Intra-Atrial Reentrant Tachycardia After Palliation of Congenital Heart Disease:

Catheter Mapping of IART. introduction: The anatomic substrate of intra-atrial reentrant tachycardia (IART) following congenital heart surgery is poorly understood, but is presumed to be different than common atrial flutter. Methods and Results: To study the mechanisms of IART, we used a new technique for high-density endocardial mapping using recordings from a multipolar basket recording catheter (25 bipolar pairs). For each recording, biplane fluorographic reference points were digitized to obtain the spatial locations of electrode pairs, and activation times were calculated using temporal reference points from the surface ECG. Using custom software, data were combined to create three-dimensional atrial activation sequence maps, which were displayed as animated sequences. Using this technique, recordings were made in induced and/or spontaneous IART in 8 patients following congenital heart surgery (5 Fontan, 2 tetralogy of Fallot repair, 1 ventricular septal defect repair), and in 3 patients with normal intracardiac anatomy (I with type I atrial flutter). Ten discrete IART activation sequences were recorded; 2 patients had 2 sequences each. IART maps were constructed using a median of 108 electrode positions (range 27 to 197) from a median of 6 recordings/sequence (range 3 to 11). Sinus or paced atrial rhythms were also recorded, and maps were created in a similar fashion. Visual analysis of activation sequences of sinus and paced rhythm were anatomically concordant with known mechanisms of atrial activation. IART sequences revealed diverse mechanisms; only 1 IART circuit was similar to that associated with common atrial flutter. Activation wavefront emergence from presumed zones of slow conduction, lines of conduction block, and apparent bystander activation were observed. Conclusions: High-density atrial activation sequence maps demonstrate that IART following congenital heart surgery utilizes diverse circuits and is distinct from common atrial flutter. The technique used to create these three-dimensional activation sequences may improve understanding of these complex atrial arrhythmias and assist in the development of ablative therapies.     

Biochemical characterization and localization of Fasciola hepatica 26-28 kDa diagnostic coproantigen

We have previously reported the usefulness of a 26-28 kDa coproantigen of Fasciola hepatica for diagnosis of infection. In this study, the 26-28 kDa coproantigen was biochemically characterized with the aid of monoclonal antibodies (MoAb) in an effort to better understand the biology of the antigen. Differential staining of chromatographically-purified 26-28 kDa coproantigen on SDS-PAGE, under reducing and non-reducing conditions, indicated that the coproantigen was a monomeric, highly glycosylated glycoprotein. Alkaline treatment of the purified coproantigen resulted in an 8 kDa protein core which still contained the epitope recognized by the MoAb. No protease activity was associated with the 26-28 kDa coproantigen. The coproantigen could be cleaved by trypsin without altering the reactive epitope recognized by the MoAb, but was resistant to pepsin digestion. Further, the coproantigen was stable under several different storage conditions. Indirect immunofluorescence on tissue sections of adult flukes indicated that the coproantigen was present in gut cells and tegument. Taken together these results confirm the stability of the 26-28 kDa coproantigen and its usefulness in diagnostic tests for F. hepatica infections.     

Omeprazole and Helicobacter Pylori: temporary suppression rather than true eradication

Twenty-four Helicobacter pylori (H. pylori)-positive patients were treated for 28 days with either 20 mg omeprazole o.m. (n = 12) or 40 mg omeprazole o.m. (n = 12). Clearance (absence of H. pylori at the end of or shortly after treatment) and eradication (absence of H. pylori 1 month after cessation of treatment) were assessed using the 14C-urea breath test. Observed clearance and eradication were: 20 mg omeprazole 3/12 and 0/12; 40 mg omeprazole 6/12 and 1/12 respectively. The effect on H. pylori is probably due to the change in gastric pH from acid to neutral, however it is insufficient to recommend the inclusion of omeprazole in regimens aimed at eradicating H. pylori.     

