In support of sibling inclusion: a literature review

The responses of siblings to a childhood mental illness have been conceptualized in different ways. When siblings have not been ignored, they have been viewed most frequently as an influence upon the illness or as subject to the same dynamics that were believed to have caused the mental illness. As conceptualizations of the causes of mental illness have changed, the literature on siblings has changed to focus on the impact of the illness on the sibling. How siblings and sibling relationships are conceptualized has important implications for clinical research and practice. More research is needed to understand the sibling experience in childhood mental illness. Clinicians can do more for the family if all of the family dynamics and responses to the illness are explored.

My brother's keeper: simultaneous hospitalization of siblings

Milieu therapists are confronted with a dilemma when more than one child in the same family requires hospitalization. Conventional wisdom discourages simultaneous hospitalization of siblings on the same unit. The sibling bond, however, is an important aspect of development and can be used therapeutically. This paper examines issues and opportunities presented to milieu therapists by the simultaneous hospitalization of siblings, and makes recommendations for maximizing therapeutic use of the sibling bond.

Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients

We evaluated the occurrence and persistence of delirium in 325 elderly patients admitted to a teaching hospital from either a defined community or a long-term care facility. Of the study participants, 34 (10.5%) had Diagnostic and Statistical Manual of Mental Disorders, Third Edition--defined delirium at initial evaluation; of the remaining patients, 91 (31.3%) developed new-onset delirium. An additional 110 patients also experienced individual symptoms of delirium without meeting full criteria. Preexisting cognitive impairment and advanced age were associated with increased risk of incident delirium in the community sample but not the institutional one. Delirium was not associated with an increased risk of mortality, but it was associated with a prolonged hospital stay and an increased risk of institutional placement among community-dwelling elderly. Only five patients (4%) experienced resolution of all new symptoms of delirium before hospital discharge, and only 20.8% and 17.7%, respectively, had resolution of all new symptoms by 3 and 6 months after hospital discharge. These data suggest that delirium is a common disorder that may be substantially less transient than currently believed and that incomplete manifestations of the syndrome may be frequent.

Monoclonal antibodies raised against semi-purified preparations of human islets define subpopulations of pancreatic cells

Monoclonal antibodies were produced from fusions between splenocytes from BALB/c mice immunised with purified human islets and the mouse myeloma cell line NS-0/Uncl. Supernatants from uncloned hybrids were screened by immunohistology on frozen sections of human pancreas. The range of specificities appeared to reflect the relative purity of the human islet preparations used. Eight monoclonal antibodies were investigated further, four of these bound to islet cells, two to acinar cells, one to ductal cells and one to occasional cells. The antigens recognised by these antibodies were characterised by immunohistology using a number of different tissues, as well as haemagglutination, immunoblotting and radioimmunoassay for insulin. Seven of the eight antibodies studied were IgM. One acinar cell antibody (IgG2a) precipitated proteins of 200Kd and 11OKd molecular weight. None of the antibodies bound directly to insulin. Seven of the antibodies appear to have defined previously unreported epitopes in the pancreas and will prove useful in further studies of human pancreatic cells.

Postmenopausal bleeding from unusual endometrial polyps in women on chronic tamoxifen therapy

There are recent reports of postmenopausal bleeding from endometrial polyps in women receiving tamoxifen therapy for breast cancer. We describe four additional patients who presented with vaginal bleeding, and emphasize the pathology. These polyps demonstrated cystically dilated glands in all cases and stromal decidualization in two; in one instance, metastatic breast carcinoma was present in the polyp. The mechanisms by which tamoxifen may affect the development of these polyps are discussed.

Isolation and purification of microvascular endothelium from human decidual tissue in the late phase of pregnancy

Normal pregnancy demands significant structural and physiologic adaptations of the uterine microvasculature, to facilitate adequate placentation. In pregnancies complicated by pregnancy-associated hypertension (preeclampsia), this process is defective, resulting in a high incidence of intrauterine growth retardation. The microvascular endothelium, a focal point for both initiation and inhibition of coagulation and control of vascular tone, may well contribute to development and aggravation of these abnormalities. We describe a method for isolation, purification, and culture of human decidual endothelial cells from biopsies performed at the time of cesarean section. The separation procedure is technically simple, requires only a small piece of tissue, and takes approximately 2 hours to perform. Some of the unique features of these cells in culture are outlined. This technique will permit the close examination of various aspects of the function of these cells in normal pregnancy, and their comparison with cells from pregnancies complicated by hypertension.

