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Hydrothermal oxidation (OVH: “Oxydation par Voie Humide”) is an innovative technology used for waste water treatment, which is presented as an alternative to sewage sludge spreading and incineration. This process generates a fine-grain (D50 = 2 μm) mineral by-product, which is very useful for the ceramics industry due to its high content in argillaceous elements, quartz, phosphate and calcium carbonate. Therefore, this work describes the recycling of this OVH residue in the ceramics industry, and more particularly in the manufacture of calcareous earthenware wall tiles. The residue can be combined with a white calcareous earthenware body up to a level of 7% without significant colorimetric deterioration, and if this is raised to 15%, it is possible to completely replace the crushed chalk, some of the quartz and reduce costly imported tight-burning clays by 6%. The developed body exceeds standardised requirements (modulus of rupture: + 40%; moisture swelling and glaze quality), which means that a 20°C reduction in firing temperature might be envisaged. An industrial pilot test of 1500 kg conducted by the DESVRES site managers with 100 m2 of tiles (format: 15 x 20 cm) confirmed these laboratory results, in particular validating the absence of rheological disturbance of the slip and the harmlessness of the addition on the maturing glaze quality. Furthermore, the nature of the fumes emitted in the test complied with current regulations, and the finished product did not exceed the thresholds defined by European regulations for inert waste classification.La oxidación hidrotérmica (OVH: “Oxydation par Voie Humide” u oxidación por vía húmeda) es una tecnología innovadora usada en la depuración de las aguas residuales, que se presenta como alternativa al esparcimiento y a la incineración de los lodos de aguas negras. Este proceso genera un producto derivado de mineral de grano fino (D50 = 2 μm) que es muy útil para la industria cerámica debido a su elevado contenido en elementos arcillosos, cuarzo, fosfato, y carbonato de calcio. Por tanto, este trabajo proporciona una descripción del proceso de reciclaje de este residuo de OVH en la industria cerámica, y más concretamente en la fabricación de azulejos de pasta calcárea. Se puede combinar el residuo con una pasta de azulejo calcárea hasta un contenido del 7% sin que se produzca un deterioro colorimétrico significativo y, si se aumenta hasta el 15%, es posible sustituir por completo la caliza triturada, algo del cuarzo y, además, reducir el alto coste de las arcillas vitrificadas de importación en un 6%. El soporte desarrollado supera los requisitos de la normativa (modulo de ruptura: + 40%; dilatación por humedad y calidad del esmalte), lo que significa que se podría prever una reducción de 20°C en la temperatura de cocción. Un ensayo piloto a nivel industrial, de 1500 kg, llevado a cabo por los gestores de las instalaciones de DESVRES con 100 m2 de baldosas (formato: 15 x 20 cm) confirmó estos resultados de laboratorio, validando, en particular, la ausencia de una perturbación de la barbotina y la inocuidad del material incorporado en la calidad de maduración del esmalte. Además, la naturaleza de los gases emitidos durante el ensayo cumplió con la normativa vigente, y el producto acabado no sobrepasó los umbrales de tolerancia definidos por la Normativa Europea para la clasificación de los residuos inertes.

Aim Management of patients (pts) presenting syncope diverges markedly from the guidelines of the European Society of Cardiology (ESC). To improve this management, the easiest option seemed to be to educate physicians. The aim of the study was to evaluate the impact of an educational process on the use of unnecessary neurological investigations. Methods and results Charts of pts presenting syncope during two 12-month periods (1999–2000 and 2002–2003) to the emergency department were systematically reviewed. Between the two periods, all physicians in charge of pts with syncope attended educational meetings. During these meetings recommendations of the ESC were presented with a special emphasis on the uselessness of neurological investigations. Conclusion Education of physicians in charge of patients with syncope is inadequate to improve the cost effectiveness of the management of these patients. [ABSTRACT FROM PUBLISHER]

Left ventricular-based pacing is an established method for treatment of congestive heart failure in patients with ventricular dyssynchrony. The transvenous epicardial approach is the method of choice to pace the left ventricle.Aims To evaluate short and long-term stability and pacing and sensing performance of an S-shaped non-steroid unipolar lead. Methods Forty-eight procedures were performed in 43 consecutive patients (mean age: 70±8 years, 32 males) with severe congestive heart failure. The left ventricular lead was placed into a coronary sinus tributary. Pacing and sensing thresholds and pacing impedance were measured at implant, 1 and 6 months. Results The mean procedure time was 90·0±35·5 min. Pacing thresholds at implant, 1 and 6 months were 1·1±0·8 V, 1·9±1·3 V and 1·9±1·5 V respectively. In 7 patients, lead implantation was unsuccessful. One of them had a successful second attempt. Lead revision was performed in 5 patients for loss of capture. Conclusion The S-shaped unipolar lead evaluated in this study provides stable long-term position and pacing thresholds. Recent improvement of this S-shaped lead model will hopefully reduce the rate of implantation failures and acute dislodgements. [ABSTRACT FROM PUBLISHER]

