Catheter Ablation of an Accessory Pathway within the Marshall Vein in a Patient with Mechanical Mitral Valve

A 37‐year‐old man, known case of mitral valve replacement, was referred for ablation. Meticulous mapping showed the earliest signal in the distal coronary sinus (CS). Endocardial ablation via transseptal approach failed to permanently ablate the accessory pathway. Similarly, ablation within the CS was unsuccessful. Finally, the mapping catheter was introduced into the vein of Marshall (VoM) and a very early signal was obtained. In the first 3 seconds of the radiofrequency energy application within the VoM, delta wave disappeared. During 1‐year follow‐up, the patient had no recurrence of the palpitations and electrocardiogram showed no delta wave. (PACE 2013; 36:e132–e135)     

Autoimmune polyglandular failure associated with malabsorption and gastric carcinoid tumour

Abstract. A 21-year-old female with autoimmune polyglandular failure (APG) manifested by insulin-dependent diabetes mellitus (IDDM), hypothyroidism and pernicious anaemia developed severe malabsorption due to exocrine pancreatic insufficiency. Supplemental pancreatic enzymes resulted in marked improvement of steatorrhea. There was also an incidental finding of gastric carcinoid tumour. We identified only 13 other patients in our institution with either type 2 or 3 APG, one of which had significant steatorrhoea. Another patient with IDDM, hypothyroidism and pernicious anaemia had an asymptomatic gastric carcinoid tumour. The possible mechanisms for malabsorption in APG are discussed.     

Pili multigemini

A patient with cleidocranial dysostosis developed extensive pili multigemini over the heavily bearded chin and cheek areas. Histological examination of serial sections revealed complicated follicular structures forming from two to as many eight hair shafts. Each hair is formed by a single branch of dermal papilla which is surrounded by all layers present in a normal follicle except for the outer root sheath cells. The outer root sheath surrounds the entire follicle. Irregularities in configuration of the hairs, longitudinal grooving and areas of bifurcation and re-adhesion of the hair shafts are demonstrated.     

Attention and Hypnosis: Neural Substrates and Genetic Associations of Two Converging Processes

Although attention is a central theme in psychological science, hypnosis researchers rarely incorporate attentional findings into their work. As with other biological systems, attention has a distinct anatomy that carries out basic psychological functions. Specific brain injuries, states, and drugs can all influence attentional networks. Investigation into these networks using modern neuroimaging techniques has revealed important mechanisms involved in attention. In this age of genomics, genetic approaches can supplement these neuroimaging techniques. As genotyping becomes an affordable and technologically viable complement to phenotyping, exploratory genetic assays offer insights into the genetic bases of both attention and hypnotizability. This paper discusses relevant aspects of attentional mechanisms and their underlying neuroanatomy as they relate to hypnosis. Underlining data from attentional networks, neuroimaging, and genetics, these findings should help to explain individual differences in hypnotizability and the neural systems subserving hypnosis.     

Cutis Laxa (Generalized Elastolysis) A Report of Four Cases with Autopsy Findings

Four children with cutis laxa (generalized elastolysis) are reported. The first three cases were siblings from a Canadian Indian family and the fourth case was the only affected child in an American Black family. Loose and sagging skin folded over the face, neck and trunk, gave a premature senile appearance. Post-mortem examination was performed on the first three cases. The most common and serious visceral involvement was development of pulmonary emphysema. This was present in two autopsied cases and was demonstrated by chest X-ray in the fourth case. Other abnormalities included large inguinal and perineal hernia, rectal diverticulum and multiple diverticulae of the urinary bladder.     

Assessing Coronary Flow Physiology with Intracoronary Doppler Following Coronary Interventions

Although coronary angiography has been the gold standard for assessing coronary artery stenoses, it yields information primarily about the anatomical severity of coronary artery disease, which frequently does not correlate with its physiological severity. Coronary interventions (PTCA, atherectomy, laser, etc.) are performed primarily to improve coronary flow physiology. Coronary flow physiology may be a more important end point than angiography following coronary interventions that were performed to normalize coronary flow physiology. In addition, the physiological significance of angiographically intermediate stenoses should he assessed before proceeding with catheter-based revascularization. Currently, the Doppler guidewire is available for routine clinical assessment of coronary flow physiology in the Cardiac Catheterization Lab. Several Doppler measurements have been used to assess the physiological effect of a stenosis, including the diastolic-systolic velocity ratio, proximal-distal velocity ratio, coronary flow reserve, continuity equation, and the hyperemic diastolic pressure-flow relationship. The Doppler derived coronary flow reserve correlates highly with stress nuclear perfusion images. These Doppler measurements have been made following PTCA, directional atherectomy, rotational atherectomy, and excimer laser. Following coronary interventions, adverse clinical events may be predicted if there is impaired flow physiology or cyclic flow variations. Many of the Doppler measurements used for assessing the lesion severity remain abnormal following successful coronary interventions for reasons unrelated to the lesion. Conversely, normalization of coronary physiology does not guarantee an adequate anatomical result. Further clinical trials will provide a more complete definition of the exact role for coronary flow velocity assessment following coronary interventions. (J Interven Cardiol 1996;9:163–173)