Recognizing and managing permanent junctional reciprocating tachycardia in the catheter ablation era

There is general agreement that an orthodromic AV reentry using a concealed slow conducting accessory pathway as the retrograde limb of the circuit constitutes the underlying mechanism of the permanent form of junctional reciprocating tachycardia (PJRT). In this arrhythmia, the standard ECG typically shows a "long R-P' tachycardia" with retrograde P wave negative in the inferior leads. A careful electrophysiologic evaluation is necessary to confirm the diagnosis of PJRT. Recent reports have demonstrated that the radiofrequency current catheter technique provides a safe and highly effective therapeutic tool for patients suffering from this arrhythmia.     

Placebo effects, common factors, and incremental effectiveness.

In his discussion of the logical consequences of the common-factor definition of the term placebo, I. Kirsch (see record 1986-01780-001) maintained that the common-factors definition of placebo is unacceptable because it (1) fails to encompass placebos such as false biofeedback and (2) overinclusively identifies as placebos traditional procedures such as contingent reinforcement. A solution offered by Kirsch is to formally define the placebo only within medicine while retaining for psychotherapy both the concept of placebo and the use of (relabeled) placebo control groups. The present author addresses the points raised by Kirsch's solution in terms of placebo effects, common factors, and incremental effectiveness. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The placebo: Conceptual analysis of a construct in transition.

Suggests that the placebo in psychotherapy has retained the negative connotation of an inert "nuisance variable," a label that it originally incurred in the field of medicine. In addition, the transition toward more cognitive models of psychotherapy, particularly A. Bandura's (see record 1977-25933-001) theory of self-efficacy, has led to problems in defining the placebo within psychology. This transition has resulted in an awkward interface between certain preferred cognitive metaphors and the negative connotations of a presumably cognitive placebo construct. Suggestions have been made to dismiss the placebo construct from psychology and to do away with the use of true placebo controls in outcome research. The present analysis maintains that (a) the placebo can be adequately defined within psychology, (b) the negative connotation of the placebo label is largely undeserved, (c) the placebo retains a continuing conceptual and empirical utility for evaluating psychotherapy, and (d) the therapeutic efficacy of current therapies is well established even though they have not generally been shown to be more effective than nonspecific treatment. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of the use of DEAE-dextran in glycemic control in diabetic patients in pregnancy

Thirty pregnant women with a pre-gestational history of type II diabetes or sugar intolerance and recruited during the second trimester of pregnancy, were administered DEAE-dextran (1 g x 3 times a day) in association with compensatory insulin therapy. Results of the end of trial tests showed amelioration of all of the parameters studied. The sugar curve after 120' from glucose load (100 g at fasting), showed a highly significant decrease at T90. Triglycerides T0 vs T90 gave p = 0.0001, probably due to improved body utilization of the insulin. DEAE-dextran was well tolerated and all of the patients enrolled at the beginning, completed the trial.     

Severe hypertriglyceridemia in pregnancy. A clinical case report]

Cholesterol (TC) and triglyceride (TG) plasma levels physiologically increase during pregnancy. The lipid increment is respectively 23%-53% above pregravidic level for TC and two-three fold the pre-pregnancy level for TG. If the TC and TG are higher than normal values in pregnancy the patient must be carefully monitored. Acute pancreatitis is the main consequence of hyperlipidemia and it can occur either during pregnancy, in the third trimester, or in the puerperium. Mortality is high both for the mother (21%) and the fetus (20%). The authors report a case of 37-year-old pregnant woman at 35 week gestation with hypercholesterolemia (TC = 425 mg/dl) and severe hypertriglyceridemia (TG = 3315 mg/dl). The patient was admitted to the hospital for treatment with an appropriate diet and drug lowering lipid levels (gemfibrozil). The baby was delivered by cesarean section at week 36. The neonatal weight at birth was 2670 g and the Apgar score was 9 at the first minute. After delivery the maternal triglyceride levels showed a remarkable reduction. According to a review of the literature, severe hypertriglyceridemia in pregnancy should be treated with a careful restriction of calories and fat; for preventing acute pancreatitis hospitalization for intravenous fluid therapy and plasma exchange must be required.     

Some peculiarities of the glucoregulatory response to glucose infusion in the rat

The glucoregulatory response to the i.v. infusion of different doses of glucose and glucose plus insulin was studied in anesthetized rats by using the primed constant infusion of glucose-2-3H. Infusion of glucose at the rate of 10 mg/kg/min induced a rise of about 100% in blood glucose, while the hepatic release of glucose showed only a small and transient decrease. A proportional increase of glycemia and glucose utilization (Rd) was observed without any appreciable change in the metabolic clearance rate (MCR) of glucose; a two-fold increase in plasma insulin was recorded at all times. In the group of rats receiving 20 mg/kg/min of glucose, changes in the above parameters were slightly greater; MCR showed a moderate increment in spite of the six-fold rise of plasma insulin. Finally, the influsion of large doses of insulin together with 20 mg/kg/min of glucose resulted in complete cessation of glucose release by the liver and in a remarkable increase of Rd and MCR. These results suggest a poor adaptability of the glucoregulatory system of the rat in response to glucose infusion as compared to other mammalian species.     

Androgyny and sex role measurement: A personal construct approach.

Reported the results of 2 studies using a new sex-role instrument, the Sex-Rep, which uses ideographically elicited sex role constructs, rather than stereotypes, to determine classification. Results from the 1st study with 40 females (mean age 31 yrs) indicate that personal feminine constructs may be healthier than feminine stereotypes in some contexts. The 2nd study, with 208 undergraduates, showed that the Sex-Rep discriminates gender as well as does the Bem Sex-Role Inventory (BSRI) and that these 2 instruments are nonredundant. Results also indicate that the apparent positive relation between masculinity and adjustment may be a measurement artifact. The different purposes of the Sex-Rep and the BSRI are discussed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)