarize care in a single comprehensive index that can be readily updated. The PI prioritizes services based on benefit, using a person‐time approach, and separates preventive from diagnostic and therapeutic services.

Conclusions. Current methods for assessing quality are expensive, cannot be applied at all system levels, and have several methodological limitations. The PI, derived from EMRs, allows comprehensive assessment of prevention quality at every level of the system and at lower cost. Standardization of quality assessment capacities of EMRs will permit accurate cross‐institutional comparisons.
The Effect of Smoking on Years of Healthy Life (YHL) Lost among Middle‐Aged and Older Americans
Authors: Østbye Truls , Taylor Donald H.
Published: May 2004

Objective. To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

Data Sources/Study Setting.

The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons≥70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

Study Design. Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.

Principal Findings. Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.

Conclusions. Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.
Linkage with Primary Medical Care in a Prospective Cohort of Adults with Addictions in Inpatient Detoxification: Room for Improvement
Authors: Saitz Richard , Larson Mary Jo , Horton Nicholas J. , Winter Michael , Samet Jeffrey H.
Published: May 2004

Objective.To identify patient characteristics and health care experiences associated with primary care linkage after alcohol or drug detoxification.

Data Sources/Study Setting.Primary data collected over two years. Subjects were adults without primary medical care, in an urban residential detoxification program.

Study Design.A prospective cohort study in the context of a randomized trial of a linkage intervention, and an expansion of Medicaid benefits.

Data Collection/Extraction Methods.Data were collected by interview assessment of predisposing, enabling, and illness variables. Linkage was defined as self‐report of at least one visit with a primary care clinician during follow‐up.

Principal Findings.Of 400 subjects, 63 percent linked with primary medical care. In a multivariable model adjusting for randomization assignment, predisposing, enabling, and illness variables, women, those with no recent incarceration, those with support for abstinence by family or friends, and those who had visited a medical clinic or physician recently were significantly more likely to link with primary care. Those with health insurance during follow‐up were also more likely to link. Recent mental health or addictions treatment utilization and health status were not associated with linkage.

Conclusions.A substantial proportion of adults with addictions do not link with primary medical care. These data suggest that efforts could be focused on those least likely to link, that contacts with mental health and addictions treatment providers are underutilized opportunities for these efforts, and that health policy changes such as expanding health insurance benefits may improve entry of substance‐dependent patients into primary medical care.
Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO
Authors: Roblin Douglas W. , Howard David H. , Becker Edmund R. , Kathleen Adams E. , Roberts Melissa H.
Published: May 2004

Objective. To estimate the savings in labor costs per primary care visit that might be realized from increased use of physician assistants (PAs) and nurse practitioners (NPs) in the primary care practices of a managed care organization (MCO).

Study Setting/Data Sources. Twenty‐six capitated primary care practices of a group model MCO. Data on approximately two million visits provided by 206 practitioners were extracted from computerized visit records for 1997–2000. Computerized payroll ledgers were the source of annual labor costs per practice from 1997–2000.

Study Design. Likelihood of a visit attended by a PA/NP versus MD was modeled using logistic regression, with practice fixed effects, by department (adult medicine, pediatrics) and year. Parameter estimates and practice fixed effects from these regressions were used to predict the proportion of PA/NP visits per practice per year given a standard case mix. Least squares regressions, with practice fixed effects, were used to estimate the association of this standardized predicted proportion of PA/NP visits with average annual practitioner and total labor costs per visit, controlling for other practice characteristics.

Results. On average, PAs/NPs attended one in three adult medicine visits and one in five pediatric medicine visits. Likelihood of a PA/NP visit was significantly higher than average among patients presenting with minor acute illness (e.g., acute pharyngitis). In adult medicine, likelihood of a PA/NP visit was lower than average among older patients. Practitioner labor costs per visit and total labor costs per visit were lower (p<.01 and p=.08, respectively) among practices with greater use of PAs/NPs, standardized for case mix.

