A rupture of lung metastasis of hepatocellular carcinoma causing haemothorax

A 67 year old male with non-resectable hepatocellular carcinoma (HCC) in both lobes and liver cirrhosis was treated with transcatheter arterial embolization and regional chemotherapy. He was doing well for 18 months. He was readmitted for fever, chest pain and multiple pulmonary metastases. During interleukin-2 therapy, he suddenly developed dyspnoea and palpitation, and was in shock. Left-sided haemothorax was confirmed by draining 3 L of fresh blood. In spite of intensive care, he died within 36 h. Autopsy showed that the haemothorax was caused by rupture of one of the metastases in the upper lobe of the left lung, and that the primary HCC was totally necrotic. Survey of the literature failed to find a report of fatal bleeding from a lung metastasis of HCC.     

Bepridil Prevents Paroxysmal Atrial Fibrillation by a Class III Antiarrhythmic Drug Effect

YOSHIDA, T., et al .: Bepridil Prevents Paroxysmal Atrial Fibrillation by a Class III Antiarrhythmic Drug Effect. Background: Bepridil, a multiple ion-channel blocker, has been reported to prevent paroxysmal atrial fibrillation (PAF). The f-f interval of PAF during treatment with bepridil versus class Ic antiarrhythmic drugs was compared. Methods: Fifty-two patients with PAF were randomized to bepridil, 200 mg/day   (n = 14)   versus flecainide, 100 to 200 mg/day   (n = 15)   or pilsicainide, 75 to 150 mg/day  ( n = 23)   . The drug was considered effective when symptomatic episodes of PAF were decreased to < 50% during a follow-up of 2 to 6 months. The f-f interval was measured in 12-lead ECGs of initial PAF episodes. Results: Bepridil and Ic were effective in 10 of 14 (71.4%) and 24 of 38 patients (63.2%), respectively (ns). In the Ic group, the f-f interval was longer in successfully   (114 ± 48  ms)   than in unsuccessfully   (68 ± 25  ms)   treated patients   (P = 0.002)   . In the bepridil group, the f-f interval was shorter in successfully   (84 ± 27  ms)   than unsuccessfully   (155 ± 68  ms)   treated patients   (P = 0.015)   . When comparing unsuccessfully treated patients, the f-f interval in the bepridil group was significantly longer than in the Ic group   (P = 0.007)   . Conclusions: Bepridil was as effective as Ic drugs in the prevention of PAF. Because it was more effective in smaller (functional) than larger (anatomical) reentrant circuits, the effect of bepridil was considered to be mainly attributable to a class III antiarrhythmic action. (PACE 2003; 26[Pt. II]:314–317)     

Role of ring size on the secondary structure and antibiotic activity of gramicidin S

In order to investigate the contribution of ring size to the secondary structure and antibiotic activity of gramicidin S, many analogs consisting of 6, 7, 8, 9, 11, 12, 13, and 14 amino acid residues were synthesized. In the analogs with smaller ring sizes than that of gramicidin S, only des-Val¹-, des-Leu³- and des-Pro⁵-gramicidin S showed weak activity against the gram-positive micro-organisms tested. On the other hand, all analogs having larger rings, in which L- or D-Leu residues were inserted, were active. The activity of the analogs consisting of 10, 11 and 12 amino acid residues was stronger than those of the analogs with other ring sizes, and the activity of endo-Leu^2a-gramicidin S against S. epidermidis SP-al-1 and B. subtilis ATCC 6633 was twice of that of gramicidin S.     

Evaluation of the timing of the booster injection after a primary vaccination against hepatitis A

To evaluate the long-term efficacy and the timing of booster injection of a lyophilized, inactivated hepatitis A vaccine (HAV), we studied the acquired anti-hepatitis A virus titres in 45 subjects who received either two or three doses of the vaccine. With three doses ≥ 0.5 μg administered at 0, 1 and 6 months, antibody titres increased to approximately half those seen in people with a history of natural hepatitis A infection. Although the titres decreased gradually, all subjects remained anti-HAV positive at least 5 years after the third injection. The geometric mean titre exceeded 100 mlU/mL, which approximated the highest titre obtainable by the inoculation of immune serum globulin. A prompt antibody reaction was seen with two doses administered 2 weeks apart, with the titres achieved being 5.6-fold the peak titres obtained by the inoculation of immune serum globulin. All 33 subjects were antibody positive 18 months after the first injection, but some became seronegative by 30 months, suggesting that a third booster dose would be desirable at 18 months.     

