Brugada Syndrome: A Case Report of an Unusual Association with Vasospastic Angina and Coronary Myocardial Bridging

IMAZIO, M., et al. : Brugada Syndrome: A Case Report of an Unusual Association with Vasospastic Angina and Coronary Myocardial Bridging. This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias.     

Microleakage and penetration of a hydrophilic sealant and a conventional resin‐based sealant as a function of preparation techniques: a laboratory study

International Journal of Paediatric Dentistry 2013; 23: 13–22 Background. Optimal pit and fissure sealing is determined by surface preparation techniques and choice of materials. Aim. This study aimed (i) to compare the microleakage and penetration depth of a hydrophilic sealant and a conventional resin‐based sealant using one of the following preparation techniques: acid etching (AE) only, a diamond bur + AE, and Er:YAG laser combined with AE, and (ii) to evaluate the microleakage and penetration depth of the hydrophilic pit and fissure sealant on different surface conditions. Design. Eighty recently extracted 3rd molars were randomly assigned to eight groups of ten teeth according to the material, preparation technique, and surface condition. For saliva contamination, 0.1 mL of fresh whole human saliva was used. All samples were submitted to 1000 thermal cycles and immersed in 2% methylene blue dye for 4 h. Sections were examined by a light microscope and analysed using image analysis software (Sigmascan^®). Results. The combination of Er:YAG + AE + conventional sealant showed the least microleakage. The sealing ability of the hydrophilic sealant was influenced by the surface condition. Conclusion. Er:YAG ablation significantly decreased the microleakage at the tooth–sealant interface compared to the non‐invasive technique. The hydrophilic sealant applied on different surface conditions showed comparable result to the conventional resin‐based sealant.     

Patient Selection for Biventricular Pacing

Biventricular Pacing. Introduction: Biventricular pacing improves functional status in the majority of patients with drug‐refractory heart failure, dilated cardiomyopathy, and interventricular conduction delay. The aim of this study was to analyze the baseline clinical and functional data of a cohort of patients implanted with a biventricular stimulation system in a single‐center experience, to verify if the pathophysiologic characteristics of patients affect outcome, and to determine if preliminary identification of the right candidates for the new therapy is possible with noninvasive parameters. Methods and Results: Since March 1999, 52 patients with advanced heart failure (idiopathic cardiomyopathy 50%, ischemic cardiomyopathy 35%, other etiology 15%) and left bundle branch block underwent cardiac resynchronization and were followed prospectively. Paired analysis over mean (± SD) follow‐up of 348 ± 154 days showed an overall significant decrease of QRS width (baseline 194 ± 33.2 msec vs follow‐up 159.6 ± 20.1 msec), New York Heart Association (NYHA) functional class (baseline 3.2 ± 0.5 vs follow‐up 2.3 ± 0.5), quality‐of‐life score (baseline 54 ± 25 vs follow‐up 25 ± 16), and increase of maximal VO₂ (baseline 12.6 ± 2.5 mL/kg/min vs follow‐up 15.0 ± 3.3 mL/kg/min). There were 80% responders (documented, persistent decrease ≥1 NYHA class) and 20% nonresponders (same NYHA class or decline of status; need for heart transplant; death due to progressive pump failure). No significant differences in baseline clinical and functional variables between the two subgroups were observed. In responders, there was a highly significant global improvement of all variables; in nonresponders, no parameters changed between baseline and follow‐up. Conclusion: These data confirm the role of biventricular pacing in improving the functional status of the great majority of a selected patient population having advanced heart failure and left bundle branch block with wide QRS complex. Basal demographic, clinical, and functional characteristics are not helpful in preliminary selection of responders. Simple evaluation of NYHA class confirms favorable outcome (improvement of functional and hemodynamic status).     

Detection of Helicobacter pylori in Faeces with a New Enzyme Immunoassay Method: Preliminary Results

Objective. The epidemiology of Barrett's oesophagus (BO) is characterized by divergent results. The aim of this study was to estimate the prevalence of BO and intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) in a population-based series of patients referred for first-time gastroscopy. Material and methods. Consecutive patients who underwent endoscopy for the first time at endoscopy units exclusively serving defined catchment areas were invited to take part in the study. Biopsies were taken immediately below the GOJ and from the distal oesophagus, and clinical data were recorded. Results. A total of 769 patients (mean age 53 years, 43% M) were examined. Overall IM prevalence was 14%. BO was noted in 4%. Overall, the prevalence of IM increased by 8% (95% CI 6–10%) per year of age. BO patients were predominately women (69%). Presence of cardia-type mucosa in the cardia increased with age from 25% among the youngest to 59% among the oldest patients. Pancreatic acinar metaplasia (PAM) was found in 18%. Conclusions. While BO is not common among Swedish gastroscopy patients, IM and PAM are found in every 7th and 6th patient, respectively. Age-dependent increments in prevalence suggest that not only BO and IM, but also cardia-type mucosa are acquired and/or progressive lesions.     

TREATMENT OF ALOPECIA AREATA WITH SQUARIC ACID DIBUTYLESTER

Background. Among contact allergens that are frequently used in the treatment of alopecia areata (AA), squaric acid dibutylester (SADBE) stands out for its good tolerability and its mild side effects. Methods. One hundred and forty-four patients with AA of varying degrees were treated with SADBE. Of these, 71 had AA affecting less than 50% of the scalp, and 73 had a severe form, including 13 patients with alopecia totalis (at) and two with alopecia universalis (AU). The patients were treated using both traditional and nontraditional methods. Results. In the less severe form, we obtained a 80% rate of regrowth, compared to the 49% of the more severe form including 13 cases of at and the two of au. The failure rate was higher for patients with the more severe form (29%) compared to a 7% rate only for patients with mild AA. We also observed four cases of initial regrowth on the side of the scalp opposite to the site of application (‘castling phenomenon‘). Among those patients who were treated with application of SADBE on the right side of the back, three displayed regrowth on the left side of the scalp, (i.e., on the opposite side) and in an area distant from the site of application; for two patients the regrowth began on the right side of the scalp and one of them also displayed growth of fine hairs in the right dorsal region, the site of application of the compound. Conclusions. Our data further support the hypothesis of a systemic action of SADBE; however, further confirmation on a larger sample of cases is needed.     

A description of two cases of factor V deficiency

Summary We report two cases of factor V deficiency. A 12-year-old girl with thalassemia major was admitted for bone marrow transplant (mismatched). She was found to have a heterozygous deficiency of factor V (21%), but this was considered compatible with the transplant, which was performed without the support of suppernatant cryoprecipitate. A 14-year-old girl (factor V 2%) with a negative history (menarche at age 12, menstrual cycle regular and normal in quantity and length). One year previously she had complained of menorrhagia (length of period, 9 days); tests revealed server anaemia (Hb 4.9 g/dl). We show how even severe cases of factor V deficiency may often be silent, and not require transfusion in surgical procedures, thus avoiding the risks associated with such therapy.