bluuebunny/crossref_metadata_2025 huggingface dataset:
Juvenile Xanthogranuloma with Ocular Involvement
Authors: LIANG SI , LIU YUE‐HUA , FANG KAI
Published: April 2009

Abstract:  Juvenile xanthogranuloma is a benign histiocytic skin disorder encountered primarily in infancy and childhood. Approximately 0.4% of cases exhibit ocular manifestations, which can result in glaucoma and blindness. We present a case of a 7‐month‐old male with unilateral glaucoma associated with Juvenile xanthogranuloma, and emphasize the importance of an ocular screening in patients with Juvenile xanthogranuloma, especially those with periocular lesions.
Simultaneous Occurrence of two Squamous Cell Carcinomas within a Nevus Sebaceous of Jadassohn in an 11‐Year‐Old Girl
Authors: BELHADJALI HICHEM , MOUSSA ADNENE , YAHIA SAMIRA , NJIM LEILA , ZAKHAMA ABDELFATTAH , ZILI JAMELEDDINE
Published: April 2009

Abstract:  The development of a squamous cell carcinoma within a nevus sebaceous of Jadassohn is very rare. We report here for the first time, the simultaneous occurrence of two squamous cell carcinomas within a single nevus sebaceous of Jadassohn.
Even Easier Griseofulvin Dosing—Why not Weigh Children in Kilograms?
Authors: TAIBJEE SALEEM M. , KOCH DIMITRA
Published: April 2009

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, and must not exceed two pages of text including references. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.
The Utility of a Touch Preparation in the Diagnosis of Fluctuant Subcutaneous Fat Necrosis of the Newborn
Authors: Lund Jared J. , Xia Ling , Kerr Sarah , Stratman Erik J. , Patten Stella F.
Published: April 2009

Abstract:  Subcutaneous fat necrosis of the newborn (SFNN) is an uncommon self‐limiting panniculitis. Lesions may be fluctuant and spontaneously drain. Here we report a technique to rapidly confirm the diagnosis of SFNN when fluctuance exists via a touch preparation that demonstrates the characteristic histologic features of this condition. The material can be collected by fine needle aspirate, from draining fluctuant lesions, or if biopsy if performed.
Trichomegaly in a 3‐Year‐Old Girl with Alopecia Areata
Authors: Nazareth Michael R. , Bunimovich Olga , Rothman Ilene L.
Published: April 2009

Abstract:  We report here a case of bilateral trichomegaly associated with alopecia areata in a 3‐year‐old girl, healthy except for mild atopic dermatitis. Trichomegaly is a rare condition and, in many cases, is a side effect of medication such as ophthalmic solution prostaglandin analogs and epidermal growth factor receptor inhibitors. Trichomegaly has also been associated with acquired medical conditions such as HIV, systemic lupus erythematosus, anorexia nervosa, porphyria cutanea tarda, hypothyroidism, and dermatomyositis. In very rare circumstances, trichomegaly has been described as part of congenital conditions such as Oliver‐McFarlane syndrome. We believe that the development of bilateral trichomegaly in conjunction with alopecia areata in this patient represents a novel finding as it occurred in the absence of any significant health problems, congenital abnormalities, or medications.
Prevalence of Cutaneous Findings in Hospitalized Neonates: A Prospective Observational Study
Authors: Ferahbas Ayten , Utas Serap , Akcakus Mustafa , Gunes Tamer , Mistik Selcuk
Published: April 2009

Abstract:  Objective:  To determine the frequency of physiologic and pathologic skin findings in the newborns hospitalized in our Newborn Unit.

Methods:  All of newborn infants hospitalized in the Newborn Unit of Erciyes University Medical School Hospital in Central Anatolia, Turkey from February 1 to November 30, 2003, were included prospectively in the study. A questionnaire regarding maternal gestational history, maternal and family history was administered to the parents of each child. All skin lesions were recorded and mapped on a body chart.

Results:  Of the 816 newborns, parents of 650 gave informed consent. Only 28 (4.3%) of the infants had no dermatologic examination findings. The most common 10 diagnoses were: xerosis/desquamation 257 (39.5%), sebaceous hyperplasia 207 (31.8%), transient toxic erythema 201 (30.9%), salmon patch 125 (19.2%), Mongolian spot 86 (13.2%), cutis marmorata 69 (10.6%), suction bulla 67 (10.3%), miliaria 55 (8.5%), hypertrichosis 51 (7.8%), and dermatitis (irritant, seborrheic, or diaper) 14 (2.1%).

Conclusions:  This study confirms that skin changes in the newborn are common, particularly desquamation, sebaceous hyperplasia, and transient toxic erythema.
The Relationship Between Sensory Hypersensitivity and Sleep Quality of Children with Atopic Dermatitis
Authors: Shani‐Adir Ayelet , Rozenman Dganit , Kessel Aharon , Engel‐Yeger Batya
Published: April 2009

Abstract:  This study aims to investigate the impact of sensory hypersensitivity in children with atopic dermatitis (AD) and to evaluate a possible relationship between sensory hypersensitivity, sleep quality and disease severity in AD. Fifty‐seven AD patients and 37 healthy children, aged 3–10 years, participated in this study. Disease severity was assessed using the Severity Scoring of Atopic Dermatitis (SCORAD) Score. The sensory profile was assessed using the Short Sensory Profile (SSP) and sleep characteristics were evaluated using the Children’s Sleep Habits Questionnaire (CSHQ). The AD group demonstrated significantly worse sleep quality compared with the controls in the following CSHQ subscales: sleep duration; parasomnias; sleep disordered breathing and daytime sleepiness. Sensory hypersensitivity was correlated with lower sleeping quality. Severity Scoring of Atopic Dermatitis Scores was positively correlated with sleep anxiety and with parasomnias. Sensory hypersensitivity and disturbed sleep patterns were common in the children with AD that participated in this study. A possible common underlying mechanism of hyper‐arousability may account for both phenomena. Evaluation of AD children should also refer to their sensory processing abilities and sleep habits to create optimal intervention programs that will be better focused on the child and family needs.
A Familial Case of Trichorhinophalangeal Syndrome Type I
Authors: Vaccaro Mario , Guarneri Fabrizio , Barbuzza Olga , Gaeta Michele , Guarneri Claudio
Published: April 2009

