[Temporary pacemaker treatment in Denmark]

The employment of temporary pacing (TP) in Denmark in 1986 is illustrated by means of a questionnaire investigation. Seventy-four out of 77 Danish hospitals with a medical-cardiological specialist returned usable replies. Facilities for temporary pacing were available in 39 (53%) of the hospitals. The method of pacing most extensively employed was the transvenous method which was used in 33 hospitals while external transcutaneous pacing by Zoll's method was available in 13 hospitals. In transvenous pacing, the subclavian vein was employed routinely in 24 hospitals while a cubital vein was used primarily in eight hospitals. More than 85% of the pacing catheters employed were of disposable type. Only one hospital always employed a permanent pacing lead which could be utilised if permanent pacing should be required. A total of 486 patients with or without acute myocardial infarction (AMI) were submitted to temporary pacing. Employment of temporary pacing in patients with AMI was 0-8.3% (average 3.7%). In general, it was found that hospitals with cardiac laboratory facilities showed the greatest temporary pacing activity. The indications for temporary pacing are assessed on the basis of two case reports. The greatest employment of temporary pacing was found in patients with AMI with third degree atrioventricular block and ventricular escape rhythm (anterior wall 74%, posterior wall 56%). Employment of temporary pacing was least in symptomfree patients with anterior wall AMI and bifascicular block (9%).

Regression of outflow tract obstruction subsequent to treatment with verapamil in hypertrophic obstructive cardiomyopathy

A 29-year-old man suffering from hypertrophic obstructive cardiomyopathy was treated with verapamil 240 mg daily for 4.5 years. During this period the symptoms were reduced, and an intraventricular gradient diminished from 80 to 20 mm Hg, possibly due to a decrease in left ventricular ejection fraction combined with an improved diastolic filling.

Entrapment of a tined pacemaker electrode in the tricuspid valve. A case report

A tined pacemaker electrode was entrapped in the tricuspid valve apparatus. Nonresponding, sustained ventricular tachycardia, and cardiac arrest necessitated forcible removal of the electrode causing partial avulsion of the tricuspid valve. Hemodynamically insignificant tricuspid regurgitation developed subsequently.

[Out-of-hospital heart arrest. Prospective study of various types of expanded prehospital treatment in Odense]

During the period 1.2.1988-31.1.1989, a prospective investigation was undertaken of the intensive prehospital treatment in Odense. Comparison was undertaken between a medically staffed ambulance (2 months), a motorized doctor (rendez-vous, model 4 months) and the heart ambulance (recommended by the Danish National Board of Health (6 months]. Out of 28 patients brought in by the medically staffed ambulance, two (7%) were discharged alive. Out of 57 patients brought in the phase with the motorized doctor nine (16%) were discharged alive. Out of 78 patients brought in by heart ambulance one (1%) was discharged alive. The results of this investigation reveal that the prehospital treatment of cardiac arrest in Odense can be improved by participation of a doctor in the treatment, (particularly the rendezvous model). Suggested improvements consist of 1) improved alarm system, 2) intensification of training laymen in treatment of cardiac arrest and 3) increased information to the population.

[First aid in cases of out-of-hospital heart arrest]

In connection with participation of doctors in the emergency ambulance service in Odense, the number of cases of observed cardiac arrest outside hospital was registered during a period of six months. The object was to assess how often primary treatment for cardiac arrest was instituted by passers-by before arrival of the ambulance. Seventy-four cases of observed cardiac arrest occurred. In 11 of these (15%) primary resuscitation was attempted outside hospital. In only three (4%) cases the primary resuscitation was undertaken by lay persons. Treatment of cardiac arrest before arrival of the ambulance increases survival. It is therefore essential to increase the number of courses in the treatment of cardiac arrest for lay persons, if mortality is to be reduced.

[Klinefelter's syndrome associated with primary mediastinal germinal cell tumor]

A case of a man aged 25 year with Klinefelter's syndrome (KS) associated with a primary malignant germinal cell tumour is presented. Echocardiography was of assistance in the diagnosis as a tumour behind the heart was demonstrated. If patients with KS develop cardiopulmonary symptoms, referral for x-ray of the thorax is recommended. If there is enlargement of the heart or increase in width of the mediastinum, echocardiography should be performed. This case history emphasizes further that a negative cytological test does not disprove malignancy.

[Epididymitis caused by amiodarone]

A case of epididymitis developed in a 33 year old man after treatment with the anti-arrhythmic agent, amiodarone, for approximately 18 months. No signs of bacterial infection or anatomical abnormalities were found. Amiodarone as the cause of epididymitis has only previously been described on a few occasions. We stress the importance of considering this adverse effect of amiodarone therapy as a differential diagnosis in the etiology of epididymitis.

