bluuebunny/crossref_metadata_2025 huggingface dataset:
Recommendations of the Italian League Against Epilepsy Working Group on Generic Products of Antiepileptic Drugs
Authors: Perucca Emilio , Albani Fiorenzo , Capovilla Giuseppe , Bernardina Bernardo Dalla , Michelucci Roberto , Zaccara Gaetano
Published: December 2006

Summary:  The availability of generic products of antiepileptic drugs (AEDs) has been increasing in recent years. In view of the importance of the issue, the Italian League against Epilepsy (LICE) set up an ad hoc working group whose task was to assess available evidence on the efficacy and safety of generic AEDs in the treatment of epilepsy and to produce recommendations on their use. A careful review of the literature revealed no adequately powered randomized controlled trials that assessed the risk/benefit ratio of generic substitution. Although there have been reports of loss or worsened seizure control, or appearance of adverse events, following the switch from brand products to generics, a critical assessment of the evidence generally does not allow us to establish a cause–effect relationship between the switch and a change in clinical status. Overall, the working group concluded that generic AEDs meeting current regulatory criteria for bioequivalence represent a valuable choice in the management of epilepsy by allowing a substantial reduction of treatment costs, particularly in patients initiating monotherapy or adjunctive treament and in those with persistent seizures. The working group considered that in patients who achieved seizure freedom a modest change in plasma drug levels, which may occasionally occur even after substitution of products that meet bioequivalence criteria, could in rare cases lead to seizure breakthrough. Therefore, generic substitution is not recommended in patients who achieved seizure remission. Switches between a particular generic and another generic should also be preferably avoided. Finally, sustained‐release AED formulations should not be used interchangeably with immediate‐release brand or generic products. Patients need to be informed about the stringent criteria that currently govern the approval of generic products and about the implications of the use of generic AEDs, and their opinion should be taken into consideration at the time of prescribing.
Temporal Lobe Epilepsy in Children: Electroclinical Study of 77 Cases
Authors: Fontana Elena , Negrini Francesca , Francione Stefano , Mai Roberto , Osanni Elisa , Menna Elisa , Offredi Francesca , Darra Francesca , Bernardina Bernardo Dalla
Published: December 2006

Summary: Purpose:Temporal lobe epilepsy (TLE) is probably more difficult to recognize in children than in adults. In fact, ictal symptoms in children are less stereotyped and less obvious, and the neuropathological substrate is more heterogeneous than in adults. The aim of this study is to examine the relationships between etiology, age at onset and electroclinical findings in 77 children with TLE, 32 of whom were surgically treated.

Methods:Electroclinical study including video‐EEG recording of seizures in 77 children with TLE. The investigation focused on the first five initial ictal symptoms.

Results:Age at onset was less than 3 years in 39 cases, between 3 and 6 years in 17 cases and older than 6 years in 21 cases. Auras also occurred in younger children but were more common after the age of 6 years. A peculiar initial ictal semiology consisted in staring with arrest, lip cyanosis, and very slight oral automatisms. In some cases, EEG recordings documented seizures starting independently on both temporal lobes. Based on electroclinical and neuroradiological features, we recognized three subgroups: symptomatic TLE due to cortical malformations or nonevolutive tumors, TLE with mesial temporal sclerosis, and cryptogenic TLE.

Conclusions:A correct electroclinical and neuroradiological approach allows in several cases early recognition of TLE even when onset is earlier than the age of 6 years. A correct definition of the localization relies primarily on video‐EEG recording of the seizures, possibly repeated during follow up in cases lacking obvious neuroradiological correlation.
Adult‐Onset Rasmussen's Encephalitis: Anatomical‐Electrographic‐Clinical Features of 7 Italian Cases
Authors: Villani Flavio , Pincherle Alessandro , Antozzi Carlo , Chiapparini Luisa , Granata Tiziana , Michelucci Roberto , Rubboli Guido , Simone Isa , Bellomo Rosella , Spreafico Roberto
Published: December 2006

Summary:  Purpose: A limited number of cases of adult‐onset Rasmussen's encephalitis (A‐RE) have been reported, but the features of the syndrome are still unclear. The aim of this study was to verify the clinical features of A‐RE, and outline a noninvasive approach that may allow its early diagnosis and treatment.

Methods: Retrospective evaluation of extensive noninvasive work‐up of seven patients with A‐RE, including repeat clinical, neurophysiological, and neuroimaging investigations.

Results: The study identified two distinct patterns of disease presentation, one characterized by focal motor epilepsy (the “epileptic” phenotype), and the other by focal cortical myoclonus (the “myoclonic” phenotype). Unilateral neurological deficits and brain atrophy were progressive in both phenotypes, but they were more prominent and were detected earlier in the “epileptic” phenotype.

Conclusions: The anatomo‐electroclinical features of these patients allowed a noninvasive diagnosis of A‐RE and identification of two distinct disease phenotypes. Early noninvasive diagnosis can allow faster initiation of treatment.
Lateralizing Value of the Auditory Aura in Partial Seizures
Authors: Florindo Irene , Bisulli Francesca , Pittau Francesca , Naldi Ilaria , Striano Pasquale , Striano Salvatore , Michelucci Roberto , Testoni Stefania , Baruzzi Agostino , Tinuper Paolo
Published: December 2006

Summary:  Purpose: To describe the semiological features of auditory aura and to assess their possible lateralizing value in partial epilepsy.

