[Practical considerations for the treatment of acute rhythm disturbances. Report of Belgium Interdisciplinary Working Group on Acute Cardiology]. / Recommandations pratiques pour le traitement d'arythmies aiguës. Rapport du Groupe Interdisciplinaire Belge de Cardiologie Aiguë.

Acute arrhythmia is a condition covering a wide variety of rhythm disturbances. The aim of the article is to give practical recommendations for the approach and the treatment of the patient presenting with an acute arrhythmia. We discuss bradycardia and tachycardia. Tachycardias are divided into the small QRS complex tachycardias and the wide QRS complex tachycardias. Another important distinction with immediate therapeutic consequences is that between the hemodynamic stable and unstable patient. Flowcharts with diagnostic means and therapeutic schemes are added and a table with practical considerations for electrical cardioversion.

Learning of nondomain facts in high- and low-knowledge domains.

Research on expertise has repeatedly documented that experts learn new information better than do novices, but only when the information is relevant to the expert's domain. It was found in Experiment 1 that participants showed superior learning and recall of a large quantity of new, non-domain-relevant facts about concepts within their domain of high knowledge than about concepts for which they had low domain knowledge. Experiment 2 investigated whether the participants' superior recall of new facts related to concepts within their domain of high knowledge was due to the number of prior facts associated with the concept or to the prior frequency of repetition of those concepts. It was found that participants' recall of new facts was better for concepts with 5 prior associated facts than for concepts with a single prior association but that the number of previous repetitions of each concept did not affect the level of recall for the new facts.

An unusual localization and presentation of Kaposi's sarcoma.

A case of Kaposi sarcoma was diagnosed by skin biopsy in a 71-year-old woman with severe destructive arthropathy of the right shoulder, where all other diagnostic techniques were not conclusive.

Mitral valve procedures in ischemic regurgitation.

A restrictive definition of ischemic mitral regurgitation (IMR) has allowed us to select a more uniform cohort of 41 patients having undergone mitral valve surgery for IMR between January 1993 and March 1995. Thirty-six patients (88%) presented with chronic and five with acute IMR. All patients had at least one significant stenosis in the circumflex area. Left ventricular ejection fraction averaged 35%. Transesophageal echocardiography (TEE) revealed a > or = 3+ MR in 30 patients and an intermittent, fluctuating or grade 2+ MR in 11 (27%). Annulus dilatation was found in all cases, and it was the only mechanism in 10 (24.4%). Leaflet restrictive motion was clearly seen in 17 cases (41.5%) and leaflet prolapse in 14 (34%). In doubtful cases, an intra-operative dynamic testing using TEE, and associating a loading test and an afterload test, led to the indication of a valve procedure in 11/19 patients (58%). An average of three distal coronary anastomoses per patient were constructed. Mitral valve replacement (MVR) was unavoidable in four patients (9.8%); at least the posterior leaflet subvalvular apparatus was preserved in all. Repair of the mitral valve (Mvrep) was achieved in 37 cases (90%). Ring annuloplasty alone was performed in 27 cases (73%). In the remaining 10 cases, leaflet prolapse was corrected by various artifices such as flip-over technique, quadrangular resection, papillary muscle plication or commissuroplasty. At the 10th postoperative day, a residual MR was found in 4/34 cases (11.8%), only after isolated ring annuloplasty. The four patients who have died in the ICU after MVrep belonged to the same group of isolated ring annuloplasty; this mortality of 4/27 (14.8%) illustrates the mediocre prognosis of marked annulus dilatation and impaired LV function with restrictive leaflet motion. Overall, the hospital mortality (14.6%) more reflected the mode of presentation of the patients than the type of operative technique: when a short and definitive procedure is required by a precarious general condition, one should not hesitate to prefer a rapid MVR to a complicated repair. At 4.5 months, there was no significant improvement in LV dimensions. At six months, 80.5% of the patients survived, with 88% of them being in NYHA class I or II.

Surgical treatment of acute biceps tendon ruptures with a suture anchor.

Fixation of acute proximal and distal biceps tendon ruptures can be facilitated by the use of suture anchors. Originally designed for open Bankart procedures, suture anchors provide adequate fixation for soft tissue healing, limit the extent of dissection, reduce the incidence of frozen shoulder and damage to neurovascular structures and allow early postoperative rehabilitation. Four consecutive patients were successfully treated by this method with a minimum follow-up period of 1 year.

The Harris-Galante cementless acetabular component: results in 190 cases with at least 3 years follow-up.

The results of 190 primary total hip arthroplasties with a Harris-Galante cementless acetabular cup were reviewed. All patients had a minimum follow-up of 3 years (range, 3 to 5.5 years, mean 46 months). Clinical and radiographical analysis was performed. Inguinal pain was recorded in five cases. We noted a fracture of a screw in four cases without further implications. There was no evidence of acetabular loosening. There was no migration of the acetabular cup. No acetabular component showed measurable wear of the polyethylene liner. Non-progressive radiolucent lines were recorded in 14% of the patients: among these patients, radiolucent lines were noted in zone 1 in 46%, in zone 2 in 4% and in zone 3 in 86%. Two socket revisions became necessary. One patient suffered a deep-seated infection. Another revision was necessary because of recurrent dislocation.

Correlation of computed arthrotomography with arthroscopy of the glenohumeral joint.

We report our experience with CT-arthrotomography, compared to the arthroscopic findings in a group of 54 non-selected patients with a shoulder problem. Thirty-one patients had a CAT-scan of the shoulder and subsequently underwent a videotaped arthroscopy of the shoulder. Five out of the 10 negative CAT-patients were positive on arthroscopy for impingement syndrome. Arthroscopy picked up 5 partial thickness rotator cuff tears, not seen on CAT. Arthroscopy was also very helpful in diagnosing synovitis. For biceps problems, loose bodies, labrum tears and adhesive capsulitis, the sensitivity and accuracy figures were very high, comparing CAT-scan and arthroscopy. A shoulder with a history of instability or a painful clicking shoulder seems to be the best indication for CAT-scanning.

Impact of air pollution by lead on the heme biosynthetic pathway in school-age children.

Blood-lead level (Pb-B), erythrocyte delta-aminolevulinic acid dehydratase (ALAD) activity, free erythrocyte porphyrin (FEP) concentration, delta-aminolevulinic acid concentration in urine (ALAU), hematocrit value, and hemoglobin concentration were compared for groups of children 10-13 years old from areas differently polluted by lead (rural area and lead smelter area). The biological responses of the children were also compared with those observed in adults similarly exposed to lead (Pb-B: 10-40 mug/100 ml). Compared with the rural children, children living less than 1 km from the smelter exhibited a significant increase of Pb-B and FEP, a significant inhibition of ALAD, and a slight positive correlation of ALAU with Pb-B; however, they showed no biological signs of anemia. In children living approximately 1.5 km from the smelter, there was still a significant increase of Pb-B and a concomitant inhibition of ALAD, but no change in FEP concentration. Comparison of the dose-response curves between Pb-B and FEP in adult males, adult females, and children indicates that the sensitivity to lead is in the order of children larger than or equal to women greater than men. Based on the FEP response, it is proposed that 25 mug Pb/100 ml blood be regarded as the maximum biologically allowable concentration of lead in blood of school-age children.