Effect of end-stage renal disease on decreased heart rate variability.

We compared short-term heart rate variability (HRV) in 60 patients with end-stage renal disease (ESRD) with 33 age-matched healthy controls and also assessed the contribution of known determinants of HRV in the ESRD patients. HRV was markedly decreased in the ESRD patients and the predictor variables of cardiac diseases, diabetes mellitus, age, heart rate, gender, and smoking explained only a small portion of HRV, suggesting that ESRD itself is an independent factor for decreased HRV.

Pacemaker-mediated polymorphic ventricular tachycardia.

A patient with refractory bradycardia dependent polymorphic ventricular tachycardia (PMVT) underwent permanent pacemaker placement for suppression of her arrhythmia. Following implant, the patient had recurrent PMVT. Interrogation of the device revealed a factory programmed feature (+ PVARP on PVC) designed to prevent pacemaker-mediated tachycardia that led to cycle length variability and subsequent arrhythmia recurrence. This feature was deactivated and the patients' arrhythmia did not recur.

Unipolar recording and pacing using a conductive introducer sheath as the indifferent electrode.

Unipolar recording has been shown to have advantages over bipolar techniques in certain clinical settings. Unipolar recording and pacing, however, require an indifferent electrode to complete the circuit. Current options for the indifferent electrode require additional hardware or special recording capabilities. A novel percutaneous unipolar conductive introducer sheath (PUCIS) was developed for unipolar electrophysiological recording and pacing. This article describes the development of this sheath, in vitro testing results, and initial animal data using the PUCIS as the indifferent electrode. The current silver/gold coating has acceptable mechanical and electrical properties. Electrogram appearance and amplitude, pacing thresholds, and impedances were comparable to currently used alternatives. The PUCIS sheath may therefore serve as a convenient standard as the indifferent electrode for unipolar electrophysiology.

"Pseudo" late potentials unmasked by spectrocardiography.

We present a patient with chronic obstructive pulmonary disease and sustained ventricular tachycardia in the setting of unstable coronary artery disease. Signal-averaged ECG (SAECG), inadvertently performed during an atrial tachycardia with 2:1 atrioventricular (AV) block, was abnormal by time-domain analysis, but was normal by a relatively new frequency analysis technique of the entire QRS (spectrocardiography). The patient was noninducible for sustained ventricular arrhythmias. Following cardioversion to sinus rhythm, SAECG was normal by time-domain analysis and spectrocardiography. This technique may show promise in the management of patients who are at risk for sustained ventricular arrhythmias, particularly those who cannot be evaluated by time-domain analysis.

Management involvement with compliance: when distributive management fails, everyone pays.

In this article I discuss the importance of management retaining and exercising its responsibilities for control over studies, especially studies that have been distributed to contractors and subcontractors, hence the title, "Distributive Management." While the clearest examples for distributive management are found in environmental fate and crop residue studies for EPA, similar examples may be found in contemporary toxicology and carcinogenicity studies. The cost of failure to exercise control over contracted studies has been estimated by the EPA at between $600 M and $1,200 M. These are costs that will be borne by the public through higher prices and higher taxes.

"The anti-Ashman maneuver": a bedside method for distinguishing aberrancy from ventricular ectopy.

This is a report of a patient who develops new onset atrial fibrillation in the postoperative setting which is further complicated by the presence of wide beats in singles, pairs, and short runs. Presented are the differential diagnosis of these wide beats and a simple bedside maneuver to help distinguish their origin.

The National Commission on AIDS.

A decade after the first cases were recognized in the United States, AIDS continues to vex policymakers and fascinate the public. It has been said that AIDS acts as a prism, refracting a spectrum of controversial topics. For bioethicists, these topics include: equity in the allocation of resources for treatment and research; forgoing life-sustaining care and proxy decision making; informed consent in the context of HIV testing and screening; the ethical duties of health care workers to provide care for persons with HIV disease; and competing obligations of health care professionals to patients and to third parties who may be put at risk.

Six-month course of depression in female alcoholics.

To evaluate the persistence of depression in alcoholic women, depressive symptomatology was assessed systematically via the Beck Depression Inventory at intake, 3, and 6 months of treatment. Fifty-five female alcoholics were diagnosed for concurrent psychiatric diagnosis. Results revealed differences in the course of depression for female alcoholics with (a) no concurrent diagnosis, (b) dysthymic disorder, and (c) personality disorder. Despite a decrease in depression for the sample as a whole, dysthymic alcoholics were consistently more depressed than the other two subgroups and remained depressed during the first 6 months of treatment. Depression did not significantly remit with sobriety.

Miniaturized spectrometer employing planar waveguides and grating couplers for chemical analysis.

Polymeric and metal oxide planar waveguides were used to demonstrate the potential of a miniature spectrometer. Multiwavelength light was transmitted through the substrate and coupled into the waveguide through a diffraction grating located at the substrate/waveguide interface. A second diffraction grating spatially dispersed the light propagated through the waveguide into component wavelengths for rapid analysis with a photodiode array detector. These results suggest that planar waveguides can be used to perform attenuated total internal reflection measurements in the visible and near-IR regions for chemical analysis of weak vibrational overtones and combination modes with effective path lengths of several millimeters.