Methods: Out of a series of 8,000 patients with epilepsy, we investigated 121 cases with partial seizures in whom auditory features were the first ictal symptom. According to the dominant type of aura, patients were divided into four subgroups—1A (67 cases), 1B (22 cases), 2A (14 cases), and 2B (18 cases)—corresponding to the presence of simple or complex hallucinations and positive or negative illusions, respectively. The side of the epileptic zone (EZ) was defined based on available data: surgical/presurgical study or presence of a neuroradiological lesion, corresponding interictal epileptiform EEG and ictal semiology (level 1); a left EZ was also hypothesized in right‐handed patients with ictal aphasia plus a left neuroradiological lesion or a left interictal EEG focus (level 2).

Results: Forty‐five patients (37%) described the aura as unilateral. The side of epileptogenic zone (EZ) was definable in 36 patients (level 1: 24; level 2: 12). Overall, a unilateral auditory aura was contralateral to the EZ in half of the cases (8/16), but always contralateral in patients studied for presurgical evaluation (4/4). Simple hallucinations lateralized seizure onset on the right side in nine cases, on the left in 12. Among 1B patients (either musical and verbal contents), the EZ was on the left side in all cases (5/5). Positive illusions were associated with right foci in two cases, and left foci in two. Negative illusions always lateralized seizure onset to the dominant hemisphere (6/6).

Conclusions: Auditory aura is a rare symptom in partial epilepsy. The perception of the auditory sensation referred to one ear is not a unique lateralizing sign for the contralateral temporal neocortex. Complex hallucinations with verbal content and negative illusion may lateralize seizure onset in the dominant hemisphere. The role of laterality for musical hallucinations remains unclear as it depends on individual musical ability and hemispheric dominance for music.
Excessive Daytime Sleepiness and Subjective Sleep Quality in Patients with Nocturnal Frontal Lobe Epilepsy: A Case‐Control Study
Authors: Vignatelli Luca , Bisulli Francesca , Naldi Ilaria , Ferioli Simona , Pittau Francesca , Provini Federica , Plazzi Giuseppe , Vetrugno Roberto , Montagna Pasquale , Tinuper Paolo
Published: December 2006

Summary:  Purpose: Nocturnal frontal lobe epilepsy (NFLE) may be associated with sleep fragmentation and reduced sleep efficiency. Daytime sleepiness and disturbed sleep quality have been reported in some patients. We investigated the occurrence of daytime sleepiness‐related symptoms and subjective sleep quality in patients with NFLE in comparison with matched controls.

Methods: Patients with NFLE at a single epilepsy center and matched controls randomly selected from the general population self‐administered questionnaires on daytime sleepiness‐related symptoms and subjective sleep quality [Epworth sleepiness scale (ESS), Bologna questionnaire on sleepiness‐related symptoms (BQS), Berlin questionnaire].

Results: Thirty‐three patients with NFLE and 27 controls were enrolled. “Tiredness after awakening” and “spontaneous mid‐sleep awakenings” were more frequent in NFLE patients than in controls (36.4% versus 11.1%, p = 0.04, and 50.0% versus 22.2%, p = 0.03). The frequency of excessive daytime sleepiness (EDS) did not differ between groups. Posthoc analysis showed that patients with a complaint of “midsleep awakenings” had higher ESS and BQS scores than those without (7.3 versus 4.3, p = 0.004, and 5.0 versus 2.2, p = 0.001, respectively) and more frequent “tiredness after awakening” (56.3% versus 18.8%, p = 0.03).

Conclusions: Patients with NFLE have no pathological level of EDS with respect to controls. However, daytime sleepiness‐related symptoms could be more frequent in a subgroup of patients with subjective disturbed sleep quality, irrespective of the perceived frequency of seizures.
REM Sleep Behavior Disorder and Epileptic Phenomena: Clinical Aspects of the Comorbidity
Authors: Manni Raffaele , Terzaghi Michele , Zambrelli Elena
Published: December 2006

Summary:  Purpose: To document the occurrence of REM sleep behavior disorder (RBD) episodes in patients with epilepsy, and of interictal EEG epileptiform abnormalities (IEA) in patients with idiopathic RBD.

Methods: Consecutive observations in a tertiary epilepsy center and a tertiary sleep center. RBD diagnosis was based on standard clinical and video‐polysomnographic findings.

Results: Co‐occurrence of epileptic seizures and RBD episodes was found in six cases (all men; mean age 70.5 ± 11.1 years). Focal, isolated, sporadic sharp waves during wakefulness and/or during sleep were documented in 9 out of 34 (26.4%) patients with idiopathic RBD; no significant differences in age at onset and duration of RBD emerged between RBD patients with and without IEA.

Conclusions: RBD episodes can occur in epilepsy patients and focal IEA in patients with idiopathic RBD. This, apart from being a possible cause for misdiagnosis, may indicate a possible link between the two disorders. Further systematic investigations of the occurrence of RBD episodes in epilepsy will help to establish the real extent of this comorbidity and its ultimate neurobiological significance.
Elderly People and Epilepsy: Cognitive Function
Authors: Piazzini Ada , Canevini Maria Paola , Turner Katherine , Chifari Rosanna , Canger Raffaele
Published: December 2006

Summary:  Purpose: To evaluate cognitive function in a group of elderly patients with focal epilepsy versus healthy controls.

