Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS: The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS: Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS: The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.

The Role of Occlusal Factors in the Presence of Noncarious Cervical Lesions in Young People: A Case-Control Study.

OBJECTIVE:: The aim of this retrospective case-control study was to evaluate the influence of different occlusal characteristics and self-referred bruxism in the presence of noncarious cervical lesions (NCCLs). METHODS AND MATERIALS:: The participants were 280 students (140 cases and 140 controls), with an average age of 24.5 years, from six schools of dentistry in Spain. Clinical examination was carried out to record the NCCLs and the static and dynamic occlusal characteristics. The side of mastication and bruxism was collected by questionnaire. Data variables were analyzed by means of univariate and multivariate logistic regression. Odds ratios and the respective 95% confidence intervals were calculated ( p<0.05). RESULTS:: The presence of NCCLs was significantly more likely in subjects with protrusive interferences (odds ratio [OR]=1.82); with lateral interferences, especially on the nonworking side (OR= 1.77); or who were self-reported bruxists (OR=1.72). In the multivariate analysis, protrusive interferences, bruxism, age, and the presence of attrition were risk factors for the development of NCCLs. These factors resulted in a model with an area under the receiver-operating characteristic curve of 0.667 and a positive predictive value of 61.43%. CONCLUSIONS:: There was no significant relationship between most occlusal factors and the presence of NCCLs. Only bruxism, protrusive interferences, age, and occlusal wear were risk factors. The predictive model was not sufficiently explanatory. Occlusal factors alone do not appear to be sufficient to explain the presence of NCCLs.

First report of anthelmintic resistance of equine cyathostomins in Cuba.

Anthelmintic resistance in equine cyathostomins has been described worldwide, with resistance to the benzimidazole class being particularly widespread. The status of anthelmintic efficacy in Cuba has been virtually unknown due to the lack of equine labelled products. One recent report documented suboptimal efficacy levels of extra-label albendazole products against cyathostomins, but it remains unknown to which extent benzimidazole resistance exists in the population. The aim of the present study was to evaluate the anthelmintic efficacy of two benzimidazole products labelled for equines, fenbendazole and oxibendazole. A fecal egg count reduction test (FECRT) was carried out on 132 horses aged 4 months to 18 years in 14 herds, belonging to six provinces. Ten herds exhibited signs of resistance to at least one of the benzimidazoles (mean FECRT<90%). Overall, oxibendazole exhibited higher efficacy than fenbendazole (p = 0.0062), and higher efficacy levels were found in horses never dewormed before compared to those treated within 3-12 months prior to the study (p = 0.0015). Pre-treatment larval cultures revealed the presence of large strongyles and cyathostomin larvae in all herds, while only cyathostomin larvae were detected post treatment. The present work is the first report of anthelmintic resistance in equine cyathostomins in Cuba, and suggests pre-selection for resistant strains by extra-label use of albendazole on the studied farms.

Helminth egg excretion in horses kept under tropical conditions-Prevalence, distribution and risk factors.

Increasing levels of anthelmintic resistance observed in equine cyathostomin parasites have led to recommendations of selective anthelmintic treatment strategies to lower the selection pressure favoring resistant populations. This principle is based on determining strongyle fecal egg counts from all herd members, and treating those exceeding a predetermined treatment cutoff. However, epidemiological information is lacking from horses kept under tropical conditions, where parasite burdens may be of a different composition and magnitude compared to those of horses kept under temperate climate conditions. The aim of the present work was to characterize the strongylid fauna in horses kept in tropical Camagüey, Cuba and identify risk factors associated with strongylid and ascarid egg counts. A total of 396 horses from eight different establishments were included in the study. Coprocultures revealed that Strongylus vulgaris and cyathostomins, sensu lato, were detected in all of those establishments. Prevalence and mean value of strongylid eggs per gram of feces were 97% and 1436, respectively. Eggs of Parascaris spp. were observed in 10% of horses. A multivariate mixed linear model identified sex (p=0.022), month (p=0.044), operation type (p=0.037) and time since last deworming (p<0.001) to be significantly associated in with the magnitude of strongylid fecal egg counts. A multivariate logistic regression identified horses less than two years of age (p=0.010) and horses not receiving anthelmintic treatment (p<0.001) to be significantly more likely to harbor Parascaris spp. parasites. The high magnitude and prevalence of strongylid fecal egg counts observed and the common occurrence of S. vulgaris suggest that strongylid parasite burdens are substantially different from those typically observed in managed equines kept under more temperate conditions.

Usefulness of unipolar electrograms to detect isthmus block after radiofrequency ablation of typical atrial flutter.