Abstract:  Trichorhinophalangeal type I (TRPS I) is a rare autosomal dominant disorder characterized by variable clinical expression of sparse and slow‐growing hair, pear‐shaped nose, elongated philtrum, and bone deformities, including cone‐shaped epiphyses of the phalanges and short stature. We describe three members of a family who consulted us because of slow‐growing scalp hair with craniofacial and radiological features typical of TRPS I.
A Clinical and EEG Survey on Infantile and Childhood Epilepsy
Authors: VIZIOLI RAFFAELLO
Published: April 2009

Infantile and childhood epilepsy are an important starting‐point for the physiopathological problems of epilepsy in general.

A survey is given of present‐day views on the various epileptic manifestations which may present themselves in these periods of life.

L'épilepsie infantile et celle de l'enfance sont un point de départ important au point de vue des problemes physiopathologiques de l'épilepsie en général.

L'auteur donne un aperçu des opinions actuelles en ce qui concerne différentes manifestations épileptiques susceptibles de se présenter dans ces périodes de la vie.
Non‐Jacksonian Hemiconvulsive Seizures One‐sided Generalized Epilepsy
Authors: GASTAUT H. , ROGER J. , FA1DHERBE J. , OUAHCHI S. , FRANCK G. , CRITICOS A. , ESQUIVEL‐RODON O. , IRRIGOYEN‐ARROYO M.
Published: April 2009

The “hemiconvulsive seizures” here described concern all epileptic convulsions – tonic or clonic – interesting only one side of the body. The “Jacksonian epilepsy” is one of the aspects of this type of epilepsy, the others being:

“Hemi grand mal”: typical grand mal seizures, but strictly localized to one side of the body and, electroencephalographically, to the contralateral hemisphere.

“Hemiclonic seizures”: clonic phenomena often beginning with an “oculoclonic crisis”, spreading to the whole ipsilateral half of the body. On the EEG are observed, on the contralateral hemisphere, 2–3 c/s slow waves and 8–10 waves predominating in the posterior region.

The hemiclonic seizures occur in two main groups of epileptics:

Those with neurological, radiological and/or electroencephalographical signs of focalization (among whom are found some with “H.H.E. syndrome”).

Those without any sign of cerebral focalization, but suffering from petit mal or grand mal.

The authors discuss the differences between the two latter types of non‐jacksonian hemiconvulsive seizures (hemi grand mal and hemiclonic seizures) and the “Jacksonian seizures”, both from a pathophysiological and from a therapeutical point of view.

Les crises hémiconvulsives décrites dans ce travail englobent toutes les convulsions toniques ou cloniques intéressant seulement un côté du corps.

L'épilepsie Jacksonienne représente un des aspects de ce type d'épilepsie; les autres aspects décrits par les auteurs sont:

L'hémi grand‐mal: crises présentant toutes les caractéristiques du grand mal, mais strictement localisées cliniquement à un hémicorps et électroencéphalographiquement à l'hémisphère contralatéral.

Les crises hémicloniques: les manifestations cloniques commencent souvent par une “crise oculoclonique” et s‘étendent ensuite à tout l'hémicorps homolatéral. Le tracé EEG montre, sur l'hémisphère controlatéral, des ondes lentes à 2–3 c/s associées à des ondes plus rapides (8–10 c/s) prédominant dans la région postérieure.

Malades où peuvent être mis en évidence des signes de focalisation neurologique, radiologique et/ou électroencéphalographique (un certain nombre de ceux‐ci présen‐tent un syndrome H.H.E.: Hémiconvulsion‐Hémiplégie‐Epilepsie).

Malades chez qui aucun signe de focalisation cérébrale ne peut être relevé, mais sujets à des crises généralisées petit mal ou grand mal.

Les auteurs discutent les différences entre ces deux types de crises hémiconvulsives non Jacksoniennes (hémi grand‐mal et crises hémicloniques) et les crises Jacksoniennes, tant du point de vue physiopathogénique que thérapeutique.
The Methionine Sulfoximine Syndrome in the Cat
Authors: PROLER M. , KELLAWAY P.
Published: April 2009

Methionine sulfoximine, the toxic principle of the agenized protein diet, produces in the cat a complex syndrome characterized by behavioral and convulsive changes. In a series of 50 cats, the following features were most consistently observed:

Sniffing movements, involving the upper lip, nose and lower eyelid, and accompanied by profuse salivation and impairment of consciousness.

Episodic behavioral changes consisting of head‐turning, sniffing, and crouching movements strongly suggesting apprehension, orientation and fear.

Running fits at the onset of which the animal may appear fearful or hysterical.

Generalized tonic‐clonic convulsions.

A detailed description of the syndrome is given and the influence of external stimuli and such factors as dosage of toxic agent, age, nutritional status of experimental animal, upon the character, frequency, rapidity of onset, and duration of the various behavioral and convulsive phenomena are discussed.

