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  • Ovid Technologies (Wolters Kluwer Health)  (8)
  • 1995-1999  (8)
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  • Ovid Technologies (Wolters Kluwer Health)  (8)
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Language
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  • 1995-1999  (8)
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Subjects(RVK)
  • 1
    Online Resource
    Online Resource
    Childhood chronic inflammatory demyelinating neuropathies : Clinical course and long-term follow-up
    Ovid Technologies (Wolters Kluwer Health) ; 1996
    In:  Neurology Vol. 47, No. 1 ( 1996-07), p. 98-102
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 1 ( 1996-07), p. 98-102
    Abstract: Chronic inflammatory demyelinating neuropathy (CIDP) is a rare disease in childhood.We reviewed the clinical characteristics, response to therapy, and long-term prognosis in 13 children (1.5 to 16 years of age) diagnosed with CIDP at Washington University Medical Center, St. Louis, and the Royal Children's Hospital, Melbourne, Australia, between 1979 and 1994. The most common presenting symptom (in 11/13 [85%]) was lower extremity weakness associated with difficulty in walking. Preceding events within 1 month of onset, mostly intercurrent infections or vaccinations, occurred in seven children (54%). The disease was monophasic in three children (23%). One relapse occurred in four (30%) and multiple relapses in six (46%). All patients had at least short-term response to steroids. Three children (23%) recovered completely during the first year. Ten children (77%) had residual weakness after an average follow-up of 6 years. There seems to be two populations of children with CIDP. One subgroup, with a favorable prognosis, progressed to peak disability over less than 3 months; these children often have a monophasic course with complete resolution of symptoms and signs and withdrawal from all medications by 1 year after onset. A second subgroup progressed for 3 months or longer; these children all required substantial doses of prednisone for prolonged periods and had considerable long-term morbidity with persistent weakness. NEUROLOGY 1996;47: 98-102
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.47.1.98
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1996
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  • 2
    Online Resource
    Online Resource
    Sevoflurane Has No Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia 
    Ovid Technologies (Wolters Kluwer Health) ; 1999
    In:  Anesthesiology Vol. 90, No. 1 ( 1999-01-01), p. 60-65
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 1 ( 1999-01-01), p. 60-65
    Abstract: The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures. Methods Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied. Anesthesia was induced with alfentanil (20-50 microg/kg) and midazolam (0.15 mg/kg), and vecuronium (20 mg) and maintained with alfentanil (0.5 to 2 microg x kg(-1) x min(-1)) and midazolam (1 or 2 mg every 10-15 min, as required). An electrophysiologic study measured the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest conducted cycle length of the atrioventricular node and accessory pathway during atrial pacing; the effective refractory period of the right ventricle and accessory pathway; and the shortest retrograde conducted cycle length of the accessory pathway during ventricular pacing. Parameters of sinoatrial node function included sinus node recovery time, corrected sinus node recovery time, and sinoatrial conduction time. Intraatrial conduction time and the atrial-His interval were also measured. Characteristics of induced reciprocating tachycardia, including cycle length, atrial-His, His-ventricular, and ventriculoatrial intervals, also were measured. Sevoflurane was administered to achieve an end-tidal concentration of 2% (1 minimum alveolar concentration), and the study measurements were repeated. Results Sevoflurane had no effect on the electrophysiologic parameters of conduction in the normal atrioventricular conduction system or accessory pathway, or during reciprocating tachycardia. However, sevoflurane caused a statistically significant reduction in the sinoatrial conduction time and atrial-His interval but these changes were not clinically important. All accessory pathways were successfully identified and ablated. Conclusions Sevoflurane had no effect on the electrophysiologic nature of the normal atrioventricular or accessory pathway and no clinically important effect on sinoatrial node activity. It is therefore a suitable anesthetic agent for patients undergoing ablative procedures.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/00000542-199901000-00010
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1999
    detail.hit.zdb_id: 2016092-6
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  • 3
    Online Resource
    Online Resource
    The Etiology of Syncope in Patients With Negative Tilt Table and Electrophysiological Testing
    Ovid Technologies (Wolters Kluwer Health) ; 1995
    In:  Circulation Vol. 92, No. 7 ( 1995-10), p. 1819-1824
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 92, No. 7 ( 1995-10), p. 1819-1824
