Pulmonary agenesis: Importance of the diagnosis

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Hypersensitivity to clavulanic acid in children.

We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was based on the confirmation of an IgE-mediated aetiology by an oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloyl G and V, amoxicillin, ampicillin and cefaclor < 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroxime axetil.

Hypersensitivity to clavulanic acid in children

We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was basedon the confirmation of an IgE-mediated aetiology byan oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloy lG and V, amoxicillin, ampicillin and cefaclor< 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroximeaxetil

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Adenocarcinoma colorrectal: factores pronósticos de supervivencia en el tratamiento adyuvante con 5-Fluorouracilo-Levamisol (5FU-Lev) / Colorectal adenocarcinoma: survical prognostic factors of the adjuvant treatment with 5-fluorouracil-levamisole (5FU-LEV)

- Propósito: Valoración de la supervivencia global (SG) y libre de enfermedad (SLE) a 5 años y estudio de los factores pronósticos de los pacientes operados, con finalidad curativa, de adenocarcinoma colorrectal estadios II y III, que recibieron tratamiento adyuvante con 5FU-LEV.- Material y métodos: ciento veintiséis pacientes tratados con esquema 5FU-LEV durante 12 meses, entre septiembre de 1990 y noviembre de 1997.- Resultados: La SG a los 5 años es de 68.3 por ciento y la SLE de 54 por ciento. El número de ganglios afectos por el tumor y la afectación vásculo-linfática y perineural, han resultado factores pronósticos significativos tanto en la SLE como en SG a los 5 años. La existencia de obstrucción intestinal tan sólo resulta factor pronóstico significativo en la SLE a los 5 años.- Conclusiones: los resultados que presentamos son semejantes a otras grandes series conocidas, tanto en supervivencia global y libre de enfermedad como en el estudio univariante de los factores pronósticos. La afectación ganglionar continúa presentando significación pronóstica con el análisis multivariante (AU)

Evidence based general practice.

OBJECTIVES: To estimate the proportion of interventions in general practice that are based on evidence. DESIGN: A one-year cross-sectional study involving all consultations by patients over age 15 years seen in 34 national primary health care centers. SETTING: The rural Castellon provincial district within the Valencian Community in eastern Spain, with a total population of 21,155 inhabitants. SUBJECTS: of 1990 case histories registered in the course of one year, 4800 consultations were identified; of these, 2341 (49%) distinct diagnosis-intervention pairs were identified and coded. MAIN RESULTS: The evidence basis for the diagnosis-intervention pairs in the study was derived from a computerized search of the scientific literature published in 1992-1996. The quality of the evidence was classified according to the method of Ellis et al. Within the 2341 diagnosis-intervention pairs, there was positive evidence in support of the intervention used in 55%. The evidence basis was sound for 42%, with 38% being based on Type I (clinical trials) evidence and 4% on Type II evidence. The most frequently presenting diseases involved the circulatory (18.7%), respiratory (14.9%), nervous (14.2%), musculo-skeletal (12.5%) and nutrition and metabolism and digestive systems, with 12.1% each. CONCLUSIONS: Clinical practice was clearly supported by positive evidence of all Types (I-III) in a total of 55% of interventions, and by good positive evidence of Type I or II in 42% of interventions. The percentage of evidence-based interventions in general practice serving a substantial population in rural Spain was lower than had been reported by some authors.

Automatic adjustment of pacemaker stimulation output correlated with continuously monitored capture thresholds: a multicenter study. European Microny Study Group.

Pacing threshold is affected by many factors. A pacing system able to confirm capture at each beat and automatically adjust its output close to the actual pacing threshold is highly desirable. This study evaluates the safety and efficacy of the Autocapture function of the Pacesetter Microny SR+. One hundred thirteen patients were recruited from 16 centers in 7 European countries and followed up for 1 year. All pacemakers were implanted with Pacesetter's low polarization, bipolar leads. The key feature of Autocapture is the immediate delivery of a 4.5 V safety backup pulse 62.5 ms after any ineffective ongoing low output pulse. Holter recordings confirmed total reliability of this feature without any exit block. The measured evoked response (ER) signal was stable over time. Acute and chronic pacing thresholds measured by VARIO and Autocapture tests correlated (r > 0.79) over the period of the study. The incidence of backup pulses was 1.1% during pacing. With Autocapture programmed ON, the overall total current consumption was 4.1 microA for VVI and 5.0 microA for VVIR pacing. This study proved that the Autocapture safely and reliably regulates the pacemaker's output according to the prevailing threshold thus providing maximum patient safety and prolonging service life.

[Complete congenital atrioventricular block. Prenatal diagnosis and perinatal management]. / Bloqueo auriculoventricular completo congénito. Diagnóstico prenatal y manejo perinatal.