The significance of the sulfoximine syndrome, as regards its biochemical and behavioral similarities to certain types of human epilepsy and its value as an experimental tool i n the investigation of the patho‐physiology of seizures are discussed.

RÉUMÉ

La méthionine sulfoximine, principe toxique du régime de protéine agénisée, produit chez le chat un syndfrome complexe charactérisé par des changements du comportement et des convulsions. Les caractéristiques suivants ont été constamment observées sur une série de 50 chats:

Mouvements de reniflument comprenant la lèvre supérieure, le nez et la paupière inférieure, accompagnés de salivation profuse et d'abaissement de la conscience.

Des changements épisodiques du comportement consistant en tournement de la těte, reniflement et mouvements de rampement donnant fortement l'impression de crainte, d'orientation et d'appréhension.

Accès de course folle au début desquels l'animal peut sembler très craintif ou hystérique.

Convulsions toniques‐cloniques généralisées.

L'auteur donne une description détaillée du syndrome et décrit l'influence de stimuli externes et celle de facteurs tels que le dosage d'un agent toxique, de l'ǎge et de l'état de nutrition de l'animal d'expérience, sur le caractère, la fréquence et la rapidité du début de la crise, la durée du changement du comportment et des phénomènes convgulsifs.

La significatin du syndrome de la sulfoximine fait l'objet d'une discussion en ce qui concerne les similitudes biochimiques et celles du comportement à l'endroit de certains types d'épilepsie humaine ainsi que sa valeur en tant qu'instrument d'expérience dans des recherches sur la pathophysiologie des crises.
Calculation of a Toxic Potential Indicator Via Chinese‐Language Material Safety Data Sheets
Authors: Yen Sheng‐Bou , Chen Jahau Lewis
Published: April 2009

This article presents an approach to evaluating the toxic potential for products or materials using Chinese‐language material safety data sheets (MSDSs). The toxic potential indicator (TPI) is one of many simple methods used to evaluate the environmental impact of toxins in products and materials. According to actual application experience in Taiwan, difficulties and problems arise in the preliminary implementation of TPI values calculated via Chinese‐language MSDSs. Some adjustment techniques combining Chinese vocabulary conversion and unit transformation are proposed in this article to overcome these obstacles. The proposed procedures and evaluated results can serve as a basis for environmentally conscious product design, especially with regard to the choice of materials used in Chinese‐speaking countries.
Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of Care
Authors: Baumgarten Mona , Margolis David J. , Orwig Denise L. , Shardell Michelle D. , Hawkes William G. , Langenberg Patricia , Palmer Mary H. , Jones Patricia S. , McArdle Patrick F. , Sterling Robert , Kinosian Bruce P. , Rich Shayna E. , Sowinski Janice , Magaziner Jay
Published: April 2009

OBJECTIVES: To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.

DESIGN: Prospective cohort study.

SETTING: Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.

PARTICIPANTS: Hip fracture patients aged 65 and older who underwent surgery for hip fracture.

MEASUREMENTS: A full‐body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.

RESULTS: In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3–3.7) and during re‐admission to the acute hospital (RR=2.2, 95% CI=1.1–4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8–2.3) and 1.3 (95% CI=0.8–2.1), respectively.

CONCLUSION: Approximately one‐third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital‐APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.
Low Parathyroid Hormone Levels in Bedridden Geriatric Patients with Vitamin D Deficiency
Authors: Björkman Mikko P. , Sorva Antti J. , Risteli Juha , Tilvis Reijo S.
Published: April 2009

OBJECTIVES: To identify the clinical conditions associated with low parathyroid hormone (PTH) in patients with vitamin D deficiency and to evaluate the stability of the blunted PTH response to vitamin D deficiency over 6 months.

DESIGN: Secondary analysis of a randomized double‐blind controlled vitamin D supplementation trial.

SETTING: Four long‐term care hospitals in Helsinki, Finland.

PARTICIPANTS: Two hundred eighteen chronically bedridden patients.

MEASUREMENTS: Plasma 25‐hydroxyvitamin D (25‐OHD), intact PTH, amino‐terminal propeptide of type I procollagen (PINP), carboxy‐terminal telopeptide of type I collagen (ICTP), activities of daily living (ADLs), and body mass index (BMI) were measured at baseline and at 6 months. Patient records were reviewed for demographic data.

RESULTS: PTH was within reference values (8–73 ng/L) despite low 25‐OHD level (<50 nmol/L) in 74.8% (n=163) of patients (mean age 84.5±7.5). Patients in the lowest PTH quartile (<38 ng/L) were characterized by a history of hip fractures (OR=2.9, P=0.01), low BMI (OR=0.9, P=.02), and high ICTP (OR=1.1, P=.03). PTH remained within reference values even after 6 months in 76.2% of the patients with persistent vitamin D deficiency in the placebo group.

CONCLUSION: The absence of secondary hyperparathyroidism seems to be common and persistent in frail chronically bedridden patients with vitamin D deficiency. Attenuated parathyroid function appears to be associated with immobilization that causes accelerated bone resorption. Further studies addressing the possible adverse effects of low PTH are warranted.
Defibrillation Threshold Testing: Tradition or Necessity?
Authors: KOLB CHRISTOF , TZEIS STYLIANOS , ZRENNER BERNHARD
Published: April 2009

