Granulocyte Elastase in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Granulocyte elastase (GE) is a powerfulproteolytic enzyme that is released by PMNs whendegranulated in infectious processes. The aim of thisstudy was to measure GE in ascites and plasma ofcirrhotic patients with spontaneous bacterial peritonitis(SBP). We studied 29 cirrhotic patients, 17 of themhaving SBP (group A). Twelve patients with noninfectedascites formed the control group (group B). At the time of diagnosis of SBP, GE levels inascites (183.17 ± 86.11 g/liter) and plasma(114.6 ± 35.99 g/liter) were higher in groupA than in group B (27.41 ± 11.54 g/liter, P< 0.00001 and 82.54 ± 20.52 g/liter, P = 0.01,respectively). Levels of GE in ascites had a high valuefor discriminating between patients with and withoutSBP. In the patients who responded to the initialantibiotic treatment, these values significantly decreasedin ascites (67.69 ± 54.22 g/liter, P = 0.003)and plasma (67 ± 22.39 g/liter, P = 0.01) 48hr after therapy was started, in parallel with thedecrease of PMN in ascites. In patients who did notrespond, the production of GE remained elevated.Patients who developed renal insufficiency following SBPhad more marked elevation of GE in plasma (144.8± 33.43 g/liter) than those with normal renalfunction (99.5 ± 27.53 g/liter, P = 0.02).These results suggest that the measurement of GE may behelpful for the diagnosis of SBP in patients withcirrhosis and for assessing the efficacy of therapy. Inaddition, the release of GE into plasma may contributeto the impairment of renal function that follows SBP insome patients.     

A Three-dimensional Analysis of Blood Vessels in Bronchioloalveolar Carcinoma

The three-dimensional architecture of blood vessels within lung adenocarcinomas has not been well studied. In 19 cases with bronchioloalveolar carcinoma with central fibrosis, we three-dimensionally examined blood vessel architecture in 150 m thick sections stained with elastin staining and anti-CD34 antibody. We examined four regions: normal alveoli and three regions within the tumor including an area adjacent to the normal alveoli (external area), an area in which tumor cells were replacing epithelial cells (replacement area), and a central fibrotic area (fibrotic area). Elastin staining showed that elastic fibers formed the framework of the alveoli, and the alveolar structure shrank more strongly to the center of the tumor due to folding of alveolar walls invaded by adenocarcinoma cells. We also measured three vessel parameters in these four regions. The vessel diameters were 4.08±1.10 m, 3.95±1.02 m, 5.04±1.56 m, and 6.11±2.23 m, the circumferences of those vessels seen as complete circles were 43.11±12.78 m, 43.71±12.87 m, 95.21±39.32 m, and 126.77±54.65 m; the lengths between vessel bifurcations were 13.28±3.08 m, 13.47±4.58 m, 24.91±9.66 m, and 41.82±28.08 m in the normal alveoli, and the external, replacement, and fibrotic areas, respectively. Blood vessel architecture changed such that the vessels became larger and coarser towards the center of the tumor. Our three-dimensional analysis suggests continuous remodeling of alveolar capillaries rather than angiogenesis within bronchioloalveolar carcinoma.     

Bildgebung der Atemwege

Zusammenfassung Die Erkrankungen der Atemwege umfassen das gesamte sog. Leitungssystem, das vom Alveolarraum als sog. Austauschsystem unterschieden wird. Das Leitungssystem gliedert sich in die verschiedenen Abschnitte der oberen Atemwege inklusive Nasenhöhle, Pharynx und Larynx, die Trachea mit den zentralen Bronchien und den Bronchialbaum bis hin zu den Bronchiolen. Als Krankheitsursachen kommen extra- und intraluminale Prozesse in Frage, die kongenital, inflammatorisch, traumatisch, neoplastisch oder idiopathisch bedingt sein können. Je nach Lokalisation der Atemwegserkrankungen beeinflussen sie den Luftstrom bei In- und Exspiration. Der Befall der gesamten Strecke des Leitungssystems bis hin zu den small airways ist möglich. Daher sind auch die Veränderungen bei Asthma, Bronchiolitis, chronisch-obstruktiven und interstitiellen Lungenerkrankungen zu beachten. Die bildgebende Diagnostik umfasst Sonographie, Thoraxaufnahmen (Th) in 2 Ebenen, hoch auflösende (high resolution) Computertomographie (HRCT) mit Mehrzeilentechnik, im weiteren Sinne auch PET und MRT. Die Th in 2 Ebenen ist nach wie vor wegen ihrer ubiquitären Verfügbarkeit die bildgebende Basisuntersuchung, für eine exakte nichtinvasive Untersuchung des Thorax ist die HRCT heutzutage aber unerlässlich.     