This is a case-report of two patients with superior vena cava syndrome related to pacemaker leads. Both patients were treated successfully using intravenous stenting. [ABSTRACT FROM PUBLISHER]

Aims Syncope is a frequent and potentially dangerous symptom. The epidemiological data are based on series mainly collected 20 years ago in the U.S.A. and do not adequately assist in the management of patients admitted now for this symptom in Europe.Methods and Results To evaluate prospectively the epidemiological aspects and the management of the patients admitted in the emergency department of an adult university hospital for a ‘verified’ syncope, charts of all the patients consecutively admitted between June 1999 and June 2000 were systematically reviewed by a member of the cardiology staff. Those with a loss of consciousness were selected and those with a definite syncope were included in the study group and followed until they were discharged from the hospital. Among the 37475 patients who presented to the emergency department, 454 (1·21%) had a definite syncope. For 296 it was the first episode and 169 (mean age 43±23 years) were discharged straight away; 285 (mean age 66±19 years;P <0·0001) were admitted to internal medicine (n=151), cardiology (n=65), neurology (n=44), endocrinology (n=14) and surgery (n=11) services. In 75·7% of all the patients a diagnosis was reported but it was inadequate to explain a syncopal episode in 56 cases (16·3%). Management differed by department: 36% of the patients had ‘neurological’ investigations mainly in internal medicine and neurology. Except in cardiology very few had ‘cardiological’ investigations particularly tilt test and electrophysiological studies (5%).Conclusion Syncope is a frequent symptom but its cause often remains unknown partly due to inadequate management. Precise and simple guidelines are urgently needed. [ABSTRACT FROM PUBLISHER]

Background: Beneficial effects of left ventricular (LV)-based pacing on acute hemodynamic parameters were reported in several series, but only a few studies examined the long-term effects of this new pacing procedure.Aims: To assess long-term effects of permanent LV-based pacing on LV function and mitral regurgitation (MR) in patients with refractory congestive heart failure (CHF).Methods: A prospective evaluation of LV function and MR was performed in 23 patients with severe but stable CHF and left bundle branch block (mean QRS: 186+/-31 ms) by radionuclide and echocardiographic techniques at baseline and 6 months after implantation of a permanent LV-based (LV alone: 13 patients; biventricular: 10 patients) pacemaker programmed either in a DDD mode (sinus rhythm; n=14) or in a VVIR mode (atrial fibrillation; n=9).Results: Compared to baseline, the 6 months follow-up visit demonstrated a significant increase in radionuclide derived LV ejection fraction from 23.3+/-7 to 26.2+/-7% (P<0.01) and in echocardiographic LV fractional shortening from 13+/-4 to 16+/-6% (P<0.05), without any change in cardiac index, a significant decrease in LV end-diastolic diameter (from 73.2+/-6 to 71.2+/-7 mm; P<0.05), end-systolic diameter (from 63.6+/-6 to 60.2+/-8 mm; P<0.05) and color Doppler MR jet area (from 11.5+/-6 to 6.6+/-4 cm(1); P<0.001). A comparison of patients with LV pacing alone and patients with biventricular pacing showed similar beneficial effects of pacing on MR severity in the two subgroups and a non-significant trend for a better improvement of LV function during biventricular pacing.Conclusion: Thus, in patients with severe CHF and left bundle branch block, permanent LV-based pacing may significantly improve LV systolic function and decrease MR. [ABSTRACT FROM AUTHOR]

Aims Assessment of complications following implantation of transvenous ventricular electrodes to pace the left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and left bundle branch block were prospectively followed for adverse effects of implantation of a left ventricular transvenous pacing system. Immediate followup was associated with loss of left ventricular pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher pacing amplitude in all five cases, but with intermittent diaphragmatic contraction in one case). After 1 month, one patient died, one patient with severe coronary heart disease suffered a myocardial infarction, and left ventricular pacing was lost in two patients. Pericardial effusion, new significant ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16±9·2 months, pacing leads remained stable and no late complications related to the transvenous left ventricular epicardial pacing were observed. Conclusion Placement of a permanent lead in a tributary of the coronary sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application. [ABSTRACT FROM PUBLISHER]