    Abstract: Background Patients with syncope of unknown etiology after negative noninvasive and electrophysiological testing may suffer from recurrent disability. Syncopal episodes are often too infrequent and unpredictable for detection by conventional ambulatory monitoring techniques. Methods and Results A long-term subcutaneous monitoring device was implanted in patients with negative ambulatory monitoring, tilt table and electrophysiological testing to establish cardiac rhythm during spontaneous syncope. Sixteen patients aged 57±19 years with a mean of 8.4±4.4 previous episodes of syncope underwent device implantation. Fifteen patients (94%) had recurrent syncope 4.4±4.2 months after implantation. The remaining patient has not had recurrent syncope and continues to be followed. A diagnosis was obtained in every patient who had recurrent episode. Syncope was secondary to sinus arrest in 5, atrioventricular block in 2, ventricular tachycardia in 1, supraventricular tachycardia in 1, and nonarrhythmic in 6. Successful therapy was implemented in all 15 patients, without recurrence of syncope during 13.0±8.4 months of follow-up. Conclusions Unexplained syncope in patients with negative investigations has a broad spectrum of etiologies, the most common of which is bradycardia. An implantable long-term monitoring device is useful for establishing a diagnosis when symptoms are recurrent but too infrequent for conventional monitoring techniques.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.92.7.1819
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1995
    detail.hit.zdb_id: 1466401-X
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  • 4
    Online Resource
    Online Resource
    THE EFFECT OF ANESTHETIC AGENTS UPON VENTRICULAR DEFIBRILLATION THRESHOLD
    Ovid Technologies (Wolters Kluwer Health) ; 1998
    In:  Anesthesia & Analgesia Vol. 86, No. 2S ( 1998-02), p. 102S-
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 86, No. 2S ( 1998-02), p. 102S-
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1097/00000539-199802001-00102
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1998
    detail.hit.zdb_id: 2018275-2
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  • 5
    Online Resource
    Online Resource
    Hysteresis of the RT Interval With Exercise : A New Marker for the Long-QT Syndrome?
    Ovid Technologies (Wolters Kluwer Health) ; 1997
    In:  Circulation Vol. 96, No. 5 ( 1997-09-02), p. 1551-1556
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 5 ( 1997-09-02), p. 1551-1556
    Abstract: Background The diagnosis of the long-QT syndrome (LQTS) may be difficult to establish in patients with normal or borderline prolongation of the QT interval. Noninvasive markers are needed to identify patients with LQTS. Methods and Results Fourteen patients with known LQTS, 9 unaffected family members, and 40 control subjects underwent modified Bruce protocol exercise testing. The RT interval (peak of R wave to peak of T wave) and rate-corrected RT interval (RTc) were measured during exercise and recovery. The RT interval at 1 minute into recovery was subtracted from the RT interval at a similar heart rate during exercise (ΔRT). The RTc shortened by 61 milliseconds (ms) in the LQTS patients compared with 23 to 26 ms in the other two groups ( P =.003 by ANOVA). The RT interval shortened in a linear fashion in all patients but demonstrated persistent shortening during recovery in the LQTS patients. This was manifested as a hysteresis loop in the curve relating the RT interval to cycle length. The hysteresis loop was present in 13 of 14 LQTS patients and only 4 of 40 control subjects. ΔRT 〉 25 ms had a sensitivity of 73%, a specificity of 92%, a positive predictive value of 79%, and a negative predictive value of 90% for LQTS. Conclusions Hysteresis of the RT interval with exercise may be useful for the diagnosis of LQTS.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.96.5.1551
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1997
    detail.hit.zdb_id: 1466401-X
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  • 6
    Online Resource
    Online Resource
    Use of an Extended Monitoring Strategy in Patients With Problematic Syncope
    Ovid Technologies (Wolters Kluwer Health) ; 1999
    In:  Circulation Vol. 99, No. 3 ( 1999-01-26), p. 406-410
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 99, No. 3 ( 1999-01-26), p. 406-410
    Abstract: Background —The conventional investigation of patients who present with syncope involves short-term ECG monitoring or provocative testing with head-up tilt and electrophysiological testing. A symptom-rhythm correlation is often difficult to obtain during spontaneous syncope because of its sporadic, infrequent, and unpredictable nature. Methods and Results —We used a prolonged monitoring strategy to determine the cause of syncope in 85 patients (age, 59±18 years; 44 men) with recurrent undiagnosed syncope with an implantable loop recorder capable of cardiac monitoring for up to 18 months. During a mean of 10.5±4.0 months of follow-up, symptoms recurred in 58 patients (68%) 71±79 days (2.3±2.6 months) after implantable loop recorder insertion. An arrhythmia was detected in 42% of patients who recorded a rhythm during recurrent symptoms, with bradycardia present in 18 and tachycardia in 3. Five of the 18 bradycardic patients and 2 additional sinus rhythm patients received a clinical diagnosis of neurally mediated syncope. Patients who experienced presyncope were much less likely to record an arrhythmia during symptoms compared with recurrence of syncope (24% versus 70%, P =0.0005). There were no adverse events associated with recurrent symptoms, and there were no sudden deaths. Inability to freeze after an event occurred in 8 patients, and pocket infection occurred in 3. Conclusions —The strategy of prolonged monitoring is effective and safe in patients with problematic syncope.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.99.3.406
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1999
    detail.hit.zdb_id: 1466401-X
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  • 7
    Online Resource
    Online Resource
    Atrioventricular Node Reentry With ‘Smooth’ AV Node Function Curves : A Different Arrhythmia Substrate?
