Perinatal inflammation/infection and its association with correction of metabolic acidosis in hypoxic-ischemic encephalopathy.

OBJECTIVE: To investigate the decreased response to hypothermia in neonates with hypoxic-ischemic encephalopathy (HIE) and infection, we sought to determine the association of fetal inflammation/infection with perinatal metabolic acidosis. STUDY DESIGN: We performed a retrospective cohort study of neonates with suspected HIE started on whole-body hypothermia within 6 h of birth that had a cord gas at delivery and placental pathology performed. Neonates were compared based on the presence of clinical and histologic chorioamnionitis. The cord gas at delivery was compared with the initial arterial gas after birth. RESULTS: In all, 50 out of 67 (74.6%) neonates admitted for therapeutic hypothermia met inclusion criteria. Chorioamnionitis did not affect the cord gas at delivery, but both clinical and histologic chorioamnionitis were associated with a significantly increased metabolic acidosis on the initial neonatal arterial gas. CONCLUSION: Chorioamnionitis, diagnosed both clinically and histologically, is associated with a persistent state of acidosis in neonates with HIE that may contribute to worse neurologic outcomes.

Complementary and alternative medicine in obstetrics.

OBJECTIVE: To identify, survey and review randomized controlled studies of the use of complementary and alternative medicine (CAM) for obstetric treatment or health promotion. METHODS: The MEDLINE database was searched to identify randomized controlled trials of CAM treatment and therapies in obstetrics. Studies examining modalities for treatment or improvement of health status were reviewed. RESULTS: Fifty-four articles assessing a variety of health modalities met the criteria for inclusion. Acupressure and ginger for prenatal nausea and vomiting, moxibustion for version of breech presentation, sterile water injections for back pain relief in labor, and perineal massage to prevent perineal trauma have three or more studies demonstrating beneficial effect. Other interventions have been studied less, and evidence for them is limited. CONCLUSIONS: Some CAM interventions have evidence of effectiveness for use in obstetric patients, while others require further investigation before they can be considered for use in practice.

Successful external cardioversion of atrial fibrillation in patients referred to an electrophysiologist for internal cardioversion.

BACKGROUND: Internal cardioversion of atrial fibrillation with direct current energy has become an increasingly employed technique for patients who fail external cardioversion. HYPOTHESIS: The purpose of this study was to determine whether internal cardioversion could be avoided by careful attention to cardioversion technique in a group of patients referred specifically for internal cardioversion after failed external cardioversion by community cardiologists. METHODS: We performed external cardioversion utilizing two operators applying significant pressure to the thorax with up to 360 J prior to the planned internal cardioversion in 20 patients referred for internal cardioversion after failed attempts at external cardioversion. RESULTS: Sixteen patients (80%) were successfully cardioverted and avoided the risk, inconvenience, and cost of internal cardioversion. CONCLUSION: External cardioversion with significant anterior paddle pressure by two operators can decrease the need for internal cardioversion in a significant portion of patients referred to electrophysiologists for internal cardioversion and should be considered prior to an invasive procedure.

Psychological treatment of secondary insomnia.

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia.

Relaxation therapy for insomnia: nighttime and day time effects.

We compared day time functioning in college students with and without insomnia and explored changes in day time functioning after progressive relaxation (PR) treatment for insomnia. Students with insomnia (SWI; n = 57) were compared to a control group of students not complaining of insomnia (SNI; n = 61) on self-reported sleep variables and five questionnaires: Insomnia Impact Scale (IIS), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Penn State Worry Questionnaire (PSWQ). SWI demonstrated significant impairment on all day time functioning and sleep measures compared to SNI. To investigate treatment effects on day time functioning, 28 SWI were randomly assigned to PR. Treated SWI were compared to untreated SWI and SNI at posttreatment. Treated participants improved sleep in comparison to untreated SWI, but failed to show significant improvements in day time functioning. Insomnia treatments focused on improving sleep may not improve day time functioning, or day time gains may emerge more slowly than sleep gains. This study documents the wide range of day time functioning complaints in young adults with insomnia and suggests that the goal of insomnia treatment should be to not only improve sleep but also to improve the subjective experience of day time functioning.