Pyruvate carboxylase deficiencies: Complementation studies between “French” and “American” phenotypes in cultured fibroblasts

Pyruvate carboxylase (PC) deficiencies (McKusick 26615) are heterogeneous clinically and biochemically. We performed a complementation study with fibroblast strains from seven patients, (four patients with French phenotype, two patients with American phenotype, one patient with biotin responsive multiple carboxylase deficiency, MCD). The six isolated pyruvate carboxylase mutants (two cross-reacting material CRM –ve and four CRM +ve) failed to complement each other, but did complement a form of biotin responsive MCD.     

Homeless Youth: Drug Use Patterns and HIV Risk Profiles According to Peer Group Affiliation

Research was conducted to identify subcultural peer groups within a homeless youth population and determine whether these groups differ with respect to drug use patterns and HIV risk. Using systematic sampling methods, 309 homeless youth (ages 13–23 years) were recruited from street and service sites. Drug use patterns and HIV risk profiles were found to vary according to group affiliation. Respondents in the punks and gay/bisexual groups were more likely to have a substance abuse disorder. Respondents in the punker group also were at increased risk for having unprotected sex and sharing needles. Respondents in the gay/bisexual and hustler groups were at increased risk for having survival sex. Yet, unlike the gay/bisexual group, the hustler group was more likely to report being tested for HIV. These findings suggest that outreach and intervention strategies may need to be tailored to the specific norms, values, and behavioral risk profiles of each peer group.     

Plasma acidic glycohydrolases in insulin-dependent diabetes mellitus

Summary We assayed plasma activities of -galactosidase, -hexosaminidase, -mannosidase, -fucosidase and -galactosidase involved in degradation of the glycoprotein molecule in 110 insulin-dependent diabetics aged 3-1/2 to 19 years and compared them to a group of normal youngsters. We correlated the plasma enzyme activities with the duration, control and sequelae of insulin-dependent diabetes. Insulin-dependent diabetics had a significantly higher plasma activity of -hexosaminidase and -mannosidase (p<0.01) and a significantly lower plasma activity of -fucosidase and -galactosidase (p<0.01). Of the 5 enzymes studied, only plasma -hexosaminidase correlated with fasting and postprandial blood sugar (p<0.01), cholesterol and triglycerides (p<0.05). Additionally, poor control of diabetes was also associated with a significantly higher plasma -hexosaminidase activity (p<0.01). Proteinuria or an abnormal Addis count suggestive of renal involvement was associated with various changes in plasma acidic hydrolases. These changes may be related to insulin deficiency rather than hyperglycemia and may be genetically determined.Deceased on August 2, 1981.     

γ/δ Receptor-expressing T-cell clones from a cutaneous T-cell lymphoma suppress hematopoiesis

Summary Recently we described a cutaneous T-cell lymphoma expressing the / T-cell receptor [5]. The patient suffering from this lymphoma showed low numbers of myeloid and T cells in peripheral blood, while B and NK cells were relatively increased. In vitro culture of the patient's bone marrow (BM) cells revealed a significant suppression of myeloid/monocyte colony formation (GM-CFU) compared with normal controls. This was not due to infiltration of the BM with lymphoma cells. We speculated that a soluble factor either secreted or induced by the lymphoma cells might be responsible for the marked suppression of hematopoiesis in this patient. From a skin biopsy with infiltrating / T-lymphoma cells we established T-cell clones bearing the / T-cell receptor and resembling the phenotype of the lymphoma cells. The supernatant (SN) of these / T-cell clones reduced the number of colonies in a CFU-GM assay (using normal control BM) in comparison to SN of / T-cell clones established from the same biopsy. This suppression was seen mainly on day 7 of culture and was not neutralized by the addition of placenta-CM. The main mediator of this suppression seems to be IFN-,since it was detectable in high amounts in the SN of these / T-cell tumor clones as well as in the serum of the patient. In addition, anti-IFN- antibodies can reverse the T-cell SN-mediated suppression of CFU-GM. We conclude that high serum levels of interferon-, which is secreted in high amounts from / T-cells grown from a biopsy of a cutaneous lymphoma, can suppress hematopoiesis.Abbreviations TCR T-cell receptor - IFN- interferon- - SN supernatant - placenta CM placenta conditioned medium - BM bone marrow - CFU-GM myeloid/monocyte colony formation - NK cells natural killer cells - Ab antibody M. Wilhelm was supported by theDeutsche Forschungsgemeinschaft (DFG Wi 728-2)     

