A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989

BACKGROUND: Virtually all natural history studies of Wolff-Parkinson-White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. METHODS AND RESULTS: We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records-linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. CONCLUSIONS: The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those < 40 years old, should return for medical follow-up should symptoms develop.     

Comparison of magnetic resonance volume flow rates, angiography, and carotid Dopplers. Preliminary results

BACKGROUND AND PURPOSE: We compared the results of conventional angiography, carotid Doppler, and magnetic resonance angiography volume flow rates to determine the clinical utility of volume flow rate assessment of blood flow to the anterior circulation in patients with carotid occlusive disease. METHODS: From 11 symptomatic patients, a total of 22 extracranial carotid arteries were studied with all three techniques. The studies were independently read, and regression analysis was used to compare the measurements. RESULTS: Carotid Doppler measurements of the distal extracranial carotid arteries were proportional to the inverse of the extracranial carotid volume flow rate (r = .53, R2 = 29%, P < .01), volume flow rates were proportional to the inverse of measured percent stenosis on angiography (r = .84, R2 = 71%, P < .01), and Dopplers were proportional to angiography (r = .94, R2 = 90%, P < .01). Symptomatic Doppler systolic velocity was significantly higher (P < .002), symptomatic measured stenosis was significantly higher (P < .002), and symptomatic volume flow rate was significantly lower (P < .01) than their respective asymptomatic-side values. These preliminary observations, however, may well change once a large data set, especially one in which more patients with high-grade carotid stenosis are included, is studied. CONCLUSIONS: Assessment of carotid volume flow rates by magnetic resonance angiography quantifies flow reduction secondary to atherosclerotic occlusive disease. The easily obtained flow data add both documentation of arterial flow characteristics related to internal carotid stenosis and information regarding the adequacy of collateral pathways.     

Improvement options for a former water-driven-mill building now used as a theatre

After investigating the financial feasibility (and so abandoning the idea) of providing self-generated electricity using hydro-power, it was recommended that the top priority should be the direct connection of an electricity supply, from the mains grid to the building; this would cost £8800. Thereby, the theatre would receive a relatively unrestricted supply of electricity at cheaper unit tariffs. This improvement should be followed by the most urgent repairs being carried out to the building fabric, at an estimated cost of £6990. These repairs are necessary to ensure the continued integrity of the building's structure, thereby inhibiting the on-going deterioration.

The energy and financial appraisal also suggested a priority listing of overall improvements to the building in order to achieve a significant, economically justifiable reduction in energy demand; the recommended options are estimated to cost in total £39819. However, the capital cost of such an upgrading would only be recouped, and the theatre achieve a sustainable future, if the building were to be used more intensively and for a wider range of activities than at present in order to increase its revenue significantly.

All prices as stated are those at August 1991.     

Performance variability is related to change in cognition: Evidence from the Victoria Longitudinal Study.

Performance variability across repeated task administrations may be an important indicator of age-related cognitive functioning. In the present investigation, the authors examined whether age differences and change in inconsistency were related to 6-year (3 occasion) cognitive change. Inconsistency scores were computed from 4 reaction time tasks performed by 446 older adults (54-89 years). Replicating previous cross-sectional results, greater inconsistency was observed for older participants even after controlling for differences in response speed. New longitudinal results demonstrated (a) associations between inconsistency at baseline measurement and 6-year change in cognitive performance; (b) longitudinal change in inconsistency; and (c) intraindividual covariation between 6-year change in inconsistency and 6-year change in level of cognitive function. These findings support the view that performance variability serves as a marker of cognitive aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

X-ray digital subtraction angiography to magnetic resonance-digital subtraction angiography using three-dimensional TRICKS. Historical perspective and computer simulations: a review

Seventeen years after the introduction of x-ray digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography techniques have become available for the performance of MR-DSA. For the purposes of this article, we will consider this to include two-dimensional and three-dimensional approaches using time-resolved and non-time-resolved applications. Magnetic resonance-DSA is one in a historical progression of techniques which have aimed to produce less invasive forms of angiography. After outlining some historical milestones, several current issues regarding current methods for MR-DSA are discussed.