Successful Prevention of Recurrent Ventricular Fibrillation by Intravenous Isoproterenol in a Patient with Brugada Syndrome

TANAKA, H., et al. : Successful Prevention of Recurrent Ventricular Fibrillation by Intravenous Isoproterenol in a Patient with Brugada Syndrome. Intravenous administration of isoproterenol restored the ST-segment configuration to nearly normal in the right precordial leads and completely prevented spontaneous VF attacks in a patient with Brugada syndrome. The formation of a Brugada-type ECG has been attributed to the transmural dispersion of repolarization of the right ventricular epicardium and related to modulation of the autonomic nervous system. Our case may provide clues to the pathophysiological mechanism of this syndrome.     

Psychiatric manifestations accompanying interferon therapy for patients with chronic hepatitis C: An overview of cases in Japan

Abstract  Thirty case reports published in Japan that refer to psychiatric symptoms accompanying interferon (IFN) therapy were examined. These papers covered a total of 49 cases. We categorized these 49 cases into 35 cases of mood disorder, 10 of delirium and four of psychotic disorder. The key findings of our study of these cases are as follows: (i) in total, 11 patients had psychiatric past histories: five patients in the mood disorders group were susceptible to the influence of social or psychological factors; (ii) whereas the symptoms of mood disorder or delirium appeared soon after IFN was administered, the symptoms of psychotic disorders appeared later. The patients with delirium displayed many neurological abnormalities, which were reduced by suspending IFN therapy. This suggests the neurological toxicity of IFN; (iii) the outcome of most patients was good; and (iv) we suspect that IFN-induced psychiatric symptoms other than delirium are connected with psychoneuroimmunological functions.     

Electroencephalographic findings in functional psychoses: State or trait indicators?

The clinical significance of electroencephalographic (EEG) changes in patients with functional psychoses is not yet clearly defined, particularly whether these changes are state indicators or trait indicators. In the present review, the EEG abnormalities in schizophrenia are discussed. In early EEG studies of schizophrenics, the various specific EEG patterns were suggested to be trait indicators, but those findings were not confirmed. The EEG patterns of some patients with catatonic schizophrenia, especially periodic catatonia, were thought to be episode or state indicators, and some of the patients diagnosed as having atypical psychoses in Japan were suggested to show state indicator EEG findings. As the computerized and spectral analyses of EEG have advanced, the contradictory findings of EEG in schizophrenia have been reported, interpreted as `hyperstable' or `hypernormal' EEG findings and `hypofrontal' EEG findings (slow waves in the frontal region). However, no conclusion can be made as to whether these EEG findings are state or trait indicators. On the borderland of functional psychoses, the behavioral changes in temporal lobe epilepsy were described as a trait indicator, and the psychotic states in non-convulsive generalized status epilepticus and acute confusional states were suggested to be state indicators. Further studies of EEG abnormalities in schizophrenia are necessary from multi-dimensional perspectives, including in comparison with the symptomatic psychoses.     

What are parents of obese children concerned about in their children?

We retrospectively examined the issues that concern parents of obese children to determine the most effective means of motivating them to seek treatment for obesity in their children. Children with an obesity index > 40%, aged six to 12 years, were screened in Kagoshima City in 1992. Parents were notified if their children needed an evaluation that included a family history and measurements of the blood pressure, total cholesterol, high density lipoprotein (HDL)-cholesterol, atherogenic index (ASI), triglycerides, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Parents were informed of the results of the evaluation and invited to attend a lecture on the treatment of obesity in children. A total of 378 obese children were evaluated. However, the parents of only 39 children attended the lecture. Children whose parents attended had higher mean total levels of cholesterol (190 ± 25 vs 175 ± 28, P < 0.01) and ASI values (3.2 ± 0.9 vs 2.7 ± 0.9, P < 0.02) than those whose parents did not attend. There were no significant differences in other factors. Only 4.2% of parents whose children showed no abnormal values, except for obesity, attended the lecture, compared with 20.3% (P< 0.01) or 16.9% (P< 0.05) of parents whose children had abnormal levels of cholesterol or abnormal ASI. Parents may be more concerned about hypercholesterolemia or arteriosclerosis than obesity per se. We should perhaps use the total cholesterol or ASI values, not just the severity of obesity, to motivate parents to enter their children into treatment programs for obesity.     

An autopsy case of leiomyosarcoma of the maxilla

Abstract. An autopsy case of leiomyosarcoma originating in the maxilla is presented. Although repeated light microscopic findings were consistent with a diagnosis of fibrosarcoma, electron microscopic examination revealed myofilaments with dense patches in the spindle-shaped cytoplasm of the tumor cells. It is suggested that “fibrosarcomas” of the oral cavity diagnosed by light microscopy could be leiomyosarcomas.     

Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation

DOI, A., et al. : Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation. Hemodynamic instability is a crucial determinant of the best therapeutic option in paroxysmal supraventricular tachycardia (PSVT). However, it is still unclear if hemodynamic instability is tachycardia dependent or independent. We performed frequency-domain analysis of electrocardiographic RR variations during induced PSVT and head-up tilt tests after successful ablation to investigate the role of autonomic vasomotor function in hemodynamic instability during PSVT. Thirty-six patients with (syncope group,  n = 18  ) and without (nonsyncope group,  n = 18  ) syncope and/or presyncope during PSVT were enrolled in this study. Serial blood pressure, heart rate, and variations in heart rate during induced PSVT and head-up tilt tests were examined. Initial blood pressure fall and heart rate changes during induced PSVT were greater in the syncope group than in the nonsyncope group. A significant positive linear relationship was found between these two. Delayed blood pressure fall was observed in the syncope group, independent of heart rate changes. Syncope in PSVT could be predicted from the results of head-up tilt tests with 82% accuracy. Heart rate responses after isoproterenol infusion were significantly greater in the syncope group than in the nonsyncope group. The changes in low frequency to high frequency (LF:HF) values during induced PSVT and head-up tilt tests were significantly greater in the syncope group than in the nonsyncope group, and an exponential correlation was found between LF:HF changes in both tests. We conclude that PSVT rate and vasomotor reaction are related with hemodynamic instability during PSVT and head-up tilt testing is a useful method for determining if patients will have syncope during PSVT.