Zur Epidemiologie und Ätiologie des Oesophaguscarcinoms in China

Ohne Zusammenfassung

---

The epidemiology and etiology of esophageal cancer in China

---

Stipendiaten der Alexander von Humboldt-Stiftung aus der Volksrepublik China

---

The Journal of Cancer Research and Clinical Oncology publishes in loose succession Editorials and Guest Editorials on actual and/or controversial problems in experimental and clinical oncology. These contributions represent exclusively the personal opinion of the author.Die Zeitschrift Journal of Cancer Research and Clinical Oncology bringt in zwangsloser Folge Editorials zu aktuellen und/oder kontroversen Problemen der experimentellen und klinischen Onkologie. Diese Beiträge geben ausschließlich die persönliche Meinung des Autors wieder.     

Heat shock protein induction in rat pancreatic islets by recombinant human interleukin 1β

Summary Interleukin 1, potentiated by tumour necrosis factor , is cytotoxic to pancreatic Beta cells in vitro. We have hypothesized that interleukin 1 induces oxygen free radicals in Beta cells. Since cytotoxicity induced by free radicals and by heat may activate the same cellular repair mechanism (the heat shock response), the aim of this study was to investigate the pattern of protein synthesis in isolated islets after exposure to interleukin 1 (150 pg/ml, 24 h), tumour necrosis factor (50 ng/ml, 24 h), heat shock (43°C, 30 min) and H₂O₂ (0.1 mmol/l, 20 min). By polyacrylamide gel electrophoresis, autoradiography, Western-blot analysis and partial peptide mapping of ³⁵S-methionine labelled islets, interleukin 1 was found to induce a 73 kilodalton protein belonging to the heat shock protein family heat shock protein 70, a heat shock protein 90, and haem oxygenase. A minor induction of heat shock protein 73 and haem oxygenase was seen after H₂O₂. Interleukin 1 did not induce heat shock proteins in rat thyroid cells, rat mesangial cells or in human monocytes. Tumour necrosis factor did not induce selective protein synthesis. Pre-exposure of islets to heat, tumour necrosis factor , or H₂O₂ did not prevent the impairment of glucose-stimulated insulin release seen after 24 h of interleukin 1 exposure. The data are compatible with free radical induction by interleukin 1. However, the heat shock response is not specific for oxidative injury, and previous studies have shown discrepant effects as to a protective effect of free radical scavengers against interleukin 1-mediated beta-cytotoxicity. Thus, a role for free radicals in this context is not definitely proven.     

Efficacy of mizoribine treatment in patients with SjÖgren’s syndrome: an open pilot trial

The aim of this study was to evaluate the efficacy and safety of mizoribine in patients with SjÖgrens syndrome. Forty patients with sicca syndrome, whose conditions were definitely diagnosed as SjÖgrens syndrome, were given mizoribine orally at a dosage of 150mg/day for 12 months. The percentage change in salivary secretion after 3, 6, and 12 months of the therapy increased to +112.2% (P 0.001), +119.9% (P 0.01), and +147.3% (P 0.001), respectively, compared with the baseline. Serum IgG levels decreased significantly throughout the study, and the level was 1969.4 ± 620.0mg/dl after treatment for 12 months compared with the pretreatment value of 2094.3 ± 746.6mg/dl (P 0.05). The patients assessment of clinical signs and symptoms on a 10-cm visual analog scale improved significantly from 7.2 ± 2.3cm at the start of the treatment to 5.0 ± 1.9cm after 12 months (P 0.001). There was a similar improvement in the physicians assessment using the 10-cm visual analog scale: 7.1 ± 1.6cm at the start of the treatment and 5.2 ± 1.9cm after 12 months (P 0.001). With regard to safety, no serious adverse reactions were observed. Although a controlled study would be required to clarify the efficacy of mizoribine, these preliminary observations indicate its efficacy for ameliorating glandular symptoms through improvements in immune abnormalities in patients with SjÖgrens syndrome.     