{micro}-HEAVY CHAIN AND MONOCLONAL IgG K PARAPROTEINAEMIA IN SYSTEMIC LUPUS ERYTHEMATOSUS

We report the association of monoclonal µ-heavy chainand a monoclonal IgG K paraprotein in a patient with systemiclupus erythematosus (SLE). This association and the apparentlybenign nature of this biclonal gammopathy has not been previouslyreported. KEY WORDS: Systemic lupus erythematosus, µ-Heavy chains, Paraproteinaemia     

The effects of antifungal therapy on severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis

Background and objective:   Very little is known about the response rates to or appropriateness of treatment for patients with allergic fungal diseases of the lung. This study assessed the effect of antifungal therapy in patients with severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA).
Methods:   A retrospective cohort study of 33 adult patients who fulfilled the criteria for either SAFS ( n  = 22) or ABPA ( n  = 11) was conducted. All patients had received antifungal therapy for at least 6 months. The primary study end point was the effect of antifungal therapy on patients' lung function.
Results:   Overall, total IgE values and radioallergosorbent test (RAST) for A. fumigatus markedly decreased after 6 months of therapy in both SAFS and ABPA patients ( P  = 0.004 and P  = 0.005, respectively). Reduction was seen in the eosinophil count ( P  = 0.037), dose of oral steroids ( P  = 0.043) and courses of systemic steroids required ( P  = 0.041). Lung function also improved ( P  = 0.016). Four of 10 patients discontinued oral steroids after 6 months of therapy. Reduction in IgE levels ( P  = 0.015) and RAST for A. fumigatus was also observed ( P  = 0.006) for those patients treated for at least 1 year with antifungal drugs.
Conclusions:   Both ABPA and SAFS patients benefited from oral antifungal therapy. The antifungal therapy may act by reducing the antigenic load, interacting with corticosteroids or by a direct immunological effect.     

Peripheral Blood Lymphocyte Adhesion Molecule Deployment in the Immune Response

Using precise and reproducible flow cytometric measurements, the surface densities of the cell adhesion molecules (CAMs) CD29, CD2 and CD11a were studied on the CAMhigh (primed) subsets of peripheral blood CD4⁺ and CD8⁺ lymphocytes in 56 healthy subjects; 18 patients with acute bacterial infections, 19 with acute viral infections and 18 with chronic inflammatory conditions. By Mann–Whitney analysis, with significant P values adjusted for multiple comparisons to <0.0007, patients with viral infections were found to have increased CD11a on CAMhigh cells (an increase in median values of 13.7% for CD4⁺ lymphocytes and 15.8% for CD8⁺ lymphocytes); patients with chronic conditions have increased CD29 on CD8⁺CAMhigh lymphocytes (an increase in the median of 19%); and patients with bacterial infections have increased CD2 on CD8⁺CAMhigh cells (an increase in the median of 8%). There were marked individual increases in CD29 density: eight (15%) patients had CD29 gender-adjusted density on CD4⁺ cells greater than the control mean + 3 standard deviations (SD). CD29 densities on CD8⁺ cells were elevated to > control mean + 3 SD in 12 (22%) patients. By multiple regression analysis CD11a density on CD8⁺ and CD4⁺ cells and CD2 density on CD4⁺ cells were found to be associated with HLA-DR expression, but not with CD25 expression. Using standardized intercepts the authors demonstrated that there are very few circulating CD11ahighCD25⁺ cells, suggesting that these are rapidly extravasated. This study demonstrates that in disease, lymphocyte adhesion molecules are not deployed in concert and there are characteristic deployment patterns for different types of immune response.     

Necrobiosis lipoidica and sarcoidosis

We report the case of a female patient with necrobiosis lipoidica of the lower legs and coexistent systemic and cutaneous sarcoidosis. We review the six previously reported patients with coexisting necrobiosis lipoidica and sarcoidosis. The associations between the granulomatous disorders of the skin, especially necrobiosis lipoidica, sarcoidosis and granuloma annulare, are discussed. The common pathogenetic features of these disorders are reviewed.