Th1 and Th2 Cytokines and IgE Levels in Identical Twins with Varying Levels of Cigarette Consumption

Some have suggested that tobacco smoke may skew the immune system toward a Th2 pattern, however the effects of genetics or childhood exposures could explain these results. We compared PMBC supernatant or serum Th1 (INF-) and Th2 (IL-4, IL-5, and IL-13) cytokine and IgE levels in members of 45 pairs of nonasthmatic monozygotic twins with varying levels of current cigarette consumption to determine if smoking was associated with Th1/Th2 function after accounting for genetic factors. A statistically significant dose-response was observed between levels of smoking and IL-13 (p=0.05). Mean IL-13 level among heavy smokers (20+ cigarettes/day) was 146% higher than that among nonsmokers (+26.2 pg/mL; p=0.04). The mean IL-5 level among heavy smokers was 166% higher than that among light (<20 cigarettes/day) smokers (+3.4 pg/mL; p=0.03). No statistically significant differences in INF-, IL-4, or IgE levels were observed. Smoking appears to be associated with increased levels of IL-13.     

Reentrant Junctional Tachycardias

AKHTAR, M.: Reentrant Junctional Tachycardias. Most of the tachycardia arising in the atrioventricular (AV) junction are reentrant in nature. The two most common variety are AV nodal reentry and AV reentry utilizing an accessory pathway of the Kent bundle type. Typically these tachycardias have narrow QRS complex and are regular but an associated right or left bundle branch block could result in a wide QRS complex. Other mechanisms for wide QRS in AV junctional tachycardia include: (a) antidromic reentry; (b) preexcited tachycardia using two accessory pathways; (c) AV nodal reentry with incidental accessory pathway participation; and (d) atriofascicular (nodoventricular) Mahaim participation. A variety of surface ECG and intracardiac electrophysiological methods are used to delineate the precise mechanisms which is essential for successful nonpharmacological therapy in these patients.     

Role of Cardiac Electrophysiologic Studies in Patients with Unexplained Recurrent Syncope

Cardiac electrophysiologic studies (EPS) with programmed electrical stimulation (PES) were performed in 30 patients with recurrent syncope to uncover possible arrhythmic etiology. All patients had undergone thorough medical and neurologic evaluation prior to EPS without finding a definitive cause for syncope. In the majority of patients an arrhythmic etiology for syncope was suspected but could not be documented utilizing the 12-lead surface ECG, extended in-hospital and/or ambulatory monitoring (for ≥ 48 hours) and exercise testing prior to the EPS. The studies provided a clue to the possible underlying rhythm disturbance which could have caused syncope in 16/30 patients. Sustained or nonsustained ventricular tachycardia and/or ventricular fibrillation was induced in 11/30, sinus node dysfunction in 4/30 and intra-His block in the remaining one. Fourteen of the 16 have remained free of symptoms following therapy based on results of EPS during a follow-up period ranging from 6–30 months (mean 16.5 ± 7.8). In 2/16 syncope recurred (one arrhythmic and one non-arrhythmic) despite pacemaker therapy for sinus node dysfunction detected during EPS. In the remaining 14/30 patients, EPS and PES did not induce arrhythmia which could account for patient symptomatology and therefore no specific therapy could be recommended. Eleven of these 14 patients experienced a recurrence of symptoms within a 6–25 month period (mean 16.2 ± 6.8). Of the 16 patients with inducible arrhythmias considered clinically significant, 15 had associated structural heart disease. On the other hand, of the 14 patients without clinically significant arrhythmias, structural heart disease could be detected in only three. It is concluded that cardiac arrhythmias constitute a common cause of unexplained syncope, particularly in patients with structural heart disease, and that EPS with PES can uncover the type of arrhythmic disturbance in a significant number of cases.     

Hepatoprotective and Antioxidant Activity of Rhizome of Podophyllum hexandrum against Carbon Tetra Chloride Induced Hepatotoxicity in Rats

Objective To test possible antioxidant activity of n-hexane extract of Podophyllum hexandrum under in vitro and in vivo conditions. Methods The in vitro antioxidant activity was evaluated by the ability of the extract to interact with the stable free radical DPPH, Superoxide (O2-), Hydroxyl (OH-), Hydrogen peroxide (H2O2) radicals, and reducing power ability of the extract was also evaluated. Under in vivo conditions the extract was evaluated for its hepatoprotective activity by measuring different biochemical parameters, such as serum alanine aminotransaminase, serum aspartate aminotransaminase and serum lactate dehydrogenase and antioxidant enzymes. Antioxidant status was estimated by determining the activities of antioxidative enzymes, glutathione reductase (GR), glutathione peroxidase (GPx), glutathione-S-transferase (GST) and superoxide dismutase (SOD), and by determining the levels of reduced glutathione (GSH) and thiobarbituric acid reactive substances (TBARS). Results Hexane extract of P. hexandrum exhibited good radical scavenging capacity in neutralization of DPPH, O2-, OH -, and H2O2 radicals in a dose dependent manner. n-hexane extract of Podophyllum hexandrum at the doses of 20, 30, and 50 mg/kg-day produced hepatoprotective effect by decreasing the activity of serum marker enzymes, while it significantly increased the levels of glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), super oxide dismutase (SOD), and glutathione-S-transferase (GST) in a dose dependant manner. The effect of n-hexane extract was comparable to that of standard antioxidant vitamin E. Conclusion The extract of Podophyllum hexandrum possess free radical scavenging activity under in vitro conditions and could protect the liver tissue against CCl 4 induced oxidative stress probably by increasing antioxidant defense activities.     