Implantable cardioverter defibrillators (ICDs) have become an essential tool for primary and secondary prevention of sudden cardiac death. Traditionally, defibrillation threshold (DFT) testing is part of the “lege artis” ICD implantation. Taking into consideration that the absolute mortality reduction in primary prevention trials is estimated around 8% and in secondary prevention trials around 7%, it is only in these patients that an acceptable DFT is expected to affect survival. Using a high‐energy ICD, the likelihood of obtaining an inadequate DFT is about 2.5%. Thus, the number of patients needed to be subjected to DFT testing in order to avert one potential death is about 500. Application of antitachycardia pacing for rapid ventricular tachycardias further reduces the percentage of patients dependent on reliable ICD defibrillation capability. Thus, the mortality rate that can be prevented by DFT testing is below 0.2%. This contrasts a 0.4% risk of life‐threatening complications and a low but not negligible mortality risk owed to the procedure. Although in light of these data the balance between DFT‐related risk and benefit seems to tilt toward the former, insights gained from prospective randomized trials will clarify whether the abandonment of routine DFT testing can be claimed on a rightful basis.
Atrial Electromechanical Sequence and Contraction Synchrony during Single‐ and Multisite Atrial Pacing in Patients with Brady‐Tachycardia Syndrome
Authors: DĄBROWSKA‐KUGACKA ALICJA , LEWICKA‐NOWAK EWA , RUCIŃSKI PIOTR , ZAGOŻDŻON PAWEŁ , RACZAK GRZEGORZ , KUTARSKI ANDRZEJ
Published: April 2009

Objectives: Investigation of which atrial pacing modality provides atrial synchrony and the most physiological atrial contraction pattern in patients with brady‐tachycardia syndrome.

Methods: Fifteen healthy subjects and 57 patients with sinus node dysfunction, atrial fibrillation recurrences, and prolonged P‐wave on the electrocardiogram treated with multisite atrial (MSA) pacing were studied. One atrial lead was implanted in the coronary sinus (CS) ostium area, the other at the right atrial appendage (RAA): RAA+CS group (28 patients), or Bachmann's bundle (BB) region: BB+CS group (29). Sinus rhythm (SR) and CS, RAA, BB, RAA+CS, and BB+CS pacing modalities were evaluated. Electromechanical delay (EMD) in atrial walls was assessed by tissue Doppler echocardiography. Interatrial (ΔinterA), intra‐right (ΔRA), and intra‐left (ΔLA) atrial dyssynchrony were calculated.

Results: During SR, in the study group versus controls, important ΔinterA: 55 ± 23 versus 22 ± 11 ms (P < 0.01) and ΔLA: 47 ± 21 versus 21 ± 6 ms (P < 0.001) were present. Single‐site BB and both MSA pacing modes restored ΔinterA and ΔLA (ΔinterA: 24 ± 16, 20 ± 13 and 14 ± 9 ms, ΔLA: 28 ± 18, 28 ± 13 and 20 ± 10 ms during BB, RAA+CS and BB+CS pacing, respectively). CS pacing prolonged lateral RA EMD, while RAA pacing LA walls EMD, which resulted in ΔinterA persistence. CS pacing induced ΔRA (50 ± 23 vs 16 ± 8 ms, P < 0.0001 vs controls). Atrial contraction sequence during BB pacing resembled that observed in controls.

Conclusions: (1) Single‐site BB and both MSA pacing modes restored atrial synchrony. (2) Single‐site RAA and CS ostium pacing retained interatrial dyssynchrony; moreover, CS pacing created RA dyssynchrony. (3) Single‐site BB pacing provided physiological atrial contraction sequence.
Gender Differences in Anxiety and Concerns about the Cardioverter Defibrillator
Authors: SPINDLER HELLE , JOHANSEN JENS B. , ANDERSEN KIRSTEN , MORTENSEN PETER , PEDERSEN SUSANNE S.
Published: April 2009

Background: Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health‐related quality of life (HRQL), ICD concerns, and ICD acceptance.

Methods: A cohort of consecutive, surviving patients (n = 535; mean age = 61.5 ± 14.4, 81.9% male) implanted with an ICD between 1989 and 2006 completed the Hospital Anxiety and Depression Scale, the Short‐Form Health Survey (SF‐36), the ICD concerns questionnaire, and the Florida Patient Acceptance Survey.

Results: High levels of anxiety (52% vs 34%, P < 0.001) and ICD concerns (34% vs 16%, P = 0.001) were more prevalent in women than men, whereas no significant differences were found on depression and device acceptance (Ps > 0.05). Women were more anxious (odds ratio [OR]: 2.60 [95% confidence interval (CI): 1.46–4.64], P < 0.01) and had more ICD concerns (OR: 1.81 [95% CI: 1.09–3.00], P < 0.05) than men, adjusting for demographic and clinical characteristics. Those ICD patients experiencing shocks were also more anxious (OR: 2.02 [95% CI: 1.20–3.42], P < 0.01) and had higher levels of ICD concerns (OR: 2.70 [95% CI: 1.76–4.16], P < 0.01). In multivariable analysis of variance, significant gender differences were found for only three of the eight subscales of the SF‐36 (the physical social functioning and the mental health subscale), with women reporting poorer HRQL on all three subscales.

Conclusions: Women were more prone to experience anxiety and ICD concerns compared to men regardless of whether they had experienced shocks. In clinical practice, female ICD patients should be closely monitored, and if warranted offered psychosocial intervention, as increased anxiety has been shown to precipitate arrhythmic events in defibrillator patients.
Gender Differences in Patients Referred for Atrial Fibrillation Management to a Tertiary Center
Authors: ROTEN LAURENT , RIMOLDI STEFANO F. , SCHWICK NICOLA , SAKATA TAKAO , HEIMGARTNER CHRIS , FUHRER JUERG , DELACRÉTAZ ETIENNE , TANNER HILDEGARD
Published: April 2009

Background: Atrial fibrillation (AF) ablation is less frequently performed in women than in men. Although the prevalence of AF is slightly higher in men, this does not fully account for the lower number of AF ablations performed in women. This study sought to examine the effect of gender on referral for AF and subsequent AF management.

