Evaluation of fibronectin as a marker of malignant ascites

The aim of the study was to assess the accuracy of fibronectin, a glycoprotein, for the diagnosis of malignant ascites and to compare it with conventional parameters. Ascitic fluid samples from 50 patients, 25 with intra-abdominal malignancy and 25 without it were analysed for total protein concentration, fluid/serum protein ratio, glucose concentration, leucocyte count, pH, fibronectin concentration (by ELISA) and for malignant cell cytology. Twenty-two of the 25 patients with ascites and intra-abdominal malignancy had documented peritoneal metastases in group A. The 25 patients with non-malignant ascites constituted group B. Mean values of ascitic fluid fibronectin, for groups A and B were 538 +/- 46 micrograms/mL and 60 +/- 4.92 micrograms/mL, respectively (P less than 0.001). Within the group with malignant ascites, patients who had positive malignant cytology (n = 12) exhibited a significantly higher ascitic fluid fibronectin concentration than patients with negative cytology (P less than 0.05). While mean ascitic fluid protein concentration showed a significant difference (P less than 0.01) between the two groups, there was no difference in respect to ascitic fluid pH, glucose concentration and leucocyte count. Malignant cell cytology was positive in 54.5% of group A patients with no false positive report in group B. The diagnostic accuracy for differentiating malignant from non-malignant ascites was 100% for a fibronectin value of greater than or equal to 110 micrograms/mL as compared with 78.7% for ascitic fluid protein concentration greater than or equal to 0.5 g/dL, 57.4% for leucocyte count greater than or equal to 1000/mm3, 59.6% for pH less than 7.45 and 78.7% for malignant cell cytology.     

Statistical Distribution of Ventricular Ectopic Beats Assessed by Computer Analysis of Long-Term Electrocardiograms: Problems Related to the Definition of Arrhythmogenesis

The severity and clinical importance of arrhythmogenic effects of antiarrhythmic drugs have been well recognized, but only empirical and naive approaches have been used to define antiarrhythmic and proarrhythmic effects when comparing baseline and on-therapy Holter recordings. This article suggests a new method for the assessment of these effects, based upon comparisons of statistical distributions of ectopic beats recorded on long-term electrocardiograms. Since these distributions are very individual, the Smirov test was used for their comparison. This enables the antiarrhythmic and arrhythmogenic effects to be defined on a precise statistical basis. To demonstrate this method, an analysis is reported of Holter recordings made on six patients suffering from different types of ventricular arrhythmia. In each of these patients, one baseline Holter recording and one recording on each of three different drugs (flecainide, sotalol, and verapamil) were made. The records were digitized using a commercially available system for the analysis of long-term electrocardiograms and random sampling was used to obtain independent samples of arrhythmic episodes that were subsequently statistically analyzed. The results show that the problem of the definition of arrhythmogenesis can be partly addressed in a precise mathematical way and that treatment with an antiarrhythmic preparation may not only have general antiarrhythmic or arrhythmogenic effects, but may also cause a significant change in the character of arrhythmia that can neither be classified as antiarrhythmic nor as arrhythmogenic influence. The clinical implications of this approach are discussed.     

Flecainide acetate in the treatment of tachycardias associated with Mahaim fibres

Patients with Mahaim fibres are susceptible to tachycardiaswhich can be refractory to conventional drug therapy, leadingto treatment with surgery and catheter ablation. The effectsof flecainide acetate were studied in 3 patients (61, 21 and35 years of age) with Mahaim fibres presenting with tachycardiasrefractory to beta-blockers, quinidine and verapamil. One alsohad ophthalmic side-effects from amiodarone. Three types oftachycardias were induced: a reentrant tachycardia with leftbundle branch block morphology (LBBBM) in all 3 patients, atrialflutter in one and atrial fibrillation in another. Intravenousflecainide acetate (2 mg kg–1) terminated reentrant tachycardiaand abolished duality of atrioventricular conduction in patient1. In patient 2, it abolished preexcitation during atrial flutterprior to termination. Atrial fibrillation could not be inducedin patient 3 after flecainide acetate. In all patients, retrogradeconduction was blocked, preexcitation was not present with atrialpacing and no tachycardia was induced after flecainide. Allhave remained asymptomatic on oral flecainide acetate (100 mgbd) for a mean follow-up period of 9 months. We conclude that (1) flecainide acetate is effective for thetreatment of various tachycardias associated with Mahaim fibres;(2) since different mechanisms responsible for the tachycardiawith LBBBM may be present in the same patient and difficultto determine in some, treatment with flecainide acetate whichaffects both the atrioventricular node and Mahaim fibre conductionmay be appropriate for the condition and; (3) its use shouldbe considered before more aggressive therapies.     