Multiple venous and arterial thromboses associated with the lupus anticoagulant and antibodies to cardiolipin in the absence of SLE

Summary A 53-year-old man with a history of multiple venous thromboses presented with widespread occlusions of the abdominal arterial system associated with the presence of the lupus anticoagulant and antibodies to cardiolipin in serum. There was no serological evidence of systemic lupus erythematosus and vasculitis of the affected vessels was not evident on post mortem examination. The presence of these antibodies, associated with a tendency to thrombosis, positive anti nuclear factor and cryoglobulinaemia were the only indicators of an auto-immune disturbance in this patient.     

The inborn errors of peroxisomal β-oxidation: A review

Summary In recent years a growing number of inherited diseases in man have been recognized in which there is an impairment in peroxisomal -oxidation. In some diseases this is due to the (virtual) absence of peroxisomes leading to a generalized loss of peroxisomal functions including peroxisomal -oxidation. In most inborn errors of peroxisomal -oxidation, however, peroxisomes are normally present and the impairment in peroxisomal -oxidation is due to the single or multiple loss of peroxisomal -oxidation enzyme activities. In all these disorders there is accumulation of very-long-chain fatty acids in plasma, which allows biochemical diagnosis of patients affected by an inborn error of peroxisomal -oxidation to be done via gas-chromatographic analysis of plasma very-long-chain fatty acids. Subsequent enzymic and immunological investigations are required to identify the precise enzymic defects in these patients. In all inborn errors of peroxisomal -oxidation known today there are multiple abnormalities, especially neurological with death usually occurring in the first decade of life. Prenatal diagnosis of these disorders has recently become possible.     

Vigorous achalasia with high-amplitude esophageal body contractions: a case report

A 25-year-old woman presented with dysphagia and chest pain in November 1999. Esophagography revealed esophageal stasis with spindle-shaped tapering at the cardia without dilatation of the lower esophagus. Manometry showed a hypertonic sphincter with incomplete relaxation on swallowing. Esophageal body contractions were simultaneous with an amplitude in excess of 200mmHg with tertiary contractions. These findings were not compatible with classic achalasia, but with vigorous achalasia. The patient underwent pneumatic dilatation with immediate relief of her symptoms. However, improvement in dysphagia and chest pain was temporary, necessitating four sessions of dilatation over three and a half years. The literature on this rare esophageal motility disorder is reviewed.     

Compound heterozygosity for a β∘-thalassemia (frameshift codons 38/39; -C) and a nondeletional swiss type of HPFH (A→C at NT -110, Gγ) in a Czechoslovakian family

Summary We have analyzed the levels and composition of the fetal hemoglobin (Hb F) in several members of a Czechoslovakian family with a heterozygosity for a newly discovered -thalassemia (codons 38/39; -C), or for a newly detected nondeletional hereditary persistence of fetal hemoglobin (a form of Swiss-HPFH with an AC mutation at nucleotide –100 5 to the Cap site of G), or with a compound heterozygosity for these two conditions. The Hb F level in the -thalassemia heterozygotes averaged 0.3% with low G values ( 28%) and relatively high AT values ( 50%), that in the two Swiss-HPFH heterozygotes averaged 0.8% with 95% G, while that of the compound heterozygote was 3.1% with 95% G. The low Hb F levels were determined with a recently published cation exchange high-performance liquid chromatography (HPLC) procedure that is accurate at the 0.1%–0.2% Hb F level [3]. This method, together with a reversed-phase HPLC procedure, made it possible to detect this unusual type of nondeletional G-HPFH and provided the data indicating that the increased Hb F in the compound heterozygote was derived mainly from the chromosome with the HPFH determinant.This study was supported in part by USPHS Research Grant HLB-41544     

Inactivation of HIV in plasma derivatives by β-propiolactone and UV irradiation

Summary The inactivation of HIV in human plasma and plasma derivatives by combined treatment with -propiolactone and UV-irradiation was investigated. -propiolactone inactivated 3.5 log₁₀ and UV 2.8 log₁₀ HIV in plasma and -propiolactone 3.5 log₁₀ in cryoprecipitate and UV irradiation 4.5 log₁₀ in factor VIII concentrate.