    Ovid Technologies (Wolters Kluwer Health) ; 1996
    In:  Circulation Vol. 93, No. 5 ( 1996-03), p. 969-972
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 93, No. 5 ( 1996-03), p. 969-972
    Abstract: Background Some patients with otherwise typical AV node reentry do not manifest discontinuous AV node function curves. We examined the effects of an ablation in the slow-pathway region in patients with smooth AV node function curves. Methods and Results Fifteen patients with AV node reentrant tachycardia (AVNRT) and discontinuous AV node function curves were compared with 15 patients with AVNRT and smooth AV node function curves. In the group with a discontinuous curve, the “net” anterograde effective refractory period (AERP) of the AV node increased (270±28 versus 304±37 ms, P =.03) and AERP of the remaining fast pathway decreased (367±100 versus 304±37 ms, P =.026) after the ablation. In the group with a smooth curve, the AERP of the AV node increased (266±42 versus 299±76 ms, P =.07) and the anterograde Wenckebach cycle length increased (336±66 versus 379±86 ms, P =.008) after the ablation. Retrograde conduction over the AV node was similar in both groups and was unchanged after ablation. The longest attainable AH interval (AH max ) measured during atrial extrastimulus testing was more prolonged in patients with a discontinuous curve than in patients with a smooth curve (326±48 versus 250±70 ms, P =.002). The AH max shortened in both groups after ablation (326±48 versus 173±34 ms, P 〈 .0001, and 250±70 versus 179±34 ms, P 〈 .0003, respectively) and were similar. Successful ablation in the slow-pathway zone in patients with a smooth AV node function curve resulted in the loss of the “tail” of the curve representing the slow pathway. Conclusions These data suggest that the smooth AV node function curve consists of two distinct components representing both fast and slow AV node pathways even when the typical discontinuity is absent.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.93.5.969
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1996
    detail.hit.zdb_id: 1466401-X
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  • 8
    Online Resource
    Online Resource
    Progressive Anterior Ablation in the Coronary Sinus Region : Evidence to Support the Presence of a ‘Slow Pathway’ Input in Normal Patients?
    Ovid Technologies (Wolters Kluwer Health) ; 1997
    In:  Circulation Vol. 96, No. 10 ( 1997-11-18), p. 3477-3483
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 10 ( 1997-11-18), p. 3477-3483
    Abstract: Background AV node modification is an emerging approach to rate control in patients with medically refractory atrial fibrillation. The mechanism of benefit of this procedure is not completely understood. Methods and Results Twenty-two patients (age, 65±11 years; 16 women) with medically refractory paroxysmal atrial fibrillation referred for complete AV node ablation underwent serial ablations beginning at the level of the coronary sinus os progressing in a superior and anterior direction toward the His bundle. Serial atrial extrastimulus testing was performed to determine the effect of the progressive posteroseptal ablation in the region of the coronary sinus on the AV node antegrade refractory curve. Two of 22 patients had antegrade dual AV node pathways before ablation. Three patterns of response to serial ablation were noted. In 10 patients (45%), loss of the terminal portion of the AV node antegrade refractory curve occurred without evidence of fast pathway injury. In 7 patients (32%) the curve was shifted upward and to the left, consistent with nonspecific AV node damage. In 5 patients (23%), no effect could be attained before induction of complete AV block at superior and anterior ablation sites. Clinical variables and site of ablation did not predict response to serial ablations. Conclusions These data suggest that the mechanism of benefit of AV node modification in this population may be through elimination of “slow pathway” tissue in half of patients and nonspecific injury in the remainder. Modification without complete AV block may not be possible in a minority of patients, as the response to progressive ablation appears to be “all or none” conduction.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.96.10.3477
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1997
    detail.hit.zdb_id: 1466401-X
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