Conclusions. Primary care practices that used more PAs/NPs in care delivery realized lower practitioner labor costs per visit than practices that used less. Future research should investigate the cost savings and cost‐effectiveness potential of delivery designs that change staffing mix and division of labor among clinical disciplines.
Emergency Department Use among Michigan Children with Special Health Care Needs: An Introductory Study
Authors: Pollack Harold A. , Dombkowski Kevin J. , Zimmerman Janet B. , Davis Matthew M. , Cowan Anne E. , Wheeler John R. , Hillemeier A. Craig , Freed Gary L.
Published: May 2004

Objective. To describe patterns of emergency department (ED) use among children dual‐enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS).

Data Sources. Individual claims and enrollment data from Michigan's Medicaid and CSHCS programs for the period January 1, 1998, to June 30, 1999. Claims data were linked with eligibility data and then used to develop a 100 percent sample of claims for individuals enrolled in both Medicaid and CSHCS.

Study Design. Poisson regression analysis was used to examine the rate of ED use for dual‐enrolled children. A time‐varying hazard analysis was also used to examine the impact of changes over time. The key variables were gender, age, race, county of residence, Medicaid eligibility category, and qualifying diagnosis.

Principal Findings. Dual‐enrolled children under one year of age, and those with qualifying diagnoses of anemia, hemophilia, asthma, epilepsy, and juvenile diabetes displayed especially high rates of ED use. Significant geographic variation in ED use remained after controlling for qualifying diagnoses, race/ethnicity, and other factors. African Americans displayed higher rates of ED utilization than non‐Hispanic whites. Supplemental Security Income (SSI) recipients demonstrated higher utilization than other groups.

Conclusions. Children dually enrolled in CSHCS and Medicaid face diverse challenges of both poverty and chronic illness. Differences in patterns of use highlight the importance, but also the difficulty, of developing systems of care to manage complex chronic conditions in low‐income populations.
Postfibrillatory Enhancement of Left Atrial Contractility After Short Paroxysms of Atrial Fibrillation
Authors: ZARSE MARKUS , SCHAUERTE PATRICK , MÜHLENBRUCH GEORG , WALDMANN MATHIAS , PLISIENE JURGITA , SCHIMPF THOMAS , MISCHKE KARL , SINHA ANIL M. , KNACKSTEDT CHRISTIAN , SCHÖNDUBE FRIEDRICH A. , HANRATH PETER , STELLBRINK CHRISTOPH
Published: May 2004

Implantable cardioverter defibrillators and pacemakers detect an increasing number of silent episodes of AF. In a porcine model, the study evaluated the contractility of the left atrial appendage (LAA) during AF paroxysms as they may occur in patients. Peak outflow velocity of the LA and mean outflow velocity of the LAA (LAA‐Voutmean) (n = 17) were measured before, during, and after induction of self‐terminating AF. LAA‐Voutmean was also measured during incremental pacing from different atrial sites using epicardial Doppler probes (n = 6) and during continuous recordings (n = 5) of 40 minutes of pacing maintained AF. Compared to baseline sinus rhythm, LAA‐Voutmean increased during short AF episodes (41 ± 3 vs 35 ± 2 cm/s, P < 0.05). After termination of the AF episodes, LAA‐Voutmean further increased (69 ± 15 cm/s, P < 0.001 vs baseline). This “postfibrillatory enhancement” maintained after repeated induction of short AF paroxysms. During prolonged AF episodes lasting 40 minutes, an initial hypercontractility (44 ± 2 vs 38 ± cm/s, P < 0.01) was followed by a hypocontractility after 20 minutes (29 ± 12 P < 0.05 vs SR) and a postfibrillatory enhancement after cessation of AF (56 ± 12 vs 27 ± 9 cm/s at 40 minutes AF, P < 0.001). L‐type Ca channel blockade abolished the initial hypercontractility during AF and the postfibrillatory enhancement. Repetitive AF paroxysms up to 2 minutes did not decrease left atrial contractility. During maintained AF up to 40 minutes an initial hypercontractility and a consecutive hypocontractility, which is overcompensated by a postfibrillatory enhancement of atrial inotropy after cessation of AF, are present. The observed phenomenon seems to be related to an increased Ca2+ influx through the L‐type Ca2+ channel. (PACE 2004; 27:579–585)
Deep Myocardial Ablation Lesions Can Be Created with a Retractable Needle‐Tipped Catheter
Authors: SAPP JOHN LEWIS , COOPER JOSHUA MORREY , SOEJIMA KYOKO , SORRELL TIMOTHY , LOPERA GUSTAVO , SATTI SRINIVASA DINAKAR , KOPLAN BRUCE ANDREW , EPSTEIN LAURENCE MARK , EDELMAN ELAZER , ROGERS CAMPBELL , STEVENSON WILLIAM GREGORY
Published: May 2004

