Acute fatty liver of pregnancy

Acute fatty liver of pregnancy is a serious complication of the 3rd trimester associated with high rates of maternal-fetal morbidity and mortality. Prompt diagnosis and treatment are essential to achieve optimal maternal-fetal outcomes. Collaboration between critical-care and perinatal nursing staffs is a crucial component of managing patient care. A recent case of acute fatty liver of pregnancy is reported. A team approach resulted in the survival of the patient and the delivery of healthy twins.     

On-Line Interval Measurement During Invasive Cardiac Electrophysiologic Testing

A microprocessor-based timer has been developed for routine and research use in cardiac electrophysiologic studies. The cycle length (A-A) and the conduction times through the right atrium (A(HRA)-A(HIS], the AV node (A-H) and the His-Purkinje system (H-V) can be automatically measured beat-to-beat in real-time both during sinus rhythm and during atrial pacing. The design has been refined during three years of use in over 80 clinical studies. A comparison between manual and automatic measurements has been executed for randomly chosen portions of 10 studies. With the manual measurements as reference procedures the sensitivities of the automatic measurements of the A, H and V waves were 0.98, 0.88 and 0.92, respectively, while the specificities were 0.93, 0.92 and 0.93, respectively. For the true positive measurements the correlation coefficients of the intervals were r(A-A) = 0.9998, r(A-H) = 0.987 and r(H-V) = 0.988. The statistical analysis of the differences between manual and automatic readings for the intervals A-A, A-H and H-V yielded mean values of -1 ms, -0.8 ms and 0.6 ms and standard deviations of 3 ms, 4 ms and 4 ms which are smaller than the accuracy of the common manual measurements.     

Structure of cyclic peptides: the crystal and solution conformation of cyclo(Phe-Phe-Aib-Leu-Pro)

A solid-state and solution conformation analyses of the cyclopentapeptide cyclo(Phe-Phe-Aib-Leu-Pro) has been carried out by X-ray diffraction and nuclear magnetic resonance techniques. The structure of the hexagonal crystals, grown from a methanol solution [a=b= 16.530(4) Å, c= 21.356(9) Å, space group P6₅, Z = 6], shows the presence of one intramolecular N-H?O=C hydrogen bond with the formation of a γ-turn (C₇). The Aib³ residue, at the center of the γ-turn, presents unexpected values of the torsion angles [φ= 70.5° and ψ= -73.8°], which have been observed only once before for this helicogenic residue. A cis peptide bond occurs between Leu⁴ and Pro⁵; all other peptide bonds are trans. The overall conformation for the cyclopentapeptide with one cis-peptide bond on one side and an intramolecular γ-turn on the opposite side results in an equatorial topology of the side-chains of the Phe¹, Phe² and Leu⁴ residues. Indeed, the C^α-C^βand C^β-C^γ bonds of these residues lie approximately in the mean plane of the cyclic ring system. The structure is compared with data in the literature on cyclic pentapeptides. In addition the Pro-Phe-Phe moiety shows a conformation similar to that observed in other larger cyclic bioactive peptides, which indicates a reduced number of conformations for this sequence. The solution study was carried out in three different solvent systems: chloroform, acetonitrile and methanol in the temperature interval 220–300 K. In all three solvents the room temperature spectra show that the peptide is conformationally nonhomogeneous. In acetonitrile at low temperatures it is possible to reduce the conformational equilibrium to two predominant conformers which differ for the cis-trans isomerism of the Leu⁴-Pro⁵ peptide bond.     

Validation of a Method for Choice of Pacing Mode in Carotid Sinus Syndrome With or Without Sinus Bradycardia

A new method for selection of the pacing mode in 60 consecutive patients with severe cardie-inhibitory or mixed carotid sinus syndrome was prospectively validated. ODD pacing was preferred for 26 patients with: (1) the cardioinhibitory form and who had symptomatic pacemaker effect; (2) mixed type I form, (cardioinhibitory and vasodepressor) with symptomatic pacemaker effect, ventriculoatrial conduction or orthostatic hypotension; (3) mixed type II; or (4) severe bradycardia. VVI pacing was seiected in the remaining 34 patients without these symptoms. During a 32 ± 10 month follow-up period syncope and severe dizziness persisted in five patients in the VVI group (15%) and in three patients in the ODD group (12%). Symptomatic relief occurred in 87% (52/60) of patients. Minor symptoms persisted in 47% of the VVI group and 42% of the DDD group. No patient developed cardiac insufficiency or intolerance to pacing. During a 2-month duration a single-blind, randomized, cross-over study compared VVI and DDD pacing, 69% of the patients programmed from DDD to VVI suffered more frequent, severe, and intolerable symptoms. (1) Thirty four of 60 patients (57% of the entire group) in whom VVI pacing was satisfactory were identified prior to pacemaker implant. In the remainder, VVI pacing was contraindicated as it produced frequent side effects. (2) The preimplant predictive value that VVI pacing would be successful was 85% for those eventually receiving VVI pacemakers and the preimplant predictive value that VVI pacing would fail was 69% for those who underwent DDD implant.     

The Parotid and the Pancreas

Physiologic, experimental, and clinical studies have been presented concerning the salivary secretion in man and animals with and without pancreatic disease. Further evidence is presented that hoth organs tend to respond to noxious agents, to show a parallelism of secretion, and to display a glandular histologic and fvuictional relationship which may he concordant or inverse.     

The effect on epidermal DNA synthesis of a combination of topical steroid with either dithranol or tar as used for psoriasis

The hairless mouse was used to investigate the effects of a combination of glucocorticosteroid with either dithranol or tar on epidermal DNA synthesis, in order to determine whether such combinations reduce epidermal DNA synthesis more effectively than the single agents. Dithranol alone produced a significant local inhibition of DNA synthesis at concentrations of 0.1% and 0.05% but not at lower concentrations. Dose-response data for dilutions of clobetasol propionate and betamethasone 17-valerate showed progressive diminution of both local and systemic effects with decreasing concentrations. An additive effect was found from combining clobetasol propionate with dithranol and from combining betamethasone 17-valerate with liquor picis carbonis. These combined preparations were tested again after storage for 6 months and 2 months respectively and showed no loss of efficacy. These results lend justification to the use of these combined preparations in the treatment of psoriasis.     

Radiofrequency Catheter Ablation and Modulation of Atrioventricular Conduction in Patients with Atrial Fibrillation

We attempted radiofrequency ablation of the AV junction with a sequential right- and left-sided approach in 78 patients affected by severely symptomatic, drug refractory atrial fibrillation. Stable third-degree A V block was obtained in 99% of cases and, after 3 months, persisted in 92% of cases. Single session, stepwise, radiofrequency modulation of the AV node was attempted in 13 patients with paroxysmal atrial fibrillation. During sinus rhythm, ablation of the slow and fast AV node pathways was performed in order to increase the nodal refractory period or to slow conduction. Clinically successful modulation of AV conduction was achieved in 15% of cases and persisted during a 3-month follow-up. In conclusion. AV junction ablation is a well-established means of treating atrial fibrillation, but implies the implant of a permanent pacemaker. AV node modulation avoids the pacemaker implant, but is efficacious only in a minority of patients. Thus, in patients affected by paroxysmal atrial fibrillation, AV modulation should be attempted first; if this is ineffective. AV ablation can be performed during the same session.