BACKGROUND: RS morphology of the unipolar electrogram is associated with propagation of the wave front through the exploring electrode, whereas positive uniphasic (R) unipolar electrograms are characteristic of the end of activation. METHODS AND RESULTS: Unipolar electrograms were recorded in 45 consecutive patients with atrial flutter who were undergoing radiofrequency ablation (RFA). Bidirectional cavotricuspid isthmus (CTI) block was achieved in 44 patients. The unipolar electrogram obtained before RFA at the low anterolateral right atrium during coronary sinus pacing changed from RS, rS, or QS to R or Rs in all patients after clockwise CTI block was obtained. The morphology of unipolar electrograms recorded close to the coronary sinus during pacing from the low anterolateral right atrium changed from RS or rS to R or Rs in all but 4 patients after counterclockwise CTI block. In the patient in whom CTI block was not achieved, the RS morphology of the unipolar electrogram remained unchanged. In 18 patients, the results of the RFA were assessed with only the unipolar electrogram. The unipolar electrogram correctly predicted 100% and 89% of the cases of clockwise and counterclockwise CTI block, respectively. CONCLUSIONS: The creation of CTI block is associated with an easily detectable loss of negative components and development of an R or Rs pattern of the unipolar electrogram recorded close to the ablation line while pacing at the opposite side of the CTI.

Rate-dependent conduction block of the crista terminalis in patients with typical atrial flutter: influence on evaluation of cavotricuspid isthmus conduction block.

BACKGROUND: The crista terminalis (CT) has been identified as the posterior boundary of typical atrial flutter (AFL) in the lateral wall (LW) of the right atrium (RA). To study conduction properties across the CT, rapid pacing was performed at both sides of the CT after bidirectional conduction block was achieved in the cavotricuspid isthmus by radiofrequency catheter ablation. METHODS AND RESULTS: In 22 patients (aged 61+/-7 years) with AFL (cycle length, 234+/-23 ms), CT was identified during AFL by double electrograms recorded between the LW and posterior wall (PW). After the ablation procedure, decremental pacing trains were delivered from 600 ms to 2-to-1 local capture at the LW and PW or coronary sinus ostium (CSO). At least 5 bipolar electrograms were recorded along the CT from the high to the low atrium next to the inferior vena cava. No double electrograms were recorded during sinus rhythm in that area. Complete transversal conduction block all along the CT (detected by the appearance of double electrograms at all recording sites and craniocaudal activation sequence on the side opposite to the pacing site) was observed in all patients during pacing from the PW or CSO (cycle length, 334+/-136 ms), but it was fixed in only 4 patients. During pacing from the LW, complete block appeared at a shorter pacing cycle length (281+/-125 ms; P<0.01) and was fixed in 2 patients. In 3 patients, complete block was not achieved. CONCLUSIONS: These data suggest the presence of rate-dependent transversal conduction block at the crista terminalis in patients with typical AFL. Block is usually observed at longer pacing cycle lengths with PW pacing than with LW pacing. This difference may be a critical determinant of the counterclockwise rotation of typical AFL.

Mechanism and location of atrial flutter in transplanted hearts: observations during transient entrainment from distant sites.

OBJECTIVES: This study was designed to elucidate the location and mechanism of typical atrial flutter in the transplanted heart. BACKGROUND: Although the F wave morphology in atrial flutter is similar in nontransplanted and transplanted hearts, the surgical incision needed for the atrial anastomosis may create a distinct electrophysiologic substrate of atrial flutter. METHODS: Entrainment from the lateral wall of the right atrium and interatrial septum was used to determine the location of atrial flutter in five patients with a transplanted heart and six patients with a nontransplanted heart. The difference between the first postpacing interval (FPPI) and the flutter cycle length (FCL) was used as an index of proximity to the circuit. RESULTS: In the transplant group, the FPPI was equal to the FCL at sites located close to the tricuspid annulus (TA); the mean differences (+/-SD) were 1 +/- 5 and -1 +/- 2 ms at the lateral wall and interatrial septum, respectively. However, from sites close to the surgical incision at the lateral wall and at the interatrial septum, these differences were significantly longer (29 +/- 12 and 27 +/- 9 ms, respectively, p < 0.05). In the nontransplant group, the FPPI was similar to the FCL at points in the lateral wall and interatrial septum close to the TA (mean difference 7 +/- 6 and 6 +/- 11 ms, respectively) and at sites close to the crista terminalis (CT) in the lateral wall (mean difference 4 +/- 4 ms). However, in sites separated from the TA at the interatrial septum the difference was markedly longer (35 +/- 11 ms, p < 0.05). CONCLUSIONS: Atrial flutter in transplanted hearts may best be explained by macroreentry around the tricuspid ring. In non-transplanted hearts a different structure (perhaps the CT?) may be the basis for atrial flutter at the lateral wall.