Epididymitis caused by treatment with amiodarone

Epididymitis is described in a man aged 33 who had been treated with the antiarrhythmic agent, amiodarone. No signs of bacterial infection or anatomical abnormalities were found. Amiodarone as the cause of non-infectious epididymitis has been reported. This additional case stresses the importance of considering an adverse effect of amiodarone treatment as a cause when making a differential diagnosis of epididymitis.

[Cardiac arrest outside of hospital. A retrospective study in Odense]

During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement of treatment include: 1. Information to the population. 2. Training of first-aid staff in treatment of cardiac arrest. 3. Quicker arrival of ambulances and 4. Better staffing and training of ambulance staff in the use of a defibrillator possibly with participation of a doctor.

The spread of freshwater snails including those of medical and veterinary importance

The present paper discusses the spread of freshwater snails that act as intermediate hosts for various trematodes that cause diseases in man and in cattle. Examples of snail species which have spread across natural barriers are reviewed as well as the mechanisms involved in this transport. Focus is put on the extensive trade in freshwater aquatic plants and aquarium fish, and the need for better control of this trade is emphasized in order to minimize the risk of unintended import of potentially harmful snails.

Seasonal patterns in the transmission of Schistosoma haematobium, S. mattheei and S. mansoni in the highveld region of Zimbabwe

The pattern of fluctuation in the population size of Bulinus globosus and Biomphalaria pfeifferi, in their infection rates with Schistosoma haematobium/S. mattheei and S. mansoni, respectively, and in the cercarial population size as monitored using hamster immersions, was elucidated in streams in the temperate highveld region of Zimbabwe over a 27-month period during 1982-1984. The results revealed that transmission of S. mansoni was erratic and unpredictable without a clearcut seasonal transmission pattern. In contrast, transmission of S. haematobium and S. mattheei exhibited a marked seasonal pattern, being most intensive during the hot, dry season (September-November) and markedly reduced during the cold, dry season (June-August). During the rainy (December-February) and warm, post-rainy (March-May) seasons transmission was moderate and variable, but occasionally intensive. The results also showed that rodent immersion is to be preferred to measurements of snail population size and snail infection rate in elucidating seasonality of transmission of schistosomiasis.

[Morphology of the tegument of Schistosoma intercalatum; comparison of three stocks from Cameroon, Zaire and Gabon]

The study of the teguments of male Schistosoma intercalatum with SEM shows two different morphological types: a) Type Cameroon (Edea) (consistent with the previous studies by Kuntz et al.). b) Type Zaïre (Kisangani) similar to type Gabon (Libreville).

A study of the biological characteristics of a hybrid line between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun)

The viability of a hybrid between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun) was studied for up to the F7 hybrid generation and the biological characteristics of the hybrid were compared with those of each of the parental species. Using the total cercarial production/100 exposed snails/5 weeks value (TCP) as an index the hybrid miracidial infectivity to Bulinus forskalii (Kinshasa, Zaire), the host snail for S. intercalatum, remained comparable to that of S. intercalatum for up to at least the F5 generation and the TCP values for the hybrid/B. wrighti combination remained for up to the F7 generation intermediate between those of the parental species in B. wrighti. The hybrid also retained the infectivity for up to at least the F5 generation to B. globosus (Mazeras, Kenya), the host snail for S. haematobium, but the TCP values for the hybrid/B. globosus combination remained consistently lower than that of the S. haematobium/B. globosus combination. The hybrid cercarial infectivity to hamsters was for up to the F7 generation comparable to that of both parental species and the egg production capacity/worm pair/day of production of the F1 hybrid generation exceeded in both hamsters and mice that of both parental species. However, the egg production capacity subsequently decreased with that of the F3 to F6 generations in hamsters and with that of the F2 and F5 generations in mice being comparable to that of S. intercalatum. The pattern of distribution of eggs in tissue of hamsters of the F1 and F2 generations resembled that of S. haematobium and S. intercalatum, respectively, but the distributional pattern of the F3 to F6 generations deviated markedly from that of both the parental species and the preceding hybrid generations. The hybrid cercarial infectivity to mice and the pattern of egg distribution corresponded to that of S. intercalatum. The egg morphology of the P1 generation corresponded to that of S. intercalatum while that of the F1, F2 and F3 hybrid generations exhibited great polymorphism with a range of shapes through those of the parental species but with most eggs being intermediate in shape. However, the eggs of the F4 to F7 hybrid generations exhibited less polymorphism and resembled those of S. bovis in both size and shape.