Mothers' remembrances of newborn intensive care: a predictive study

Six months after discharge, 94 mothers described their memories of their infant's hospitalization on an NICU. Mothers of sicker infants, those who had claimed difficulties with NICU staff, and those who felt less attached to their infant more often described painful reminders of this crisis. Pleasurable reminders were reported more often by mothers who had perceived greater personal control over their infant's recovery and had construed a purpose in this crisis. Mothers described several benefits of their memories and were more likely to do so when they had perceived a purpose in their misfortune.

Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization

Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.

Nursing assessment of children of alcoholics

Children of alcoholics frequently grow up in families that do not foster growth. They learn roles and rules that help them survive in the family but that are not always helpful in the world outside. These children are at risk for a wide range of problems including teratogenic effects, academic problems, child abuse, psychiatric disorders, substance abuse, and other psychosocial and behavioral difficulties. Nurses who work with children or parents should be prepared to identify the possibility of parental alcoholism and the associated risks.

Effects of formal support on mothers' adaptation to the hospital-to-home transition of high-risk infants: the benefits and costs of helping

94 mothers were randomly assigned to a control group or to a group who received a formal support program designed to aid their adaptation to the transition from hospital to home care of high-risk infants. Mothers' predischarge need for support and the severity of infants' predischarge medical problems moderated program effects assessed 6 months after NICU discharge. Positive effects of the program on mothers' sense of competence, perceived control, and responsiveness were evident for mothers who had needed the most support. But at low levels of need for support, participation in the program had negative effects on these outcomes. A similar pattern was found for the effects of the program on mothers' positive mood as a function of the severity of infants' medical problems. Secondary findings suggest why some mothers may benefit from formal support after NICU discharge and others may experience at least temporary disruptions in their adaptation from such support.

Human monoclonal antibodies to human cytomegalovirus

Human monoclonal antibodies (HMAbs) to human cytomegalovirus (HCMV) have been developed by using electric field-induced cell fusion of human B lymphocytes to the human-mouse cell line SBC-H20. By this procedure, multiple hybridomas have been produced that secrete IgG 1 HMAbs with distinct patterns of indirect immunofluorescence on HCMV-infected cells. HMAbs Z01 and X20 immunoprecipitated a major protein at 64 kDa. HMAb Z02 immunoprecipitated a major protein of 48-50 kDa. HMAb Z10 identified a single protein at 65 kDa and HMAb X16 identified proteins at 100, 65, and 36-38 kDa. The HMAbs demonstrated varying degrees of virus-neutralizing activity. The production of HMAbs to HCMV provides an important approach to studying the human host response to HCMV by elucidating biologically relevant antigens and epitopes. In addition, HMAbs are a potentially unlimited source of relevant human antibodies for treating life-threatening HCMV infection.

Effect of changes in dietary sodium on active electrolyte transport by erythrocytes at different stages of human pregnancy

1. Active electrolyte transport was examined in erythrocytes from women in the second and third trimesters of pregnancy and post partum, and compared with that in ovulating women. 2. There was a significant reduction in intracellular sodium ([Na]i) and increase in intracellular potassium ([K]i) in pregnancy with a return towards normal values in the post-partum period. 3. Maximum specific ouabain binding [number of Na+,K+-adenosine triphosphatase (Na+, K+-ATPase) units] was increased by 70% in pregnancy and returned slowly towards normal values post partum. 4. Na+,K+-ATPase activity as determined by ouabain-sensitive 86Rb influx in artificial media was also increased in pregnancy by 13%. It returned towards normal post partum. 5. The increases in Na+,K+-ATPase in pregnancy were not closely related to the concomitant increases in aldosterone or cholesterol nor to reticulocytosis and were not affected by 7 days of high (greater than 250 mmol/day) or low (less than 50 mmol/day) sodium intake.

