Acquired von Willebrand''s disease associated with gastrointestinal angiodysplasia: a case report

Acquired von Willebrand syndrome (AVWS) is a rare and probably underestimated bleeding disorder which mimics most of the clinical symptoms and laboratory features of hereditary von Willebrand disease (VWD) in patients devoid of both personal and family history of bleeding diathesis. In this study, we present a case of 55 yrs male patient, presented with gastrointestinal bleeds since three years, diagnosed to have AVWS with inhibitors. From this study it is concluded that AVWS is rare and it is important to diagnose this bleeding disorder so that appropriate treatment with plasmapheresis and IV:Ig can effectively correct the haemostatic defect and manage severe bleeding in these patients.     

Inhibition of Spermatogenesis in House Rat (Rattus rattus Rufescens) Following the Administration of α-Chlorohydrin

Hemmung der Spermatogenese bei der Hausratte (Rattus rattus Rufescens) nach Applikation von alpha-Chlorohydrin
Die Langzeitapplikation von alpha-Chlorohydrin (25 mg/kg Körpergewicht) verursachte Schäden der Testes der Hausratte. Es zeigten sich degenerative Veränderungen der Keimzellen. Der Durchmesser der Tubuli seminiferi und der Kerndurchmesser der Leydigschen Zellen waren verringert. Die Zellhöhe der Nebenhodenzellen war beträchtlich vermindert. Das Lumen war frei von Spermatozoen.
Gaben von alpha-Chlorohydrin hemmten die Synthese von RNS, Eiweiß, Sialinsäure in den Hoden und akzessorischen Geschlechtsorganen. Das Gesamtcholesterin in den Testes war erhöht. Auffällig war die Verarmung der Nebennieren an Ascorbinsäure. Alpha-Chlorhydrin wirkt antagonistisch auf die stimulierende Wirkung des Testosterons bei kastrierten Hausratten. Alpha-Chlorohydrin kann als eine biologisch wirksame Verbindung betrachtet werden, um die Zahl der Hausratten in menschlichen Behausungen zu kontrollieren. Seine dosisabhängige Wirksamkeit wird diskutiert.     

Distinct Electrocardiographic Form of Idiopathic Ventricular Arrhythmia Originating From the Left Bundle Branch

Most premature ventricular contractions (PVCs) arise from the right or left ventricular outflow tract. Some VPCs originate near the His‐bundle region. However, there remains a paucity of information on PVCs originating directly from the cardiac conduction system. We describe 2 cases with idiopathic frequent PVCs that were mapped directly to the left bundle branch itself. We also provide an anatomic‐based mapping and ablation approach for management of these uncommon and challenging arrhythmias. In both cases we were able to either eliminate or significantly suppress the ectopic source by applying radiofrequency at this location without causing any significant impairment of the atrioventricular conduction.     

Optimization of Shocking Lead Configuration for Transvenous Atrial Defibrillation

Optimum Electrodes for Atrial Defibrillation. Introduction : High atrial defibrillation energy requirements (ADER) in patients with chronic atrial fibrillation (AF) may limit the acceptance of transvenous atrial defibrillation. We evaluated an optimized defibrillation electrode configuration that could help to reduce the ADKR in patients with AF.
Methods and Results : We tested ten different configurations in nine dogs with AF (3.33 ± 2.92 days) induced by rapid atrial pacing. The configurations were: right atrial (RA) appendage as anode und coronary sinus (CS) as cathode; RA and innominate vein (I) as anode to CS (cathode); RA-CS (anode) to I (cathode); I-CS (anode) to RA (cathode); RA and left lateral subcutaneous patch (P) as anode to CS (cathode); RA-CS (anode) to P (cathode); P-CS (anode) to RA (cathode); superior vena cava (SVC) and CS (anode) to RA (cathode); RA-CS (anode) to SVC (cathode); and RA-SVC (anode) to CS (cathode). ADER was defined as the voltage needed to defibrillate the atria in 10% to 90% of 20 consecutive shocks. Three lead systems had ADER lower than the RA (anode) to CS (cathode) configuration, which required a mean of 143 ± 58 volts. These three were: RA-SVC (anode) to CS (cathode) 103 ± 29 V; I-CS (anode) to RA (cathode) 129 ± 39 V; and P-CS (anode) to RA (cathode) 130 ± 38 V. The remaining configurations had ADER higher than the RA (anode) to CS (cathode) configuration.
Conclusion : Adding an additional shocking electrode may reduce ADER when compared with the RA (anode) to CS (cathode) configuration. This concept could he incorporated into future implantable atrial defibrillators or used for refractory patients undergoing temporary transvenous cardioversion.     

Biliary ascariasis complicating endoscopic sphincterotomy for choledocholithiasis in India

Endoscopic sphincterotomy is the treatment of choice for patients with choledocholithiasis. Biliary ascariasis has been reported from many parts of the world but is common in Kashmir, India. We report five cases of biliary ascariasis of which four were the result of post-endoscopic sphincterotomy for choledocholithiasis. Therefore, biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy.