Prediction of Arrhythmic Events After Acute Myocardial Infarction Using Two Methods for Late Potentials Recording

One hundred consecutive patients recovering from an acute myocardiai infarction underwent, prior to home discharge, signal-averaged electrocardiography (ECG), left ventriculography. and 24-hour Holter ECG recording. The signal-averaged ECG was recorded and analyzed using two procedures: the orthogonal bipolar XYZ lead configuration with a bidirectional filter: and a precordial unipolar lead configuration with a uonrecursive digital filter. An abnormal signal-averaged ECG was seen in 40% of patients with the XYZ system and in 30% of patients in the precordial method, abnormal ejection fraction (< 40%) in 24% of patients and high grade ectopy activity in 22%. During the 24-month follow-up period, 12 patients (12%) had an arrhythmic event defined as either sudden death (11 patients) or sustained ventricular tachycardia (1 patient). Neither the signal-averaged ECG with the XYZ configuration, the abnormal ejection fraction, nor the high grade ectopy were able to statistically predict a higher arrhythmic event rate. The signal-averaged ECG with the precordial configuration was able to statistically predict a higher arrhythmic event rate, P < 0.03; odds ratio = 3.96. The combination of the orthogonal XYZ configuration signal-averaged ECG with the ejection fraction (P < 0.01, odds ralio = 7.33), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio = 6.17) was able to predict a higher arrhythmic event rate. The combination of the precordial configuration signal-averaged ECG with the ejection fraction (P < 0.002, odds ratio = 14.4), or with ejection fraction and Holter monitoring (P < 0.06. odds ratio =10) was able to better predict a higher arrhythmic event rate. The combination of a normal or abnormal signal-averaged ECG and ejection fraction gave a sensitivity, specificity, positive, or negative value prediction of arrhythmic events of 60%, 90.6%, 37.5%, and 96%, respectively. It must be emphasized that the number of arrhythmic events during the 2-year follow-up was small and further study is required to determine the true predictive value of each method for arrhythmic events.     

Glucocorticoids Increase Repair Potential in a Novel in vitro Human Airway Epithelial Wounding Model

Airway epithelial damage is a cardinal feature of chronic asthma. Agents which enhance epithelial repair without triggering uncontrolled fibrosis of the mesenchyme would be predicted to be useful in the management of asthma. We have developed a repeat wound model using mucociliated human bronchial epithelial cell (HBEC) cultures to define the key pathways involved in airway epithelial repair, and to study the effects of potential therapeutic agents on epithelial repair in a chronic setting. We show that repair occurs primarily by cell migration to close a defect; this process requires activation of the EGF receptor (EGFR) and subsequent tyrosine kinase signalling. Migration is accompanied by up-regulation of CD44 in motile cells at the wound margins with proliferation of non-migrating cells adjacent to the wound area. In long-term studies β2 adrenoceptor agonists and phosphodiesterase (PDE) inhibitors have no effect on repair potential, in contrast chronic treatment with the glucocorticoid dexamethasone extends the lifespan of repeatedly wounded differentiated cultures. We suggest part of the beneficial effects of glucocorticoids in asthma is related to this ability to prolong repair potential following repeated episodes of epithelial injury.     

Apoptosis of Hodgkin–Reed–Sternberg cells in classical Hodgkin lymphoma revisited

Benharroch D, Einav I, Feldman A, Levy A, Ariad S, Gopas J. Apoptosis of Hodgkin–Reed–Sternberg cells in classical Hodgkin lymphoma revisited. APMIS 2010; 118: 339–45. We scrutinized the role of apoptosis of the Hodgkin–Reed–Sternberg (HRS) cells in classical Hodgkin lymphoma (cHL) and critically reviewed its features in the light of conflicting evidence. In this study, we found that tumor cells in this neoplasm showed inhibition of apoptosis in 55% of the 217 cHL cases only. It is also suggested that the two factors considered responsible for apoptosis inhibition in HRS cells, nuclear factor‐κB and the latent membrane protein‐1 of the Epstein–Barr virus, do not correlate with apoptosis inhibition, in contrast with the findings in the consensual pathogenetic scheme. The most significant association of HRS cell apoptosis was with p53, the negative expression of which related with a high apoptotic index (p = 0.001). These findings support our contention that the role of apoptosis in the HRS cells of Hodgkin lymphoma has not been completely elucidated and is at variance with that in the consensus.     

Undifferentiated carcinoma of the renal pelvis with osteoclast‐like giant cells: a report of two cases

McCash SI, Unger P, Dillon R, Xiao G‐Q. Undifferentiated carcinoma of the renal pelvis with osteoclast‐like giant cells: a report of two cases. APMIS 2010; 118: 407–12. Undifferentiated carcinoma with osteoclast‐like giant cells arising in the urothelium of the bladder or upper urinary tract is an extremely rare entity. The majority of cases found in the renal pelvis and bladder are associated with either an in situ urothelial malignancy or a conventional high‐grade urothelial carcinoma. These malignancies tend to behave poorly with a grim prognosis and course. We report two additional cases of undifferentiated carcinoma with osteoclast‐like giant cells of the renal pelvis in two patients disease free 42 and 18 months after surgical treatment, respectively.     

EPIDEMIOLOGY IN ANAESTHESIA: I: ANAESTHETIC PRACTICE OVER 20 YEARS

The practice of anaesthesia and its outcome is compared, bymeans of the Cardiff Anaesthetic Record System, between twoperiods of 6 years, in whiph 53 541 and 108 878 anaestheticswere administered by the staff of one department. The proportionof emergency cases has increased from 10.6% to 18.7%, but themortality m hospital has declined from 1 in 35 anaestheticsto 1 in 46     

Studies on the Use of "Prophylactic" Intrathecal Amethopterin in Childhood Leukemia

Central nervous system infiltration was studied in a group of 47 childrenwith acute leukemia. CNS involvement was found to occur more frequentlyand appear more rapidly in patients who presented with elevated peripheralWBC counts. CNS infiltration not suspected clinically was identified by spinalfluid examination in a significant minority of children at the time of theinitial diagnosis of leukemia, indicating that lumbar puncture should be aroutine part of the initial evaluation of patients with acute leukemia. Intrathecal amethopterin administered "prophylactically" at the time of initialdiagnosis of leukemia did not prevent or decrease the frequency of occurrenceof CNS infiltration. However, it did delay the onset of CNS involvement in patients with elevated WBC counts. Intrathecal amethopterin administered before the onset of CNS infiltration appears to be useful in delaying morbidityresulting from CNS involvement in children who present with elevated peripheral WBC counts.

Submitted on July 21, 1969 Revised on January 27, 1970 Accepted on February 10, 1970