"Pseudodisappearance" of atrial electrogram during orthodromic tachycardia: new criteria for successful ablation of concealed left-sided accessory pathways.

OBJECTIVES: This study sought to analyze two new criteria along with other known predictors of success of radiofrequency ablation. Background. Although the overall success rate of radiofrequency ablation of accessory pathways is high, the individual predictive value of each of the established criteria is low. METHODS: We prospectively studied the local electrograms obtained before the application of radiofrequency energy in 33 patients with a left-sided concealed accessory pathway successfully ablated. Two new criteria ("pseudodisappearance" during tachycardia of a bipolar atrial electrogram visible during sinus rhythm and the presence of an "atrial notch" in the ascending limb of the unipolar ventricular electrogram during tachycardia) were studied along with other known predictors. Electrograms recorded at a total of 157 sites were analyzed (33 successful applications, 124 failures). RESULTS: Electrogram characteristics that were predictive of success during ablation on the basis of univariate analyses were a pseudodisappearance criterion (p<0.001), the presence of a Kent potential (p<0.005) and the presence of an "atrial notch" (p<0.005). After adjustment for between-patient differences, logistic regression analysis showed that only the "pseudodisappearance" criterion (odds ratio [OR] 7.2, 95% confidence interval [CI] 1.2 to 42.5, p<0.03) and the presence of a Kent potential (OR 2.4, 95% CI 1.01 to 5.79, p<0.05) had independent predictive value. CONCLUSIONS: The pseudodisappearance during tachycardia or ventricular pacing of a bipolar atrial electrogram present during sinus rhythm is associated with a good outcome during radiofrequency ablation of concealed accessory pathways. These observations may help to ablate accessory pathways and to avoid missing appropriate sites for ablation when the atrial activation is not clearly visible at the local electrogram.

Determinants of inducibility of ventricular tachycardia.

We analyzed the incidence and predictive factors for induction of clinical ventricular tachycardia (VT) during an electrophysiologic study in 127 patients with structural heart disease and spontaneous VT documented by 12-lead electrocardiography. Eighty-five patients had coronary artery disease (CAD), 24 had idiopathic dilated cardiomyopathy (IDC), and 18 had right ventricular dysplasia (RVD). Clinical variables were age, gender, electrocardiographic patterns of spontaneous arrhythmia, cardiac diagnosis, left ventricular (LV) ejection fraction (EF), infarct location, and presence of LV aneurysm. Clinical VT was induced in 76 patients (60%, group 1) and was not induced in 51 patients (group 2). Clinical VT was induced in 83% of patients with RVD, 58% of patients with CAD, and 50% of patients with IDC (p = 0.07). LVEF tended to be significantly higher in group 1 than in group 2 (p = 0.06). The presence of left QRS axis in the frontal plane during spontaneous VT was significantly associated with a higher inducibility both in the general group (69% vs 46%, p <0.02) and in patients with CAD (70% vs 44%, p <0.02). In patients with CAD, only the presence of a left QRS axis was significantly associated with a higher inducibility. A multivariate analysis identified only the left QRS axis as a significant and independent predictor of induction of clinical VT. The association of a leftward axis with inducibility suggests that vectorial factors in the depolarization wavefronts may be related to inducibility since conventional stimulation is performed from the right ventricle, producing a leftward axis in most cases.

Frequency and implications of resetting and entrainment with right atrial stimulation in atrial flutter.

Thirty-three patients (24 with typical and 9 with atypical flutter-wave morphology) were studied to evaluate the incidence and implications of resetting and entrainment of atrial flutter with right atrial stimulation. Resetting with single extrastimulus was present in 23 cases (group A) and absent in 10 (group B). Most cases of reset flutter were typical (20 of 23). Fixed fusion indicative of entrainment was observed in all 29 cases with pacing trains. Groups A and B did not differ significantly in flutter cycle length (230 +/- 20 vs 223 +/- 19 ms), atrial functional refractory period (165 +/- 18 vs 167 +/- 22 ms) or longest paced cycle length producing entrainment (213 +/- 19 vs 210 +/- 19 ms). In contrast, the return cycle after the longest paced cycle length producing entrainment was significantly shorter in group A (228 +/- 27 vs 284 +/- 56 ms; p = 0.001). The return cycle in group A was virtually identical to the flutter cycle length, whereas in group B it was greater (p = 0.002 compared with group A). Resetting was more frequent in typical than atypical flutter (20 of 24 vs 3 of 9; p = 0.01). Both typical and atypical flutter can be transiently entrained by right atrial pacing. Lack of resetting and longer return cycle, suggesting a longer conduction time between the reentrant circuit and the stimulation site, were mostly observed in atypical flutter. The data suggest a different location for both types of flutter, and may have implications for ablation techniques. A more cautious approach, with more extensive mapping, appears appropriate for ablation attempts of atypical flutter.

