Two unusual complications after surgical interruption of an accessory pathway.

In a patient with the Wolff-Parkinson-White syndrome, Ebstein's anomaly of the tricuspid valve, a right atrial Chiari net and a patent foramen ovale two unusual complications developed after surgical epicardial dissection combined with cryoablation of the anomalous pathway. The first complication was that ablation of the right atrial wall led to changes in interatrial pressure gradients and the development of a right to left shunt necessitating surgical closure of the atrial septal defect. The second complication was the development of a thrombotic mass in the Chiari net simulating on intracavity tumour, which also had to be removed surgically.

Value of the 12-lead electrocardiogram in arrhythmogenic right ventricular dysplasia, and absence of correlation with echocardiographic findings.

The 12-lead electrocardiogram during sinus rhythm was studied in 20 patients with arrhythmogenic right ventricular (RV) dysplasia with symptomatic ventricular tachycardia. Findings were analyzed, together with echocardiographic evaluation of site, extent and progression of RV wall abnormalities. Electrocardiographic abnormalities were found in 90% of patients.

Radiofrequency catheter ablation of accessory atrioventricular pathways in children and young adults.

Objective: To assess the efficacy of radiofrequency ablation for reentrant tachyarrhythmias in children and young adults.

Setting: A tertiary cardiac referral centre.

Patients And Interventions: Over a 16 month period 22 patients aged less than 20 years (median age 16.

Ba 679 Br, a new long-acting antimuscarinic bronchodilator: a pilot dose-escalation study in COPD.

Preclinical studies with Ba 679 Br have demonstrated a significantly longer duration of action than ipratropium bromide. Following inhalation of single doses, no systemic antimuscarinic effects were noted at doses likely to be bronchodilating in man. The objective of the present pilot-study of Ba 679 Br was to establish the dose-range for its bronchodilatory activity in a small number of chronic obstructive pulmonary disease (COPD) patients, before initiating a formal dose- and time-response study.

Echocardiographic wall motion abnormalities and the signal averaged electrocardiogram in the acute phase of a first myocardial infarction.

We studied the relationship between wall motion abnormalities determined by echocardiography and the signal-averaged electrocardiogram in 82 consecutive patients during the acute phase of a first myocardial infarction. An abnormal signal-averaged electrocardiogram was defined as the presence of two of the following criteria: a QRS duration > or = 114 ms, a root mean square voltage (RMS) of the last 40 ms < or = 25 microV and an amplitude signal lower than 40 microV lasting > or = 39 ms. The left ventricle was divided into 13 segments and the contraction pattern divided into akinesia alone (including dyskinesia) (group A), hypokinesia alone (group B) and both hypokinesia and akinesia (group C).

Adjuvant chemohormonal therapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) with or without medroxyprogesterone acetate for node-positive breast cancer patients.

Background: The Comprehensive Cancer Center trial 82-01 is a prospective randomized study to investigate the value of the addition of high-dose medroxyprogesterone acetate (MPA) to chemotherapy in patients with node-positive operable breast cancer. MPA may be of advantage in this setting because of its activity in estrogen receptor ER-positive as well as ER-negative tumors and since it may protect against chemotherapy-induced myelosuppression and thus enable maintenance of the appropriate chemotherapeutic scheduling.

Patients And Methods: Four hundred eight evaluable patients with node-positive (N+) operable breast cancer (T1-3, N1) were entered in a multicenter randomized trial.

Effects on the signal-averaged electrocardiogram of opening the coronary artery by thrombolytic therapy or percutaneous transluminal coronary angioplasty during acute myocardial infarction.

One hundred twenty-nine patients were retrospectively analyzed and divided into 3 groups according to (1) the presence of a patent artery obtained either spontaneously or after thrombolytic therapy but without percutaneous transluminal coronary angioplasty (PTCA) (group I, n = 83), (2) the presence of a patent artery after opening by PTCA (group II, n = 29), or (3) absence of reperfusion despite thrombolytic therapy or PTCA (group III, n = 17). Thrombolytic therapy was given within 4 hours after onset of symptoms (mean 2.5 +/- 1.

[Double supraventricular tachycardia and its surgical treatment].

A case history is presented of a patient in whom a left-free-wall accessory pathway was surgically ablated to treat symptomatic Wolff--Parkinson--White syndrome. Subsequently, AV-nodal reentrant tachycardia became manifest. The patients's AV-nodal reentrant tachycardia was interrupted by Cox's discrete cryosurgical procedure.

Acquired atresia of the external auditory canal. Surgical treatment and results.

Atresia of the external ear canal following recurrent external otitis or surgery for chronic otitis media was treated in 17 ears with a canalplasty procedure using a retroauricular incision. The stenotic meatus was widened by removing fibrous tissue, and the tympanic membrane was deepithelialized. The posterior, superior, and inferior bony canal was widened until the first mastoid cells were encountered.

Chemotherapy consisting of cisplatin, epirubicin, and cyclophosphamide in advanced ovarian carcinoma. The Gynecologic Oncology Group of the Comprehensive Cancer Center, Limburg, The Netherlands.

Between January 1985 and May 1988, 87 patients with stage III-IV ovarian carcinoma were entered in a study assessing chemotherapy consisting of cyclophosphamide, 500 mg/m2, epirubicin, 75 mg/m2, and cisplatin, 50 mg/m2, intravenously (IV) on day 1, every 4 weeks (CEP-1). The results after a median follow-up of 4 years are presented. The pathologically complete remission rate was 36%.

