Management of Spinal Cord Stimulators in Patients with Cardiac Pacemakers

We report a case of spinal cord stimulation (neurostimulation) as treatment for angina pectoris pain in a patient with a demand pacemaker. The precautions to avoid inhibition of the demand pacemaker by the neurostimulator are discussed.     

A variant form of X-linked chronic granulomatous disease with normal nitroblue tetrazolium slide test and cytochrome b

Chronic granulomatous disease was diagnosed in a boy who suffered from severe generalized infections. Family investigations revealed the inheritance of the disease to be X-linked. However, unlike other cases of X-linked chronic granulomatous disease, the membrane oxidase of the neutrophils from this patient was not totally defective and sufficient activity was left to result in a normal phorbol myristate acetate-stimulated nitroblue tetrazolium slide test. Also, unlike the usual findings in X-linked chronic granulomatous disease, cytochrome b was present in normal amounts in the neutrophils from this patient. The cytochrome was normal, judged from its midpoint potential of -245 mV and its ability to bind CO. It is thus apparent that X-linked chronic granulomatous disease may result from at least two different defects and that the phorbol myristate acetate stimulated nitroblue tetrazolium slide test fails to detect some cases.     

EFFECTS OF THE EXTRADURAL ADMINISTRATION OF LOCAL ANAESTHETIC AGENTS AND MORPHINE ON THE URINARY EXCRETION OF CORTISOL, CATECHOLAMINES AND NITROGEN FOLLOWING ABDOMINAL SURGERY

Twenty patients undergoing major abdominal surgery were allocatedrandomly to receive either general anaesthesia with low-dosefentanyl plus intermittent systemic morphine for postoperativepain or the same general anaesthetic plus extradural analgesiaduring and following surgery (local anaesthetics from beforeskin incision until 24 h after skin incision plus extraduralmorphine 4 mg every 12 h from 3 h to 72 h after skin incision).Postoperative pain scores were lower (P < 0.05) in the groupreceiving extradural analgesia, but this regimen failed to preventthe increase in the urinary excretion of cortisol, adrenaline,noradrenaline and nitrogen both on separate days and on cumulativemeasurements over 4 days. Pain scores did not correlate to urinaryexcretion of the various endocrine-metabolic indices eitheron separate days or over the cumulative 4-day period. It isconcluded that the relief of pain per se has no major influenceon the catabolic response to abdominal surgery.     

The effect of vagal nerve stimulation on net fluid transport in the small intestine of the cat

The effect of electrical vagal nerve stimulation on intestinal net fluid transport rate was studied in the small intestine of the cat. The splanchnic nerves were severed in all experiments. Absorption was quantified with a new gravimetric technique which made it possible to study fluid transport also during intestinal motility. The stimulation characteristics were varied to activate selectively low threshold fibres or low and high threshold fibres. The observations did not reveal any affects of low threshold stimulation on intestinal fluid transport whereas an inhibition was seen when also the high threshold fibres were stimulated. This inhibitory vagal mechanism could also be elicited after the administration of atropine. Atropine in itself increased “resting” net fluid absorption. The results speak against a role for vagal cholinergic mechanisms in the control of net fluid absorption. There seem, however, to be tonically active intramural cholinergic pathways and noncho-linergic inhibitory vagal neurons of unknown physiological significance.     

Hydrogen bond connectivity patterns and hydrophobic interactions in crystal structures of small,acyclic peptides

Crystal structures of all available unblocked linear peptides with two to five residues were retrieved from the Cambridge Structural Database and their intermolecular contacts and packing modes studied using molecular graphics. This survey reveals that interactions between hydrophobic portions of the molecules are critically important in determining the overall features of their crystal packing patterns. Distinct hydrophobic columns or layers are observed in almost all crystal structures. Analyses of the relationships between these interactions and crystal growth properties of small peptides are given. It is suggested that needle growth is promoted by hydrophobic packing, usually along a short crystallographic axis (4.6-6.0 Å). Also contributing to these morphologic characteristics are entropic factors associated with hydrophobic aggregation as well as tightly bound water molecules on hydrophobic faces. The paper also provides a comprehensive overview of hydrogen bond patterns in acyclic peptide crystals. It is demonstrated that one of their primary roles is to provide a scaffolding within which hydrophobic groups can aggregate. Even though there is a high density of hydrogen bonds in the crystals, often with complex patterns and networks, certain motifs are found to recur in a number of structures indicating specific hydrogen bond preferences. Water, for example, is an integral part of the hydrogen bond networks in these crystals, usually acting as the primary donor for main-chain carboxylate groups in peptide hydrates.     