Evidence favoring the hypothesis that ventricular arrhythmias have prognostic significance in left ventricular hypertrophy secondary to systemic hypertension.

In the present review 6 lines of evidence will be discussed that suggest a prognostic significance for ventricular arrhythmias in patients with systemic hypertension and left ventricular hypertrophy: (1) in patients with systemic hypertension there is a statistical relation between asymptomatic ventricular arrhythmias and left ventricular hypertrophy; (2) in nonhypertensive left ventricular hypertrophy the prognostic value of ventricular arrhythmias is well known; (3) left ventricular hypertrophy is related to sudden death in patients with systemic hypertension; (4) it is generally acknowledged that ventricular arrhythmias are a frequent cause of sudden death; (5) there is experimental evidence to support the arrhythmic risk of left ventricular hypertrophy; and (6) it has been recently demonstrated that ventricular arrhythmias influence mortality in patients with left ventricular hypertrophy secondary to systemic hypertension. However, whether asymptomatic ventricular arrhythmias are specific markers for more severe sustained arrhythmias, or just markers for a more severe stage of the disease, remains to be determined.

Comparison of electrophysiologic effects of quinidine and amiodarone in sustained ventricular tachyarrhythmias associated with coronary artery disease.

Fifteen patients with spontaneous ventricular tachyarrhythmias underwent electrophysiologic studies at baseline and during therapy with quinidine and amiodarone. In 9, ventricular tachycardia (VT) with a similar QRS morphology was induced with quinidine, amiodarone and under the control state. Both quinidine and amiodarone significantly increased QRS duration and the VT cycle length. Amiodarone increased the VT cycle length more than quinidine (85 vs 121 ms, p < 0.05). Amiodarone increased the percent QRS duration (during sinus rhythm, ventricular pacing and VT) significantly less than percent VT cycle length, whereas quinidine did so only at slow rates (at faster rates the percent increase in QRS duration is not different from the percent increase in VT cycle length). The percent increase in QRS duration produced by quinidine correlated significantly with the percent increase in VT cycle length (the best correlation was observed during pacing, r = 0.78). In contrast, no such significant correlations were obtained for amiodarone. Thus, amiodarone prolongs VT cycle length more than quinidine (at the doses used). The effects of quinidine on conduction in tissue mostly unrelated to tachycardia origin predict effects in the tachycardia cycle length. In contrast, the effects of amiodarone on the latter are more intense but not predicted by those on tissue unrelated to the tachycardia origin.

Radiofrequency catheter ablation of ventricular tachycardia from right ventricle late after myocardial infarction.

In summary, this case illustrates how complex VT circuits may be. If the findings of this case are substantiated with additional cases, mapping and radiofrequency energy application from right ventricle would have to be considered in VT with left bundle branch blocks QRS morphology, whenever ablation from the left ventricule is ineffective.

Randomized, prospective comparison of four burst pacing algorithms for spontaneous ventricular tachycardia.

"Less aggressive" burst stimulation is more effective in terminating spontaneous monomorphic ventricular tachycardia with a lesser acceleration rate. Higher ventricular tachycardia cycle length and use of 91% coupling interval were independent predictors for pacing termination.

DMFT, dmft and treatment requirements of schoolchildren in Asturias, Spain.

An epidemiological survey was carried out in 1992 to study the dental health status of schoolchildren aged 6, 9 and 12 in Asturias, Spain. It focused on the caries prevalence, dmtf, DMFT, restoration indices and dental treatment needs of this population. A representative sample of 1839 subjects, randomly selected and proportionally assigned by age group (6, 9 and 12) with the classroom as the sample unit, was examined. Analysis of the data showed that in 6-year-old children the caries prevalence in primary teeth was 45.8%. The mean caries indices were 2.10 dmft and 0.25 DMFT. At 9 years old the prevalence of caries in primary teeth was 62.8% and in the permanent teeth 49.1%. The mean level of caries was 2.38 dmft and 1.50 DMFT. At 12 years old the caries prevalence in permanent teeth was 71% and in first molars 64.2%. The mean caries experienced was 3.30 DMFT. In all groups the D-component constituted the major part of the caries index. The results for girls were higher than for boys in almost all age groups. Surface fillings were the treatment most required in all age groups.