Ablation of Left Free-Wall Accessory Pathways Using Radiofrequency Energy at the Atrial Insertion Site:

Transseptal versus Transaortic Ablation. Introduction: Transcatheter ablation of the left free-wall atrioventricular accessory pathways (AP) by delivery of radiofrequency current at the ventricular insertion site has been shown to be effective. The efficacy of such a technique targeting the atrial insertion site of the AP was evaluated.
Methods and Results: One hundred consecutive patients with left free-wall APs and symptomatic supraventricular tachyarrhythmias were included. APs were manifest in 55 patients and concealed in 45. There were 55 men and 45 women with a mean age of 35 years. A total of 107 left free-wall APs were identified in these patients. In these 100 patients, successful ablation was accomplished in all by using a transseptal (45 patients) or transaortic (54 patients) technique. In one patient, ablation was accomplished from within the coronary sinus. Seven patients required a repeat ablative procedure, which was performed successfully. During 107 ablative procedures, six were associated with nonfatal complications including pericardial effusion (hemopericardium) in two patients, mild mitral regurgitation in two patients, swelling of the left arm in one patient, and staphylococcal bacteremia in one patient. Eighty-two (82%) patients underwent a repeat electrophysiologic study 6 to 8 weeks after successful ablation and were found to have no functioning AP or inducible supraventricular tachycardia. During a mean follow-up of 20 ± 8 months, none of the 100 patients had a recurrence of tachyarrhythmias.
Conclusion: These data indicate that the atrial insertion site of the AP can be successfully ablated in the majority of patients with left free-wall APs by using cither a transseptal or transaortic approach. Furthermore, both techniques are associated with minimal morbidity and no mortality.     

Reversal of streptokinase induced bleeding with aprotinin for emergency cardiac surgery

Two patients requiring emergency cardiac surgery following the administration of streptokinase are described. In each case aprotinin was given to counteract the haemorrhagic effects of the streptokinase.     

Catheter Ablation of the Left Bundle Branch for the Treatment of Sustained Bundle Branch Reentrant Ventricular Tachycardia

Sustained Bundle Branch Reentrant VT. Radiofrequency catheter ablation of the left bundle branch (LBB) was attempted in a patient with sustained bundle branch reentry. During sinus rhythm, the QRS had a complete LBB block pattern, and the LBB was activated retrogradely (transseptal). Ablation of the LBB eliminated inducibility of the tachycardia, while the QRS complex and the duration of the HV interval (70 msec) remained unchanged. Successful ablation of the LBB eliminated bundle branch reentry and yet maintained the anterograde conduction properties of the His-Purkinje system, obviating implantation of a permanent pacemaker.     

Sinus Tachycardia with Atrioventricular Block:

Sinus Tachycardia with AV Block During VVS. Introduction : Neurocardiogenic (vasovagal) syncope is characterized by hypotension and bradycardia. The presence of sinus tachycardia along with AV block during syncope in patients with neurocardiogenic syncope has not been described previously.
Methods and Results : Two female patients (18 and 16 years old) with recurrent syncope and documented sinus tachycardia at the time of syncope are described. Patient 1 had recurrent episodes of syncope. During one of these episodes, which occurred while she was being monitored, sinus tachycardia along with high-grade AV block was seen at the time of syncope and hypotension. Patient 2 had a history of recurrent syncope and seizure. During one of these episodes, she was documented to have ventricular asystole lasting for about 39 seconds. The sinus rate was 480 msec at the beginning, before slowing down to 960 msec prior to restoration of sinus rhythm with 1:1 AV conduction. The same scenario was repeated during head-up tilt testing. Both patients were treated successfully with oral disopyramide and, during a follow-up of 28 months and 9 months, have remained symptom-free.
Conclusion : Sinus acceleration along with high-grade AV block during syncope and hypotension can occur in some patients with neurocardiogenic syncope. The exact mechanism of this phenomenon is unclear.     

ERYTHROMELANOSIS FOLLICULARIS FACIEI ET COLLI

Three Iranian men of light complexion, aged 15, 18, and 28, were seen in 1992. All three patients were referred with the chief complaint of increasing pigmentation over both cheeks since childhood. The pigmentation had gradually extended to involve the preauricular areas bilaterally. There was no history of pruritus or discomfort. Two patients related an increase in pigmentation to extremes of temperature, and one patient also complained of a burning sensation when exposed to sunlight. The third patient cited no change at different temperatures. All three patients had visited a few local physicians and had received sunblocks and topical steroids with no definite diagnosis. No improvement was noticed by use of the prescribed medications. Family history of pigmentary disturbance was negative in all three cases. Examination in all three cases revealed a well-demarcated reddish-brown pigmentation over both cheeks extending to the preauricular area (Fig. 1). In one patient part of the auricle was also involved. No extension to the neck area was seen in any of the cases. Pinhead sized white follicular papules producing a granular texture were clearly evident over the involved areas (Fig. 2). Vellus hair growth was affected in all three cases. No evidence of scar formation or atrophy was noted. Diascopy in all three patients revealed blanching of the erythematous component of the pigmentation with no change in the brown discoloration. Keratosis pilaris was evident over both arms in all three patients, and in one patient mild keratosis pilaris was also noted on the legs. A biopsy was performed in two patients. Histopathologic examination of both biopsy specimens revealed a similar picture. There was slight hyperkeratosis with no parakeratosis and only mild acanthosis. Follicular hyperplasia and plugging were evident. Fontana staining revealed intense melanin pigmentation of the basal layer. Mild perivascular mononuclear cell infiltration was observed in the upper dermis (Fig. 3).