Adaptational features of mothers' risk and prevention appraisals after the birth of high-risk infants

Sixty-seven mothers were interviewed at the time of their child's discharge from a newborn intensive care unit and 6 months after hospital discharge. After 6 months, mothers who had done more to prevent adverse pregnancy outcomes, had been more optimistic about the outcomes of their pregnancy, and saw their infant's complications as more avoidable reported greater concurrent mood disturbance and/or more distress ensuing from their child's hospitalization. Mothers' risk and prevention appraisals also played a role in their attitudes toward future childbearing, independent of mothers' reproductive history, the severity of the infants' medical condition, and the infant's behavioral difficulty at 6 months. The single most important predictor of mothers' expectations of future pregnancies, however, was whether the child was first born.

Transposition of breakpoint cluster region (3' bcr) in CML cells with variant Philadelphia translocations

A probe derived from the 3' end of the CML breakpoint cluster region (bcr) was localized in chronic myelocytic leukemia (CML) cases with complex Philadelphia translocations, [t(8;9;22)(q13;q34;q11) and t(12;9;22)(p11;q34;q11)], and with "masked" Ph chromosomes, [t(9;5;22)(q34;q31;q11) and t(9;22)(q22;q34)], by a chromosomal in situ hybridization technique. In some cases, the 3' bcr rearrangements in the DNA were examined with Southern blot analysis. In each case, a significant accumulation of grains hybridized to the 3' bcr probe was observed at chromosomal segments derived from the long arm of a chromosome #22. In some cases, the accumulation of grains was detected on both translocated segments derived from the 22q and terminal portions of Ph chromosomes; Southern blot analysis revealed that breakage in chromosome #22 occurred within DNA sequences of the 3' bcr probe involved in the Ph translocations. In a CML cell line, K562, no accumulation of grains hybridized to the 3' bcr probe was detected, except at 22q11 of the normal chromosomes #22; Southern blot analysis of this cell line revealed that the 3' bcr sequences were missing. Thus, the data presented here suggest a complexity in the formation of "masked" Ph chromosomes.

The bedfast

Many geriatric beds are occupied by bedfast patients. Most were immobile from the time of admission and many were admitted from other hospital departments or residential care. More are discharged home than remain in hospital or are transferred to any other institution. Although a small minority of admissions become long-term bedfast inpatients this group require a disproportionate resource commitment. Reduction in the number of bedfast inpatients is more likely to be effected by changes in unit policy than by improvement in clinical practice.

Nursing the immobile: a preliminary study

Permanent loss of mobility has profound physical and mental consequences for both sufferers and carers, and is a major challenge to the National Health Service. A recent study has shown that 42% of beds in departments of Geriatric Medicine are occupied by people with longstanding immobility. These people are highly dependent on nursing staff for their daily activities and quality of life. The assessment of mobility, as a single parameter of dependency, and the measurement of allocated nursing hours are both rapidly and easily performed on geriatric wards. It is felt that a simple correlation of these two variables might highlight areas where more detailed audit is desirable. This study demonstrates that the more immobile patients on a ward, the less the hours allocated to Registered and Learner grade nurses. Some possible reasons for this are suggested and the effects of this deployment on nursing practice and staff recruitment are discussed. It is felt that provision of appropriate nursing care to the most dependent patients in continuing care areas is essential, and that high levels of trained staff are needed to ensure this.

Doctors' knowledge of the cost of common medications

Fifty doctors completed a questionnaire which assessed their knowledge of the basic National Health Service cost of 15 commonly prescribed medications. Nearly half the estimates exceeded twice the actual cost of the drug. As well as ignorance of absolute prices, the study demonstrated imperfect knowledge of the relative prices of drugs of the same type. Estimates of the costs of commonly prescribed medications were no more accurate than those for rarely prescribed drugs. Self perception of cost consciousness was not related to the accuracy of the responses.