RF catheter ablation of ventricular tachycardia is sometimes limited by inadequate lesion depth. This study investigated the use of a retractable needle‐tipped catheter to create deep RF lesions in vivo in porcine myocardium. An 8 Fr electrode catheter with an extendable 27‐gauge needle at the tip was modified for RF ablation by embedding a thermocouple and attaching a pin connector. In three swine (32–58 kg) the left ventricle was entered via the femoral artery and endocardial contact was made. The needle was advanced 10 mm and 13 RF applications were made under a controlled temperature (90°C × 120 s). Nine control lesions were made using a standard 4‐mm tip catheter (60°C × 120 s). The lesions were fixed, serially sectioned from the endocardium, digitally imaged, and quantified. Needle ablation lesions were deeper (10.15 ± 0.77 vs 5.67 ± 0.37 mm, P < 0.001) and more likely to be transmural (77 vs 11%, P = 0.008) than control lesions. The volume of control lesions, however, was larger (358.4 ± 56.2 vs 174.7 ± 18.6 mm3, P = 0.002) due to a significantly larger cross‐sectional area at the endocardium (0.548 ± 0.04 vs 0.151 ± 0.01 cm2, P < 0.001). At depths > 6 mm, the needle electrode lesions had a greater cross‐sectional area (0.136 ± 0.01 vs 0.005 ± 0.004 cm2, P < 0.001). Catheter‐based needle ablation is feasible and allows creation of deeper lesions that can be transmural. Although deep, the lesions had a small cross‐sectional area such that precise targeting would be required for success. (PACE 2004; 27:594–599)
Is Isolated Congenital Heart Block Associated to Neonatal Lupus Requiring Pacemaker A Distinct Cardiac Syndrome?
Authors: CRUZ ROSANA B.P. , VIANA VILMA S.T. , NISHIOKA SILVANA A.D. , MARTINELLI‐F MARTINO , BONFA ELOISA
Published: May 2004

Isolated congenital heart block (ICHB) is frequently associated with neonatal lupus syndrome (NLS). Therefore few data are available regarding the long‐term cardiac outcome of newborns with ICHB and the pathogenic mechanisms are not yet defined. In order to compare demographic features and cardiological outcome of patients with ICHB submitted to pacemaker (PM) implantation with and without NLS, forty ICHB patients were evaluated pre‐ and post‐PM implantation, by clinical, electrocardiogram, Holter Monitoring, treadmill test, and electrophysiological study. According to the presence of antibodies to 52 and 60 kDa Ro/SSA and La/SSB proteins in mother's sera, it was found that 60% (24/40) of patients had ICHB associated to NLS (ICHB/NL+). Twenty‐three of 24 ICHB/NL+ patients were asymptomatic, and 16 (67%) were female (P = 0.013). The frequency of syncope, mitral insufficiency (MI), and congestive heart failure (CHF) was similar pre‐PM implantation in both ICHB/NL+ and ICHB/NL− groups (P > 0.05). After PM implantation, MI and CHF were only observed in ICHB/NL+ patients, although not statistically significant. Interestingly, 67% of ICHB/NL+ were noticed before one year of age while only one fourth of ICHB/NL− was diagnosed in this period (P = 0.024). Almost half (46%) of ICHB/NL+ patients required PMs in the first 24 months of life, whereas only one in the ICHB/NL− received a PM at the same age (P = 0.02). In ICHB patients requiring PM implantation, the antibody‐mediated lesion seems to be associated with an earlier onset and a more severe heart disease, in spite of the uniform criteria for PM indication. (PACE 2004; 27:615–620)
Atrioventricular Block During Upright Tilt Table Test
Authors: VANERIO GABRIEL , DE LEÓN ANA VANERIO , AMARAL JUAN LUIS VIDAL , MONTENEGRO JOSÈ LUIS , BANIZI PABLO FERNÀNDEZ
Published: May 2004