Methods: A neuropsychological battery assessing major cognitive domains was administered to 40 patients with focal epilepsy aged ≥60 years, and to 40 controls matched for sex, age, and education.

Results: Epilepsy patients performed significantly worse in most of the administered tests than controls (p < 0.05). Poor cognitive performances correlated with use of polytherapy.

Conclusions: Given the high prevalence of epilepsy in the elderly, our results could have important implications for clinical and research purposes.
The Risk of Lower Mental Outcome in Infantile Spasms Increases after Three Weeks of Hypsarrhythmia Duration
Authors: Primec Zvonka Rener , Stare Janez , Neubauer David
Published: December 2006

Summary:  To assess the correlation between hypsarrhythmia duration and mental outcome in infantile spasms (IS) the medical records of 48 infants with IS were reviewed retrospectively and psychological assessments undertaken at follow‐up at the age of 3 to 13 years. We found 18 (38%) cryptogenic IS cases with typical hypsarrhythmia and 30 symptomatic with modified hypsarrhythmia—further classified into 15 cases as multifocal, 10 as pseudoperiodic and 5 as unilateral hypsarrhythmia. A short treatment lag (one to two weeks) occurred in 25, three to four weeks in 10 cases. Spasms ceased within one month after treatment in 23 infants. At follow‐up 15 children had normal mental outcome (borderline included). A correlation between hypsarrhythmia duration longer than three weeks and lower mental outcome was found using the logistic regression model. The duration of hypsarrhythmia represents a sensitive prognostic parameter in IS; the risk of mental retardation increases after three weeks of hypsarrhythmia.
Direct and Indirect Costs of Refractory Epilepsy in a Tertiary Epilepsy Center in Germany
Authors: Hamer Hajo M. , Spottke Annika , Aletsee Christiane , Knake Susanne , Reis Janine , Strzelczyk Adam , Oertel Wolfgang H. , Rosenow Felix , Dodel Richard
Published: December 2006

Summary:  Purpose: There are only few studies on the costs of epilepsy in Germany. Therefore, we performed a pilot study to estimate the direct and indirect costs of refractory epilepsy in a German epilepsy center.

Methods: A “prevalence‐based,” cross‐sectional convenience sample of adults with active epilepsy attending the outpatient clinic of our tertiary epilepsy center was evaluated. Seizure‐free patients and patients presenting with their first seizure were excluded. Direct and indirect costs were prospectively recorded over a three‐month period using questionnaires and a patient diary. Cost driving factors were identified.

Results: One hundred one patients were included (40.7 ± 15.2 years; disease duration: 18.1 ± 15.3 years; 6 patients had focal epilepsy with simple partial seizures only, 28 with complex partial seizures, 43 with secondarily generalized tonic–clonic seizures; 20 had idiopathic generalized epilepsy with generalized tonic–clonic seizures). The total costs of epilepsy per patient were in average € 2610 ± 4200 over the three‐month period. Direct cost contributed 39% to the total costs. Costs of anticonvulsant medication were the main contributor to the direct costs while indirect costs were caused mainly by losses due to early retirement. Cost driving factors included higher seizure frequency, longer disease duration, ictal falls, and situationally inappropriate complex behavior during or after the seizure.

Conclusions: Indirect costs were higher than direct costs in adult patients with active epilepsy attending a German epilepsy center. Medication contributed the most to the direct costs and early retirement was the main factor for the indirect costs. The costs of poorly controlled epilepsy in this German study were above average of the European costs of epilepsy.
Cerebral Malaria and Sequelar Epilepsy: First Matched Case‐Control Study in Gabon
Authors: Ngoungou Edgard Brice , Koko Jean , Druet‐Cabanac Michel , Assengone‐Zeh‐Nguema Yvonne , Launay Marylène Ndong , Engohang Edouard , Moubeka‐Mounguengui Martine , Kouna‐Ndouongo Philomène , Loembe Paul‐Marie , Preux Pierre‐Marie , Kombila Maryvonne
Published: December 2006

Summary:  Purpose: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas. The purpose of this article was to evaluate the relationship between CM and epilepsy in Gabon.

Methods: A matched case–control study was carried out on a sample of subjects aged six months to 25 years and hospitalized between 1990 and 2004 in three hospitals in Libreville, Gabon. Cases were defined as patients suffering from epilepsy and confirmed by a neurologist. Controls were defined as patients without epilepsy. The exposure of interest was CM according to WHO criteria.

Results: In total, 296 cases and 296 controls were included. Of these, 36 (26 cases and 10 controls) had a CM history. The adjusted odds ratio (aOR) to develop epilepsy after CM was 3.9 [95% CI: 1.7–8.9], p < 0.001. Additional risk factors were identified: family history of epilepsy: aOR = 6.0 [95% CI: 2.6–14.1], p < 0.0001, and febrile convulsions: aOR = 9.2 [95% CI 4.0–21.1], p < 0.0001.

Conclusions: This first case–control study on that issue suggests that epilepsy‐related CM is an underrecognized problem. It emphasizes the need for further studies to better evaluate the role of convulsions during CM.
A Survey of Public Awareness, Understanding, and Attitudes toward Epilepsy in Greece
Authors: Nicholaos Diamantopoulos , Joseph Kaleyias , Meropi Tzoufi , Charilaos Kotsalis
Published: December 2006

Summary:  Purpose: To assess familiarity, understanding, and attitude toward epilepsy in Greece and identification of negative predictive factors.