Methods: Consecutive patients referred to our tertiary arrhythmia outpatient clinic for AF management were retrospectively analyzed.

Results: Of 264 patients referred, only 27% were women. Women were older than men (63 ± 9 vs 58 ± 11 years, P = 0.002), more often had paroxysmal AF (78% vs 63% in men, P = 0.022), and women more frequently complained about palpitations (71% vs 49%, P = 0.002). In addition, they had more often experienced amiodarone side effects than men (56% vs 36%, P = 0.046). In this referred population, there was no difference in the proportion of women and men undergoing AF ablation immediately following the initial evaluation (21% vs 25%, P = ns), at any time during the follow‐up (38% vs 44%, P = ns), and there was no difference in the proportion of patients undergoing atrioventricular node ablation in both sexes (6% of women vs 3% of men, P = ns).

Conclusions: There is an important difference in the proportion of men and women referred for management of AF in a specialized outpatient arrhythmia clinic, with women being referred three times less often than men. However, there is no gender‐related difference in the subsequent treatment decisions. These findings emphasize the importance of focusing on management of symptomatic AF in women.
Does Bipolar Pacemaker Current Activate Blood Platelets?
Authors: GJESDAL GRUNDE , BO HANSEN ANNEBIRTHE , BRANDES AXEL
Published: April 2009

Objective: The aim of this study was to investigate whether bipolar pacemaker current lead can activate blood platelets. The null hypothesis was that 1 minute of electrical stimulation of platelets would not influence their subsequent reactivity to adenosine diphosphate (ADP).

Background: Both platelets and muscle cells contain actin and myosin filaments, and both cells are activated following calcium influx. Muscle cells open their calcium channels and contract when exposed to an electric current. Current through a bipolar pacemaker lead will expose a small volume of blood, including platelets, to the depolarizing current. Platelet activation may ensue, resulting in aggregation, release reaction, and contraction. In contrast, a unipolar pacemaker system will not depolarize blood, but transmit current directly into the myocardium, and the current afterward passes through other tissues before returning to the pacemaker can.

Methods: Platelet‐rich plasma was prepared from two healthy subjects. Platelet reactivity to the agonist ADP was tested in paired samples in an aggregometer in a case/control setup.

Results: Eighteen of 46 tested pairs of platelet‐rich plasma showed increased reactivity in the paced sample; 26 were unchanged while two showed decreased reactivity in the paced sample. Using a two‐sided sign test, the null hypothesis was rejected (P = 0.0004).

Conclusions: The study demonstrates increased reactivity to ADP in platelets exposed in vitro to stimulation by pacemaker current. The clinical relevance of these findings remains to be investigated.
Predictors of Syncope in Patients with Hypertrophic Cardiomyopathy
Authors: HAGHJOO MAJID , FAGHFURIAN BABAK , TAHERPOUR MEHDI , FAZELIFAR AMIR FARJAM , MOHAMMADZADEH SHABNAM , ALIZADEH ABOLFATH , SADR‐AMELI MOHAMMAD ALI
Published: April 2009

Background: Approximately 30% of patients with hypertrophic cardiomyopathy (HCM) suffer syncope and syncope was the only symptom associated with sudden death. However, no systematic studies in large cohorts looking at predictors of syncope are available in the literature. Therefore, we sought to determine predictors of syncope in patients with HCM.

Methods: One hundred and seventy‐three consecutive patients with HCM and a mean age of 42 ± 18 years (range 10–78) underwent extensive clinical, electrocardiographic, and echocardiographic testing to identify predictors of syncope.

Results: During the mean follow‐up duration of 50 months, syncope occurred in 28% of the HCM patients. Univariate analysis showed male gender, age <40 years, family history of sudden death, PR interval, QRS width, ≥2 bursts of nonsustained ventricular tachycardia (NSVT), ≥3 bursts of nonsustained supraventricular tachycardia (NSSVT), maximum left ventricular wall thickness ≥30 mm, and abnormal blood pressure response, out of 24 demographic, clinical, hemodynamic, electrocardiographic, and echocardiographic features, to be significantly associated with syncope. Of these nine variables, the only independent predictors of syncope at multivariate analysis were age <40 years (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 2.2–16, P = 0.003), ≥2 bursts of NSVT (OR: 9.9, 95% CI: 2.0–46, P = 0.0001), and ≥3 bursts of NSSVT (OR: 2.7, 95% CI: 0.38–8.25, P = 0.001). The concomitant occurrence of all three variables had a sensitivity of 87% and specificity of 73% in identifying the patients with syncopal events.

Conclusions: The results of this study showed that age <40 years, bursts of NSVT, and NSSVT were independently associated with the risk of syncope in patients with HCM. Demographic data and ambulatory ECG findings could help in risk stratification of patients with HCM.
Long‐Term Sinus Rhythm Stability after Intraoperative Ablation of Permanent Atrial Fibrillation
Authors: DENEKE THOMAS , KHARGI KRISHNA , VOSS DOMINIK , LEMKE BERND , LAWO THOMAS , LACZKOVICS AXEL , MÜGGE ANDREAS , BÖSCHE LEIF‐ILJA , LINDSTAEDT MICHAEL , GERMING ALFRIED , HORLITZ MARC , GREWE PETER H. , FRITZ MARKUS
Published: April 2009

Introduction: Short‐ and medium‐term sinus rhythm (SR) rates after intraoperative radiofrequency ablation to treat permanent atrial fibrillation (AF) are well documented. Is rhythm success stable during a long‐term follow‐up?

