"Left-variant" atypical atrioventricular nodal reentrant tachycardia: electrophysiological characteristics and effect of slow pathway ablation within coronary sinus

Introduction: Recent anatomical and electrophysiological studies have demonstrated the presence of leftward posterior nodal extension (LPNE); however, its role in the genesis of atrioventricular nodal reentrant tachycardia (AVNRT) is poorly understood. This study was performed to characterize successful slow pathway (SP) ablation site and to elucidate the role of LPNE in genesis of atypical AVNRT with eccentric activation patterns within the coronary sinus (CS).
Methods and Results: Among 45 patients with atypical AVNRT (slow-slow/fast-slow/both = 20/22/3 patients) with concentric (n = 37, 82%) or eccentric CS activation (n = 8, 18%), successful ablation site was evaluated. Among 35/37 patients (95%) with concentric CS activation, ablation at the conventional SP region outside CS eliminated both retrograde SP conduction and AVNRT inducibility. Among eight patients with eccentric CS activation, the earliest retrograde atrial activation was found at proximal CS 16 ± 4 mm distal to the ostium during AVNRT. The earliest retrograde activation site was located at inferior to inferoseptal mitral annulus, consistent with the presumed location of LPNE. Ablation at the conventional SP region with electroanatomical approach only rendered AVNRT nonsustained without elimination of retrograde SP conduction in seven of eight patients (88%). Ablation targeted to the earliest retrograde atrial activation site within proximal CS (15 ± 4 mm distal to the ostium); however, eliminated retrograde SP conduction and rendered AVNRT noninducible in six of eight patients (75%).
Conclusion: In 75% of "left-variant" atypical AVNRT, ablation within proximal CS was required to eliminate eccentric retrograde SP conduction and render AVNRT noninducible, suggesting LPNE formed retrograde limb of reentrant circuit.     

Phase I/II Trial of Docetaxel and Carboplatin as a First-Line Therapy in Patients with Stage IV Non-Small-Cell Lung Cancer

A phase I/II study was conducted to determine the maximum-tolerated dose, the safety and tolerability, and the clinical efficacy of carboplatin and docetaxel in combination in patients with stage IV non–small-cell lung cancer. Patients with measurable, previously untreated, good performance status, and stage IV non–small-cell lung cancer were eligible. Increasing doses of docetaxel were given in combination with a fixed dose of carboplatin except at level 5. Cycles were repeated every four weeks. Seventy-seven patients were registered. In phase I, 27 patients were entered at five different dose levels. A docetaxel dose of 60 mg/m² and carboplatin area under the concentration time curve 6 was recommended for phase II, and an additional 50 patients were entered at this level for a total of 56 patients. Grade 3/4 neutropenia was the most common adverse event and occurred in 70% of the patients. Two patients had febrile neutropenia. Fifty-six patients were assessable for response; 21 partial responses were observed for an overall response rate of 37.5%. The median time to tumor progression was 4.0 months (range, 1.0–21.0 months), and the median survival was 12.9 months (range, 0.4–51.3 months). The one-year survival rate was 46.4%. The combination of docetaxel 60 mg/m² and carboplatin area under the concentration time curve 6 is feasible and effective in patients with stage IV non–small-cell lung cancer.     

Sleep-disordered breathing and blood pressure levels among shift and day workers

BACKGROUND: Sleep-disordered breathing (SDB) can be one of the major determinants of high blood pressure (BP), but there has been no study on SDB with an emphasis on shift workers. The objective of this study was to examine whether a relationship between SDB and blood pressure/hypertension is more evident among shift workers than among day workers. METHODS: In this cross-sectional study, we measured BP levels and oxygen desaturation index (by nocturnal pulse oximetry) among 253 male shift workers and 206 male day workers aged 30 to 62 years at nuclear power plants in Japan. RESULTS: The prevalence of SDB (3% oxygen desaturation index >or=10 and >or=15 per hour) in all subjects was 11.3% (95% confidence interval [95% CI] 8.4-14.2) and 6.1% (95% CI 3.9-8.3), respectively, with no statistical difference between shift and day workers. Systolic and diastolic BP levels were correlated with 3% oxygen desaturation index in all subjects after adjustment for potential confounding variables. This association was primarily observed among workers aged >or=40 years, more specifically older shift workers. CONCLUSIONS: A correlation between SDB severity and diastolic BP levels among shift workers aged >or=40 years suggests the importance of screening for SDB among shift workers for BP control.     

Out-of-Hospital Cardiopulmonary Arrest Due to Penetrating Cardiac Injury Treated by Percutaneous Cardiopulmonary Support in the Emergency Room: Report of a Case

Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients.     

Two cases of type 1 diabetic women with diabetic ketoacidosis presenting as alkalaemia

We report two type 1 diabetic patients with diabetic ketoacidosis accompanied by alkalaemia. Twenty-three cases have been reported to date, and the main causes for alkalaemia were vomiting, alkali ingestion, and diuretics use. Our report indicated that poorly controlled diabetic patients who already had autonomic neuropathy are at risk.