Methods: A 19‐item questionnaire was administered to 750 adults. The magnitude of social stigma toward epileptic people with epilepsy was measured with a quantitative scale of social rejection. Statistical analysis with chi‐square and multiple regression analysis were used to identify factors associated with negative attitudes.

Results: Of our respondents 38.8% knew someone with epilepsy and 50.8% had witnessed a seizure. Ninteen percent believed that epilepsy is a type of mental retardation, 15% believed it is a type of insanity, 91.8% considered epilepsy as a brain disorder while 5.2% considered it as a supernatural phenomenon. Seventy‐seven percent considered epilepsy as a curable disease while 57.5% believed that the risk of inheriting it is very high. Regarding marriage to a patient with epilepsy 45.4% rejected it while regarding his employment 37.7% were positive, 47.8% were skeptical while 12.8% were against it. The Greek public's rejection tendency toward epileptic people was generally low. Negative predictive factors were older age, low educational level, unfamiliarity with epilepsy, and erroneous beliefs about epilepsy.

Conclusions: The Greek public is familiar with epilepsy but has a suboptimal level of appropriate understanding of essential aspects of the disease. The overall public's level of rejection toward people with epilepsy is low but certain groups of people are highly rejective. Information campaigns targeting specific population subgroups are necessary in Greece in order to improve the public's understanding of epilepsy and tolerance toward people with epilepsy.
Validation of Criteria for Selective His Bundle and Para‐Hisian Permanent Pacing
Authors: CANTÙ F. , DE FILIPPO P. , CARDANO P. , DE LUCA A. , GAVAZZI A.
Published: December 2006

Background: His Bundle (HB) pacing is a valid alternative to right ventricular pacing for patients with preserved His‐ventricle conduction who are candidates for permanent stimulation. Permanent pacing in the HB area enables Selective HB pacing (SHBP) or para‐Hisian pacing (PHP) to be achieved. The aim of our study was to draw up a set of easy criteria to differentiate and validate the two kinds of stimulations according to the pacing output and the ECG/EKG signals.

Methods and Results: From February to July 2005, 17 patients eligible for a pacemaker (PM) procedure underwent implantation with the Medtronic SelectSecure® lead (Medtronic, Minneapolis, MN, USA) screwed into the HB area.
SHBP was defined when the intrinsic QRS was equal, in both duration and morphology, to the paced QRS, the His‐Ventricular (H‐V) interval was equal to Pace‐Ventricular interval (Vp‐V) and, at low output, only the HB was captured, while increasing the output resulted in both the HB and right ventricular (RV) being captured (widening of QRS at high output). Conversely, PHP was defined when the intrinsic QRS differed from the paced one, either in morphology or in duration and, at high output, both the RV and HB were captured (non‐SHBP), while decreasing the output resulted in losing HB capture (widening of QRS at low output). According to these criteria, SHBP was achieved in 11 patients, while in the remaining 6, PHP was obtained. No adverse events were reported.

Conclusions: The above criteria enabled SHBP and PHP to be validated easily and clearly. A longer follow‐up will be needed in order to ascertain whether the clinical outcome of these two approaches differs.
Intrathoracic Far‐Field Electrocardiogram Allows Continuous Monitoring of Ischemia After Total Coronary Occlusion
Authors: ASBACH STEFAN , WEISS INGO , WENZEL BEATE , BODE CHRISTOPH , ZEHENDER MANFRED
Published: December 2006

Introduction: Recording of intrathoracic far‐field electrocardiograms (FF‐ECG) via can and electrodes of implantable cardioverter‐defibrillators (ICD) is a promising method for continuous monitoring of myocardial ischemia. We assessed the hypothesis that experimentally induced ischemia provokes segment changes in the FF‐ECG that can be detected by the ICD.

Methods and Results: In seven pigs with an ICD implanted in the left pectoral region and electrodes placed in the right ventricle and the superior vena cava, we occluded all major coronary arteries in proximal and distal locations for 180 s each. Surface and FF‐ECGs were compared for presence and time course of ischemic ST segment changes. Reliable detection of ischemia by ST segment analysis was possible in all (38/38) experiments. Maximum deviation from baseline was larger in FF‐ECG (1.21 mV) than surface ECG leads (0.23 mV, P < 0.01) for all occlusion sites. Ischemia could be detected earlier (P < 0.05) in the FF‐ECG, with a sensitivity of 100%, 93%, and 100% after occlusions in the left anterior descending, left circumflex, and right coronary arteries, respectively.

Conclusion: Intrathoracic FF‐ECG allows reliable and reproducible detection of experimentally induced ischemia originating from all major coronary arteries and therefore could be an interesting tool for clinicians in monitoring high risk patients.
Perioperative Biventricular Pacing Leads to Improvement of Hemodynamics in Patients with Reduced Left‐Ventricular Function—Interim Results
Authors: DZEMALI OMER , BAKHTIARY FARHAD , DOGAN SELAMI , WITTLINGER THOMAS , MORITZ ANTON , KLEINE PETER
Published: December 2006

Background: Cardiac resynchronization therapy (CRT) has been introduced as a new therapeutic modality in patients with chronic heart failure. However, most studies have investigated the hemodynamic effects in congestive, but not postoperative heart failure.