Methods and Results: A total of 130 patients who had undergone intraoperative radiofrequency cooled‐tip endocardial ablation (SICTRA) of permanent AF (mean AF duration 6±5 years) concomitant to open heart surgery more than 3 years ago were followed up using electrocardiogram (ECG), Holter‐ECG, and echocardiography and compared with 12‐month follow‐up data. In 55% of patients, only the left atrium and in 45%, both atria were treated using SICTRA. Mitral valve replacement was performed in 21, mitral valve reconstruction in 25, aortic valve replacement in 13, CABG procedures in 51 (including 11 patients with additional mitral valve surgery), and complex procedures in 20 patients. Sixty‐nine percent of patients (90/130) were in stable SR after a median period of 48 months, whereas 28% (36/130) were in AF and 3% (4/130) were in atrial flutter. In between the 12‐month follow‐up and the long‐term follow‐up, seven patients converted to AF after having documented SR, two patients converted to typical right atrial flutter after being in SR, and two patients from AF to left atrial macroreentry. After left and biatrial SICTRA, SR rates were comparable (73% vs 66%, P = 0.45). Echocardiography revealed 73% of patients in SR to have effective left atrial contraction.

Conclusions: SICTRA restores long‐term stable SR in 69% of all patients. Nine percent of patients reconverted back to atrial arrhythmia after having documented SR at 12 months.
Interatrial Block: The Pandemic Remains Poorly Perceived
Authors: SPODICK DAVID H. , ARIYARAJAH VIGNENDRA
Published: April 2009

Interatrial block (IAB; P duration ≥110 ms) is a common electrocardiogram abnormality, which in addition to reduced left atrial function predicts atrial fibrillation and other arrhythmias. P terminal force (Ptf) ± biphasic P in lead V1≥ the area of one small square on the grid also indicates left atrial abnormality, particularly left atrial enlargement, which is a strong correlate of IAB. Among 482 consecutively recorded electrocardiograms, IAB and Ptf were strongly and significantly correlated (χ2= 68.041; P ≤ 0.001).
In conclusion, interatrial block exists in pandemic proportions in unselected hospital patients. Because of its pathologic implications it requires widespread attention which, heretofore, has been lacking.
A Shock Lead Intentionally Placed in the Left Ventricle
Authors: KRAAIER KARIN , VERHORST PATRICK M.J. , SCHOLTEN MARCOEN F.
Published: April 2009

The implantable cardioverter defibrillator is effective in reducing sudden cardiac death in high‐risk patients. The implantation procedure is usually simple; however, in those patients who have congenital heart disease (CHD) placement of leads can be a challenge. In this report we present a patient with CHD where due to the complex cardiac anatomy it was decided to place the shock lead in the left ventricle.
Dilated Cardiomyopathy with Short QT Interval: Is It a New Clinical Entity?
Authors: BOHORA SHOMU , NAMBOODIRI NARAYANAN , THARAKAN JAGANMOHAN , VK AJIT KUMARA , NAYYAR SACHIN
Published: April 2009

Short QT syndrome is a rare autosomal dominant channelopathy of structurally normal hearts characterized by atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. We report a case having short QT, dilated ventricles, and severe ventricular dysfunction, an unreported association so far.
Successful Transseptal Catheter Ablation of Premature Ventricular Contractions Arising from the Mitral Annulus: A Case with a Pure Annular Origin
Authors: YAMADA TAKUMI , MCELDERRY H. THOMAS , ALLISON J. SCOTT , DOPPALAPUDI HARISH , EPSTEIN ANDREW E. , PLUMB VANCE J. , KAY G. NEAL
Published: April 2009

A 74‐year‐old man with symptomatic premature ventricular contractions (PVCs) with a right bundle branch block and right inferior axis QRS morphology underwent electrophysiologic testing. During the PVCs, coronary sinus mapping revealed ventricular prepotentials with the earliest activation in the distal great cardiac vein (GCV) where the local ventricular electrograms were smaller in amplitude than the atrial electrograms. The transaortic approach could not reach the earliest activation site within the GCV, but the transseptal catheter ablation successfully eliminated the PVCs on the mitral valve. With catheter ablation of ventricular arrhythmias with pure mitral annular origins, a transseptal approach may be necessary.
Head‐to‐Head and Extrapolated Comparisons of Different Drug‐Eluting Stents: Differences in Late Loss, Restenosis, and Clinical Outcomes
Authors: HELLIGE GERRIT , WINDECKER STEPHAN
Published: April 2009

Drug‐eluting stents (DES) have been appraised as breakthrough technology owing to their potent reduction of restenosis, an important nuisance in the quality of life of affected patients, the rare cause of myocardial infarction, and the principal shortcoming compared with coronary artery bypass surgery. First‐generation DES with controlled release of sirolimus or paclitaxel from durable polymers have been attested to reduce the need of target lesion revascularization by 40% to 70% compared with bare metal stents (BMS) requiring treatment of only eight patients (number needed to treat [NNT] 6–10) in order to prevent one revascularization event. The benefit, albeit attenuated, persisted in studies without protocol‐mandated angiographic follow‐up, was particularly pronounced in diabetic patients, and endured during long‐term follow‐up extending to 5 years.

