Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms.

AIMS: This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): Brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. METHODS AND RESULTS: Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. CONCLUSION: Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.

[Screening and treatment for retinopathy of prematurity at the Markusovszky County Hospital, (experience of 20 years: 1989-2009]. / Koraszülöttek retinopathiaszûrése és annak eredményei a Vas Megyei Markusovszky Kórházban (20 év tapasztalatai: 1989 és 2009 között végzett vizsgálatok alapján).

The aims of this study was to obtain the frequency and therapy of retinopathy of prematurity (ROP) in Markusovszky Teaching Hospital, Szombathely, Hungary. A population based study on ophthalmological status of preterm infants was performed, between 01.01.1989 and 01.01.2009. During the study period, ophthalmological status was detected in 543 premature infants. Among them, 34 children (6.3%) suffered from retinopathy of prematurity, and all of them were bilateral. ROP occurred in the highest rate (23/78 cases, 29.5%) at the birth weight of lower than 1000 grams, but frequency was only l.2% (2/169 cases) between weight 1250-1500 grams. Spontaneous recovery was observed in 19 eyes of 10 cases. The frequency of spontaneous resolution was 40% and 50% in the group of larger birth weight: between 1251-1500 grams and weight > or = 1500 grams, but on the other hand, complete recovery was only 26% (6/23 cases) below 1000 grams of birth weight. "Threshold retinopathy" (stage 3 plus), that needed therapy was detected in 25 children's 49 eyes. Cryotherapy was performed in both eyes of 16 children (32 eyes), laser photocoagulation was performed in 9 patients (16 eyes). ROP regressed after cryotherapy in 26 eyes, but in 6 eyes symptoms progressed to stage 5. After laser photocoagulation, recovery was observed in 16 eyes; this therapy was not successful in only one case. According to our experiences, stage 5 ROP developed only in two patients' both eyes, and in 1-1 eye of three children, during the 20 years of study. Our ophthalmological screening program proved that providing cryopexia or laser photocoagulation in time, severe visual impairment of retinopathy can be prevented. In spite of the few number of patients, this population based investigation with a long duration (20 years) offers new data in Hungarian ROP epidemiology.

[Severe visual impairment and blindness in children in the past 15 years in county Vas--in the context of Vision 2020]. / Gyermekkori gyengénlátás és vakság az elmúlt 15 évben Vas megyében-- a Vision 2020 program tükrében.

AIM: To investigate the causes of severe visual impairment and blindness in children. METHODS: A retrospective view of data of children under 16 years over a 15 years period, from 1990 to 2004 was performed. RESULTS: 49 visually impaired children were found. The aetiological factors were: congenital anomalies (coloboma iridis, aniridia, coloboma papillae, hypoplasia papillae, albinism, corneal opacities) 7, congenital cataract 4, retinal degenerations (macular degeneration, Stargardt, retinal degeneration, achromatopsia, retinal ablation) 8, retinopathy of prematurity 5, other eye disorders (uveitis chr., glaucoma, retinoblastoma, nystagmus + hypermetropia, myopia) 8, neurological/cerebral diseases (hydrocephalus, tumor, M. Recklinghausen, xanthogranuloma juvenile, meningoencephalitis, unknown) 13 cases. The visual impairment was diagnosed under one year in more than half of the children. CONCLUSIONS: In the context of Vision 2020 the priorities for action to reduce childhood blindness in our county are: developing neonatal care can reduce ROP and cerebral visual pathway impairment. Prevention of intrauterine infections is an other possibility for the reduction of blindness in children.

[Neurofibromatosis type 1 in children--with special consideration of ophthalmologic symptoms]. / Az 1-es típusú neurofibromatosisban szenvedó gyermekek tünetei--különös tekintettel a szemészeti elváltozásokra.

PURPOSE: Analysis of neurofibromatosis type I in children with special respect to ophthalmological symptoms. METHODS: It was performed a retrospective review of 18 children in period 1986-2002. The authors analysed the clinical, especially ophthalmological data, and the treatment of ophthalmological signs. RESULTS: The most frequent were the skin symptoms. All of the 18 patients had cafe au lait spots; 4 children had cutane neurofibroma; In 3 patients plexiform neurofibroma were observed. Ocular symptoms were: cutane neurofibroma in the left upper eye lid: 1 case; Lisch nodules in the iris: 5 cases; bilateral optic pathway glioma: 3 cases. One child's bilateral gliomas were inoperable, because of the intracranial progression. One child underwent surgical treatment because of the extreme exophthalmus in the right eye. Her left eye's glioma and the third case bilateral glioma needed only observation because of the loss of clinical signs, and slow progression. Family examinations were also performed: 12 children had signs in the II., III. and IV. generations, there were no symptoms in 6 family, they were new mutations. CONCLUSIONS: The most serious cases had ophthalmological symptoms, namely bilateral visual pathway gliomas that could lead to blindness. The treatment needed individually medical decision.