---

Inaktivierung von HIV in Plasmaderivaten durch -Propiolacton in Kombination mit UV-Bestrahlung

Zusammenfassung Untersucht wurde die Inaktivierung von HIV in humanem Plasma und Plasmaderivaten durch die kombinierte Behandlung mit -Propiolacton und UV-Bestrahlung. HIV wurde durch -Propiolacton um 3,5 log₁₀ und UV um 2,8 log₁₀ in Plasma und durch -Propiolacton um 3,5 log₁₀ in Kryopräzipitat bzw. durch UV um 4,5 log₁₀ in Faktor VIII-Konzentrat inaktiviert.

     

Down-regulated β-adrenoceptors in severely failing human ventricles: Uniform regional distribution,but no increased internalization

Summary In chronic heart failure cardiac -adrenoceptors are decreased. In this study we investigated whether a) in severely failing human ventricles -adrenoceptors are uniformly decreased or regional variations exist, and b) the -adrenoceptor decrease is caused by increased internalization or is a real loss in -adrenoceptors. For this purpose we assessed -adrenoceptor number and subtype distribution in a particulate fraction (mainly sarcolemmal plasma membranes) and a light vesicle fraction of right and left ventricular segments (obtained by cutting transversal, rings of 2 cm from the midventricular regions) of explanted hearts from 2 patients with end-stage congestive dilated cardiomyopathy (DCM) and one patient with end-stage ischemic cardiomyopathy (ICM). In all three hearts ventricular -adrenoceptor number was very low (7.5–10 and 21–26 fmol/mg protein in DCM, 15–22 fmol/mg protein in ICM compared to 68–74 fmol/mg protein in non-failing ventricles). -Adrenoceptors were uniformly decreased over the whole ventricular region and no considerable regional variations existed. The same held true for ₁- and ₂-adrenoceptors. In ICM decrease in -adrenoceptors was due to a concomitant reduction in ₁- and ₂-adrenoceptors, in DCM it was mainly caused by ₁-adrenoceptor down-regulation. In all ventricular segments investigated light vesicle -adrenoceptors amounted to about 5–7% of total ventricular -adrenoceptors and this was not significantly different from non-failing left ventricles. We conclude that a) in severely failing human ventricles -adrenoceptors are evenly down-regulated and no regional variations exist and b) the decrease in -adrenoceptors is not due to enhanced internalization but is a real loss of -adrenoceptors.Abbreviations DCM dillted cardiomyopathy - ICM ischemic cardiomyopathy - ICI 118,551 erythro-(±)-1-(7-methylindan-4-yloxy)-3-isopropylaminobutan-2-ol hydrochloride - CGP 12177 (±)-4-(3-tertiarybutylamino-2-hydroxypropoxy)-benzimidazole-2-on hydrochloride - ICYP (–) [¹²⁵I]-Iodocyanopindolol     

Die Bildungsarten,Entwicklungsstadien und Wachstumsstufen des Carcinoms am Beispiel der Epithelproliferationen der Brustdrüse

Zusammenfassung Am Beispiel früher (1937) schon beschriebener Drüsenkrebse und am Beispiel neu untersuchter Epithelproliferationen der Brustdrüse bei der Mastopathia fibrosa cystica lassen sich 2 Bildungsarten des Krebses herausstellen. Sie unterscheiden sich durch den Zeitpunkt der morphologisch erkennbaren Cancerisierung vor oder nach einer Zellproliferation. Sie stimmen darin überein, daß bei beiden Bildungsarten im Beginn ein matrizides (Rössle) Wachstum vorliegt, d. h. ein intraepithelialer Beginn im zunächst unveränderten Muttergewebe. Nach Maßgabe wissenschaftlicher Übereinkunft kann man eine zweiphasische oder eine dreiphasische Entwicklung unterscheiden. Es gibt eine intraepitheliale Zellabartung, bei der morphologisch Cancerisierung und Epithelproliferation zeitlich zusammenfallen (1. Bildungsart). Es gibt eine Zellabartung, bei der morphologisch eine gutartige Proliferation der morphologisch erfaßbaren Cancerisierung vorangeht (2. Bildungsart). Die Cancerisierung ist bei der 1. Bildungsart unabhängig von Zellzahl und Differenzierung, bei der 2. Bildungsart teilweise abhängig von der Zellzahl, aber wiederum nicht von der Differenzierung. Die Befunde bei der Mastopathia fibrosa cystica sprechen für das Vorliegen langdauernder cytostatischer Phasen der so verschiedenen Zellproliferationen und Zelldifferenzierungen.Mit 5 Textabbildungen.Herrn Prof. Dr. Dietrich in Dankbarkeit und Verehrung zum 80. Geburtstag.     