Intraoperative autotransfusion in cardiac operations. Effect on intraoperative and postoperative transfusion requirements.

The Southern Arizona Regional Red Cross Blood Program, in cooperation with two cardiac surgery groups, examined the effect of intraoperative autotransfusion on red cell, plasma, and platelet usage during and after cardiac operations. The study evaluated whether intraoperative autotransfusion influenced intraoperative or postoperative blood usage and whether regular use was more effective than selective use. The study demonstrated that intraoperative autotransfusion reduces intraoperative and postoperative blood use and that regular use of intraoperative autotransfusion is more effective than selective use.

Identification of the protein product of the c-mos proto-oncogene in mouse testes.

The mouse c-mos proto-oncogene RNA is expressed primarily in mouse gonadal tissues and embryos. Until now, the c-mos protein has not been identified. Utilizing two different site-directed affinity purified anti-peptide antibodies, we have identified a 43 kDa c-mos protein in mouse testes and in germ cell preparations derived from testes. This 43 kDa testicular protein was found to be structurally related to a bacterially expressed c-mos protein by peptide mapping. Immunoblots of whole mouse sections were employed to establish that the c-mos protein is expressed primarily in the testes.

Post-transcriptional processing suggests that c-mos functions as a maternal message in mouse eggs.

Transcripts of the c-mos proto-oncogene were recently found to accumulate to high levels in mouse oocytes. We report here that the oocyte c-mos RNA is polyadenylated in concert with oocyte maturation, retained in mature ovulated eggs and zygotes but degraded by the late two cell embryo stage. These results suggest that c-mos functions as a maternal mRNA which is translated during oocyte maturation or fertilization and may play a role in these or other early developmental processes.

Expression of c-mos RNA in germ cells of male and female mice.

We have investigated the cell types in mouse testis and ovary in which the c-mos protooncogene is normally transcribed. Blot hybridization analysis of electrophoretically fractionated RNAs from testes of mice with defects in germ-cell development and from prepubertal and adult mice indicated that c-mos was transcribed during male germ-cell development. Analysis of purified populations of spermatogenic cell types detected c-mos RNA in the earliest haploid postmeiotic germ cell, the round spermatid, indicating that c-mos was expressed transiently during spermatogenesis. c-mos RNA was detected by blot hybridization in the ovaries of prepubertal mice and decreased in relative concentration following gonadotropin-stimulated proliferation of granulosa cells. These results suggested that c-mos was transcribed in oocytes and were confirmed by detection of high levels of c-mos RNA in isolated grown oocytes. Thus, c-mos is expressed in both male and female germ cells, suggesting possible roles for this protooncogene in meiosis, germ-cell development, fertilization, and early embryogenesis.

Survey of attitudes among three specialties in a teaching hospital toward alcoholics.

Although physicians are typically "gatekeepers" for the diagnosis and treatment of alcoholism, a lack of specific alcoholism training and negative attitudes toward alcoholics can establish formidable barriers to recognition and treatment of the condition. In the study reported here, the authors examined differences in attitudes toward and knowledge and treatment of alcoholism among physicians in three specialties. A questionnaire pertaining to alcoholism and alcoholics was mailed to 385 internists, surgeons, and psychiatrists at a teaching hospital. Half received a version concerning male alcoholics, and half received one concerning female alcoholics; the versions were identical except for the gender of the alcoholic referred to in the questionnaire. Fifty-three percent returned the questionnaire, and their responses showed that these physicians viewed male and female alcoholics similarly. Overall, the respondents considered them treatable but maintained negative perceptions of their personalities. The psychiatrists held the most positive views of the treatability of alcoholism and the most negative views of alcoholics' personalities, whereas the surgeons held the most positive views of alcoholics' personalities and the most negative views of treatability. The internists, surgeons, and psychiatrists reported significant differences in the adequacy of their education on alcoholism, in their methods of handling alcoholics, and in their desire to learn about alcoholism. These findings are discussed in terms of continuing education in alcoholism treatment for physicians.

Care of the young hemophiliac. New socioeconomic demands and the changing patient-physician relationship.

Over the past two decades, greater knowledge about hemophilia and vastly improved treatment have led to a veritable revolution in the care of this crippling disease. In prospect is an era in which both short- and long-term sequelae may be avoided altogether. Much of the progress has been effected through novel methods of care delivery in which the relationship of the physician and his patient begins to resemble more a partnership between equals than the traditional dependency of the chronically handicapped on his doctor. Yet with, and because of, these changes ethical and legal aspects are inevitably introduced, some of which are discussed in the article. These deal with issues of public policy, distributive justice, avoidance of harm, risk imposition and risk-taking, confidentiality, and paternalism. When applicable, the discussion surrounds a prototypical case which illustrates the real dilemmas which treaters and patients may have experienced or may encounter. Following each issue is a discussion intended to show how the ethical and legal dimensions may be analyzed in a way which allows certain justifiable decisions. These analyses are themselves based upon ethical premises which are commonly accepted, legal precedent, or both. While some of these considerations are relevant to the older hemophiliac as well, most deal with topics affecting those most likely to benefit from the advances and to contend with the challenges of this new era of hemophilia care: the young hemophiliac and his physician.