OBJECTIVE: To describe our experience in prenatal diagnosis and perinatal management of congenital atrioventricular heart block, as well as pacemaker treatment in the neonate. MATERIAL AND METHODS: A total of 13 fetuses are included. The diagnosis of atrioventricular dissociation was established by Doppler heart rate sample in the right atrium to show the atrial activity while the sample in the Aorta reflected the ventricular heart rate. Gestational age at diagnosis, ventricular heart rates, autoimmune maternal pathology, maternal blood tests for autoantibodies antiRo+, congenital structural heart disease, fetal hydrops, maternal medical treatment, perinatal results and pacemaker neonatal implantation are described. RESULTS: Gestational age at diagnosis ranged between 22 and 32 (mean 27.6) weeks. Ventricular heart rates ranged between 32 to 80 (mean 54) beats/min. AntiRo+ antibodies were detected in 5 mothers, and clinical systemic lupus erythematosus was found in only one. Four had congenital heart disease (2 ventricular inversion and corrected TGA, 1 complete atrio-ventricular canal and 1 tricuspid atresia). Signs of heart failure and hydrops were detected in 9 fetuses. Treatment with beta-metasona and ritodrine was administered to 7 mothers when the ventricular heart rate dropped below 60 beats/min. Intrauterine fetal death occurred in 3 fetuses with structural congenital heart disease and hydrops. Delivery was performed by cesarean section in 8 preterm fetuses (one them a twins), 3 spontaneous deliveries at term and 3 stillbirth. Postnatal pacemaker implantation was carried out in 9 newborns (3 cases with unicameral temporal right ventricle electrode and 6 cases with permanent bicameral electrodes implanted through the subclavian vein and DDD pacemaker). Follow-up of the bicameral pacemaker group was satisfactory. CONCLUSION: Persistent fetal bradycardia is the first sign to diagnose prenatal complete atrioventricular heart block. Echocardiography asses fetal haemodynamic status and may detect signs of fetal deterioration. Hydrops and further drop in the ventricular heart rate warrant urgent cesarean section and pacemaker management of the newborn.

Clinical evaluation of a thin bipolar pacing lead.

The main disadvantages of bipolar pacing leads have traditionally been related to their relative thickness and stiffness compared to unipolar leads. In a new "drawn filled tube" plus "coated wire" technology, each conductor strand is composed of MP35N tubing filled with silver core and coated with a thin ETFE polymer insulation material. This and parallel winding of single anode and cathode conductors into a single bifilar coil resulted in a bipolar lead (ThinLine, Intermedics) with a body diameter and flexibility similar to unipolar leads. The lead is tined, polyurethane, with the cathode and the anode made of iridium-oxide-coated titanium (IROX). The slotted 8-mm2 cathode tip is coated with polyethylene glycol, a blood soluble material. We present the clinical evaluation results from four pacemaker clinics, where 47 leads (23 atrial-J model 432-04 and 24 ventricular model 430-10) were implanted in 25 patients and followed for up to 2 years. The lead handling characteristics were found to be very satisfactory. Electrical parameters of the leads were measured at implant and noninvasively on postoperative days 1, 2, 21, 42, and months 3, 6, 12, and 24. Mean chronic pulse width thresholds at 2.5 V were 0.14 +/- 0.05 ms in the atrium and 0.10 +/- 0.02 ms in the ventricle, pacing impedances 443 +/- 104 omega and 520 +/- 241 omega, while median electrogram amplitudes were > or = 3.5 mV and > or = 7 mV, respectively. Pacing impedances and thresholds were found to be slightly but statistically significantly higher in unipolar than in bipolar configuration--the findings are explainable by the lead construction. One of 47 leads failed 3 weeks after implant; the conductors were short circuited due to an error during the manufacturing process. We conclude that the new lead thus far has demonstrated appropriate mechanical and electrical characteristics.

Comparison of continuously recorded sensor and sinus rates during daily life activities and standardized exercise testing: efficacy of automatically optimized rate adaptive dual sensor pacing to simulate sinus rhythm.

The normal sinus rhythm remains the gold standard to compare the rate response of a rate adaptive pacemaker. The aim of this study was to assess an automatically optimized dual sensor system by continuous comparison of the normal sinus (SR) and sensor indicated rates (SIR). Twelve patients with complete heart block (mean age 60 +/- 9 years) with normal sinus rhythm received a dual sensor pacemaker driven by combined, automatically adaptive activity and QT sensors. After 1 month of automatic adaptation, patients performed a treadmill exercise in the VDD mode with simultaneous collection of SR and combined SIR. Thereafter the difference between SR and SIR was recorded over a 1-month period using a software downloaded into the pacemakers, with the patients ambulatory during this period. During exercise testing, the SR and SIR were significantly correlated (r = 0.96 +/- 0.02, P < 0.001), and the mean difference between SR and SIR was 4.01 +/- 4.47 beats/min. The percentages of paced beats, over the 1 month ambulatory period, that exhibited a difference between SR and SIR of 8 beats/min were 98% +/- 2%, 90% +/- 4% and 67% +/- 8% for low, medium, and high workloads, respectively (P < 0.05, ANOVA), whereas > 95% of SIR were within 15 beats/min of SR independent of the level of activities. Thus, an automatically programmed dual sensor gives an accurate reflection of SR during exercise. SIR was less accurate for more vigorous daily life activities, but most of the SIR were within the normal SR variation of 15 beats/min.