Objective: The following study investigates hemodynamic effects of perioperative temporary biventricular pacing in patients undergoing open heart surgery.
In 54 patients one left and one right ventricular epicardial wire was placed during open heart operations. Hemodynamic parameters were measured immediately after the operation and 6 as well as 24 hours postoperatively. Transesophageal echocardiography was performed 1 hour postoperatively.

Results: Of the 54 patients (59.2%), 32 responded to biventricular pacing with an increase in cardiac output; in these patients synchronized ventricular contraction could be verified echocardiographically. This hemodynamic benefit persisted 6 hours and 24 hours postoperatively. The remaining 22 patients did not show any hemodynamic improvement from biventricular stimulation.

Conclusion: Biventricular pacing leads to significant rise in cardiac output in approximately 59% of patients with severely reduced left ventricular function and widened QRS complexes. Further studies are necessary to define clearly the clinical characteristics of patients who show remodeling by CRT.
Pacemaker‐Induced Superior Vena Cava Syndrome: Clinical Evaluation of Long‐Term Follow‐Up
Authors: MELZER CHRISTOPH , LEMBCKE ALEXANDER , ZIEMER SABINE , EDDICKS STEPHAN , WITTE JOACHIM , BAUMANN GERT , BORGES ADRIAN C.
Published: December 2006

Background: Pacemaker‐induced superior vena cava (SVC) syndrome is a rare but serious complication of permanent pacemaker implantation. Because of its rarity, little is known about the long‐term prognoses of such patients.

Methods: Five patients, mean age 62 ± 11.4 years, with pacemaker‐induced SVC syndrome for more than 10 years were investigated. The clinical evaluation included: exercise testing, thrombophilia lab tests, and a chest CT.

Results: Two of the patients manifested complications of SVC syndrome which included thoracoabdominal subcutaneous collaterals. One of these patients simultaneously developed an increase in the pacing threshold which required the implantation of epicardial leads. Three of the five patients had normal age‐adjusted VO2 AT und VO2 max. Four of the patients were both heterozygous for a polymorphism of PAI‐1 and were homozygous for a polymorphism of t‐PA. One of these patients also was heterozygous for a polymorphism of factor V and glycoprotein IIb/IIIa. The chest CTs revealed extensive and varying collateral circulation patterns in all of the patients.

Conclusions: The development of pacemaker‐induced SVC syndrome is the result of various predisposing factors including thrombophilia. Many patients retain normal age‐adjusted cardiopulmonary capacity and demonstrate stable clinical findings on the long‐term as the result of the development of extensive collateral vessel systems. The most serious complication was the combination of SVC syndrome and the simultaneous malfunctioning of one of the leads requiring implantation of a new lead.
Laser Assistance for Extraction of Chronically Implanted Endocardial Leads: Infectious versus Noninfectious Indications
Authors: GAYNOR SYDNEY L. , ZIERER ANDREAS , LAWTON JENNIFER S. , GLEVA MARYE J. , DAMIANO RALPH J. , MOON MARC R.
Published: December 2006

Background: Powered sheaths, including Excimer laser sheaths, were introduced for the removal of transvenous pacing and defibrillator leads. The purpose of this study was to develop an algorithm to better predict which patients are likely to benefit from these devices.

Methods: We reviewed 283 consecutive patients in whom a total of 500 leads (302 pacing and 198 defibrillator leads) were extracted over a 5‐year period at our operative facilities. Laser assist was utilized whenever moderate traction failed.

Results: In 128 patients, 203 leads were removed for noninfectious indication. In 155 patients, 297 leads for infectious indications, including sepsis 22% (111), pocket infection 23% (115), and erosion 14% (71). Laser assistance was required for 6%± 5% (± 95% confidence interval) of septic leads, 51%± 7% of leads associated with erosion or pocket infection and 60%± 7% of noninfected leads (P = 0.001). Laser assistance was necessary more often for leads implanted >12 months (53%± 5%) than 12 months or less (6%± 5%) (P = 0.001) and for ventricular (52%± 6%) compared to atrial (35%± 7%) leads (P = 0.001).

Conclusions: Chronically implanted leads (>12 months), especially noninfected leads and leads associated with erosion or pocket infection, should be referred for extraction with powered sheaths to ensure successful removal. However, leads that are associated with systemic sepsis can generally be removed without powered sheaths.
Magnetocardiography Study on Ventricular Depolarization‐Current Pattern in Patients with Brugada Syndrome and Complete Right‐Bundle Branch Blocks
Authors: KANDORI AKIHIKO , MIYASHITA TSUYOSHI , OGATA KUNIOMI , SHIMIZU WATARU , YOKOKAWA MIKI , KAMAKURA SHIRO , MIYATAKE KUNIO , TSUKADA KEIJI , YAMADA SATSUKI , WATANABE SHIGEYUKI , YAMAGUCHI IWAO
Published: December 2006

Background:The objective of this study is to use magnetocardiography to determine the existence of a small abnormal current during ventricular depolarization in patients with Brugada syndrome. To understand this small difference in abnormal current during ventricular depolarization, we compared abnormal currents of patients with cases of complete right‐bundle‐branch block (CRBBB).

