Successful use of high dose rate brachytherapy for non-malignant bronchial obstruction.

High dose rate (HDR) endobronchial brachytherapy is a palliative treatment for symptomatic airway obstruction by malignant tumours. We report a novel use of HDR brachytherapy for treating non-malignant bronchial obstruction. The patient had a metal stent placed in a reconstructed airway after a bronchial tear to ensure patency. Granulation tissue formation in and around the stent caused symptomatic occlusion of the airway, necessitating multiple laser applications. A single treatment of HDR brachytherapy (1000 cGy) was delivered following laser therapy. The patient remains well 15 months after treatment with no evidence of recurrent granulation tissue formation on bronchoscopy. HDR brachytherapy is an effective treatment for non-malignant airway obstruction.

Clinical significance of variability of ventricular late potentials detected before discharge in patients after myocardial infarction.

BACKGROUND: Signal-averaged electrocardiography (SAECG) in patients after myocardial infarction (MI) is widely used to identify patients at risk for ventricular tachycardia (VT) and sudden cardiac death (SCD). It is believed that ventricular late potentials when detected after day 5 after MI are relatively stable and carry the most significant relation to subsequent arrhythmic events. This study sought to determine if ventricular late potentials in patients after MI exhibit variability when recordings were made 10 to 12 hours apart on day 7 and to assess the clinical significance of this variability. METHODS AND RESULTS: SAECG was recorded in 261 patients on the 7th day after MI at 7 to 10 AM (morning) and 6 to 8 PM (evening). Forty of these patients also had recordings 30 to 40 minutes apart to determine the 95% confidence interval of variability of each parameter of SAECG. The data were analyzed with the criteria of the American College of Cardiology policy statement. A prospective analysis for the clinical end points of VT and SCD was carried out for a period of 1 year. We identified 3 groups of patients. Group 1 (54, 20.7%) had consistently positive SAECG by at least 2 abnormal parameters in both morning and evening. Group 2 (37, 14.2%) had positive SAECG at 1 time only, either morning or evening. Group 3 (170, 65.1%) had negative SAECG on both occasions. Diabetes mellitus was an independent predictor of the variability of late potentials (P <.0001). A prospective analysis for the clinical end points of VT and SCD showed that the event rate was significantly higher in group 1 than in group 2 (P <.019). CONCLUSIONS: To improve the positive predictive value of SAECG in patients after MI, we advise that all positive tests be repeated 10 to 12 hours later, especially in patients with diabetes mellitus. Such testing will identify patients with consistently positive SAECG who appear to be at the highest risk for VT and SCD.

An unusual case of multiple right atrial thrombi in a patient with a dual-chamber pacemaker--a case report.

The authors present an unusual case of multiple large atrial thrombi attached to permanent pacemaker leads identified by transesophageal echocardiography. Pathogenesis, clinical implications, and therapeutic options of pacemaker thrombi are discussed.

A review of erythromycin-induced malignant tachyarrhythmia--torsade de pointes. A case report.

The term torsade de pointes refers to a ventricular tachycardia characterized by QRS complexes of changing amplitude that appears to twist around the isoelectric line and occurs at rates of 200-250/minute. Most cases of torsade de pointes are iatrogenically induced by drugs or electrolyte abnormalities. The most important feature is QT interval prolongation. Torsade de pointes was first described in 1966 in France by Dessertenne. The authors report a case of a fifty-year-old woman with medical history of corrective surgery for tetralogy of Fallot who was admitted to the hospital with pneumonia and atrial fibrillation and later developed recurrent episodes of polymorphic ventricular tachycardia with QT interval prolongation after i.v. administration of erythromycin. The episodes did not recur after discontinuation of erythromycin, and the QT interval returned to normal. The association of erythromycin with torsade de pointes has been reported in 18 cases to date. Erythromycin has been shown to produce electrophysiologic effects similar to those of class Ia and class III antiarrhythmic drugs on the cardiac muscle. This potentially fatal complication of a commonly used antibiotic is rare, but increased physician awareness is important, especially in patients with predisposing factors like electrolytes abnormalities, use of class Ia and Class III antiarrhythmic drugs, and presence of prolonged QT interval (congenital prolonged QT syndromes). This is the second case reported in a patient with previous cardiac surgery and erythromycin administration.

Comparison of ST-segment/heart rate slope analysis with standard ST-segment measurement criteria to outcome of exercise thallium-201 imaging.

We compared standard ST-segment analysis and ST/HR slope analysis of exercise ECG studies with reference to outcome of exercise thallium-201 studies in 341 patients. Sensitivity was significantly better using ST/HR slope compared with standard ST analysis. Specificity was not significantly different.

A case report of complete heart block caused by non-Hodgkin's lymphoma: the diagnostic role of transesophageal echocardiography.

We present a very rare case of complete atrioventricular block caused by malignant lymphoma diagnosed before death by transesophageal echocardiography. We believe that early detection of metastatic cardiac involvement of tumor is important for proper diagnostic and therapeutic interventions.

Radionuclide simultaneous dual-isotope stress myocardial perfusion study using the "three window technique".

Several methods are available for performing radionuclide stress myocardial perfusion studies. All of these methods require two separate acquisition and processing iterations, which is time-consuming and inconvenient for the patient. The authors introduce a new method using the "three window technique" that they developed to perform simultaneous dual-isotope imaging for stress myocardial perfusion studies. In addition to Tl-201 and Tc-99m windows centered at 70 KeV and 140 KeV, respectively, a third window centered at 105 KeV, representing scattered radioactivity from Tc-99m, is established. By subtracting the radioactivity in the third window from the radioactivity in the Tl-201 window, "crosstalk" interference is significantly reduced. The simultaneous dual-isotope imaging method acquires and processes resting and stress myocardial perfusion images simultaneously. It halves imaging time and doubles patient throughput, improves scheduling flexibility, and reduces patient waiting time and discomfort.

Intention, perceived control, and weight loss: an application of the theory of planned behavior.

Success at attempted weight reduction among college women was predicted on the basis of a theory of planned behavior. At the beginning of a 6-week period, participants expressed their attitudes, subjective norms, perceived control, and intentions with respect to losing weight. In addition, the extent to which they had made detailed weight reduction plans was assessed, as were a number of general attitudes and personality factors. In support of the theory, intentions to lose weight were accurately predicted on the basis of attitudes, subjective norms, and perceived control; perceived control and intentions were together moderately successful in predicting the amount of weight that participants actually lost over the 6-week period. Actual weight loss was also found to increase with development of a plan and with ego strength, factors that were assumed to increase control over goal attainment. Other factors, such as health locus of control, perceived competence, and action control, were found to be unrelated to weight reduction.