An Achilles tendinosis masking an intramedullary astrocytoma.

We report the case of a 53-year-old male with a right Achilles tendinosis, who complains about a mild gait disorder starting after walking several kilometers. In the following months he develops neurological symptoms. MRI lumbar spine shows an intramedullary tumor at level Th12.

Turning 18 with congenital heart disease: prediction of infective endocarditis based on a large population.

Aims: The risk of infective endocarditis (IE) in adults with congenital heart disease is known to be increased, yet empirical risk estimates are lacking. We sought to predict the occurrence of IE in patients with congenital heart disease at the transition from childhood into adulthood.

Methods And Results: We identified patients from the CONCOR national registry for adults with congenital heart disease.

The concept of sustainability and the use of outcome indicators. A case study to continue a successful health counselling intervention.

Background: To ensure the continuation of a successful pilot programme, the change process and the concept of sustainability need to be elaborated. So far, there are different theories on organizational change and sustainability but its practical application stay far behind.

Objectives: To test the practical application of a theory-based concept of sustainability and to assess the role of the change agent.

[Frankness regarding errors in medical care].

In recent years, increasing attention has been given to the importance of disclosing medical errors. Many physicians are still reluctant to disclose errors and to discuss them with the patient. Recent legislative developments have reduced the existing uncertainty regarding the legal consequences of full disclosure.

Predicting capacities required in cardiology units for heart failure patients via simulation.

The management of a department of cardiology has to plan the capacity of both elective and non-elective patients. Heart failure (HF) patients are admitted to the hospital in a non-elective way. The precision with which the capacity needed for non-elective patients can be predicted determines the degree of flexibility in planning the admission of elective patients.

Peripartum cardiomyopathy: a condition intensivists should be aware of.

We use an illustrative case of severe peripartum cardiomyopathy with congestive heart failure to introduce this topic and proceed to cover its pathophysiology, incidence, management and outcome.

Quality of life in older patients with systolic and diastolic heart failure.

Aims: To get insight into the quality of life of a clinical practice sample of patients with heart failure that are admitted to the hospital. Secondly to determine differences between patients with systolic and diastolic dysfunction and finally to describe factors relating to quality of life.

Methods: Three dimensions of quality of life (functional capabilities, symptoms and psychosocial adjustment to illness) were assessed during interviews of 186 patients with chronic heart failure.

Management of atrial arrhythmias secondary to severe congenital heart disease with the Atrioverter.

An atrial defibrillator was implanted in a patient with congenitally corrected transposition of the great arteries, associated cardiac abnormalities, and persistent atrial arrhythmias. During a 15-month follow-up, 14 of 20 spontaneous episodes of his arrhythmias were successfully treated with the device. Two of these episodes were converted to sinus rhythm during ambulatory use of the device.

The relative bioavailability of metoprolol following oral and rectal administration to volunteers and patients.

The pharmacokinetics, efficacy and safety of metoprolol tartrate 25 mg fatty suppositories were studied in 5 healthy volunteers and in 8 patients suffering from instable angina pectoris. Metoprolol 25 mg capsules were used as a control oral dosage form. Metoprolol showed a considerable rectal bioavailability (AUC, C max) and was absorbed quickly from the rectum (T max).

Effects of education and support on self-care and resource utilization in patients with heart failure.

Aims: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure.

Methods: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'.

Improvement of systolic and diastolic left ventricular wall motion by serial echocardiograms in selected patients treated for unstable angina.

The purpose of the study was to evaluate the effect of antiischemic treatment on left ventricular function in selected patients with unstable angina pectoris that was due to severe proximal left anterior descending coronary artery narrowing and to identify subgroups liable to an adverse outcome (mean term 2.7 years). Effect of antiischemic treatment on systolic and diastolic left ventricular wall motion was studied in 35 patients who had unstable angina pectoris and an electrocardiogram that indicated severe proximal left anterior descending coronary artery narrowing.

Identical QRS complexes during atrial fibrillation with aberrant conduction and ventricular tachycardia. The value of a His bundle recording.

In a patient with chronic congestive heart failure, right bundle branch block-shaped QRS complexes occurred in salvos during atrial fibrillation. The site of origin of these complexes could not be determined from the 12-lead ECG alone. Recording of a His bundle electrogram showed that both intraventricular aberrant conduction and ventricular tachycardia were responsible for salvos having the same QRS complexes in the 12-lead ECG.