Increased luminol enhanced chemi-luminescence from peripheral granulocytes in juvenile periodontitis

Abstract – The granulocyte function in patients with juvenile periodontitis (JP) (eight men and six women, aged 13–33 yr) and sex and age matched controls was determined by the luminol enhanced chemiluminescence (CL) induced by opsonized and unopsonized bacteria or latex beads. Maximal CL induced by latex beads with or without autologus serum did not differ between the two groups. However, bacteria with or without autologous serum seemed to induce a higher maximal CL in the JP group. The difference was statistically significant for the results obtained with opsonized bacteria. Serum opsonized bacteria induced a much higher maximal CL than the unopsonized. The opsonin dependent reaction indicates a close association with the process of phagocytosis. The increased CL of granulocytes in JP could indicate the formation of extracellularly free oxygen radicals with the potential to damage tissue. These observations support a possible involvement of the granulocytes in the pathogenesis of JP.     

Substrate Characterization and Catheter Ablation for Monomorphic Ventricular Tachycardia in Patients With Apical Hypertrophic Cardiomyopathy

VT Ablation in Apical Hypertrophic Cardiomyopathy . Introduction: Monomorphic ventricular tachycardia (VT) is uncommon in apical hypertrophic cardiomyopathy (HCM). The purpose of this study was to define the substrate and role of catheter ablation for VT in apical HCM. Methods: Four patients with apical HCM and frequent, drug refractory VT (mean age of 46 ± 10 years, left ventricular [LV] ejection fraction; 54 ± 14%) underwent catheter ablation with the use of electroanatomic mapping. Endocardial mapping was performed in 4 patients and 3 patients underwent epicardial mapping. Results: In 3 patients, VT was related to areas of scar in the apical LV where maximal apical wall thickness ranged from 14.5 to 17.8 mm, and 2 patients had apical aneurysms. Endocardial and epicardial substrate mapping revealed low voltage (<1.5 mV) scar in both endocardial and epicardial LV in 2 and only in the epicardium in 1 patient. Inducible VT was abolished with a combination of endocardial and epicardial ablation in 2 patients, but was ineffective in the third patient who had intramural reentry that required transcoronary ethanol ablation of an obtuse marginal vessel for abolition. The fourth patient had focal nonsustained repetitive VT from right ventricular outflow tract (RVOT), consistent with idiopathic RVOT‐VT, that was successfully ablated. During follow‐ups of 3‐9 months, all patients remained free from VT. Conclusion: Monomorphic VT in apical HCM can be due to endocardial, epicardial or intramural reentry in areas of apical scar. Epicardial ablation or transcoronary alcohol ablation is required in some cases. (J Cardiovasc Electrophysiol, Vol. 22, pp. 41‐48, January 2011)     

High‐Density Mapping of the Sinus Node in Humans: Role of Preferential Pathways and the Effect of Remodeling

Sinus Node Mapping . Introduction: The area of the functional sinus node complex exceeds that of the anatomical sinus node; however, reasons for this discrepancy are unknown. We aimed to characterize the functional sinus node complex in health and disease with high‐density simultaneous mapping. Methods and Results: Sinus node activity was characterized in 15 reference patients after ablation for supraventricular tachycardia. A further 16 patients were studied following ablation of chronic atrial flutter to determine effects of atrial remodeling. High‐density simultaneous mapping of the sinus node complex was performed using a multi‐electrode array. In reference patients, distance from superior vena cava‐right atrial (SVC‐RA) junction to earliest activation (EA) was 4 ± 4 mm and sinus break‐out (SBO) 9 ± 6 mm. Preferential pathways of conduction were observed between EA and SBO. For patients with flutter, these distances were greater (EA: 15 ± 12 mm, P = 0.003; SBO: 23 ± 11 mm, P < 0.001). Conduction time along preferential pathways was 15 ± 5 ms for reference patients and 23 ± 8 ms for patients with flutter (P = 0.005). Following pacing, distance from SVC–RA junction to EA and SBO lengthened to 13 ± 8 mm (P = 0.006) and 16 ± 10 mm (P = 0.02), respectively, in reference patients, and 19 ± 12 mm (P = 0.045), 28 ± 9 mm (P = 0.02) in patients with flutter. This resulted in caudal shifts in EA and SBO of 10 ± 9 mm and 7 ± 8 mm in reference patients but diminished shifts in patients with flutter; 4 ± 7 mm and 4 ± 6 mm. Conclusion: The functional sinus node complex demonstrates dynamic changes in activation. There are preferential pathways of conduction from sinus node to atrial myocardium. The remodeled atria demonstrate longer conduction times along preferential pathways and a restricted functional sinus node complex. (J Cardiovasc Electrophysiol, Vol. 21, pp. 532‐539, May 2010)     

Leukemia in Fanconi's Anemia: Cytogenetic and Tumor Virus Susceptibility Studies

Fanconi’s anemia is an inherited disordercharacterized by multiple congenital abnormalities, chromosome anomalies andirreversible aplastic anemia. Patients,and possibly family members, have beennoted to have an increased incidenceof leukemia and other tumors. A familywith two affected male children, one ofwhom developed acute myelomonocyticleukemia, is described. Chromosomepreparations in both parents showed abnormalities, a previously unreportedfinding. Fibroblast cultures from bothparents and one brother inoculated withSimian Virus 40, a known oncogenicagent, developed increased numbers oftransformed colonies, compared withnormal control cultures similarly inoculated. The presence of chromosome abnormalities and cellular susceptibility tooncogenic agents appear to be relatedto an increased risk of malignancy.

