Beneficial hemodynamic effects of prostaglandin E1 infusion in catecholamine-dependent heart failure: results of a prospective, randomized, controlled study.

Objective: To study the hemodynamic effects of prostaglandin E1 (PGE1) administered in addition to a standard catecholamine infusion in patients with severe chronic heart failure.

Design: Prospective, placebo-controlled, randomized, single-blind study.

Setting: Intensive care unit at a university hospital.

Exercise chronotropy in patients with normal and impaired sinus node function after cardiac transplantation.

The chronotropic response during graded, symptom limited exercise was investigated in 32 cardiac transplant recipients a mean of 49 +/- 18 days after transplantation. All patients had systematic evaluation of postoperative donor sinus node (SN) function and the cardioacceleratory response was compared according to the SN function. Twenty-one patients had normal postoperative SN studies (corrected SN recovery time < 520 msec, group I) while the SN function was impaired postoperatively in the remainder (n = 11, group II; corrected SN recovery time 4,149 +/- 6,283 msec in 5 patients, junctional escape rhythm in 6 patients).

Alterations of orthodromic circus movement tachycardia by dual atrioventricular nodal pathways in a patient with Wolff-Parkinson-White syndrome.

In a patient with a left sided accessory pathway (AP) three different types of orthodromic circus movement tachycardia were observed: (1) narrow QRS complex tachycardia with a stable cycle length (CL); (2) wide QRS complex tachycardia with a functional bundle branch block ipsilateral to the AP, which, paradoxically, had a shorter CL. The decrease in CL was due to a decrease of the AH interval; and (3) narrow QRS complex tachycardia with alternating CL, due to alternations of the AH interval. These phenomena were attributed to a concomitant dual atrioventricular (AV) node, which was eventually proven after successful catheter ablation of the AP.

Management of elderly patients with the Wolff-Parkinson-White syndrome: is less aggressive treatment justified?

To study the age-related differences in Wolff-Parkinson-White syndrome an elderly group of 20 patients aged 40-65 years was compared to a younger group of 26 patients aged 18-39 years with respect to clinical profile and electrophysiological characteristics. The two groups were comparable in terms of the mechanism of reentry tachycardia, accessory pathway location, the number of patients reporting syncopal episodes, and the incidence of inducible and/or documented atrial flutter/fibrillation while only elderly patients had also atrial tachycardias. The elderly group was characterized by a higher incidence of associated organic heart disease and a significantly higher percentage of resuscitation from circulatory arrest.

[Therapy of urinary tract infection].

The choice of therapy in urinary tract infections depends on the infection site, complications, previous history, and recrudescence. Acute uncomplicated urinary tract infections which do not respond to general measures as increased fluid intake will be cured with antibiotics for 3 days. If the compliance of the patient is sufficient a single shot therapy may be applied.