Pharmacological Properties of Pteleprenine,a Quinoline Alkaloid Extracted from Orixa japonica,on Guinea-pig Ileum and Canine Left Atrium

We have investigated the pharmacological properties of pteleprenine, a quinoline alkaloid, on contractile responses of the guinea-pig ileum and on inotropic responses of the canine left atrium. Although pteleprenine (0·1–1 μM) had no effect on the contraction of the ileum induced by acetylcholine at 10 μM it significantly inhibited acetylcholine-induced contraction of the ileum. Pteleprenine (0·1–10 μM) reduced nicotine induced-contraction of the ileum in a concentration-dependent manner yet had no maximum relaxant effect even at a concentration of 10 μM From Schild analysis the pA₂ of pteleprenine on the guinea-pig ileum was found to be 6-6. The contraction of the ileum induced by 10 μM 1,1-dimethyl-4-phenylpiperazinium, a specific agonist of nicotinic acetylcholine. receptors, was concentration-dependently suppressed by 10 nM-10 μM pteleprenine. In contrast, 0.1–10 μM pteleprenine did not antagonize the acetylcholine- and nicotine-induced negative inotropic contractile responses of the canine left atrium. These results show that pteleprenine has inhibitory action against nicotinic acetylcholine receptors in the guinea-pig ileum but not in the canine left atrium. Our findings also suggest that pteleprenine might be a novel lead compound as a nicotinic receptor antagonist.     

Gastric diverticulum preoperatively diagnosed as one of two left adrenal adenomas

A 47-year-old man was diagnosed with primary aldosteronism due to two left adrenal adenomas, suggested on computed tomography (CT) to be located at the upper and lower adrenal portion. However, adosterol scintigraphy revealed negligible uptake at the upper portion of the left adrenal. Laparoscopic left adrenalectomy was performed, but macroscopic examination of the specimen revealed only one adrenal tumor. Continued surgical exploration detected another mass between the spleen and the stomach, which was demonstrated to be continuous with the stomach and was eventually diagnosed as a gastric diverticulum. Postoperatively, aldosteronism resolved and repeat CT revealed staining of the adrenal pseudotumor when oral contrast was administered. Since organs located near the adrenals can simulate adrenal tumors, caution must be exercised in interpreting suprarenal masses on CT. To our knowledge, this is the first reported case of concurrent pseudotumor and true tumor of the ipsilateral adrenal.     

Ventricular Fibrillation and Ventricular Tachycardia Triggered by Late‐Coupled Ventricular Extrasystoles in a Brugada Syndrome Patient

Premature ventricular complexes (PVC) falling after the end of the T wave triggered ventricular fibrillation (VF) at night and monomorphic ventricular tachycardia (MVT) during daytime, in a recipient of implantable cardioverter defibrillator with Brugada syndrome. Treatment with bepridil (1) decreased the height of ST segment elevation in leads V1‐V3, (2) completely eliminated VF, and (3) markedly decreased the incidence of PVC and MVT. Albeit rare, VF can be triggered by late‐coupled PVC, due to a mechanism other than phase 2 reentry in some patients with Brugada syndrome. (PACE 2011; e1–e5)     

Effect of Kil769, a Novel K+-channel Opener,on Sensitivity to Ca2+ of Contractile Elements and Inositol Phosphate Formation in Porcine Coronary Artery

To determine whether Kil769, a novel K⁺-channel opener, acts intracellularly in vasorelaxation, we compared the effects of Kil 769 on force of contraction, intracellular Ca²⁺ concentration ([Ca²⁺]_i) and inositol phosphate (IP₁) formation with those of Ca²⁺-channel blockers in isolated porcine coronary artery. Kil 769 (10 μm) and verapamil (1 μm), which produced submaximal relaxation, reduced the increase in [Ca²⁺]_i and force of contraction induced by 25 mM KC1. Verapamil reduced [Ca²⁺]_i and the force of contraction to a similar extent but Kil 769 reduced force of contraction more strongly than it did [Ca²⁺]_i. Kil 769 also inhibited U46619 (9,11-dideoxy-9α, 11α-methano-epoxy-PGF_2a)-induced IP₁ formation and glibenclamide blocked its inhibitory effect. These results suggest that the opening of K⁺ channels induced by Kil 769 reduces the Ca²⁺ sensitivity of contractile elements and inositol phospholipid hydrolysis which is related to the Ca²⁺ release from intracellular storage.