Methods and Results:We developed a whole‐heart electrical bull's eye map (WHEBEM) that uses magnetocardiograms (MCGs) to visualize the current distribution in a circular map. MCGs of Brugada syndrome patients (n = 16), CRBBB patients (n = 10), and controls (n = 12) at rest were recorded. In the WHEBEMs of Brugada syndrome patients, the magnitude of the S‐wave current in the upper‐right direction of the anterior side is larger than that of the controls. In addition, the R‐wave current direction is similar to that of the controls, and the R‐wave vector is distributed over a larger area than that of the controls. On the other hand, the CRBBB patients have a distribution of R‐wave currents over a larger area in the left anteromedian region and the left posteromedian region. Moreover, in all CRBBB patients, S‐wave currents with a large magnitude have the same direction distributed over a small area.

Conclusions:The WHEBEM findings suggest that there is an abnormal current in the direction to the upper right (in the S‐wave) in the anterosuperior region of Brugada syndrome patients. We thus conclude that a WHEBEM has the potential to detect characteristics of heart disease.
Convective Cooling Effect on Cooled‐Tip Catheter Compared to Large‐Tip Catheter Radiofrequency Ablation
Authors: PILCHER THOMAS A. , SANFORD ANNA L. , SAUL J. PHILIP , HAEMMERICH DIETER
Published: December 2006

Background. Both actively cooled‐tip and large‐tip catheters are currently available clinically to create large endomyocardial lesions during application of radiofrequency (RF) energy. The purpose of this study was to compare the effect of convective cooling at physiologic flow rates on RF lesion size using both actively cooled and large‐tip catheters.

Methods. Porcine hearts were sectioned into 72 pieces and placed in a temperature‐controlled saline bath (37°C) with varying directed flow rates (0, 1, 2, and 3 L/min). Cooled‐tip RF ablation (4 mm tip) was performed for 1 minute on 36 tissue sections with power manually titrated to keep tip temperature below 40°C. Large‐tip catheter ablation (10 mm tip) was performed at 65°C target temperature for 1 minute on 36 tissue sections. For each catheter, flow rates were randomized between applications. The tissue pieces were sectioned and measured to determine lesion depth, width, and volume.

Results. Lesion dimensions were independent of the flow rate for the cooled‐tip catheter (mean volumes: 382.0 ± 121.6, 419.9 ± 133.4, 375.9 ± 169.1, and 346.7 ± 173.4 mm3 for 0, 1, 2, and 3 L/min flow rate, respectively, P = 0.78). For the large‐tip catheter, lesion size varied significantly with flow, such that higher flow rates produced larger lesions (mean volumes: 120.7 ± 50.7, 256.5 ± 97.9, 393.4 ± 149.9, and 548.9 ± 157.0 mm3 for 0, 1, 2, and 3 L/min flow rate respectively, P < 0.001)

Conclusion. During RF ablation, blood flow rate significantly affects lesion size for large‐tip but not cooled‐tip catheters. At low flow rates (0–1 L/min) cooled‐tip catheters create larger lesions, while at high flow rates (3 L/min) large‐tip catheters create larger lesions.
Randomized Study of Propofol Effect On Electrophysiological Properties of the Atrioventricular Node in Patients with Nodal Reentrant Tachycardia
Authors: WARPECHOWSKI PAULO , LIMA GUSTAVO G. , MEDEIROS CLÁUDIO M. , SANTOS ARI TADEU L. , KRUSE MARCELO , MIGLORANSA MARCELO H. , KALIL RENATO A.K.
Published: December 2006

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is probably the most common form of paroxysmal supraventricular tachycardia. Percutaneous catheter ablation is a technique to interrupt cardiac conduction pathways selectively. The anesthetist is challenged to provide a safe anesthetic which takes into account the electrophysiologist's requirements for minimal cardiac conduction interference. Propofol is an ideal drug. However, previous studies have shown that the infusion of propofol has sometimes been associated with bradyarrhythmias or conversion of arrhythmias to sinusal rhythm. The purpose of this report is to verify the interferences of propofol in the electrophysiological properties of the atrioventricular (AV) node conduction system in patients with AVNRT.

Methods: Patients were randomly assigned to receive either a placebo or propofol at sedative doses. An electrophysiological study was performed consisting of measuring the anterograde (AERPFP) and retrograde effective refractory period of the fast (RERPFP) and the anterograde effective refractory period of the slow (AERPSP) AV nodal pathway. Reciprocating tachycardia was induced and the cycle length (CL) and atrial‐His (AH), His‐ventricular (HV), and ventriculoatrial (VA) intervals were measured.

Results: Propofol did not cause alteration (P > 0.05) in the AERPFP or RERPFP and the AERPSP AV nodal pathway. The AH, HV, and VA intervals were not affected. Sustained reciprocating tachycardia could be induced in the all patients. All slow pathways were successfully identified and ablated.

Conclusion: Propofol has no effect on the electrophysiological properties of the AV node conduction system. It is thus a suitable anesthetic agent for use in patients undergoing ablative procedures.
Low Energy Biphasic Waveform Cardioversion of Atrial Arrhythmias in Pediatric Patients and Young Adults
Authors: LIBERMAN LEONARDO , HORDOF ALLAN J. , ALTMANN KAREN , PASS ROBERT H.
Published: December 2006

Background: Low‐dose biphasic waveform cardioversion has been used for the termination of atrial arrhythmias in adult patients. The energy required for termination of atrial arrhythmias in pediatric patients is not known. The objective of this study is to determine the minimum energy required for successful external cardioversion of atrial arrhythmias in pediatric patients using biphasic waveform current.

