A Case of Funnel Liver Induced by Dimethylformamide

Abstract: The laparoscopic and histological findings of a patient suffering from dimethylformamide (DMF) intoxication are discussed. A 20-year-old man was admitted to our department for further evaluation of a liver injury. A laparoscopy revealed that the liver was markedly deformed by a combination of depressions and protuberances, and this finding was compatible with the funnel liver reported by H. Kalk. After an intravenous injection of high dose indocyanine green, broad whitish depressions appeared as a non-staining area and surrounding protuberances were stained a dark green color. A biopsy specimen taken from the site of the depression showed massive hepatic necrosis and a scar under the capsule. The histological diagnosis was a convalescent stage of toxic liver injury. The present report is apparently the first to consider the detailed laparoscopic findings of a liver injury induced by DMF.     

Early Detection of Pulmonary Vein Reconnection After Isolation in Patients With Paroxysmal Atrial Fibrillation: A Comparison of ATP‐Induction and Reassessment at 30 Minutes Postisolation

Introduction: Catheter ablation for paroxysmal AF (PAF) is limited by an unacceptable recurrence rate, mainly due to pulmonary vein (PV) reconnection. Strategies to minimize reconnection include adenosine infusion and also a waiting period of 30 minutes after PV isolation. The aim of the present study was to assess whether these two strategies revealed the same conduction gap. Methods and Results: In total, 88 consecutive patients (54 males, mean age of 60 years) with drug refractory PAF underwent circumferential PV isolation (CPVI). After isolation of ipsilateral PVs, with entry and exit block checked using a circular mapping catheter, 20 mg ATP was injected during isoproterenol infusion to reveal dormant conduction gap(s). Unless the reconnection revealed by ATP persisted, PVs were further remapped with the circular mapping catheter at 30 minutes postisolation. Totally, PV reconnection was observed in 56 (64%) patients. 24.3% veins (80/329) were found reconnected. Reassessment at 30 minutes postablation was more efficient as compared to ATP induction (19.8% vs 14.6% for ATP). The agreement between these 2 methods is moderate (kappa value = 0.50). In veins that transiently reconnected after ATP administration and later observed at 30 minutes postablation, 94% (17 of 19) of them were found being reconnected with the same gap. Conclusion: Acute PV reconnection is common, occurring in 64% of patients, as detected by adenosine infusion and waiting time. Each shows a unique quality as compared to one another. The combined use of these 2 methods may reduce the AF recurrence rate after CPVI.     

A Deductive Mapping Strategy for Atrial Tachycardia Following Atrial Fibrillation Ablation: Importance of Localized Reentry

Background: Atrial tachycardia (AT) occurring following catheter ablation of persistent atrial fibrillation (AF) may be challenging to map and ablate because their mechanism and location is unpredictable and may be multiple in an individual patient.
Methods and Results: A prospective cohort of 128 consecutive patients presenting 246 AT in the context of prior AF ablation was investigated. Using activation and entrainment mapping and applying the consensus definition of AT, we evaluated a deductive diagnostic approach based on up to three steps: (1) cycle length regularity, (2) search for macroreentry (i.e., involving >2 separate atrial segments), and (3) if macroreentry excluded, search for focal origin giving a centrifugal activation of the atria. A total of 238/246 (97%) sustained AT (mean cycle length [CL] 284 ± 87 ms) were successfully mapped (single AT, 51 pts; multiple AT, 77 pts) with a diagnostic time of 10 ± 8 min per tachycardia. AT were macroreentrant in 109 (46%) and focal in 129 (54%). Of the latter, only 34 focal AT originated from a discrete point site fulfilling the consensus criteria, while a distinct mechanism, localized reentry (AT that was neither macro reentry nor focal), was identified in 95. Localized reentry was defined by (1) electrograms covering ≥75% of the cycle length of AT within an area covering a single or 2 contiguous segments, (2) postpacing interval (PPI) < 30 ms at the site, (3) an identifiable zone of slow conduction, and (4) centrifugal activation of the atrium from the area.
Conclusions: This prospective study demonstrates the feasibility of rapid and accurate identification of all types of postablation AT in a large cohort of patients and describes the dominant role of localized reentry as a novel mechanism of AT.     

Epstein-Barr virus infection,Hodgkin's disease,non-Hodgkin's lymphoma,and reactive follicular hyperplasia in Japanese children: Evaluation of paraffin-embedded specimens using polymerase chain reaction and immunohistochemistry

Epstein-Barr virus (EBV) infections are common in Japanese children, with infections by EBV type 1. The relationships between EBV infection and lymphadenopathies in Hodgkin's disease (HD), non-Hodgkin's lymphomas (NHL), reactive follicular hyperplasia (RFH), and infectious mononucleosis (IM) in 37 Japanese children were evaluated. Formalin-fixed, paraffin-embedded lymph node specimens that were obtained at surgical resection or biopsy were evaluated for the presence of EBV DNA and the latent membrane protein-1 (LMP-1) using polymerase chain reaction (PCR) and immunohistochemical staining. The PCR detected EBV DNA in nine of 13 (69.2%) patients with RFH, including a case of IM, all three (100%) patients with HD, and one of 21 (4.8%) patients with NHL. All EBV-positive samples contained EBV type 1. Reed-Sternberg's cells in HD were immunohistochemically positive for LMP-1, whereas all cases of RFH and NHL were negative for LMP-1. Results suggest that EBV infection may be related to HD. Although no proof exists that EBV infection contributes to the transformation of cells, thus causing RFH or NHL, the present authors suggest that the EBV-positive cases in Japanese children demonstrate a relationship between the clinical and histopathological features of the lymphadenopathy and EBV-type 1 infection.     

Proximal Renal Tubular Acidosis Associated with Glycogen Storage Disease, Type 9

ABSTRACT. A 21/2-year-old Japanese boy with glycogen storage disease, type 9, developed proximal renal tubular acidosis (RTA). The RTA significantly improved in response to cornstarch therapy, implying a direct causal relationship between subtle metabolic derangements in glycogen storage disease, type 9, and proximal RTA.