The Paclitaxel‐Eluting Coroflex™ Stent Study II (PECOPS II) Acute and 6‐Month Clinical and Angiographic Follow‐Up, 1‐Year Clinical Follow‐Up

Background and Objectives: Paclitaxel‐coated stents have proven their efficacy for reducing restenosis in de novo coronary artery lesions and in‐stent restenoses with superiority compared to bare metal stents. This study was performed to evaluate the procedural and 1 year results of the Paclitaxel‐eluting Coroflex? Please stent in coronary artery lesions. Methods: One‐hundred and twenty‐nine patients (66.2 ± 8.2 years, 31.0% diabetics, 20.2% unstable angina, 41.8% multivessel disease) were enrolled per protocol for elective single stent deployment into native de novo or post‐PTCA restenotic coronary lesions.The mean reference diameter was 2.84 ± 0.43 mm, the lesion length 12.51 ± 4.6 mm, and the minimal lumen diameter 0.75 ± 0.29 mm. Follow‐up was performed clinically in 129/129 (100%) after 6 and 12 months and angiographically in 120/129 (93%) patients after 6 months. Results: The success rates of the procedure and deployment were 100% and 95.3%, respectively. The in‐stent late loss and the late‐loss index were 0.27 ± 0.59 mm and 0.17 ± 0.40 resulting in binary in‐stent restenoses in 16/120 (13.3%) subjects and in‐segment restenoses in 20/120 (16.7%) subjects. Major adverse cardiac events occurred in 23/129 (17.8%) during the first 6 months of follow‐up with 3/129 (2.3%) myocardial infarctions, 1/129 (0.8%) secondary to stent thrombosis. From 6 to 12 months, 2/129 (1.6%) nonlesion related PCI were performed. Conclusion: The data of the Paclitaxel‐eluting Coroflex? Please stent evaluated in PECOPS II are within the range of the other currently available Paclitaxel‐eluting stent. (J Interven Cardiol 2010;23:160‐166)     

ANTI-IgG ANTIBODIES IN JUVENILE RHEUMATOID ARTHRITIS

ABSTRACT. Egeskjold, E.-M., Permin, H., Hørbov, S. and Graudal, H. (Rheumatism Research Unit of Aarhus University, Aarhus, Denmark). Anti-IgG antibodies in juvenile rheumatoid arthritis. Acta Paediatr Scand, 70:711,.–Sixty-two patients, 48 children and 14 adults, with juvenile rheumatoid arthritis (JRA) and 62 age and sex matched controls were studied for anti-IgG antibodies of the classes IgG, IgM and IgA by an indirect immunofluorescence method. 88 % of 48 children =≤16 years and in 64 % of 14 patients >16 years with JRA against 2 % of the controls. IgM anti-IgG occurred inIgG anti-IgG occurred in 4 % of the children, in 24 % of the adults and in 2 % of the controls. IgA anti-IgG occurred in 2 % of the patients and in none of the controls. The prevalence of IgG anti-IgG was the same in pauciarticular, polyarticular and systemic cases, whereas the titres were higher in polyarticular than in pauciarticular cases, and higher in children with a disease duration of more than 5 years. Higher titres were related to higher ESR and lower hemoglobin values. The relationship of higher titres to clinically active disease was not statistically significant. No relationship was found to age, sex, age at onset, or to the dureation of disease. The titres were not related to the concentrations of serum IgG or to the titres of antinuclear antibodies. IgG anti-IgG are common to all the clinical types of JRA, whereas antinuclear antibodies separate the systemic type from pauci- and polyarthritis. Their possible pathogenic significance must therefore be different.     

Stage-specific immunity to Taenia taeniaeformis infection in mice. A histological study of the course of infection in mice vaccinated with either oncosphere or metacestode antigens

The course of Taenia taeniaeformis infection in mice previously vaccinated with antigens prepared from either oncosphere (TtO) or metacestode (TtM) was followed by histological examination of livers from mice killed at various times post-infection (p.i.). Distinctly different immune responses occurred in the two groups. Very few cysts were seen at any stage of infection in TtO-vaccinated mice and most of those which were present appeared histologically similar to cysts in control mice. In TtM-vaccinated mice many cysts were present from early in infection but histologically it was apparent that most were dying from 15 days p.i. because the tegument had lost its integrity, and degranulated polymorphonuclear leucocytes were present inside the parasites. These findings support earlier suggestions that stage-specific antigens are expressed in oncospheres and metacestodes. Parasites developing normally were surrounded by a halo of alcian blue staining amorphous acellular material. This material appeared to act as a barrier to attack by host inflammatory cells, and disappearance of this layer signalled death of the parasite. The possibility that the gut acted as a barrier to delay migration of oncospheres to the liver in vaccinated mice was investigated, but no evidence for this could be found.