Coronary Sinus Aneurysm and Left Ventricular‐Coronary Sinus Fistula. Implantation of CRT Device

We describe a 72‐year‐old man referred for implantation of a cardiac resynchronization therapy device who had previously undergone repeated operations to replace the mitral valve. Retrograde venography of the coronary sinus (CS) to implant the left ventricular (LV) pacing lead revealed aneurysmal dilatation of the CS with LV‐CS fistula that hindered—but did not prevent—complete implantation of the system. (PACE 2013; 36:e38–e40)     

Partial hepatectomy for benign or malignant liver diseases; experience in 94 patients

In this retrospective study, we analyse the results of 94 partial liver resections performed between 1972 and January 1989. The resections were performed for malignant (48 patients) and benign (46 patients) liver tumours. Nine patients (9.6%) died of resection-related complications. Mortality was significantly lower in the patients with resections for benign liver tumours (2.2%) compared with patients with resections for malignant liver tumours (16.7%) (p less than 0.05). In the patients who survived the first 30 days, complications occurred in 25.9%. The 5-year survival of patients with a primary malignant liver tumour (57%) is significantly (p = 0.05) better than in patients with a secondary malignant liver tumour (19%). From this study we conclude that partial liver resections for primary or secondary liver tumours can be performed with an acceptable mortality and morbidity, and should be the therapy of choice for selected patients.     

Satisfaction with technological equipment in individuals with tetraplegia following spinal cord injury]

OBJECTIVE: To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects. DESIGN AND SETTING: A questionnaire was mailed to 102 tetraplegic subjects who were hospitalised in the rehabilitation center of Kerpape (Ploemeur, France) between 1998 and 2004, and 59 subjects responded. The questionnaire asked about the use of telephones, computers, wheelchairs and environmental controls at home. RESULTS: When a piece of equipment was acquired, it was very often used. Patient satisfaction with equipment was 79.3%. Home phones and mobile phones were often used with options such as hands-free devices (78 and 59% respectively). A total of 64.4% of subjects acquired a manual wheelchair and 61% a power wheelchair. The most commonly acquired options on the power wheelchairs were the powered recline (73,7%) and tilt (71,1%) systems. All options were used but all were more desired than acquired. A total of 27.1% of subjects desired a pushrim-activated power-assist wheelchair, but only 15.3% had acquired one; 695% of subjects had a computer. Communication was the first use for the computer (82.5%); 49.2% of subjects had acquired an environmental control system, but 20% desired one. The first reason for lack of acquisition was financial difficulties but also accessibility and information problems. The factor that influenced the acquisition and need for equipment was the degree of spinal cord injury. No other factor reduced patient satisfaction with equipment. CONCLUSION: Patients were satisfied with the equipment they acquired. But their needs, especially wheelchair options and environmental control systems, were not satisfied.     

When three is not a crowd: a Crossregulation Model of the dynamics and repertoire selection of regulatory CD4+ T cells

Summary:  Regulatory CD4⁺ T cells, enriched in the CD25 pool of healthy individuals, mediate natural tolerance and prevent autoimmune diseases. Despite their fundamental and potential clinical significance, regulatory T (T_R) cells have not yet been incorporated in a coherent theory of the immune system. This article reviews experimental evidence and theoretical arguments supporting a model of T_R cell dynamics, uncovering some of its most relevant biological implications. According to this model, the persistence and expansion of T_R cell populations depend strictly on specific interactions they make with antigen-presenting cells (APCs) and conventional effector T (T_E) cells. This three-partner crossregulation imposes that T_R cells feed on the specific autoimmune activities they suppress, with implications ranging from their interactions with other cells to their repertoire selection in the periphery and in the thymus, and to the relationship between these cells and the innate immune system. These implications stem from the basic prediction that the peripheral dynamics sort the CD4⁺ T-cell repertoire into two subsets: a less diverse set of small clones of autoreactive effector and regulatory cells that regulate each other's growth, and a more diverse set of barely autoreactive T_E cell clones, whose expansion is limited only by APC availability. It is argued that such partitioning of the repertoire sets the ground for self–non-self discrimination.     

NMDA antagonist and antipsychotic actions in cortico-subcortical circuits

Cognitive deficits in schizophrenia are associated with prefrontal cortex (PFC) abnormalities. Schizophrenic patients show a reduced performance in tasks engaging the PFC and a reduction of markers of cellular integrity and function. Non-competitive N-methyl-Daspartate (NMDA) receptor antagonists are widely used as pharmacological models of schizophrenia due to their ability to exacerbate schizophrenia symptoms in patients and to elicit psychotomimetic actions in healthy volunteers. Also, these drugs evoke behavioral alterations in experimental animals that resemble schizophrenia symptoms. The PFC seems to be a key target area for these agents. However, the cellular and network elements involved are poorly known. Cognitive deficits are of particular interest since an early antipsychotic-induced improvement in cognitive performance predicts a better long-term clinical outcome. Here we report that the non-competitive NMDA receptor antagonist phencyclidine (PCP) induces a marked disruption of the activity of PFC. PCP administration increased the activity of a substantial proportion of pyramidal neurons, as evidenced by an increase in discharge rate and inc- fos expression. Examination of the effects of PCP on other brain areas revealed an increasedc- fos expression in a number of cortical and subcortical areas, but notably in thalamic nuclei projecting to the PFC. The administration of classical (haloperidol) and/or atypical (clozapine) antipsychotic drugs reversed PCP effects. These results indicate that PCP induces a marked disruption of the network activity in PFC and that antipsychotic drugs may partly exert their therapeutic effect by normalizing hyperactive cortico-thalamocortical circuits.     

Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk

Purpose To evaluated percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods Thirty-three patients with acute cholecystitis (calculous,n=22; acalculous,n=11) underwent percutaneous cholecystostomy by means of a transhepatic (n=21) or transperitoneal (n=12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decreased in body temperature (n=13), normalization of the white blood cell count (n=3), or both (n=6). There were 6 (18%) minor/moderate complications (transhepatic access,n=3; transperitoneal access,n=3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n=9) and percutaneous and endoscopic stone removal (n=8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n=2) and gallbladder ablation (n=2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusion Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.     

Human model for studying in vitro the regulating function of specific and scavenger LDL receptors

Measurements of the specific and scavenger LDL receptor activities in different disorders do not reveal all the causes and origin of hypercholesterolaemia. Studying the failure of the intracellular regulation of these receptors can give us some new information about the background of atherosclerosis. Therefore, we have tried to develop an in vitro model which is suitable for studying the specific and scavenger LDL receptor activities and their most important regulating functions, i.e. the inhibition of HMG-Co-A reductase by native LDL and the apo E secretion induced by acLDL. MDMs cultured for three days have turned out to provide a good model to test these functions.