Patients with a cardioinhibitory response (asystole or atrioventricular block [AVB]) during upright tilt table test (UTT) constitute a therapeutic challenge. Our present knowledge is partial and in those who experience AVB is absent. Furthermore, we ignore if there is any difference between both groups, particularly pacemaker indication. We aimed to study patients with a cardioinhibitory response during UTT and incidence of AVB during UTT, compared to asystole; plus the outcome during prolonged follow‐up. Of 867 patients who underwent UTT, 172 were positive for a neurally mediated response, all with normal neurocardiovascular evaluation. Of the 172 patients, 6 (3.4%) developed AV block (group A), and 26 (15.1%) experienced asystole (group B). Group A included 6 women (100%), mean age 21 ± 12 years. All patients in group A had sinus rate deceleration during AVB. Group B included 10 women (38%), mean age 28 ± 17 years, and a mean pause of 15 ± 9 seconds. We contacted 30 of 32 patients, mean follow‐up of 45 ± 38 months. Seven patients in group B had syncopal recurrences; five had 2 or more episodes. One patient from group B received a DDD pacemaker. In group A, one had one recurrence. No deaths were observed. AVB during UTT is rare, occurs in young women, and is always associated with sinus rate deceleration. Medium‐ to long‐term prognosis is good, and equivalent to patients with asystole. There is no evidence that patients with AVB during UTT require a pacemaker implant. (PACE 2004; 27:632–638)
The Use of a Modified Sphygmomanometer to Detect Atrial Fibrillation in Outpatients
Authors: WIESEL JOSEPH , WIESEL DAVID , SURI RANJIT , MESSINEO FRANK C.
Published: May 2004

This study was designed to assess the accuracy of a modified sphygmomanometer, that measures pulse irregularity, to detect atrial fibrillation (AF). An irregularity index, defined as the standard deviation of the time intervals between beats divided by the mean of the time intervals, was used to analyze standard 12‐lead ECGs from hospitalized patients. A threshold irregularity index was selected such that all ECGs with AF exceeded this irregularity index value. A modified automatic blood pressure monitor was designed to detect AF by calculating the irregularity index of the pulse. The device was used to calculate the irregularity index in an unselected group of outpatients during scheduled office visits in which a standard 12‐lead ECG was performed. A total of 125 ECGs, 53 with AF, were analyzed. Using a threshold irregularity index of 0.066, the sensitivity for detecting AF was 100%, the specificity was 92% and diagnostic accuracy 95%. A modified sphygmomanometer was used to analyze the pulse of 450 outpatients, 54 of whom were documented by ECG to be in AF. When paired readings were analyzed, the rhythm was considered to be irregular if both readings were greater than the threshold index. Using a threshold index of 0.06, all the AF patients were correctly identified while 37 non‐AF patients also exceeded the threshold irregularity index. In this analysis, the sensitivity was 100%, the specificity 91%, and the diagnostic accuracy 92% for detecting AF. The irregularity index determined using a modified sphygmomanometer can accurately identify AF. (PACE 2004; 27:639–643)
Basic Assessment of Paced Activation Sequence Mapping:
Authors: PEREZ‐CASTELLANO NICASIO , ALMENDRAL JESUS , VILLACASTIN JULIAN , ARENAL ANGEL , GONZALEZ SERGIO , MORENO JAVIER , MORALES RICARDO , MACAYA CARLOS
Published: May 2004

