Differences in arousal response between aged and middle-aged patients with obstructive sleep apnea syndrome

Abstract The aim of this study is to show the clinical significance of the differences in arousal response at a termination of apnea/hypopnea between aged and middle-aged patients with obstructive sleep apnea syndrome (OSAS). We polygraphically assessed electrocardiographic (ECG) and electroencephalographic (EEG) arousal. Electrocardiographic arousal was defined as an abrupt increase in heart rate at a termination of apnea/hypopnea. Our findings showed that EEG and ECG arousal at a termination of apnea/hypopnea were significantly suppressed in aged patients with OSAS, which might provide useful information on the pathophysiology of OSAS.     

Serial Intravascular Ultrasound Analysis of the Impact of Myocardial Bridge on Neointimal Proliferation After Coronary Stenting in Patients with Acute Myocardial Infarction

Background: Mechanisms underlying the association between myocardial bridge (MB)‐stenting and in‐stent restenosis (ISR) are still unclear. Objective: To assess the impact of MB on ISR using intravascular ultrasound (IVUS). Methods: In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS‐AMI) trial, 100 left anterior descending artery (LAD) culprit lesions (79 treated with paclitaxel‐eluting stents [PES] and 21 treated with bare metal stents) were imaged with serial IVUS immediately postprocedure and at 13 months. Results: At baseline the LAD stent extended into the MB segment beyond the culprit lesion in seven patients (MB‐stent group). In the remaining 93 patients the LAD stent was implanted only in the culprit lesion without extending into the MB segment (non‐MB‐stent group). In PES‐treated lesions intimal hyperplasia (IH) was greater in MB‐stent group than in non‐MB‐stent group (1.0 [0.9, 1.3] mm² vs. 0.4 [0.2, 0.7] mm², P = 0.007). When comparing the MB‐stent segment with the non‐MB‐stent segment in the MB‐stent group treated with PES, a significant reduction in lumen area was observed in only the MB‐stent segment, owing to an augmented IH within the MB‐stent segment (1.56 [1.40, 1.91] mm² vs. 0.77 [0.55, 1.23] mm² for non‐MB‐stent segment, P = 0.08), not significant stent recoil (Δstent area). At follow‐up, the minimum lumen area was smaller in the MB‐stent group than in the non‐MB‐stent group (2.9 [2.5, 4.2] mm² vs. 5.2 [4.1, 6.7] mm², P = 0.02). Conclusions: Increased incidence of ISR associated with MB‐stenting may be attributable to enhanced IH, specific to stented MB segment, not to chronic stent recoil. (J Interven Cardiol 2010;23:114‐122)     

Case of autoimmune progesterone dermatitis presenting as fixed drug eruption

Autoimmune progesterone dermatitis is a rare disorder that presents as a cyclical cutaneous eruption during the luteal phase of the menstrual cycle. It typically occurs in women due to an autoimmune phenomenon to endogenous progesterone production. We describe a 34‐year‐old woman with an erythematous round plaque with blistering, which recurred a few days before her menstrual cycle, at the identical site on the left arm. The diagnosis of autoimmune progesterone dermatitis is made with i.d. skin testing on the affected lesion with progesterone. After the beginning of oral prednisolone (40 mg daily) therapy during menstruation, although slight recurrence appeared, the severity was significantly improved.     

Premature Ovarian Failure in a Woman with 47,XXX Karyotype following Gonadotrophin Treatment

ABSTRACT A woman resulted in premature ovarian failure following gonadotrophin treatment for secondary sterility is described. The state of ovarian failure was confirmed by increased serum gonadotrophin titers, decreased serum estrogen levels, and lack of ovarian follicles on histological examination. The cause of premature ovarian failure was investigated and 47,XXX karyotype was found in chromosomal analysis. The role of sex chromosome abnormalities in the pathogenesis of this entity is discussed. Key words: premature ovarian failure, 47,XXX, gonadotrophin treatment     

Inappropriate ICD Discharges Due to Noise Oversensing as the First Sign of Repetitive Perforations of the Right Ventricular Lead

Acute lead perforation is one of the major complications associated with implantable cardioverter defibrillator (ICD) implantation. We describe a case with repetitive inappropriate ICD discharges due to noise oversensing as the first sign of lead perforation.     

The Response of Digitalized Canine Ventricle to Programmed Stimulation: A Study on Triggered Activity Arrhythmias in the Whole Heart

Triggered activity (TA) has recently received increased attention as a mechanism responsible for cardiac arrhythmias. However, few studies have shown TA in the intact heart. In an ouabain-treated dog's heart we have shown: (a) overdrive acceleration, (b) a concordant relationship between the postpacing interval (PI) and pacing cycle length (CL), and (c) a discordant relationship between the PI and number of paced beats necessary to induce TA. These findings appear to agree with the distinctive characteristics of TA arrhythmias elucidated in previous in vitro studies and suggest TA rather than a reentrant tachycardia. In addition, it is possible that this heart preparation could be considered as a suitable model for the study of TA arrhythmias. These results were obtained using a programmed stimulation protocol in this dog model: (1) Following single programmed ventricular stimulation during sinus rhythm, a repetitive ventricular response (RVR) of more than 3 beats occurred in only 20% of hearts. The relationship between PI and the coupling interval (CI) of the extrastimulus was concordant in 80% (12/15) and discordant in 13% (2/15) of all experiments. The PI-CI relationship was influenced by the mutual relationship between the stimulating, recording, and originating sites of TA. (2) RVR of more than 3 beats was induced by consecutive overdrive ventricular stimulation during sinus rhythm (78%). In addition, the PI-pacing CL relationship was concordant (100%). (3) The transient termination of sustained VT that occurred spontaneously after administration of a large dose of ouabain was seen in only 15% of the cases after a single programmed premature ventricular stimulation. The return cycle-CI relationship was biphasic in 75% (15/20) experiments and discordant in 25% (5/20) of the experiments. (4) The termination of spontaneous sustained VT by overdrive ventricular stimulation occurred in only 8% of the cases. Transient overdrive acceleration of VT occurred after overdrive pacing (53%). In contrast, overdrive suppression occurred in only 13%. Thus, the characteristics of TA arrhythmias observed in the whole heart preparations differed, in some respects, from those obtained by in vitro studies. These quantitative observations could suggest a differentiation, based on probability, between TA and the reentrant mechanism that would respond to programmed stimulation in a similar manner. The differentiation between reentrant and triggered ventricular tachycardia can be made with reasonable assurance using these programmed stimulation techniques.