Atypical atrial flutter originating in the right atrial free wall.

BACKGROUND: Data from experimental models of atrial flutter indicate that macro-reentrant circuits may be confined by anatomic and functional barriers remote from the tricuspid annulus-eustachian ridge atrial isthmus. Data characterizing the various forms of atypical atrial flutter in humans are limited. METHODS AND RESULTS: In 6 of 160 consecutive patients referred for ablation of counterclockwise and/or clockwise typical atrial flutter, an additional atypical atrial flutter was mapped to the right atrial free wall. Five patients had no prior cardiac surgery. Incisional atrial tachycardia was excluded in the remaining patient. High-density electroanatomic maps of the reentrant circuit were obtained in 3 patients. Radiofrequency energy application from a discrete midlateral right atrial central line of conduction block to the inferior vena cava terminated and prevented the reinduction of atypical atrial flutter in each patient. Atrial flutter has not recurred in any patient (follow-up, 18+/-17 months; range, 3 to 40 months). CONCLUSIONS: Atrial flutter can arise in the right atrial free wall. This form of atypical atrial flutter could account for spontaneous or inducible atrial flutter observed in patients referred for ablation and is eliminated with linear ablation directed at the inferolateral right atrium.

Biofiltration of high loads of ethyl acetate in the presence of toluene.

To date, biofilters have been used primarily to control dilute, usually odorous, off-gases with relatively low volatile organic compound (VOC) concentrations (< 1 g m-3) and VOC loads (< 50 g m-3 hr-1). Recently, however, U.S. industry has shown an interest in applying biofilters to higher concentrations of VOCs and hazardous air pollutants (HAPs). In this study, the behavior of biofilters under high loads of binary VOC mixtures was studied. Two bench-scale biofilters were operated using a commercially available medium and a mixture of wood chips and compost. Both were exposed to varying mixtures of ethyl acetate and toluene. Concentration profiles and the corresponding removal efficiencies as a function of VOC loading were determined through frequent grab-sampling and GC analysis. Biofilter response to two frequently encountered operating problems--media dry-out and operating temperatures exceeding 40 degrees C--was also evaluated under controlled conditions. Microbial populations were also monitored to confirm the presence of organisms capable of degrading both major off-gas constituents. The results demonstrated several characteristics of biofilters operating under high VOC load conditions. Maximum elimination capacities for ethyl acetate were typically in the range of 200 g m-3 hr-1. Despite the presence of toluene degraders, the removal of toluene was inhibited by high loads of ethyl acetate. Several byproducts, particularly ethanol, were formed. Short-term dry-out and temperature excursions resulted in reduced performance.

Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness.

A sample of 32 obstructive sleep apnea patients (27 males, 5 females) was assessed with overnight polysomnography and the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Patients also participated in a maximal exercise test, which served as an objective indicator of physical fatigue. The Fatigue Severity Scale (FSS) was used as a subjective measure of fatigue. Subjective fatigue ratings were significantly correlated with percent of predicted maximum heart rate achieved during exercise testing, suggesting that self-reported fatigue in apnea patients may refer to reduced physical fitness. FSS scores and exercise testing results were not significantly correlated with the MSLT, indicating that daytime fatigue and daytime sleepiness are independent problems in apnea patients. Participants self-reported a high level of fatigue, and exercise testing revealed decreased physical work capacity among apnea patients, but objective and subjective indicators of fatigue were not significantly correlated with apnea severity. A higher percentage of REM sleep predicted greater work capacity.

A left free-wall, decrementally conducting, atrioventricular (Mahaim) fiber: diagnosis at electrophysiological study and radiofrequency catheter ablation guided by direct recording of a Mahaim potential.

A 64-year-old female with Wolff-Parkinson-White syndrome and an ECG demonstrating a right posterolateral accessory pathway was referred for electrophysiological study. During electrophysiological testing two AV pathways were identified: a right posterolateral pathway that displayed conventional electrophysiological properties: and a left free-wall pathway that conducted only anterogradely and demonstrated decremental properties. Two separate wide complex tachycardias were induced that utilized the left free-wall pathway anterogradely and either the AV node or the right posterolateral accessory pathway retrogradely. A discrete electrical potential on the free wall of the mitral annulus was identified during tachycardia and was utilized to facilitate mapping and ablation.