Background: Acute left ventricular-based pacing has been shown to improve hemodynamics in patients with severe heart failure and left bundle branch block (LBBB). However, it is not known whether the cause of the underlying heart disease influences the potential effect of left ventricular-based pacing.Objectives: The aim of this study was to determine whether beneficial hemodynamic effects of acute left ventricular-based pacing in severe chronic heart failure are dependent on underlying heart disease.Methods: After coronary angiography, patients with severe heart failure and LBBB were separated into two groups: dilated (25 patients; 20 male) and ischemic cardiomyopathy (21 patients; 20 male). Hemodynamic parameters were evaluated at baseline and during left ventricular-based pacing.Results: Improvement in hemodynamic parameters were similar in both groups, during acute left ventricular pacing (changes expressed in percentage): pulmonary capillary wedge pressure, -16+/-15% vs. -14+/-10%; V wave amplitude, -25+/-18% vs. -21+/-17%; and biventricular pacing, -15+/-15% vs. -11+/-11% and -23+/-18% vs. -16+/-18%, respectively.Conclusion: Underlying heart disease does not influence the response to acute left ventricular-based pacing in patients with severe heart failure and LBBB. This finding provides support for including all patients with enlarged heart and heart failure in future studies evaluating left ventricular-based pacing. [ABSTRACT FROM AUTHOR]

Background: Left ventricular (LV) pacing has been suggested to complement other forms of therapy in patients with heart failure.Methods and Results: We investigated 17 patients (15 men, 2 women, aged 68 +/- 6 years, 10 ischemic and 7 primary dilated cardiomyopathy) with heart failure (13 were in New York Heart Association class IV and 4 in class III). One month after LV pacer implantation, 12 patients reported clinical improvement (mean class 3.7 before pacing vs 2.6 with LV pacing; P = .001). We report the results of 3 equilibrium-gated blood pool studies performed in each patient, 1 before pacing and 2 after pacer implantation (1 with pacing on, and 1 after turning off the pacer). LV pacing did not modify LV ejection fraction. Phase analysis demonstrated a significant decrease of the interventricular phase shift (delta(pi)) with LV pacing (no pacing, delta(pi) = 8.99 degrees +/- 19.05 degrees; delta7n= -0.97 degrees +/- 27.85 degrees with LV pacing). Clinical improvement was observed in patients with an initial positive delta(pi) that decreased with pacing and/or an initial LV phase standard deviation >50 degrees that decreased with pacing.Conclusion: LV pacing induces interventricular and intraventricular synchronization. A decrease of the interventricular phase shift seems to be the most important predictor of functional recovery for paced patients with heart failure. [ABSTRACT FROM AUTHOR]

The article presents a study on the reduction of repeated syncope as a result of training in physical counterpressure manoeuvres (PCM) in patients with vasovagal syncope. The study engaged 223 patients with recurrent vasovagal syncope who were given conventional therapy or plus training in PCM such as leg crossing, abdominal and buttock muscles or handgrip. The study reveals that conventional therapy plus PCM lessened the syncope burden than conventional therapy alone.

In patients with recent-onset atrial fibrillation (AF), restoration of sinus rhythm is considered to be the first-line therapeutic option. Although this conversion might be obtained by direct-current shock or intravenous antiarrhythmic drugs, administration of an oral loading dose of class I or III antiarrhythmic drugs is more simple and convenient. This prospective, randomized, multicenter study compares the time to conversion to sinus rhythm obtained with an oral loading dose of propafenone or amiodarone. Patients with recent-onset AF (<2 weeks), without contraindications for the 2 drugs, were randomly assigned to be treated with propafenone (600 mg for the first 24 hours and if necessary a repeated dose of 300 mg for 24 hours) or amiodarone (30 mg/kg for the first 24 hours and if necessary a repeated dose of 15 mg/kg for 24 hours). Exact conversion time during the first 24 hours was determined by Holter monitoring. In each treatment group 43 patients with the same baseline characteristics were included. The median time for restoration of sinus rhythm was shorter (p = 0.05) in the propafenone (2.4 hours) than in the amiodarone (6.9 hours) group. After 24 hours (56% in the propofenone and 47% in the amiodarone group) and 48 hours, the same proportion of patients in the 2 groups recovered sinus rhythm (no serious adverse events were noticed). Thus, oral loading dose of propafenone or amiodarone was safe with a similar conversion rate of recent-onset AF. Propafenone had a faster action. [ABSTRACT FROM AUTHOR]

Acute hemodynamic data of left ventricular based pacing were assessed in 2 groups of patients with severe cardiac failure: 11 patients with atrial fibrillation and 17 patients with sinus rhythm. Both biventricular and left ventricular pacing significantly improved acute hemodynamic findings to a similar degree in both groups, suggesting that left ventricular based pacing may be beneficial in patients with severe cardiac failure regardless of whether or not they are in sinus rhythm. [ABSTRACT FROM AUTHOR]

This study evaluates the efficacy and safety of internal right atrial cardioversion of atrial fibrillation using a defibrillation right atrial catheter and 2 thoracic patches with low-energy biphasic shocks. [ABSTRACT FROM AUTHOR]