Methods: Prospective study of all patients less than 24 years of age with and without congenital heart disease undergoing synchronized cardioversion for atrial arrhythmias. Patients were assigned to receive an initial biphasic energy shock of 0.2–0.5 J/kg and if unsuccessful in terminating the arrhythmia, subsequent sequential shocks of 1 and 2 J/kg would be administered until cardioversion was achieved. The end point of the cardioversion protocol was successful cardioversion or delivery of three shocks.

Results: Between June 2005 and June 2006, 16 patients underwent biphasic cardioversion for atrial flutter or fibrillation. The mean age was 14.7 ± 6.4 years (range: 2 weeks to 24 years). The mean weight was 51 ± 21 kg (range: 3.8–82 kg). Seven patients had normal cardiac anatomy, three had a single ventricle (Fontan), two had a Senning operation; the remaining four patients had varied forms of congenital heart disease. The median length of time that the patients were in tachycardia was 12 hours (range: 5 minutes to 2 months). Using either transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), no thrombi were identified in any patient. All patients were successfully cardioverted with biphasic waveform energy. The successful energy shock was 0.35 ± 0.19 J/kg (range: 0.2–0.9 J/kg). All but one patient were successfully cardioverted with less than 0.5 J/kg. The transthoracic impedance range was between 41 and 144 Ω; one patient had an impedance of 506 Ω (2‐week‐old infant with a weight of 3.8 kg). The mean current delivered was 5.4 ± 2.2 A (range: 1–11 A).

Conclusion: Low‐dose energy using biphasic waveform shocks can be used for successful termination of atrial arrhythmias in pediatric patients with and without congenital heart disease.
Group Purchasing Organizations: Optimizing Cardiac Device Selection, Therapy Delivery, and Fiscal Responsibility
Authors: SWEESY MARK W. , WILKOFF BRUCE L. , SMITH KERRY W. , HOLLAND JAMES L.
Published: December 2006

Group purchasing organizations (GPOs) have played a major role in supporting health care delivery in recent years as the healthcare industry has faced stronger economic pressures. Consequently, a position statement was drafted to act as a guideline for a GPO in creating a fiscally responsible, yet unrestricted environment for physicians to select the most appropriate cardiac device for their patients. This cardiac device selection guideline is to be implemented in hundreds of member hospitals but may be of use in non‐member hospitals as well. The guideline will only be effective when the physicians or cardiac device caregivers have the knowledge and skills to optimally program and match device therapies and algorithms to individual patient needs.
A Lamb in Wolff's Clothing
Authors: FISHER JOHN D. , KATZ DANIEL , LEWALLEN LINDA
Published: December 2006

A symptomatic woman with an electrocardiogram (ECG)‐based diagnosis of Wolff‐Parkinson‐White (WPW) syndrome underwent electrophysiologic studies that revealed a likely fasciculo‐ventricular tract.
Inappropriate Shock: A Failure of SVT Discriminators in a Dual Chamber ICD?
Authors: AL‐AHMAD AMIN , TSIPERFAL ANGELA , HSIA HENRY H. , WANG PAUL J.
Published: December 2006

Inappropriate shock remains a major issue in patients with implantable cardioverter defibrillators. We examine an inappropriate shock delivered in a patient with atrial tachycardia that conducted 1:1. We reconstruct the device algorithms that led to therapy delivery and discuss programming changes that could be considered.
Latent Atriofascicular Pathway Participating in a Wide Complex Tachycardia: Differentiation from Ventricular Tachycardia
Authors: JORAT MOHAMMAD V. , HAGHJOO MAJID , ALIZADEH ABOLFATH , FAZELIFAR AMIR FARJAM , NIKOO MOHAMMAD H. , EMKANJOO ZAHRA , SADR‐AMELI MOHAMMAD A.
Published: December 2006

Accessory pathways with anterograde decremental conduction properties usually are characterized by presence of antegrade preexcitation during atrial pacing. We report a 38‐year‐old man with frequent episodes of palpitation. No evidence of ventricular preexcitation was seen during sinus rhythm or atrial pacing. All electrophysiologic maneuvers were compatible with an antidromic tachycardia using atriofascicular pathway as the antegrade limb and the atrioventricular nodal pathway as retrograde limb. Radiofrequency ablation at recording site of accessory pathway potential resulted in cure of tachycardia with no recurrence during 3‐month follow‐up. This report indicated that atriofascicular pathway‐mediated tachycardia should be considered in differential diagnosis of all cases of wide complex tachycardia with left bundle branch morphology and left axis.
Successful Use of a Transvenous Dual‐Chamber Automatic Implantable Cardiac Defibrillator After a Classic Fontan Operation for Tricuspid Atresia
Authors: LOPEZ J. ALBERTO , MIHALICK MICHAEL
Published: December 2006

We report the first successful totally percutaneous pacing and defibrillation of a single ventricle in a 52‐year‐old woman who had undergone a classic Fontan operation (atriopulmonary connection) for tricuspid atresia 21 years earlier. Left ventricular pacing and sensing was obtained with a bipolar lead in the lateral cardiac vein, and defibrillation was obtained with a coronary sinus coil lead and an “active can” in the retromammary position to optimize the current vector. This approach has significant potential benefits because it avoids a repeat thoracotomy, with its associated mortality and morbidity.
Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water‐Irrigated Intraesophageal Balloon: A Pilot Study
Authors: TSUCHIYA TAKESHI , ASHIKAGA KEIICHI , NAKAGAWA SUSUMU , HAYASHIDA KIYOSHI , KUGIMIYA HIROSHI
Published: December 2006

Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water‐irrigated intraesophageal balloon (IB).