A comparison of vincristine and doxorubicin infusional chemotherapy with methylprednisolone (VAMP) with the addition of weekly cyclophosphamide (C-VAMP) as induction treatment followed by autografting in previously untreated myeloma

In a sequential nonrandomized study, 204 consecutive unselected patients aged < 70 years received induction chemotherapy with infusional vincristine and adriamycin with oral methyl prednisolone (VAMP; n =75) or with additional cyclophosphamide, C-VAMP ( n =129). 38/129 C-VAMP patients also received verapamil during induction as part of a controlled trial with the aim to overcome drug resistance. A median of five courses (range 1–11) of chemotherapy were required before maximal response was attained and this was similar in both groups. An over-all response rate of 71% was noted at the end of induction. The complete remission (CR) rate with C-VAMP was 24%, which was significantly higher ( P =0.04) than the CR rate with VAMP alone (8%). The addition of verapamil did not alter the response rate of C-VAMP. Compliance to VAMP was overall 83% and not affected by the addition of cyclophosphamide. The proportion of patients going on to receive high-dose chemotherapy and an autograft was the same for VAMP and C-VAMP treated patients (71%). The median overall survival (OS) and progression-free survival (PFS) for the whole group were 4.4 years and 2.0 years and no difference in outcome was observed between the different treatment groups. Therefore the addition of weekly cyclophosphamide to VAMP induction therapy has significantly improved the response rates of previously untreated myeloma patients. C-VAMP was not more toxic and did not compromise the chances of receiving an autograft. Verapamil was without influence on any parameters in this study.     

Langerhans Cell Histiocytosis Presenting as Hypopigmented Papules

Abstract: A 1½‐year‐old boy with Langerhans cell histiocytosis presented with a frontal bone mass showing features of eosinophilic granuloma. He subsequently developed multiple asymptomatic discrete hypopigmented papules on the face, trunk and extremities, which, on histology, were confirmed as Langerhan’s cell histiocytosis, a presentation hitherto unreported in literature. He responded well to surgery and chemotherapy.     

Role of Epicardial Mapping in Catheter Ablation of Postmyocardial Infarction Ventricular Tachycardia

The role of epicardial mapping for radiofrequency (RF) catheter ablation of postmyocardial infarction monomorphic ventricular tachycardia (VT) is still under investigation. We present two septuagenarian patients with a history of myocardial infarction, poor left ventricular function, and drug-refractory monomorphic VT who were treated with RF catheter ablation. The first patient had a history of myocardial infarction, left ventricular aneurysm, and mitral valve replacement complicated by recurrent drug refractory VT and congestive heart failure. The second patient had ischemic cardiomyopathy and VT and was implanted with a cardioverter defibrillator and subsequently suffered repeated episodes of VT refractory to multiple antiarrhythmic drugs. In both patients, coronary sinus mapping was performed with a multipolar catheter as endocardial mapping did not reveal satisfactory sites for ablation. Epicardial catheter mapping provided stable electrograms and identification of areas of slow conduction during VT. RF lesions guided by epicardial mapping resulted in successful ablation of VT and no recurrence at long-term follow-up. This report emphasizes the potential usefulness of coronary sinus mapping as an adjuvant to endocardial mapping to guide VT ablation.     

Amoebic Liver Abscess in a Four-Month-Old Infant A CASE REPORT

Amoebic liver abscess is no longer a rarity in children and the underdiagnosis of this condition in the past is due to the fact that it was considered a rarity, and many affected children are asymptomatic. This report records a case of amoebic liver abscess in a 4 month old infant, and discusses the clinical presentation, investigation and management.     

A new genetic polymorphism in the 16S ribosomal RNA gene of human motochondrial DNA

Sequence analysis of the 3' end of the 16s rRNA gene of mitochondrial DNA (mtDNA) revealed a single base change G - A, at position 3010. This mutation was first identified in a patient who had recovered from chloramphenicol- induced aplastic anaemia (CAP- induced AA). A link between this mutation and CAP-induced AA was ruled out by investigating three other similar patients, none of whom had the mutation. This mutation lies within or near the chloramphenicol binding site in a part of the 16S rRNA gene which shows high evolutinary conservation and where polymorphisms have not been previosuly reported. Hybridization tests with appropriate oligonucleotide probes in 114 individuals reveal that this mutation has polymorphic frequency of about 14% in Europeans.     

Conformational preferences of oligopeptides rich in α-aminoisobutyric acid. III. Design,synthesis and hydrogen bonding in 310-helices

Two sterically constrained peptides {ⁱBoc-Aib-Aib-Aib-DkNap-Leu-Qx-Ala-Aib-Aib-F1, (Dk⁴Qx⁶[7/9]) and ⁱBoc-Aib-Aib-Aib-DkNap-Leu-Aib-Ala-Aib-Aib-Fl, (Dk⁴7/9)} containing α-aminoisobutyric acid (Aib) and Aib-class amino acids in conjunction with selected mono-α-alkyl amino acids were synthesized by an optimized TBTU/HOBt procedure. The use of Aib-class amino acids (e.g. DkNap and Qx), defined and discussed here, gives rise to the same overwhelmingly 3₁₀-helical backbone conformation as that provided by simpler Aib-rich peptides and homopeptides. The synthetic α,α-dialkylamino acids (DkNap, Qx) are aromatic homologues of the known alicyclic variants of Aib, the Ac₅c and Ac₆c amino acids. Two new organic solubilizing groups for peptides, ⁱBoc and 2-methoxyethylamine, are introduced. The ¹H nuclear magnetic resonance analyses of the Dk⁴s/p[7/9] and Dk⁴Qx⁶[7/9] peptides demonstrate the unambiguous 310s/b-helical hydrogen bonding pattern of these peptides, confirming the design objective of these sequence patterns containing greater than 50% Aib and Aib-class composition. © Munksgaard 1994.