La función autocaptura en marcapasos VVIR: experiencia del estudio multicéntrico / Autocaptura function in a VVIR pacemaker: a multicentre clinical experience

La función de autocaptura verifica la captura latido a latido. La búsqueda automática del umbral de estimulación, ajusta el potencial de salida 0.3 V. por encima del valor medido. Ante la pérdida de captura de un estímulo, el sistema emite un segundo impulso de 4.5 V. a los 65 mseg. para conseguir captura, evitando con ello pausas del ritmo cardíaco. La función de Autocaptura nos oferece por elo una estimulación segura de bajo consumo. El sistema ha sido incorporado a un marcapasos VVIR de 12,8 gr. de peso y 5.9 cm3 de volumen, de estimulación unipolar y detección bipolar. Presentamos la experiencia de un estudio multicéntrico que incluye 113 pacientes, 57 hombres y 56 hombres y 56 mujeres. La edad media fue de 76 anos (45-93). La indicación ECG fue de fibrilación auricular con pobre respuesta ventricular en el 84 "por ciento" de los casos y de bloqueo A-V en el restante 16 "por cento". Se han revisado los protocolos de 112 controles de alta hospitalaria, 107 de 30 dias, 94 de 3 meses y 49 de 6 meses. En todos los casos se ha practicado un registro Holter de 24 horas al mes de la implantación. El valor medio de umbral de estimulación en el momento de la implatacióon fue de 0.6 V, a 1 mes de 1.3 V., a los 3 meses de 1.3 V. y a los 6 meses de 1.2 V. Los valores medios de onda R intrínseca / onda R evocada fueron en la implantación de 14.7/10.2 mV., al mes 16.8/10.0 mV., a los 3 meses 16.5/10.2 mV. y a los 6 meses 17.5/10.2 mV. Se ha calculado un consumo un consumo medio de 3.9 +ou- mA. con lo que la longevidad del generador resulta de entre 7 y 8 anos. El análisis latido a latido de 3.7 millones de estímulos de los registros Holter, nos confirma que cada pérdida de captura ha sido detectada y seguida de un estímulo de segurid efectivo. Conclusión: La función Autocaptura posee la habilidad de cambiar automaticament el potencial de salida en consonancia con el umbral de estimulación, y por ello nos permite ofrecer una terapia de estimulación segura y fiable con bajo consumo energético.

[Aneurysms of the abdominal aorta in patients on a permanent hemodialysis program]. / Aneurismas de aorta abdominal en pacientes en programa de hemodiálisis permanente.

Surgical approach of an aneurysm at the infrarenal aorta abdominal, in six patients with terminal renal failure and chronic hemodialysis, is presented. They were all men, and the middle age was 62 years. There were two hospital deaths and a latter death. At the moment of this report, the three survival patients are well, after a follow-time of 34.6 months. Treatment of this group of patients, as well as the literature concerning to this subject are reviewed.

Improvement of renal function in azotaemic hypertensive patients after surgical revascularization.

Between 1974 and 1986, 17 patients (16 men and 1 woman) with renal insufficiency (serum creatinine greater than 1.5 mg/dl, mean 3.75 mg/dl), with a mean age of 51.3 years, underwent surgical renal revascularization. Two of them were on maintenance haemodialysis. All were severely hypertensive in spite of antihypertensive drugs. Atherosclerosis was the cause of renal stenosis in 14 cases and fibromuscular dysplasia in 3. Operative procedures included splenorenal shunt (5), autotransplantation (3), aortorenal bypass (3), hepatorenal bypass (1), bilateral renal endarterectomy (1), renal ostial closure (1) and nephrectomy (3). Mean serum creatinine showed a decrease from 3.76 to 1.65 mg/dl (P less than 0.005). Mean arterial pressure dropped from 161 mmHg to 103 mmHg (P less than 0.001). Systolic and diastolic pressures also showed significant decreases. Two patients died. Four patients required a second operation and the renal function and blood pressure then improved. Renovascular disease must be ruled out in patients with renal insufficiency associated with hypertension, including those patients on haemodialysis. We conclude that renal revascularization surgery is a reliable and efficient form of treatment in selected cases of renal failure of renovascular origin.

Extracranial internal carotid artery aneurysms.

Two cases of extracranial internal carotid artery aneurysms are presented. In each case the cranial end of the aneurysm was in contact with the base of the skull. Ligation of the internal carotid artery was performed in the first case. Temporary occlusion of the distal internal carotid artery by means of a Fogarty catheter allowed resection with end-to-end anastomosis in the second case.