DMFT and treatment needs in adult population of Oviedo, Spain.

An epidemiological survey was carried out in 1992 researching dental caries and treatment needs in an adult population in Oviedo, Spain. A representative sample of 261 subjects, randomly obtained and stratified by age, was examined. Results show a dental decay prevalence of 99.6%; 12.5 DMFT index with 2.9, 7.5 and 2.1 mean values for D, M and F components. Women and the lower social class showed the highest DMFT index. Treatment needs reach a mean value of 12.1 teeth per person. Pontics are the most needed treatment, the mean value increases with age while the differences among age groups and social classes are statistically significant. The next most needed dental treatment is filling of one surface which decreases with age, is the same for men and women and higher among the middle social class; the differences are statistically significant among the social classes.

[Radiofrequency ablation of a posteroseptal accessory pathway associated with coronary sinus diverticulum]. / Ablación con radiofrecuencia de una vía accesoria posteroseptal asociada a un divertículo en el seno coronario.

The case of a patient with a symptomatic Wolff-Parkinson-White syndrome undergoing attempted radiofrequency catheter ablation of a posteroseptal accessory pathway is described. Coronary sinus venography revealed the presence of a diverticulum attaching near the os. The electrogram recorded from a catheter placed in the narrow neck of the diverticulum revealed a short atrioventricular time during sinus rhythm. The pathway was easily ablated using radiofrequency energy applied in the neck of the diverticulum, after multiple failed attempts at catheter ablation from the endocardial surface of the posteroseptal space. Our report emphasizes the importance of searching for a coronary venous diverticulum in all patients with posterior accessory pathways undergoing catheter ablation.

[The catheter ablation of accessory atrioventricular pathways using a radiofrequency]. / Ablación mediante catéter de vías accesorias auriculoventriculares utilizando radiofrecuencia.

Sixteen consecutive patients (5 males and 11 females) aged 40 +/- 22 years suffering for spontaneous symptomatic arrhythmias underwent attempted transcatheter ablation of an atrioventricular accessory pathway using radiofrequency current. Five patients had the WPW syndrome. The Kent bundle was located in the left free wall in 14 patients, in the right anteroseptal region in one patient and in the posteroseptal zone in one patient. A 7F catheter (Polaris, Mansfield) with a 4 mm2 distal electrode, was used for ablation positioned on the left atrioventricular annulus in the 13 patients with left free wall accessory pathways or at the right atrium in the two patients with right accessory pathways. Without general anesthesia, a mean of 12 +/- 9 applications of radiofrequency current were delivered between the large tip electrode and a large skin patch positioned on the left posterior chest. By using radiofrequency current, a successful clinical outcome was achieved in 14 of 16 patients (87%). In patients with concealed accessory pathways, accessory conduction was abolished in 10 of 11 patients, in 8 patients in the first radiofrequency session and in two other patients in a successful second procedure. In the 5 patients with the WPW syndrome, the anterograde conduction disappeared after the procedure but the retrograde conduction remained, although deteriorated, in 2 patients. One patient developed uncomplicated tibioperoneal thrombophlebitis and in 2 cases an elevated concentration of creatine kinase value was found. In one female patient with a concealed accessory pathway, the Kent bundle conduction reappeared 3 months after the procedure and was ablated in a second session.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of 3 algorithms to localize the accessory pathway in Wolff-Parkinson-White syndrome]. / Estudio comparativo de tres algoritmos de localización de la vía accesoria en el síndrome de Wolff-Parkinson-White.

BACKGROUND AND OBJECTIVES: Some electrocardiographic algorithms have been developed to predict the location of the accessory pathway in the WPW syndrome. Few studies address the interobserver variability of such algorithms and the possible observer-dependent changes of accuracy. This study analyzes three algorithms to localize accessory pathways recently published, comparing the inter-observer variability, their predictive value and the most frequent problems observed during their application. METHODS: Ninety-six electrocardiograms from patients who underwent successful ablation of a single accessory pathway were reviewed. The location of each pathway was predicted by two independent observers according to three different reported electrocardiographic algorithms. The interobserver agreement, percentage of correct predictions and critical steps of each algorithm were analyzed. RESULTS: The interobserver agreement varied between 64 and 79% and the accuracy between 38 and 67%. The best results were obtained in the left lateral accessory pathways (69 to 89% correctly located). All the algorithms presented critical steps at which more than 20% of pathways were incorrectly classified. CONCLUSIONS: The analyzed algorithms present a high interobserver variability. The accuracy obtained is clearly lower than that reported by the corresponding authors. These facts should be considered when being used them in clinical settings.