Methods and Results: Eight patients with drug‐refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9‐Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow‐up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.

Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.
Is there a relationship between depression and crying? A review
Authors: Vingerhoets A. J. J. M. , Rottenberg J. , Cevaal A. , Nelson J. K.
Published: December 2006

Objective: To conduct a systematic examination of the relationship between depression and crying by reviewing all relevant theory and empirical data including the performance of crying items in measures of depression.

Method: Review of the extant literature on depression and crying using PubMed, PsychInfo and Google Scholar databases.

Results: Scores on crying items of depression inventories correlate moderately with overall depression severity. Otherwise, there is surprisingly little evidence for the widespread claim that depression leads to more frequent and/or easier crying. There is also little empirical support for the competing claim that severely depressed individuals lose their capacity to cry.

Conclusion: Current claims about the relationship between depression and crying lack a robust empirical foundation. Assessment instruments and diagnostic systems for mood disorders are inconsistent in how they handle crying as a symptom. Further work to investigate the causes and the context of crying in depressed patients is needed.
Compromised GCF total antioxidant capacity in periodontitis: cause or effect?
Authors: Chapple I. L. C. , Brock G. R. , Milward M. R. , Ling N. , Matthews J. B.
Published: December 2006

Background: Oxidative stress is implicated in the pathogenesis of periodontitis. The total antioxidant capacity (TAOC) of gingival crevicular fluid volume (GCF) and plasma appears compromised in periodontitis, but it is unclear whether this predisposes to, or results from the inflammatory process.

Aim: To investigate longitudinal changes in GCF and plasma TAOC following reductions in periodontal inflammation with successful non‐surgical therapy.

Materials and Methods: Two longitudinal studies were run in series on non‐smokers with chronic periodontitis (CP). Study‐1 (n=17) assessed index sites with mild disease; Study‐2 (n=18) investigated deep sites. GCF sampling and clinical measures were performed at baseline and 3 months post‐therapy. Plasma and GCF TAOC was determined by enhanced chemiluminescence and 32 age/sex‐matched periodontally healthy controls were used.

Results: Therapy improved clinical outcomes consistent with the literature. There were no differences in plasma TAOC between periodontitis patients (507±92 μMTeq) and controls (520±100 μMTeq; p=0.57) at baseline, but GCF TAOC was lower (p<0.0001) in CP patients (680±371 μMTeq) than controls (1129±722 μMTeq). Successful periodontal therapy did not alter plasma TAOC (p=0.56), but GCF TAOC increased (by 449±722 μMTeq, p<0.001) to control subject levels (p=0.47)

Conclusions: Local total antioxidant capacity in CP appears to reflect increased oxygen radical activity during periodontal inflammation and can be restored to control subject levels by successful non‐surgical therapy.
Allergic contact dermatitis to cow’s hair
Authors: Ljubojevic Suzana , Pastar Zrinjka , Lipozencic Jasna , Milavec‐Puretic Visnja
Published: December 2006

A 32‐year‐old farmer woman with delayed type of allergy to cow’s hair is described in this study. She had the 5‐year history of erythematous, desquamative lesions on the dorsal side of the hands and forearms. Shortly after entering the cowshed, she showed relapse of skin symptoms and total regression when she was away from the farm. The patch test to European standard series, hair of the cow from the patient’s cowshed, hay, and stable hay was performed. Additionally, prick tests were performed on inhalant allergens such as hair of the cow from the patient’s cowshed, hay, stable hay and cow’s milk, total immunoglobulin class E (IgE) together and specific IgE to cow dander and milk. Patch test showed positive reaction to cow’s hair, cobalt chloride, nickel sulfate, and thimerosal. All other tests were negative.
Octyl salicylate: a new contact sensitivity
Authors: Singh M. , Beck M. H.
Published: December 2006

We describe acute contact sensitivity to octyl salicylate, an ultraviolet filter, used in many cosmetics and sunscreens.
Intervention implementation research: an exploratory study of reduction strategies for occupational contact dermatitis in the printing industry
Authors: Brown Terry P. , Rushton Lesley , Williams Hywel C. , English John S. C.
Published: December 2006

Background:  Occupational dermatitis is a problem in the printing industry but can be avoided through adequate protective measures. Research into intervention implementation is fundamental to the success of a formal intervention effectiveness trial.

Objectives:  The preliminary testing of four risk reduction strategies for occupationally caused dermatitis, which represent a range of approaches and cost implications.

Patients/Methods:  The strategies, the provision of (i) skin checks plus treatment advice; provision of (ii) gloves of the correct type/size plus use of an after‐work cream; provision of (iii) information highlighting the problem of occupational dermatitis and (iv) development of a best practice skin care policy, were evaluated over 3 months in two non‐randomly selected companies. A post‐intervention evaluation into the effectiveness and efficacy of the intervention was also carried out.

Results and Conclusions:  All interventions were found to be acceptable to some extent. No single intervention appeared to be completely effective. The most practical intervention appeared to be the regular use of gloves of the correct type and size. This preliminary intervention study has demonstrated an improvement in the skin condition of workers examined and points towards the need for further testing of risk reduction strategies for the prevention of dermatitis in the printing industry on a much larger scale.