Cytogenetic changes at 11q11, 11q23, and 17q11 in myelodysplastic syndrome

Cytogenetic studies were performed on two patients with myelodysplastic syndromes. One patient was a 68 year old Japanese male in whose bone marrow cells two translocations were established, i.e., t(4;11)(q13;q23) and t(11;17)(q11?;q11), as well as other karyotypic changes (-6,-18,15p+). The other patient was a 74 year old white male whose bone marrow cells showed six marker chromosomes, i.e., der(5),t(5;17)(q12;q11), der(6),t(6;5)(q27;q22), der(8),t(8;11;?)(q11;q11----q23;?), der(11),t(11;?)(q11;?), an isochromosome of the long arm of chromosome #8, and a small G-group sized marker chromosome of unknown origin. Though the translocation patterns in the abnormal cells in these two cases were different, the breakpoints of the marker chromosomes were almost the same, i.e., 11q11, 11q23, and 17q11. Also, changes of chromosome #6 were observed; the first case showed monosomy 6 and the second a 6q+ marker chromosome. In these two cases of myelodysplastic syndromes, common sites of chromosome breakage and reunion of 11q23 and 17q11 were close to recently established sites of human cellular oncogene homologs, c-ets (11q23) and c-erbA (17q21----24). These associations draw attention to a possible relationship between chromosome changes in myelodysplastic syndromes and oncogene (or other gene) activation and/or dysfunction.

Acute response of urinary N-acetyl-beta-D-glucosaminidase to mannitol infusion in the dog

Urinary activity of N-acetyl-beta-D-glucosaminidase (NAG) has been used as an indicator of subtle renal injury in a variety of conditions. Such enzyme activity has been shown to be increased in human and other animals with diabetes mellitus. The mechanism of this increase in urinary NAG activity is not known. To determine if the osmotic diuretic effect of the glycosuria could stimulate urinary NAG activity, mannitol was infused into the left renal artery of six dogs to cause a unilateral osmotic diuresis and compared to the right side. During three control periods of 20 minutes, each urinary NAG excretion (expressed in units as the ratio of NAG activity to urinary creatinine, NAG/Cr) was equal from both left and right kidneys, 5.0 +/- 1.5 vs 6.0 +/- 3.6 units, respectively. During the 11 mannitol infusion periods urine volume and sodium excretion rose significantly from the left kidney, .50 +/- 2 to 1.5 +/- .3 ml/min and 21 + 5 to 99 +/- 16 u Eq/min, respectively. However urinary NAG/Cr did not change, 5.0 +/- 1.5 to 5.1 +/- 1.0 units. In six control dogs not infused with mannitol, urinary NAG/Cr tended to rise with time from control to experimental collection periods, 4.7 +/- 2.0 to 8.1 +/- 3.0 respectively; however these are not significantly different. In all dogs urine volume and sodium excretion tended to rise throughout the course of the study due to hydration with normal saline; thus it is possible that the tendency for urinary NAG activity to rise may have been due to the increase in sodium excretion. However, these studies demonstrate that the osmotic diuresis induced by mannitol produced no significant change in urinary NAG activity. Thus it may be that the hyperglycemia itself, and not the glycosuria, produces the increase in urinary NAG activity seen in the diabetic.

Zinc supplementation attenuates insulin secretory activity in pancreatic islets of the ob/ob mouse

The purpose of this study was to establish whether a relationship may exist between the hyperinsulinemia, the exaggerated insulin secretion, and the resistance to insulin characteristic of the obese-hyperglycemic syndrome and the zinc status of the ob/ob mouse. To this end, mice were given control and zinc-supplemented diets, and the effects of zinc supplementation on insulin secretion in vivo and in vitro as well as on glucose tolerance were studied. These data were compared with those obtained with oxytetracycline treatment, which is known to ameliorate the insulin sensitivity and glucose tolerance of these animals. The levels of zinc were measured in several tissues of lean and obese mice and the results show that zinc supplementation attenuated the exaggerated insulin secretion in vivo and in vitro without improving the tolerance to glucose. Zinc levels were significantly higher in the tissues of the obese than of the lean mice, with the exception of bone and pancreas. The results suggest a maldistribution of zinc in the tissues of the obese mouse.

Significance of brown and/or green amniotic fluid at the time of second trimester genetic amniocentesis

