Successful Radiofrequency Ablation of an Accessory Pathway During Pregnancy

The preexcitation syndrome is a rare entity during pregnancy. We present a 20-week pregnant patient with Wolff-Parkinson-White syndrome and recurrent episodes of tachycardia with hemodynamic compromise refractory to medical treatment that required electrical cardioversion several times. Due to the poor evolution we performed a successful radiofrequency ablation of a right posteroseptal accessory pathway using 70 seconds of total fluoroscopy time without complications. We consider this is an alternative and safer treatment in those cases in which the tachyarrhythmias compromise the hemodynamic state during pregnancy.     

SLEEP DISORDERS, SLEEP APNEA. AND STROKE

Sleep is the natural suspension of consciousness during which the powers of the body are restored Sleep recurs with remarkable periodicity in alliance with the geocosmic cycle and in compliance with the circadian rhythms of the body.     

Bilateral Dental Fusion of the Upper Central Incisors: A Multidisciplinary Approach

Abstract: The multidisciplinary treatment of a case of bilateral dental fusion of the upper central incisors with maxillary constriction, crowding, and palatal inversion of one of the lateral incisors is reported. The rarity with which this anomaly appears, along with its complex characteristics, often make it extremely difficult to treat. It requires the involvement of different specialists to find the most suitable treatment for each individual patient.     

Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome

BRIGNOLE, M., ET AL: Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome. The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia < 50 beat/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal, episodes per patient (2.9 ± 2 vs 1.8 ± 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.     

Limitations and Potentialities of Doppler Echocardiography in the Evaluation of Mitral Flow

Doppler ultrasound has improved the evaluation of mitral valve diseases. There are, however, some limitations to its use. We describe a case of mitral valve disease in which an unusual concomitant rhythm disturbance highlights the limitations of the Doppler-derived pressure half-time method in evaluating the valve area, and the different behavior of the diastolic regurgitation across the two atrioventricular valves.     

RELATIONSHIP BETWEEN ETHANOL-RELATED DISEASES AND NUTRITIONAL STATUS IN CHRONICALLY ALCOHOLIC MEN

Two-hundred and fifty chronically alcoholic men (mean age, 41± 11 years) entering an alcoholism treatment programwere studied. Detailed clinical history, nutritional assessmentand measurement of muscle strength by electronic myometer wereperformed in each case. In addition, hepatic ultrasonographyand liver biopsy, echocardiography and radionuclide cardiacscanning, and electrophysiological testing of peripheral nerveswere performed when there was clinical evidence of liver disease,cardiomyopathy or neuropathy, respectively. Alcoholic cirrhosiswas diagnosed in 20 cases, skeletal myopathy in 117, dilatedcardiomyopathy in 20 and peripheral neuropathy in 41 cases.No patients with chronic myopathy or cardiomyopathy showed eitherclinical or laboratory evidence of malnutrition. Patients withcirrhosis showed a significantly lower lean body mass than controls(P = 0.03) and significantly lower nutritional protein levelsthan those alcoholics without cirrhosis. Alcoholics with peripheralneuropathy had significantly lower anthropometric parametersand nutrition protein levels than their counter parts (P <0.001). However, in the multivariate analysis, the only independentfactor for developing these complications of alcoholism wasthe total lifetime dose of ethanol (P < 0.001). We concludethat alcohol-related diseases are common in asymptomatic alcoholicmen and these diseases appear to be due to an accumulative toxiceffect of ethanol. Age and nutritional status do not seem toplay a part in the development of such diseases.     

Hyalocyte-Like Cells are more Numerous in the Posterior Chamber than they are in the Vitreous of the Rabbit Eye

The distribution and concentration of free cells inside the eye chambers of rabbits were investigated using semi-quantitative analysis of histological paraffin sections. Studies using light (methacrylate sections) as well as transmission and scanning electron microscopy were undertaken for the morphological characterization of the free cells. Immunocytochemistry and autoradiography were employed in an attempt to find out their nature and their origin, respectively. It was observed that cells morphologically similar to the vitreous hyalocytes were more numerous inside the posterior chamber than were the hyalocytes in the cortical vitreous. Neither the hyalocytes nor the posterior-chamber cells reacted with an antibody to rabbit macrophages. The finding of labeled free cells after an intravitreal injection of³H-thymidine indicates that these cells can renew themselves and that their number does not depend exclusively on monocytes migrating from the blood stream to the eye chambers, as is believed to occur. In conclusion, hyalocytes or hyalocyte-like cells are more concentrated in the posterior chamber than they are in the vitreous. Both the hyalocytes and the posterior-chamber cells could not be characterized as fully developed macrophages.