Some experiences support the use of atrial paced activation sequence mapping, but there is no systematic study assessing its spatial resolution, reproducibility, and influence of pacing parameters. The aim of this study was to evaluate these issues by using a 24‐pole catheter positioned at the atrial aspect of the tricuspid and mitral annuli in 15 patients. Bipolar pacing was performed at two sites (right and left atria), 2 cycle lengths (300 and 500 ms) and two outputs (twice and tenfold the late diastolic threshold voltage for 2‐ms pulses). The elapsed time between the atrial activation at the two dipoles adjacent to the pacing dipole (activation time [AT]) was measured during each pacing sequence. Changes in cycle length did not modify the AT. The increase in voltage slightly modified the AT (maximum −2 ms at the RA; 95% CI −3 to −1 ms) due to a greater shortening of the conduction time to the dipole located next to the anode. The 95% limits of the intraobserver and interobserver agreements in the AT measurement were −2 to 3 ms and −3 to 3 ms, respectively. The spatial resolution was studied in ten patients by measuring the AT during pacing from each dipole of a 20‐pole catheter with a 1‐3‐1 mm interelectrode distance. The mean AT change was 10 ± 4 ms per 6 mm of pacing site displacement (95% CI 8–11 ms, range 2.5–20 ms). In conclusion, paced atrial activation sequence analysis is reproducible, accurate, and relatively independent of pacing parameters. (PACE 2004; 27:651–656)
Insertable Loop Recorder Use for Detection of Intermittent Arrhythmias
Authors: KRAHN ANDREW D. , KLEIN GEORGE J. , SKANES ALLAN C. , YEE RAYMOND
Published: May 2004

The advent of prolonged monitoring with the implanted loop recorders has revolutionized the quest for detection of elusive infrequent arrhythmias in patients with unexplained syncope. The capability of prolonged monitoring has permitted us to obtain symptom rhythm correlation in the majority of patients suspected to have underlying infrequent arrhythmia. The implanted loop recorder is easily implanted in the left pectoral region with a minimally invasive procedure, providing at least 14 months of continuous monitoring that is both patient and automatically activated. Several recent studies suggest that it plays a major role in patients with infrequent symptoms and suspected arrhythmia, including patients with syncope and conduction disturbances, mild to moderate underlying heart disease, and atypical epilepsy. In a randomized trial, the device was found to be cost‐effective and improved diagnostic yield compared to conventional tilt and electrophysiological testing. Wider application of prolonged monitoring is ongoing, including assessment of ventricular arrhythmias, atrial fibrillation, and conduction disturbances. The implantable loop recorder is most useful in patients with infrequent unexplained syncope when noninvasive testing is negative. (PACE 2004; 27:657–664)
Successful Radiofrequency Catheter Ablation of an Anteroseptal (Superoparaseptal) Atrioventricular Accessory Pathway From the Left Ventricular Outflow Tract
Authors: MIYAUCHI YASUSHI , KOBAYASHI YOSHINORI , MORITA NORISHIGE , IWASAKI YU‐KI , HAYASHI MEISO , OHMURA KAZUKO , KATO TAKAO , TAKANO TERUO
Published: May 2004

This case report describes a patient with Wolff‐Parkinson‐White syndrome in whom the ECG exhibited a typical pattern of an anteroseptal (superoparaseptal) accessory pathway. Successful radiofrequency catheter ablation was achieved from the septal side of the left ventricular outflow tract. It might be worthwhile to map the left side of the anterior septum if an accessory pathway potential is not appreciable along the tricuspid annulus to avoid the potential complication of AV block in patients with a typical anteroseptal accessory pathway ECG pattern. (PACE 2004; 27:668–670)
Hyperkalemia Induced T Wave Oversensing Leading to Loss of Biventricular Pacing and Inappropriate ICD Shocks
Authors: KOUL ASHOK K. , KELLER SETH , CLANCY JUDE F. , LAMPERT RACHEL , BATSFORD WILLIAM P. , ROSENFELD LYNDA E.
Published: May 2004

Inappropriate ICD shocks remain a common problem. Double counting of single ventricular events can occur with biventricular ICDs implanted before univentricular sensing was available. Often this is due to a tachyarrhythmia or loss of left ventricular capture. This report describes a patient who developed hyperkalemia during hemodialysis, received inappropriate ICD shocks and experienced loss of biventricular pacing due to T wave rather than QRS double counting. Oversensing was abolished by reducing the potassium content of the dialysis bath. This underscores the need for careful interpretation of saved electrograms to determine the cause for, and appropriate treatment of, device related problems. (PACE 2004; 27:681–683)
Massive Transient Pulmonary Air Embolism During Pacemaker Implantation Under Mild Sedation:
Authors: TURGEMAN YOAV , ANTONELLI DANTE , ATAR SHAUL , ROSENFELD TIBERIO
Published: May 2004