During a two-year period, 83 discolored fluids (77 green, six brown) were obtained during genetic amniocenteses of 1227 patients. When compared with case-matched control subjects, those patients with discolored fluid had no differences in the incidence of spontaneous abortions, abnormal fetal karyotypes, infant abnormalities, occurrence of preterm labor, or requirement for delivery by cesarean section. The only statistically significant difference between control and test patients was that one in 83 versus 32 of 83 reported bleeding before amniocentesis (P less than .001). Both green and brown fluids had spectrophotometric peaks at 400 to 408 nm, similar to that reported for meconium. However, discolored fluid had measurable free hemoglobin, whereas meconium-stained fluid from term gestations did not, suggestive of an in utero hemorrhage. Further, when fetal blood, in concentrations calculated to yield a hemoglobin content similar to those measured in the discolored fluids, was incubated in amniotic fluid the spectrophotometric peak and absorbance units at 400 to 408 nm were similar to those for the discolored fluids. These observations are supportive of the hypothesis that blood breakdown products from an episode of intrauterine bleeding are responsible for the discolored fluid. Discolored amniotic fluid during second trimester, as an isolated finding, does not prognosticate a poor pregnancy outcome.

Hypophosphatemia and hypercalciuria in small premature infants fed human milk: evidence for inadequate dietary phosphorus

Phosphorus and calcium balance was measured prospectively in stable premature infants (less than or equal to 1600 gm) fed human milk or a standard commercial formula. Throughout the study, the P and Ca intakes of the infants fed human milk were two to three times less than those of infants fed formula. Infants fed human milk showed low serum P and normal serum Ca concentrations, complete renal reabsorption of P, and elevated renal Ca excretion. The net effect in infants fed human milk was a 50% reduction in the P and Ca retention, compared with the formula-fed group. Despite the unfavorable P and Ca balance in the group fed human milk, the only evidence of rickets was elevated alkaline phosphatase activity. Nevertheless, based on the biochemical changes in these infants, low serum P values, and excess urinary calcium losses, we conclude that the stable small premature infant fed human milk exclusively is deficient in phosphorus and only slightly more sufficient in calcium.

Prognostic value of the electroencephalogram in neonatal asphyxia

In order to determine whether an EEG early in the course of asphyxia neonatorum is of any more value than the neurological examination in predicting outcome we reviewed case histories of 38 infants with asphyxia neonatorum. The EEG background activity was valuable in predicting outcome. Normal and maturationally delayed EEGs were associated with normal outcomes while low voltage, electrocerebral inactivity and burst suppression EEGs were highly correlated with severe neurological sequelae. Epileptiform activity was not as predictive of outcome as background activity. Although initial normal neurological examinations were associated with normal developmental and neurological outcomes, moderately and severely abnormal infants had more variable courses. A single EEG done early in the course of asphyxia neonatorum is a more sensitive predictor of outcome than the neurological examination.

Plasma renin activity in normal human pregnancy and in pregnancy-associated hypertension, with reference to cryoactivation

1. Because hypertension is the central feature of pre-eclampsia, and because plasma renin activity is known to be elevated in normal pregnancy (with conflicting results published for pre-eclampsia), a prospective study of plasma renin activity was conducted in pregnancy, under conditions of a fixed sodium intake, in 178 initially normotensive volunteer subjects. Thirty of these women developed pregnancy-associated hypertension (pre-eclampsia) in the third trimester.

2. There was a significant elevation of plasma renin activity from the published values for non-pregnant women, throughout gestation in normotensive women. There was no significant difference, at any stage of gestation, between the values for normal women and those who developed pregnancy-associated hypertension.

3. The extent of cryoactivation of renin, produced by usual collection procedures, was investigated in a subgroup of the total population. It was highly significant and quite variable, but was similar in those who developed pregnancy-associated hypertension and in normal pregnant women. The mean increase in plasma renin concentration in maximally cryoactivated samples was 16-fold.

4. Neither measurement of peripheral plasma renin activity nor of cryoactivatable plasma renin concentration is of value in distinguishing between normal pregnant women and those destined for, or with pregnancy-associated, hypertension.

Issues concerning parents after the death of their newborn

Thirty-five families were interviewed by members of the intensive care nursery staff 2-4 months after the death of their newborn. Of the families interviewed, 74% wanted to review the events leading to their child's death and ask questions about information they already knew. Most families who were interested in the autopsy findings used the results to find out "how normal everything else was." Topics frequently discussed by parents involved feelings of guilt and problems that arose after the infant's death (isolation by friends, somatic complaints, marital and sexual problems, memories of prior losses, problems with siblings and disposal of baby's things). One-third of the families were felt to need continuing emotional support due to their inability to assume previously accepted responsibilities. For many families, the physician may be the only individual who can tolerate listening to their distress.