Submitted on October 27, 1969 Revised on February 3, 1970 Accepted on March 24, 1970     

Epidemiological and Diagnostic Features of Blastocystis Infection in Symptomatic Patients in Izmir Province,Turkey

Background

The aims of this study were to identify Blastocystis subtypes (STs) in a cohort of Turkish patients with various gastrointestinal symptoms using a novel Real Time PCR method developed recently for Blastocystis detection and assess the relationship between Blastocystis STs and patient symptoms.

Methods

Totally, 617 stool samples of patients with gastrointestinal symptoms were examined with microscopy and inoculated in Jones medium. Blastocystis-positive samples were further assessed to identify coinfections with other possible pathogens, including bacteria and viruses. Diagnostic efficacies of microscopy, culture and Real-Time PCR were compared. PCR products were sequenced to identify the subtypes of Blastocystis isolates.

Results

Totally 94 (15.24%) samples were positive for Blastocystis after all methods. Among these, 83 of 94 (88.3%) samples were identified with all methods, while 11 were positive only with Real Time PCR. Diarrhea and abdominal pain were the leading symptoms in the patients. The only pathogenic agent identified in 76 of 94 (80.9%) patients was Blastocystis. Subtype 3 was the leading Blastocystis subtype (44.6%), while subtypes 6 and 7 were firstly isolated from symptomatic patients in our region.

Conclusion

Comparison of three diagnostic methods indicated Real Time PCR as the most sensitive and specific method. Blastocystis was the only pathogenic agent among symptomatic patients, with subtype 3 being predominant. Patients with subtypes 6 and 7 need further assessments concerning the zoonotic potential of Blastocystis.     

Acucise endopyelotomy: A technique with limited efficacy for primary ureteropelvic junction obstruction in adults

AIM: To retrospectively evaluate the ef fi cacy of Acucise endopyelotomy in a series of patients with primary ureteropelvic junction obstruction (UPJO). METHODS: Twenty-four patients with a symptomatic primary UPJO underwent Acucise endopyelotomy. Patients with high-grade hydronephrosis and/or poor renal function were excluded. Patients were followed by ultrasound imaging, intravenous urography, diuretic renography, and clinical review. RESULTS: The overall success rate was 58% (14/24 patients), with a median follow up of 32 months. Of the ten patients in whom Acucise endopyelotomy failed, seven underwent open pyeloplasty, one required nephrectomy, and two received a permanent ureteral stent. A poor outcome was noted in patients without perioperative extravasation. CONCLUSIONS: Our experience with Acucise endopyelotomy indicates that the success rate is lower than initially reported. Larger studies are needed to clarify the role of Acucise endopyelotomy in comparison with other techniques.     

Variability of Ventricular Premature Complexes and Mortality Risk

A method using a parameter from the field of nonlinear dynamics to quantify the variability of ventricular premature complexes (VPCs) is presented. One hundred patients with coronary artery disease and ≥ 10 VPCs/hour were included in the studv. The RR intervals were plotted in a three-dimensional artificial phase space, and the structures in phase space were quantified by the local scaling indices, a. In the frequency distribution histogram, n(α), for each patient, the maximum of the ventricular ectopies αvpc, adjusted to the VPC frequency, was assessed; αvpc, was used as the risk indicator. Endpoints were total mortality and sudden cardiac death. During follow-up (mean 3.1 years), 28 out of 100 patients died, 16 suddenly; αvpc had a significant prognostic impact end was independent from other risk indicators, such as left ventricular ejection fraction (LVEF). Patients who died during follow-up were characterized by a high αvpc. The optimal discrimination of high risk patients and low risk patients occurred at αvpc — 3.0. After 4 years, the survival rate of patients with a αvpc > 3.0 was 59%, in contrast to 97% in patients with αvpc ≤ 0.3. As to the sudden death mortality, the survival rates were 74% and 97%, respectively. The difference between the groups were significant for both endpoints. Patients with an increased VPC variability (i.e., αvpc > 3.0) were at enhanced risk of sudden death and total mortality risk; αvpc was independent from other risk indicators such as the LVEF or heart rate variability parameters.     

Impedance Rise, Only Clue to Severe Insulation Damage in a Transvenous Single-Lead AICD-System

We report a case of severe insulation damage 10 months after implantation of a fourth-generation single-lead implantable cardioverter defibrillator in a 45-year-old patient with dilative cardiomyopathy. The measured impedance was > 2000 Ohm and decreased to < 100 Ohm after sligbt pressure was applied to the device. All other parameters including intracardiac ECGs and markers were normal. Despite this delicate finding operative exploration revealed severe insulation damage of the pace-sense arm of the plug and insulation loss proximal to the distal coil of the lead.