3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) as a Direct-Acting Teratogen in Micromass in vitro Tests

3-Chloro-4-(dichloromethyl)-5-hydroxy-2( 5H )-furanone (MX) causes complete inhibition of rat embryonic midbrain (CNS) cell differentiation in the micromass in vitro test when applied at a concentration of 5 μ g/ml under conditions where MX is rapidly degraded in culture medium with a half-life of 56 min. This study investigated whether or not degradation products of MX have inhibitory effects on CNS cell differentiation following pre-incubation of MX in culture medium for 0.5, 1 or 2 hr. When MX was pre-incubated for 0.5 hr, the mean number of differentiated foci was 0.2 against 62.5 for the control. However, the number increased to 44.7 when pre-incubation time was extended to 2 hr. These results suggest that MX, but not its degradation products, is a teratogen in vitro. MX manifested almost complete inhibitory effects on CNS cell differentiation by 0.5 hr of exposure.     

High‐dose unfractionated heparin therapy in a pregnant patient with antiphospholipid syndrome: a case report

A case of a 37‐year‐old pregnant patient with antiphospholipid syndrome (APS), who has a medical history of both thrombosis and recurrent fetal loss, is presented. She was treated with predonisolone and fixed‐dose unfractionated heparin (UFH) infusion, followed by plasmaphereses and fixed‐dose low‐molecular‐weight heparin infusion during her fourth pregnancy. Unfortunately, this treatment did not have beneficial effects, resulting in intrauterine growth restriction and finally neonatal death. Continuous intravenous UFH infusion and low‐dose aspirin were administrated under the monitoring of the activated partial thromboplastin time to achieve a target level of 120 s during her fifth pregnancy. A healthy baby weighing 1818 g at birth was delivered by Cesarean section at the 34th week of pregnancy. High‐dose UFH infusion may be considered to be one of the preferable options to manage pregnant patients with refractory APS.     

Idiopathic retroperitoneal fibrosis associated with IgG4-positive-plasmacyte infiltrations and idiopathic chronic pancreatitis

Idiopathic retroperitoneal fibrosis (IRPF) is an inflammatory fibrosclerosing condition, leading to renal failure by obstruction of the ureters. Idiopathic chronic pancreatitis associated with marked inflammatory infiltrates has recently been referred to as autoimmune pancreatitis (AIP), and infiltrating plasmacytes carrying immunoglobulin-gamma type 4 (IgG4) are relevant to its pathogenesis. The case is described herein of IRPF associated with subclinical pancreatitis that was most probably AIP in a 70-year-old man. Biopsy specimens of the retroperitoneal pseudotumor revealed a marked lymphoplasmacytic infiltration with dense fibrosis. Infiltrating plasma cells were immunoreactive for anti-IgG4 antibodies. Subsequent systemic examinations showed an extremely elevated serum IgG4 level and pancreatitis concordant with AIP. Following oral steroid administration, the serum IgG4 level normalized, although the appearance of the pseudotumor did not alter. Some AIP cases have been associated with idiopathic fibrosclerosing disorders including IRPF, but histological evidence of IgG4-related IRPF has rarely been provided.     

Long-Term Follow-Up After Right Atrial Radiofrequency Catheter Treatment of Paroxysmal Atrial Fibrillation

Catheter ablation of paroxysmal atrial fibrillation using long linear lesions in the right atrium is still under investigation, and its long-term follow-up is unknown. Methods: Thirty-six men and nine women (aged 51 ± 12 years) with symptomatic daily episodes of AF for 6 ± 5 years despite the use of 4.7 ± 1.5 antiarrhythmic drugs were studied between July 1994 and January 1996. Progressively longer ablation lines were performed in 3 groups of 15 consecutive patients each, using a 14-electrode catheter or a single-electrode dragging technique. Success was defined as atrial fibrillation elimination or recurrence for no longer than 6 hours over 3 months of observation. Patients who had fewer than 6 hours of atrial fibrillation per month were considered "improved." Medium- (11 ± 4 months) and long-term (26 ± 5 months) results were assessed clinically from a patient's diary and from Holter recordings. Results: After a follow-up of 11 months, 24 patients had a favorable result of the ablation procedure with or without additional antiarrhythmic drug therapy, representing 53% of the original cohort. After 26 ± 5 months of follow-up, these successful results were reduced to 17 patients (37%). Conclusions: After linear atrial ablation, a significant long-term attrition of arrhythmia-free patients was observed. This may be due to a combination of disease progression, incomplete linear block, and ineffective ablation of arrhythmogenic triggers.