Quality assessment of pacemaker implantations in Denmark.

AIMS: Quality assessment of therapeutic procedures is essential to insure a cost-effective health care system. Pacemaker implantation is a common procedure with more than 500,000 implantations world-wide per year, but the general complication rate is not well described. We studied procedure related complications for all implantations performed in an entire nation over a 3-year period. METHODS AND RESULTS: A prospective study of complications related to 99% of the 5648 primary pacemaker implantations performed in the 12 Danish pacemaker centres in 1997-1999 was carried out. Overall 76% of the patients received a physiological pacemaker system and 91% received the optimal pacing mode according to international guidelines. Perioperative complications requiring reoperation were: haematoma 0.3%, atrial lead related 1.9%, ventricular lead related 1.7%. Late complications requiring reoperation were: infection 02%, atrial lead related 13%, ventricular lead related 1.2%. The complication rate decreased over the study period, but overall the complication rate was higher than expected and showed considerable variation between centres. CONCLUSIONS: Our results demonstrate that sensitive data such as complications related to pacemaker implantations can be collected on a national basis. We suggest that a reoperation rate higher than 3% for atrial as well as ventricular pacing electrodes in the individual implanting centre should cause the centre to evaluate carefully the procedure as well as the performance of the individual implanter.

A comparison of the macrophyte cover and macroinvertebrate fauna at three sites on the River Kennet in the mid 1970s and late 1990s.

In 1974-1976, baseline studies were carried out on the flora and macroinvertebrate fauna of the R. Kennet at two sites downstream of Marlborough (Savernake Upper and Lower) and at one site upstream of Hungerford (Littlecote). Simplified maps of each site, showing the cover of macrophytes, were obtained monthly between April 1974 and April/June 1976, and replicated quantitative samples of the macroinvertebrates were collected on the dominant macrophyte and on gravel in June 1974, and also in June and December 1975. As a consequence of two major droughts and increasing concern over water quality in the Upper Kennet in the 1990s, the studies recommenced in the summer of 1997 using the same sites and methodologies. Maps and macroinvertebrate samples were obtained in early July and December 1997 and in June of both 1998 and 1999. At the Savernake sites, mapping in summer 1997 confirmed what had been apparent for some years. That is, macrophyte cover (both Ranunculus and Schoenoplectus) was much lower than in the 1970s. In contrast, the site downstream at Littlecote retained a relatively high cover of Ranunculus, despite the drought. In late autumn 1997, phosphate stripping commenced at Marlborough Sewage Treatment Works, the drought ended and in addition, the spring of 1998 was unusually wet. Ranunculus recolonised both Savernake sites with remarkable speed by summer 1998 and retained this dominant position in 1999. Quantitative samples of macroinvertebrates collected on gravel and the dominant macrophyte at each of the three study sites indicated that there was no evidence of major loss of family richness between the 1970s and 1990s as a result of the low flows or enrichment. However, at Savernake (but not Littlecote) in summer 1997, the macroinvertebrate assemblage was affected by low flows and/or enrichment. This took the form of changes in the abundance of some families, with lentic forms being favoured in relation to some lotic families. Following the end of the drought, many macroinvertebrate families at Savernake showed a rapid response to the new conditions and the assemblages reverted to those expected in a fast-flowing cretaceous chalk stream. Continued monitoring through the next drought is advisable to provide a greater understanding of the interplay between water quality, the discharge regime, habitat quality (including macrophyte growth) and the response of the macroinvertebrate fauna.

Localization of two domains of a mutant form of Escherichia coli protein L7/L12 that binds the large ribosomal subunit as a single dimer.

Escherichia coli ribosomal protein L7/L12 occurs on the large subunit as two dimers: one dimer is extended and comprises the stalk, while the second dimer is folded and occupies a site on the subunit body. A variant protein, in which all 18 amino acids of the flexible hinge region that links separate N-terminal and C-terminal domains of L7/L12 has been deleted, binds the subunit as a single dimer and does not generate stalks that are visible in electron micrographs. Monoclonal antibodies directed against each domain of the protein have been used to localize the variant in electron micrographs of 50S subunits. Both C-terminal domains are seen at a shoulder of the subunit, near its edge as viewed in the most common quasisymmetric projection. N-terminal domains are placed on the subunit body, about 50 A from the C-terminal domains. The antibody to the N-terminal domain also causes dissociation of the variant dimer from the particle and the formation of oligomeric antibody-protein dimer complexes. Similar complexes were seen previously (Olson HM et al (1986) J Biol Chem 261, 6924-6936) when this antibody induced dissociation of one dimer of the native protein. We conclude that the shortened variant most probably occupies the lower-affinity site on the subunit that is normally filled by the stalk dimer.