The treatment of hypertension: New lamps for old?

Summary Meta-analysis of clinical trials does not help the clinician to treat individual patients. A general conclusion that the reduction of high blood pressure is beneficial has to be matched by specific information about the level of blood pressure that is acceptable and about the effect of particular doses of specific drugs. Results obtained from trials of old-fashioned antihypertensive drugs cannot confidently be extrapolated to modern agents. Sufficient data do not exist to encourage universal drug treatment for patients with mild hypertension.     

Oligosaccharides accumulated in the bovineβ-mannosidosis kidney

Summary The phenotype of bovine-mannosidosis (-mannosidase deficiency), recently identified in Salers cattle, is similar to the caprine form of the disease (Abbittet al., 1991). This investigation was designed to characterize accumulated kidney oligosaccharides in bovine-mannosidosis. Oligosaccharides were extracted from the kidney of an affected Salers calf and purified by chromatographic techniques. The amount of accumulating oligosaccharides in 1 g of wet tissue was about 21µmol. Structures of derivatized oligosaccharides were characterized by high-performance liquid chromatography, mass spectrometry, methylation analysis and sequential exoglycosidase digestions. The major accumulating oligosaccharides were Man1-4GlcNAc and Man1-4GlcNAc1-4GlcNAc. Oligosaccharides accumulating in minor amounts were Man1-4GlcNAc1-4Man1-4GlcNAc, Man1-6Man1-4GlcNAc1-4GlcNAc and Man1-4GlcNAc1-4Man1-4GlcNAc1-4GlcNAc. As in caprine-mannosidosis, oligosaccharides with terminal-mannose residues and cleaved as well as uncleaved chitobiose linkages were identified in bovine-mannosidosis kidney. The accumulating oligosaccharides in tissue were thus identical in bovine and caprine-mannosidosis; however, the source of the novel oligosaccharides remains to be determined.     

A Streamlined,Anchored, Anatomical Approach to Ablation of Atrioventricular Nodal Reentry Tachycardia: Preliminary Report of the First 25 Cases

A pseudo r in V1 during supraventricular tachycardia (SVT), but not during sinus rhythm is pathognomonic for AV nodal re-entry tachycardia (AVNRT). During radiofrequency (RF) energy delivery, stability of the catheter tip is crucial. Intra-procedural catheter and patient movement as well as abrupt rhythm changes can lower efficacy, prolong procedural time, and contribute to the risk of AV block.Objectives: A novel streamlined approach using a single sheath and two catheters was evaluated that leverages the patients own anatomy to help stabilize catheter position during RF application and localize RF targets.Methods: Twenty-five consecutive patients presenting with documented SVT were ablated using a single sheath technique with only two catheters. A 12F 75 cm sheath was inserted via the right femoral vein and its tip is placed at base of the right atrium (RA). Through this sheath a 6F coronary sinus (CS) catheter and 6F ablation catheter are placed. After confirming the diagnosis of AVNRT, the ablation catheter tip is positioned anterior to the CS os in the slow pathway region. During RF application, the mobility constraints of the sheath-catheter-catheter complex provide excellent electrogram and catheter stability by taking advantage of the collaring effect of the sheath which is in turn anchored to the diagnostic CS catheter.Results: Acute procedural success was 100% with no apparent complications. Flouroscopy time was modest (8.5 min (range 3.1–22)) as were the case times (mean 120 min (range 52–206)). Cost savings compared to 3 cath-3 sheath approach was $113 U.S. and would be much larger if compared to newer non-flouroscopic navigational systems or using alternative ablation energy sources.Conclusions: This new approach minimizes ablation catheter tip movement on the slow pathway region providing a safe, successful, speedy, and economical alternative to a traditional 3 or 4 catheter approach in appropriately selected SVT patients.