We present a case of a massive pulmonary air embolism during permanent pacemaker lead implantation under mild sedation in a 73‐year‐old woman. We used a peel‐away sheath that is devoid of a hemostatic valve. The air embolism occurred after deep inspiration associated with loud snoring sounds and resolved after short chest massage and administration of adrenaline. Temporary closure of the intravenous entrance route of the peal‐away sheath before inserting the lead may prevent this potentially lethal complication. (PACE 2004; 27:684–685)
Quality of life of patients with chronic lymphocytic leukemia: results of a longitudinal investigation over 1 yr
Authors: Holzner Bernhard , Kemmler Georg , Kopp Martin , Nguyen‐Van‐Tam Dominic , Sperner‐Unterweger Barbara , Greil Richard
Published: May 2004

Objectives:  The aim of this longitudinal study was to determine the long‐term quality of life (QoL) of patients with chronic lymphocytic leukemia (CLL) and to investigate the relationship between QoL and sociodemographic and clinical parameters.

Methods:  Ninety‐seven patients suffering from CLL were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30) four times over a period of 1 yr. Clinical data on disease and treatment characteristics were collected from medical records. For the purpose of comparison, EORTC QLQ‐C30 scores were collected from 152 age‐ and gender‐matched healthy controls.

Results:  Seventy‐six patients (age: median 68 yr, range 41–89) returned one or more questionnaires and were included in the statistical analysis. Compared with healthy controls CLL patients reported a lower QoL in almost all domains. No differences regarding QoL could be observed between CLL patients who had already received chemotherapy and those who had not. Moreover, female CLL patients were found to have remarkably lower QoL scores in the areas of emotional and social functioning than male patients.

Conclusion:  Patients suffering from CLL could have their QoL improved by more effective symptom management and psycho‐oncological support. This could focus on specific symptoms such as fatigue and might have particular benefits for female patients with respect to their emotional and social well‐being.
Acquired pure megakaryocytic aplasia: a separate haematological disease entity or a syndrome with multiple causes?
Authors: Felderbauer P. , Ritter P. R. , Mattern D. , Schmitz F. , Bulut K. , Ansorge N. , Schmitt‐Graeff A. , Schmidt W. E. , Baier J. E.
Published: May 2004

We report the case of a patient with acquired pure megakaryocytic aplasia. Until today, less than 20 cases of acquired pure megakaryocytic aplasia have been reported and the disease aetiology still seems to be unclear. This report summarizes the published data concerning possible aetiologies, treatment options and outcome of patients with acquired pure megakaryocytic aplasia. Furthermore, this case report presents an example for a possible disease progression.
Sustained cytogenetic response after discontinuation of imatinib mesylate in a patient with chronic myeloid leukaemia
Authors: Ghanima Waleed , Kahrs Johannes , Dahl Tobias Gedde , Tjonnfjord Geir E.
Published: May 2004

A 58‐yr‐old woman was diagnosed with Ph+ chronic myeloid leukaemia in May 2001. She was initially treated with hydroxyurea and subsequently with interferon‐α (IFN‐α). Imatinib mesylate was started in April 2002 after failure of IFN‐α to induce a cytogenetic response. The patient remained on treatment with imatinib mesylate for 3 months during which she suffered daily fever resulting in discontinuation of the treatment. Response evaluation performed shortly after discontinuing imatinib mesylate revealed a complete cytogenetic remission and a substantial molecular response. Fifteen months later, she was still enjoying a major cytogenetic response. This case illustrates that a short course of imatinib mesylate may result in a sustained haematological and cytogenetic response.
Establishing dental hygiene education in Germany: current facts and future perspectives
Authors: Petersilka GJ , Neuhoff D , Flemmig TF
Published: April 2004