Indwelling pericardial drainage catheter break secondary to heart movement and catheter angulation.

We report on a case of a pericardial drainage catheter that severed on attempted removal. Surgery was required to remove the retained portion. No manufacturing defects were found on analysis of the catheter. Shear forces due to heart movement and the angle of catheter entry into the pericardium were the suspected reasons for the catheter disruption.

Substance abuse, traumatic brain injury and neuropsychological outcome.

The neuropsychological performance of 119 patients with severe closed traumatic brain injury (TBI) who had received toxicology screens at the time of trauma centre admission was examined. Three groups were created: normal screen, positive alcohol screen, or positive abused drugs screen (with or without the presence of alcohol). The admitting Glasgow Coma Scale (GCS) score was significantly lower in the positive alcohol screen group than the normal screen group, while the three groups did not differ in length of post-traumatic amnesia (PTA) or years of education. Neuropsychological assessment was conducted during inpatient rehabilitation, following resolution of PTA. Normal screen patients obtained significantly better scores than the abused-drugs patients on the Full Scale IQ (FIQ) and Verbal IQ (VIQ) indices of the Wechsler Adult Intelligence Scale-Revised and the Verbal Memory, General Memory, Attention-Concentration, and Delayed Recall indices of the Wechsler Memory Scale-Revised. Normal screen patients also scored significantly higher than positive alcohol screen patients on FIQ and VIQ indices and all five indices from the Wechsler Memory Scale-Revised. These data suggest the existence of an additive effect of substance abuse on neuropsychological outcome in TBI. Findings have potential implications for both acute management and rehabilitation of TBI.

Recognition memory test: validity in diffuse traumatic brain injury.

This study evaluated the validity and clinical utility of the Recognition Memory Test (RMT) as a measure of memory in severe traumatic brain injury (TBI). RMT scores for 86 TBI inpatients were related to injury severity, lesion location, and other memory indices. Only recognition memory for words (RMW) was significantly (p<0 01) related to duration of posttraumatic amnesia and a measure of "day to day" memory. Both RMT subtests showed expected modality-specific relationships with other clinical memory tasks. Patients with normal CT and right sided CT lesions tended to be more frequently impaired on recognition memory for faces (RMF) than RMW.

The bovine placentome in bacterial and mycotic abortions.

Placentomes were extracted from the uteri of 22 aborted cows and examined to detect the cause of abortion; fetuses or fetal abomasal contents from 15 of the cows were also examined. Firm diagnoses of Pasteurella haemolytica, Actinomyces pyogenes, Listeria monocytogenes, Bacillus licheniformis, Aspergillus fumigatus or Mortierella wolfii abortion were made in 11 cases. The histopathological lesions showed some correlation with the identity of the bacterium isolated; the lesions of mycotic abortion were distinct and characterised by a coagulative necrosis. The removal of a placentome was not followed by any observable deleterious effects.

Variable-interval probe test as a tool for repeated measurements of spatial memory in the water maze.

Probe tests provide an important additional converging operation to identify the characteristics of cognitive processes being assessed by other behavioral measures. We introduce a new procedure using a variable-interval (VI) probe test to assess spatial memory in the water maze. Three groups of rats were trained in spatial discrimination with traditional platform trials. For the probe trials, 2 groups had no-platform (NP) probe trials in which the escape platform was unavailable for the entire trial. The 3rd group had variable interval (VI) probe trials, in which the escape platform was available only after a VI. The VI probe trial was a more sensitive measure of spatial memory than was the NP probe trial and was useful for repeated measurements of spatial memory, a characteristic not readily attainable with the NP probe trial.

The use of an antimicrobial and competitive exclusion combination in Salmonella-infected pullet flocks.

Replacement pullets which had been found infected with Salmonella were treated with antibiotics for 12 days, moved to a clean house by the 11th day and given 2 treatments with a competitive exclusion (CE) preparation on the 13th and 15th day. It was found necessary to supply a small amount of feed to generate a thirst in the birds and ensure efficient and rapid consumption of the CE preparation. Salmonella could not be grown from the intestines or other organs of birds after this procedure had been carried out.