While the therapeutic benefit of first‐generation DES has primarily been established as compared against BMS, more recent investigations have concentrated on direct head‐to‐head comparisons between various DES. To date, a number of newer‐generation DES are already in clinical use or under investigation with newly designed stent platforms, improved polymer coatings, and a variety of different drugs. This review will address differences between various DES platforms in terms of angiographic and clinical outcomes. Moreover, the differential outcome of DES in several important patient subgroups will be analyzed.
Performance of Everolimus‐Eluting Stents: Pooled Analysis from the SPIRIT Trials
Authors: MIU RAYMOND , SERRUYS PATRICK W. , STONE GREGG W.
Published: April 2009

Background: First‐generation drug‐eluting stents (DES) still have significant rates of restenosis and stent thrombosis, especially in complex lesions. A second‐ generation stent eluting everolimus from a thin, non‐adhesive, non‐inflammatory durable polymer coated onto a low‐profile, cobalt‐ chromium stent has been developed and evaluated in patients with coronary artery disease.

Methods: Following the SPIRIT First proof‐of‐concept trial, the everolimus‐eluting stent (EES) was compared to a widely used paclitaxel‐eluting stent (PES) in patients with non‐complex coronary artery disease in 2 successive randomized trials in Europe and Asia (SPIRIT II) and the United States (SPIRIT III). The databases from these trials were pooled for a patient‐level meta‐analysis.

Results: Collectively, the SPIRIT II and SPIRIT III trials randomized 1,302 patients to either EES (n = 892) or PES (n = 410), with a total of 1,501 randomized lesions treated. EES compared to PES resulted in reduced mean in‐segment late loss (0.11 ± 0.37 vs. 0.22 ± 0.44 mm, P = 0.0004) and binary angiographic restenosis (4.1% vs. 7.8%, P = 0.039) at 6–8 months. The 30‐day rates of myocardial infarction (MI) were lower with EES than PES (1.0% vs. 2.9%, P = 0.02). At 1‐year, EES compared to PES resulted in reduced rates of target lesion revascularization (TLR; 3.1% vs. 5.8%, P = 0.02), a trend toward less MI (2.3% vs. 4.0%, P = 0.08), and comparable rates of cardiac death (0.6% vs. 1.0%, P = 0.39) and stent thrombosis (0.7% vs. 0.8%, P = 0.90). As a result, patients treated with EES compared to PES had significantly reduced rates of major adverse cardiac events (cardiac death, MI, or TLR) at 1 year (5.2% vs. 10.0%, P = 0.002).

Conclusions: The EES stent is a second‐generation DES which results in improved clinical and angiographic outcomes compared to PES at 1 year. Longer‐term follow‐up from these trials and larger comparative trials are under way to evaluate the durability and utility of this device in more complex patients and lesions.
Choice of DES: A US Clinician's Perspective
Authors: POP ANDREI , GRINES CINDY L.
Published: April 2009

With the advent of the second‐generation drug‐eluting stents, the decision process on which stent to use is becoming increasingly complex.

Our article compares the technical characteristics of the four drug‐eluting stents (DES) currently available in the United States. We review the data that led to the approval of each stent and analyze the literature comparing their performance in various patient subgroups. Finally, we present our current practice and identify a “wish list” for the ideal DES.
ECG Manifestations of Multiple Electrolyte Imbalance: Peaked T Wave to P Wave (“Tee‐Pee Sign”)
Authors: Johri Amer M. , Baranchuk Adrian , Simpson Christopher S. , Abdollah Hoshiar , Redfearn Damian P.
Published: April 2009

The surface electrocardiogram (ECG) is a useful instrument in the detection of metabolic disturbances. The accurate characterization of these disturbances, however, may be considerably more difficult when more than one metabolic abnormality is present in the same individual. While “classic” ECG presentations of common electrolyte disturbances are well described, multiple electrolyte disturbances occurring simultaneously may generate ECG abnormalities that are not as readily recognizable. We report a case of hyperkalemia, with concurrent hypocalcemia and hypomagnesemia resulting in (1) peaking of the T wave, (2) a prominent U wave, and (3) prolongation of the descending limb of the T wave such that it overlapped with the next P wave. In this particular ECG from a patient with combined electrolyte imbalance, we have dubbed the unusual appearance of the segment between the peak of the T wave to the next P wave as the “tee‐pee” sign.
Electrocardiographic Body Surface Mapping: Potential Tool for the Detection of Transient Myocardial Ischemia in the 21st Century?
Authors: Robinson Monique R. , Curzen Nicholas
Published: April 2009

Coronary artery disease (CAD) is one of the leading causes of cardiovascular mortality and morbidity worldwide. CAD presents as a wide spectrum of clinical disease from stable angina to ST segment elevation myocardial infarction. The 12‐lead electrocardiogram (ECG) has been the main tool for the diagnosis of these events for almost a century but is limited in its diagnostic ability. For patients with suspected angina, the exercise tolerance test is often used to provoke and detect stress‐induced ischemia but does not provide a definitive answer in a substantial proportion of patients. Body surface mapping (BSM) is a technique that samples multiple points around the thorax to provide a more comprehensive electrocardiographic data set than the conventional 12‐lead ECG. Moreover, recent preliminary data demonstrate that BSM can detect and display transient regional myocardial ischemia in an intuitive fashion, employing subtraction color mapping, making it potentially valuable for diagnosing CAD causing transient regional ischemia. Research is ongoing to determine the full extent of its utility.
Comparison of Quantitative T‐Wave Alternans Profiles of Healthy Subjects and ICD Patients
Authors: De Vilhena Garcia Euler , Samesima Nelson , Filho Horácio G. Pereira , Quadros Cristina M. , Da Silva Luis Tenório Cavalcante , Filho Martino Martinelli , Hannouche Maria Luciana Zacharias , Mathias Jr Wilson , Pastore Carlos Alberto
Published: April 2009

Background: Current relevance of T‐wave alternans is based on its association with electrical disorder and elevated cardiac risk. Quantitative reports would improve understanding on TWA augmentation mechanisms during mental stress or prior to tachyarrhythmias. However, little information is available about quantitative TWA values in clinical populations. This study aims to create and compare TWA profiles of healthy subjects and ICD patients, evaluated on treadmill stress protocols.