Abstract:  As there is a marked need to increase the number of dental hygienists (DHs) working in German dental practices, efforts are being made to establish dental hygiene education in accordance with international standards. However, as current German legislation does not envisage a perennial full‐time training programme, dental hygiene education may currently be provided within a modular concept only. The basic qualification for enrolment in a modular hygienist training programme of this kind is accredited vocational training as a dental assistant (DA), followed by board‐certified continuing education as an oral prophylaxis assistant. Thus, the current system of advanced training for qualification as a DH is subject to at least 6 years' work experience in the field of dentistry. A 950‐h full‐time advanced training course, meeting all the requirements of this concept, was established by the Westphalia–Lippe Dental Association in cooperation with the University of Münster. The curriculum underlying this programme was outlined considering the recommendations for dental hygiene education issued by the European Federation of Periodontology, although reduced in standards to comply with current German legislation. In addition, the recommendations for American Dental Hygiene education by the American Dental Association were used as a guide for programme development. The contents and implementation of the Münster Dental Hygienist Curriculum may allow the professional competence generated during practical work experience to be linked with international requirements of dental hygiene education.
Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan
Authors: El‐Qaderi SS , Taani DQ
Published: April 2004

Abstract:  Objective: This study aims at determining the oral health awareness level, the patterns of dental health practices and their potential relationship with certain socio‐demographic factors, including gender (sex), mother's education and the socio‐economic status of the family, among 14–15‐year‐old schoolchildren in Jerash Governorate, Northern Jordan. Participants and method: Cross‐sectional survey including 1362 public schoolchildren, who completed a self‐administered structured questionnaire. Results: Overall, the level of oral health knowledge among the surveyed children was low. Of the 1362 schoolchildren included in this survey, only 18 and 17% did know the meaning of plaque and what plaque can cause, respectively. Female performance was significantly better than male performance on two of the six knowledge questions (P < 0.01). While 17% of children have never been to the dentist, there are 10% only who visit the dentist on regular basis. The majority (56%) of these pupils said they visit the dentist when there is a serious dental or oral health problem. Fear of the dentist and difficulty in obtaining an appointment with the dentist were the causes of irregular visit to the dental clinic in 28 and 19% of the cases, respectively. Conclusion: Results of this study prove that oral health awareness level among public schoolchildren in Jordan is still poor and needs to be improved. Based upon these findings, the establishment of a long‐term school‐based oral health education programme in Jordan is highly recommended.
Maximal muscular vascular conductances during whole body upright exercise in humans
Authors: Calbet J. A. L. , Jensen‐Urstad M. , Van Hall G. , Holmberg H.‐C. , Rosdahl H. , Saltin B.
Published: May 2004

That muscular blood flow may reach 2.5 l kg−1 min−1 in the quadriceps muscle has led to the suggestion that muscular vascular conductance must be restrained during whole body exercise to avoid hypotension. The main aim of this study was to determine the maximal arm and leg muscle vascular conductances (VC) during leg and arm exercise, to find out if the maximal muscular vasodilatory response is restrained during maximal combined arm and leg exercise. Six Swedish elite cross‐country skiers, age (mean ±s.e.m.) 24 ± 2 years, height 180 ± 2 cm, weight 74 ± 2 kg, and maximal oxygen uptake 5.1 ± 0.1 l min−1 participated in the study. Femoral and subclavian vein blood flows, intra‐arterial blood pressure, cardiac output, as well as blood gases in the femoral and subclavian vein, right atrium and femoral artery were determined during skiing (roller skis) at ∼76% of and at with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise) and leg skiing (predominantly leg exercise). During submaximal exercise cardiac output (26–27 l min−1), mean blood pressure (MAP) (∼87 mmHg), systemic VC, systemic oxygen delivery and pulmonary (∼4 l min−1) attained similar values regardless of exercise mode. The distribution of cardiac output was modified depending on the musculature engaged in the exercise. There was a close relationship between VC and in arms (r= 0.99, P < 0.001) and legs (r= 0.98, P < 0.05). Peak arm VC (63.7 ± 5.6 ml min−1 mmHg−1) was attained during double poling, while peak leg VC was reached at maximal exercise with the diagonal technique (109.8 ± 11.5 ml min−1 mmHg−1) when arm VC was 38.8 ± 5.7 ml min−1 mmHg−1. If during maximal exercise arms and legs had been vasodilated to the observed maximal levels then mean arterial pressure would have dropped at least to 75–77 mmHg in our experimental conditions. It is concluded that skeletal muscle vascular conductance is restrained during whole body exercise in the upright position to avoid hypotension.