Stefan Bughi

Fetal and neonatal adverse effects profile of amiodarone treatment during pregnancy.

During pregnancy amiodarone has been used for treatment of arrhythmias in both the motherleg and the fetus.i0-14 Although the initial data on the use of amiodarone in pregnancy revealed no teratogenicity and only few minor adverse effects,‘-* other recent reports93 l3 described two cases of neonatal hypothyroid goiter, casting doubts on the safety of amiodarone during pregnancy. We report a clinical case of maternal amiodarone treatment for ventricular tachycardia (VT) during conception and throughout two successive pregnancies. A 29-year-old woman with a history of symptomatic ventricular arrhythmia refractory to treatment with beta blockers, quinidine, procainamide, and tocainide underwent extensive evaluation of arrhythmia because of worsening symptoms before she became pregnant with her third child. Previously she had had two normal pregnancies (both births at 40 week’s gestation; birth weight 2945 gm and 3000 gm, respectively) and two abortions. She also had mitral and tricuspid valve prolapse and a history of right upper lobectomy for drug-resistant pulmonary tuberculosis. Left and right ventricular size and function were normal, and there was no evidence of cardiomyopathy or right ventricular dysplasia. The diagnosis of arrhythmia was confirmed by ambulatory ECG (Holter) monitoring, which revealed up to 759 runs of nonsustained VT. During electrophysiologic testing she had inducible sustained monomorphic VT that degenerated into ventricular fibrillation. The patient was started on a regimen of amiodarone, which effectively suppressed the VT and completely relieved the symptoms. After 2 years of treatment the patient became pregnant while taking amiodarone, 400 mglday. The patient and her husband were informed in detail about the uncertainty and potential danger of amiodarone treatment during pregnancy; abortion was considered and discussed on several occasions, and the patient refused. Because of symptomatic relief the patient elected to continue amiodarone therapy during pregnancy. The patient was first seen in our clinic at 12 weeks’ gestation; at that time, to decrease the risk of adverse effects, the dosage of amiodarone was decreased to 200 mglday, and the patient was maintained on this dosage. Throughout the pregnancy se-

Hypnosis, differential expression of cytokines by T-cell subsets, and the hypothalamo-pituitary-adrenal axis.

Abstract This investigation tested the hypothesis that hypnosis can differentially modulate T-cell subsets, and that this effect is mediated by changes in hypothalamo-pituitary-adrenal (HPA) mediators. Seven healthy, highly hypnotizable volunteers participated in three one-day sessions, a baseline and two intervention sessions. Hypnosis intervention entailed a standardized induction, suggestions for ego strengthening and optimally balanced functioning of the immune and neuroendocrine systems, and post-hypnotic suggestions for stress management and continued optimal balance of bodily systems. Blood samples were drawn at five time points between 8:00 a.m. and 3:00 p.m. and were analyzed for T-cell activation and intracellular cytokine expression (Interferon (IFN)-γ, Interleukin-2, Interleukin-4,) and HPA axis mediators (ACTH, Cortisol, and β-endorphin). Following hypnosis intervention, statistically significant immunological effects were noted. Specifically, the proportion of T-cells expressing IFN-γ (p = .0001) and IL-2 (p = .013) were lower after hypnosis. T-cell activation response to polyclonal stimulation was positively correlated with ACTH (p = .01) and β-endorphin (p = .001) while IFN-γ expression was correlated with levels of Cortisol (p < .001). Further controlled studies utilizing hypnosis with patients in treatment are warranted in order to examine whether an altered T-cell response can be replicated in the presence of disease.

Amenorrhea, pregnancy, and pregnancy outcomes in women following spinal cord injury: a retrospective cross-sectional study.

OBJECTIVE To assess the prevalence of amenorrhea and pregnancy as well as pregnancy outcomes following spinal cord injury (SCI) in women. METHODS In this retrospective cross-sectional study, women with SCI were interviewed regarding demographic data, details about the timing and type of SCI they sustained, whether the neurologic deficit was complete or incomplete, and reproductive history. The study was initiated in September 2001 and lasted 3 years. Measures were compared for significance with the level of injury and extent of neurologic deficit using descriptive statistics, analysis of variance, and 2-tailed t tests. RESULTS Of 128 women, 53 (41.4%) had postinjury amenorrhea. The amenorrhea was transient in 50 of 53 women. SCI occurred at the mean (+/- SD) age of 27 +/- 9 years. In this group the lesions were at thoracic spine in 35 (66%), cervical spine in 16 (30%), and lumbar spine in 2 (4%). Neurologic deficit was complete in 31 women (58%) and incomplete in 22 (42%). The occurrence of amenorrhea was not influenced by the extent of neurologic deficit. Of 50 women who experienced transient amenorrhea, 10 (20%) became pregnant (6 livebirths, 4 elective terminations). Mean duration of amenorrhea was 7.96 +/- 10.9 months; there was no significant difference between mean duration of amenorrhea in women who got pregnant vs those who did not (6.4 +/- 3.8 months vs 15.8 +/- 30.8 months; P = .34). Pregnancy rate was significantly higher among those who sustained injury at a younger age (21.6 +/- 5.3 years vs 28.3 +/- 9.3 years; P = .033). CONCLUSIONS Level of injury did not influence duration of amenorrhea or occurrence of pregnancy. Women who experience transient amenorrhea after SCI may achieve successful pregnancies.

Hypoglycemia Reported in Patient Safety Network (PSN)

Hypoglycemia (hG) affects up to 26% of inpatients with diabetes mellitus (DM) and is responsible for an increase in cardiovascular morbidity and mortality. The goal of this pilot project (PP) was to decrease inpatient hG.