Methods: Apparently healthy subjects, not in use of any medication were recruited. All eligible ICD patients were capable of performing an attenuated stress test. TWA analysis was performed during a 15‐lead treadmill test. The derived comparative profile consisted of TWA amplitude and its associated heart rate, at rest (baseline) and at peak TWA value. Chi‐square or Mann‐Whitney tests were used with p values ≤ 0.05. Discriminatory performance was evaluated by a binary logistic regression model.

Results: 31 healthy subjects (8F, 23M) and 32 ICD patients (10F, 22M) were different on baseline TWA (1 ± 2 μV; 8 ± 9 μV; p < 0.001) and peak TWA values (26 ± 13 μV; 37 ± 20 μV; p = 0,009) as well as on baseline TWA heart rate (79 ± 10 bpm; 67 ± 15 bpm; p < 0.001) and peak TWA heart rate (118 ± 8 bpm; 90 ± 17 bpm; p < 0.001). The logistic model yielded sensitivity and specificity values of 88.9% and 92.9%, respectively.

Conclusions: Healthy subjects and ICD patients have distinct TWA profiles. The new TWA profile representation (in amplitude‐heart rate pairs) may help comparison among different research protocols.
Correlation of Noninvasive Electrocardiography with Invasive Electrophysiology in Syncope of Unknown Origin: Implications from a Large Syncope Database
Authors: Gatzoulis Konstantinos A. , Karystinos George , Gialernios Theodoros , Sotiropoulos Helias , Synetos Andreas , Dilaveris Polychronis , Sideris Skevos , Kalikazaros Ioannis , Olshansky Brian , Stefanadis Christodoulos I.
Published: April 2009

Background: The evaluation of syncope can be expensive, unfocussed, and unrevealing yet, failure to diagnose an arrhythmic cause of syncope is a major problem. We investigate the utility of noninvasive electrocardiographic evaluation (12‐lead ECG and 24‐hour ambulatory electrocardiographic recordings) to predict electrophysiology study results in patients with undiagnosed syncope.

Methods: We evaluated 421 patients with undiagnosed syncope who had an electrocardiogram (ECG), an electrophysiology study, and 24‐hour ambulatory monitoring. Noninvasive testing was used to predict electrophysiology testing outcomes. Multivariable logistic regression analysis adjusting for age, sex, presence of heart disease, and left ventricular ejection fraction (LVEF) was used to assess independent predictors for sinus node disease, atrioventricular node disease, and induction of ventricular tachyarrhythmias.

Results: Patients were divided into four groups: group 1, abnormal ECG and ambulatory monitor; group 2, abnormal ECG only; group 3, abnormal ambulatory monitor; and group 4, normal ECG and ambulatory monitor. The likelihood of finding at least one abnormality during electrophysiologic testing among the four groups was highest in group 1 (82.2%) and lower in groups 2 and 3 (68.1% and 33.7%, respectively). In group 4, any electrophysiology study abnormality was low (9.1%). Odds ratios (OR) were 35.9 (P < 0.001), 17.8 (P < 0.001), and 3.5 (P = 0.064) for abnormal findings on electrophysiology study, respectively (first three groups vs the fourth one). ECG and ambulatory monitor results predicted results of electrophysiology testing.

Conclusion: Abnormal ECG findings on noninvasive testing are well correlated with potential brady‐ or/and tachyarrhythmic causes of syncope, in electrophysiology study of patients with undiagnosed syncope.
Quinidine for Pharmacological Cardioversion of Atrial Fibrillation: A Retrospective Analysis in 501 Consecutive Patients
Authors: Schwaab Bernhard , Katalinic Alexander , Böge Uta Maria , Loh Jürgen , Blank Peter , Kölzow Tatjana , Poppe Dirk , Bonnemeier Hendrik
Published: April 2009

Background:Although quinidine has been used to terminate atrial fibrillation (AFib) for a long time, it has been recently classified to be used as a third‐line‐drug for cardioversion. However, these recommendations are based on a few small studies, and there are no data available of a larger modern patient population undergoing pharmacological cardioversion of AFib. Therefore, we evaluated the safety of quinidine for cardioversion of paroxysmal AFib in patients after cardiac surgery and coronary intervention.

Methods:In 501 consecutive patients (66 ± 9 years, 32% women), 200–400 mg of quinidine were administered every 6 hours until cardioversion or for a maximum of 48 hours. Patients were included with QT interval ≤450 ms, ejection fraction (EF) ≥35%, and plasma potassium >4.3 mEq/L. Exclusion criteria were: unstable angina, myocardial infarction <3 months, and advanced congestive heart failure. Patients received verapamil, beta‐blockers, or digitalis to slow down ventricular rate <100 bpm.

Results:Quinidine therapy did not have to be stopped due to adverse drug reactions (ADR), and no significant QTc interval prolongation (Bazett and Fridericia correction) and no life‐threatening ventricular arrhythmia occurred. Mean quinidine dose was 617 ± 520 mg and 92% of the patients received verapamil or beta‐blocker to decrease ventricular rate. Cardioversion was successful in 84% of patients. All ADRs were minor and transient. Multivariate analysis revealed female gender (OR 2.62, CI 1.61–4.26, P < 0.001) and EF 45–54% (OR 1.97, CI 1.15–3.36, P = 0.013) as independent risk factors for ADRs.

Conclusions:Quinidine for pharmacological cardioversion of AFib is safe and well tolerated in this subset of patients.