Haemodynamic profile of angiotensin II antagonism in essential hypertensive patients

1. The haemodynamic response to antagonistic (10 microgram min-1 kg-1) and agonistic (40 microgram min-1 kg-1) doses of saralasin was studied in young essential hypertensive patients. Blood pressure behaviour alone was thought to be inadequate to describe the response pattern. 2. Pre-saralasin setting of the renin-angiotensin axis was varied with salt intake (15 and 290 mmol of Na+/day) each for 10 days. This failed to influence blood pressure or plasma volume. 3. Antagonist blockade after low salt lowered blood pressure in three patients with the highest plasma renin values. Cardiac output rose in two of these, but it dropped in all others. 4. Decreases in cardiac output occurred with both doses of saralasin and even with suppression of the renin-angiotensin axis. This response is therefore unlikely to be due to removal of myocardial or venous angiotensin effects. 5. The renin-angiotensin system played a part in maintenance of blood pressure only with severe salt restriction and in a small proportion of cases. 6. No heart rate effect was seen with sarcalasin. 7. Blood pressure and total peripheral resistance responses were dependent on pre-(antagonist/agonist) setting, but heart rate and cardiac output were not influenced by this factor.

Cryoactivation of renin in plasma from pregnant and nonpregnant subjects, and its control

Plasma renin activity increased by a mean of 7% from baseline values when blood from nonpregnant persons was kept at 0 degrees C for 5 h before incubation. Freezing chilled plasma and thawing it before incubation resulted in a mean increase of 11%. The same procedures used on plasma from normal pregnant women produced mean increases in plasma renin activity of 44 and 89%, respectively. If blood from pregnant women was kept at 0 degrees C for 5 h, and the plasma then separated, frozen, and thawed before incubation, the resulting mean increase in plasma renin activity from baseline values was 160%. We conclude that plasma from pregnant women should be handled at room temperature, or, if samples must be stored, they must be rapidly frozen, then thawed as rapidly as possible before incubation and assay if results are to be reproducible.

Do parents utilize physician follow-up after death of their newborn?

Numerous authors have advocated appropriate physician-patient counseling following a perinatal death. We examined, in a prospective manner, how many families utilized physician follow-up when such follow-up was offered. Seventy-six percent of the 108 families who experienced a neonatal death chose to have physician follow-up in the weeks after the death. A family's utilization of subsequent physician contact was not related to the distance they lived from the medical center, the duration of survival of the infant, or the racial background of the mother. Parents utilized follow-up visits whether or not an autopsy was performed or an interpreter was needed. Certain features distinguished the parents who did not utilize the physician follow-up service: parents were less likely to utilize the service if they were not married, the mother was a teenager, the head of the household was unemployed, or there was no phone at home.

Cryoactivation of renin in plasma from pregnant and nonpregnant subjects, and its control

Plasma renin activity increased by a mean of 7% from baseline values when blood from nonpregnant persons was kept at 0 degrees C for 5 h before incubation. Freezing chilled plasma and thawing it before incubation resulted in a mean increase of 11%. The same procedures used on plasma from normal pregnant women produced mean increases in plasma renin activity of 44 and 89%, respectively. If blood from pregnant women was kept at 0 degrees C for 5 h, and the plasma then separated, frozen, and thawed before incubation, the resulting mean increase in plasma renin activity from baseline values was 160%. We conclude that plasma from pregnant women should be handled at room temperature, or, if samples must be stored, they must be rapidly frozen, then thawed as rapidly as possible before incubation and assay if results are to be reproducible.

Symptomatic sick sinus syndrome due to guanethidine. Case report

A patient is described who developed symptomatic sinus bradycardia as low as 20 beats per minute and sinus arrest of up to 4.4 seconds while receiving guanethidine, 75 mg daily. The bradycardia resolved following discontinuation of the drug and reappeared upon challenge with it. Intrinsic disease of the sinoatrial and atrioventricular nodes was evidenced 3 weeks following discontinuation of the guanethidine by a borderline abnormally prolonged sinus node recovery time of 1500 msec and a PR interval of 0.28 seconds. Although sinus bradycardia is a known and not infrequent side effect of guanethidine, such an extreme form as seen in our patient appears to be quite rare, and may be related to the pre-existing disease of the conduction system.