Comparison of sinus node response to exercise with responses from two different activity-based rate adaptive pacemakers in healthy subjects of different age groups.

The pacing rates from accelerometer-based (Excel) and piezoelectric-based (Legend) activity sensing rate adaptive pacemakers, both strapped externally in the pectoral position, were compared with sinus rate response in normal volunteers of two different age groups (group 1, mean age 35 +/- 16 years; group 2, mean age 72 +/- 9 years) during various physical activities. Both pacemakers were programmed in manufacturers' nominal rate adaptive settings. Both types of activity sensing pacemakers programmed in this way showed chronotropic deficiencies to metabolic demand in healthy young subjects and in those matching the usual age of pacemaker implant, especially during "burst" activities. These data suggest that present recommended activity sensing rate response algorithms for accelerometer and piezoelectric pacemakers are inappropriate for many physical activities.

Comparison of externally strapped versus implanted accelerometer- or vibration-based rate adaptive pacemakers during various physical activities.

The ability of externally strapped accelerometer- (Excel [Cardiac Pacemakers, Inc.]) and vibration-based (Activitrax [Medtronic, Inc.]) rate adaptive pacemakers to reproduce the rate response of the same implanted devices with identical programming was evaluated in ten patients by ambulatory Holter monitoring. The resting and postexercise external pacemaker rates closely resembled those of the respective implanted devices. During short bursts and more prolonged exercise, both types of strapped-on devices underestimated maximal implanted pacemaker rate response by 4%-10% when programmed to nominal rate adaptive settings. Studies evaluating chronotropic responses from either type of externally strapped activity sensor appear valid, provided the modest attenuation in maximal rate increase by this method is appreciated.

A method of obtaining, processing, and analyzing human intestinal secretions for antibody content.

Human intestinal secretions can be readily obtained using a commercially available intestinal lavage solution. Although such secretions contained abundant protease activity, significant loss of immunoglobulins was prevented by the addition of a mixture of protease inhibitors. The total content of IgA, IgM, and IgG antibody in secretions was measured using sandwich ELISA. In the secretions of ten normal volunteers IgA was most abundant (197 micrograms/ml +/- 103 SD) followed by IgM (12.5 micrograms/ml +/- 6.8 SD) and IgG (0.24 micrograms/ml +/- 0.04 SD). The IgA in secretions was predominantly secretory IgA as shown by sucrose density centrifugation. The effect of intestinal secretions on the sensitivity of the antigen-specific ELISA was tested by adding murine myeloma IgA anti-TNP added to samples of human secretions. IgA anti-TNP activity could be detected as low as 1 ng/ml, and there was no evidence of interference with the ELISA by other constituents in the secretions. Using these methods an antigen-specific secretory IgA anti-cholera toxin B subunit response in the secretions of volunteers given an oral B subunit vaccine was readily demonstrated.

Strychnine poisoning. Recovery from profound lactic acidosis, hyperthermia, and rhabdomyolysis.

Strychnine poisoning results in a predictable and treatable sequence of events involving blockade of the inhibitory neurotransmitter, extensor muscle spasms, seizures, and respiratory paralysis. These spasms may lead to hyperthermia, profound lactic acidosis, and rhabdomyolysis. Acidosis is primarily attributable to lactate, as indicated by the correlation between arterial pH and log of lactic acid concentration (r = -0.878). Interruption of the strychnine blockade is the primary therapy for strychnine poisoning. Phenobarbital in moderate doses should be the first intervention and anesthetic doses should be used if necessary. Suppression of convulsions will permit successful management of the complications of strychnine poisoning. Our patient survived, even though at one point he had a pH of 6.55, a lactate level of 32 mM/liter, a temperature of 43 degrees C, and rhabdomyolysis with an increased creatine phosphokinase level of 359,000 mU/ml (5,983 mumol/s/liter).