Phase II study of epirubicin in advanced hormone-resistant prostatic carcinoma.

Twenty-nine patients with metastatic prostate cancer that had progressed following orchiectomy were treated with intravenous epirubicin 90 mg/m2 every 28 days. Their median age was 71 years (range 49-78) and the median Zubrod scale (WHO score) was 1. Two patients had soft tissue lesions, 20 had bone metastases and 7 had both.

[Supraventricular tachycardia due to retrograde decremental conduction over accessory pathways].

Purpose: To discuss the clinical and the electrophysiologic findings, the differential diagnosis and the behaviour of concealed retrograde long conduction time accessory pathways.

Methods: Seventeen patients were submitted to electrophysiologic study using programmed electrical stimulation of the heart to assess the electrophysiologic properties of the accessory pathway.

Results: In all 17 studied patients, it was possible to advance the next atrial activation by giving a ventricular premature beat during the refractoriness of the His bundle.

[Radiofrequency energy as treatment for arrhythmias in patients with accessory atrioventricular pathways].

Objective: Evaluation of the use of radiofrequency energy to interrupt accessory atrioventricular pathways.

Design: Prospective study.

Setting: University Hospital Maastricht.

Ventricular arrhythmias in heart failure.

Heart failure is an increasingly common disorder leading to reduced quality and expectancy of life. Asymptomatic and symptomatic ventricular arrhythmias are a frequent complication and have been found to be independent prognostic predictors for sudden cardiac death in patients with heart failure. Unfortunately, the positive predictive failure for this finding is low, but in patients with sustained ventricular arrhythmias, variables indicating impaired pump function are the most important predictors of sudden and of nonsudden cardiac death.

The electrocardiographic, clinical, and electrophysiologic spectrum of idiopathic monomorphic ventricular tachycardia.

Clinical, ECG, and electrophysiologic data from 47 patients who had episodes of sustained or nonsustained monomorphic VT with no evidence of structural heart disease were reviewed. According to the QRS configuration during tachycardia, four groups were distinguished. Nine patients had a right bundle branch block configuration and superior frontal plane QRS axis (group 1).

Clinical characteristics and electrophysiologic properties of atrioventricular accessory pathways: importance of the accessory pathway location.

Objectives: This study was designed to assess the influence of accessory atrioventricular (AV) pathway location on the clinical and electrophysiologic characteristics of 384 consecutive symptomatic patients having a single accessory pathway.

Methods: Four locations were studied: left free wall (n = 270), posteroseptal (n = 52), anteroseptal (n = 29) and right free wall (n = 33). Ten clinical variables and 12 electrophysiologic variables were analyzed, including the effective refractory period of the accessory pathway and the different clinically occurring and inducible arrhythmias.

A Comparative Study Into Procedures for Postmortem Inspection for Finishing Pigs.

A postmortem meat inspection system based primarily on visual inspection without palpation or incision was compared with regular meat inspection procedures based on European Community (EC) regulations, which consists of visual inspection, palpation, and incision of organs. Two experiments included 31,682 finishing pigs. Three inspection procedures were followed: visual, i.

Ambulatory electrocardiography evaluation of supraventricular tachyarrhythmias and bradyarrhythmias.

Long-term ECG recordings are of great value in the diagnosis and management of patients with cardiac arrhythmias. Information from programmed stimulation studies and intracardiac recordings has markedly improved the diagnostic abilities of the person examining the long-term ECG recording. This article discusses how knowledge from intracardiac electrophysiologic studies has resulted in much better recognition of the type and mechanisms of a supraventricular arrhythmia on the Holter record.

Incidence and timing of recurrences of sudden death and ventricular tachycardia during antiarrhythmic drug treatment after myocardial infarction.

Incidence and timing of recurrences of sustained ventricular tachycardia (VT) or sudden death were studied in 206 patients who survived their first episode of ventricular fibrillation (VF; n = 52) or sustained VT (n = 154) after myocardial infarction. All patients were treated with (empirically selected) antiarrhythmic drugs; 49% received amiodarone. After a mean follow-up of 36 months, 64 patients (41%) in the VT group and 10 (19%) in the VF group had nonfatal VT recurrences.

Use of information from pig finishing herds for meat inspection purposes.

In a field trial on Integrated Quality Control of finishing pigs we evaluated information written on Quality Information Cards (QUIC) for meat inspection purposes. These cards were sent with 3747 shipments of pigs going from the finishing herd to the slaughterhouse. Pig suppliers answered five questions dealing with health problems and the use of drugs during the finishing period.

Relationship between pathological findings and values of haematological and blood-chemistry variables in apparently healthy finishing pigs at slaughter.

The present study was performed to study possibilities of early decision making for appropriate conveyor-line at future slaughtering of normal, clinically healthy finishing pigs. Blood was collected at slaughter from barrows (n = 112). A meticulous examination for subclinical pathological lesions was performed, revealing 5 groups of subjects listed in order of increasing disease-activity: 1--no real disease-activity; 2--with mild subchronic lesions; 3--with subacute lesions; 4--with abscesses; and 5--with fibrinous-necrotic lesions.