[Percutaneous drainage of benign nonparasitic liver cysts]. / Percutane drainage van benigne niet-parasitaire levercysten.

OBJECTIVE: To evaluate the treatment of symptomatic benign non-parasitic cysts of the liver by percutaneous drainage and sclerotherapy with alcohol. DESIGN: Descriptive, prospective. SETTING: Ikazia Hospital, Rotterdam. PATIENTS: All patients who presented with symptomatic benign non-parasitic cysts of the liver during the period 1988-1992 and in whom percutaneous drainage was not contraindicated. After drainage sclerotherapy with absolute alcohol was carried out, after which suction was applied until oozing stopped. RESULTS: Four patients were treated, all women, 51, 53, 53 and 64 years old. In 3 patients the cyst did not recur during the follow-up period, which ranged from 8 to 60 months. The 4th patient needed surgical treatment after the percutaneous drainage failed twice. No complications of the drainage were encountered. CONCLUSION: Percutaneous drainage followed by alcohol sclerotherapy and suction is the treatment of choice in patients with symptomatic benign non-parasitic cysts of the liver. Surgical treatment should be reserved for patients who fail to respond to repeated percutaneous drainage and cases in which the location of the cyst makes it technically difficult to use a percutaneous route.

Evidence Against Amplification of Four Genes in Giant Cells Induced by Meloidogyne incognita.

Giant-cell DNA was isolated from pea (Pisum sativum) inoculated with Meloidogyne incognita and used in slot blots to test for selective sequence amplification. Four sequences representing low (ribulose 1,5-bisphosphate carboxylase and actin), mid-level (histone 3), and highly repetitive (large ribosomal repeat) sequence DNA were used as probes. Known amounts of root-tip DNA and giant-cell DNA were blotted onto hybridization membranes and probed. The signal strength on autoradiographs containing equal amounts of root-tip DNA and giant-cell DNA were compared with a scanning densitometer. No difference in signal strength between equal amounts of root-tip DNA and giant-cell DNA was found. Thus, for the probes tested, there is no difference in copy number and, hence, no selective DNA sequence amplification has occurred.

Aneurysm of the popliteal vein with multiple pulmonary thrombo-emboli: a case report.

Venous aneurysms are uncommon pathologic entities, which can lead to serious complications. A 75-year old patient is reported with a thrombosed aneurysm of the popliteal vein and multiple pulmonary thrombo-emboli. The diagnosis is in general based on venography. In the present case, however, ultrasonography was performed and led to the wrong diagnosis because of unfamiliarity with this entity. When ultrasonography of the popliteal fossa is performed, the possibility of aneurysms of the popliteal vein should be considered.

Ultrasonographic diagnosis of psoas hematoma.

Ultrasonic examination of 3 patients with psoas hematoma is discussed. The main feature is a well-defined transsonic mass situated in the psoas muscle, on longitudinal sections spindle-shaped and ovoid on transverse sections. Ultrasonography is recommended as the procedure of choice in a patient with bleeding disorder and an abdominal mass. Urography shows medial deviation of the homolateral ureter.

Delayed irritation: hexanediol diacrylate and butanediol diacrylate.

Ephemeral topical contact with hexanediol diacrylate and butanediol diacrylate may cause delayed irritant dermatitis. During 4 years' observation of 20 workers utilizing these substances in the electron beam coating department of a door factory, contact sensitization did not occur. The characteristics of delayed contact irritancy are enumerated. The disease must be distinguished from allergic contact dermatitis, acute irritant dermatitis and cumulative irritant dermatitis.

Survey of reviewed patients with renal transplantation.

In 110 patients 119 renal transplantations were performed from 1968 until May 1, 1975. In this survey data are given on the recipients and the transplanted kidneys. For the following papers on different complications with renal transplantation the X-ray pictures taken until May 1, 1976 were reviewed and correlated with clinical findings.

Pulmonary complications after renal transplantation.

This study presents an analysis of the nature and incidence of pulmonary complications in the first 110 patients to undergo renal transplantation in Nijmegen. The complications are divided into primary and secondary complications. An unmistakable relation to immunosuppressive medication was established in both groups. The radiological manifestations of the pulmonary lesions were atypical due to the use of large doses of immunosuppressive drugs. Pulmonary complications account for 45.1% of the total mortality after renal transplantation. Differential diagnosis from pulmonary oedema associated with rejection is exceedingly difficult, but of paramount importance.