9-acridinyl and 2-methoxy-6-chloro-9-acridinyl derivatives of aliphatic di-, tri-, and tetraamines. Chemistry, cytostatic activity, and schistosomicidal activity

9-acridinyl derivatives of 1,6-hexanediamine, 1,8-octanediamine, bis(3-aminopropyl)amine, N,N'-bis(3-amino-propyl)piperazine, and N-ethyl-1,6-hexanediamine in the form of their hydrochlorides were prepared in high yields and converted into potential hetero bis DNA intercalating diacridines. The corresponding potential homo bis DNA intercalating reagents were prepared by heating the above amines with 9-chloroacridines. The chemical stability of the acridines was examined. Their cytostatic activity against Cloudman melanoma cells, in vitro, has been determined. The strongest cytostatic activity was observed for the acridine derivatives of the tri- and tetraamines. The schistosomicidal activity of selected acridine and diacridine derivatives against Schistosoma mansoni in mice was found to be insignificant. The S. mansoni egg development was apparently suppressed by this treatment.

Studies on the relationship between Schistosoma and their intermediate hosts. V. The genus Bulinus and Schistosoma bovis from Iringa, Tanzania

The relationship between an isolate of Schistosoma bovis from Iringa, Tanzania, and various species of the host snail genus Bulinus from East Africa was studied using the total cercarial production per 100 exposed snails over a period of 4 weeks following patency as an index of the compatibility. All populations of Bulinus forskalii and B. africanus tested exhibited a high level of susceptibility while the populations of B. truncatus and B. globosus tested were either refractory or of low to moderately low susceptibility. All populations of B. abyssinicus, B. canescens, B. nasutus and B. tropicus tested were refractory. It is suggested that B. africanus is the most important host snail for S. bovis in East Africa, that B. forskalii at least locally may contribute significantly to the transmission and that B. truncatus and B. globosus only play a limited role in the transmission.

A review of the biology and transmission ecology of African bovine species of the genus Schistosoma

The present paper reviews the information available concerning the biology and transmission ecology of the African bovine species Schistosoma bovis, S. mattheei, S. margrebowiei and S. leiperi. Criteria for species identification (egg morphology, intermediate host spectra, definitive host-parasite relationships, etc.) are listed and the geographical distribution of the four species and factors determining the relative occurrence within their overall distributional ranges are described. S bovis and S. mattheei occur north and south of 10 degrees S, respectively, and S. margrebowiei occurs mainly, and S. leiperi only, in southern central Africa. Definitive host-related factors (susceptibility, water contact pattern, ect.) providing the background for being a primary definitive host and the primary definitive host spectra for the four schistosome species are described. The primary definitive host spectrum for S. margrebowiei and S. leiperi comprise lechwe, puku and waterbuck, for S. mattheei lechwe, puku, waterbuck plus cattle, and for S. bovis cattle and possibly also some of the listed antelope species. In addition, wild bovines and cattle may provide a reservoir of S. mattheei and S. margrebowiei in humans, but wild bovines and domestic stock play no major role in the transmission of other human species of schistosomes. The intermediate snail host spectra of S. mattheei and S. leiperi only comprise members of the Bulinus africanus species complex; S. bovis is transmitted by members of the B. truncatus, B. africanus and B. forskalii species groups, and S. margrebowiei is transmitted by members of the B. forskalii species group and possibly also by members of the B. tropicus and B. truncatus species groups. Factors determining the transmission ecology of the four schistosome species, and thereby the epidemiology of bovine schistosomiasis, are discussed. Influential factors comprise environmental conditions mediated via the effect of these on the size of the snail host population and on the rate of the intramolluscan development, behavioural patterns of the definitive host population and the course of the infection in the definitive host as related to aspects of susceptibility and level of endemicity. The epidemiological pattern (prevalence and intensity of infection, seasonality of transmission, etc.) is described and exemplified, and it is finally concluded that the increasing water conservation and changing methods of husbandry may result in bovine schistosomiasis becoming a major veterinary problem in Africa.

Clinical pathology of Schistosoma bovis infection in sheep

The clinical pathology of Schistosoma bovis infection in sheep was studied for a period of 16 weeks. The length of the prepatent period was 10 weeks, and reduced haemoglobin and packed cell volume values and increased serum gammaglutamyl-transpeptidase levels were observed from eight to 10 weeks after infection and onwards. The bromsulphalein clearance rate was significantly reduced 16 weeks after infection. Eosinophil counts were increased six and eight weeks after infection and towards the end of the experiment.