Asystole Caused by Vegetation and Abscess of Right Ventricle Attached to a Tip of Pacemaker Lead

A 69-year-old man with pacemaker was referred to our center for cerebral infarction. He had a high fever for 10 days during his hospitalization. Pacing failures deteriorating to asystole were observed responsible for bacterial vegetation around the tip of the pacemaker lead, which is rare but important for the cause of pacing failure.     

Hepatitis GB virus C genome in the serum of aplastic anaemia patients receiving frequent blood transfusions

GB virus C (GBV-C) RNA was detected in five of 18 patients with aplastic anaemia who had received blood transfusions, whereas it was not detected in eight patients who had not received any transfusions. Antibody against hepatitis C virus (anti-HCV) was detected in nine patients in the transfusion group, compared with one of eight who had not received any transfusions. Therefore, the route of transmission of both GBV-C and HCV in these patients appeared to have been multiple blood transfusion. Since all of the GBV-C RNA-positive patients harboured anti-HCV, GBV-C seems to frequently superinfect with HCV. Neither GBV-C nor HCV is likely to have been a causative agent of the anaemia in the cases examined.     

Radiofrequency Catheter Ablation of Parasystole Originating from the Inferior Vena Cava

A 76‐year‐old man with a history of atrial septal defect repair underwent radiofrequency (RF) ablation of typical atrial flutter. During electrophysiological study, incessant sharp potentials were recorded, originating from the ostium of the inferior vena cava (IVC), and dissociated from atrial activity. During sinus rhythm, these potentials propagated to the atria and caused premature complexes when falling beyond the atrial refractory period. Electro‐anatomical mapping revealed the presence of the earliest potential in the postero‐lateral ostium of the IVC, propagating to the septal region. After RF isolation of the IVC, the patient has remained arrhythmia‐free over a 5‐year follow‐up. (PACE 2010; e62–e64)     

A Case of Adult T-Cell Leukemia Initiated with Central Nervous System Symptoms

We treated a 52-year-old Japanese woman with adult T-cell leukemia(ATL) initiated with central nervous system (CNS) symptoms.Her chief complaints were paraplegia and left facial palsy.CNS-ATL was diagnosed because of the following three features.1) Various sized lymphoid cells with marked nuclear convolutionwere numerous in her cerebrospinal fluid. 2) These cells werea monoclonal proliferation of T lymphocytes with OKT 4 marker.3) The patient's serum was positive for anti-ATL associatedantigen (ATLA). Although the neurological signs and symptomsimproved markedly after intrathecal administration of combinedchemotherapy (methotrexate, cytarabine and corti-costeroid),these ATL cells were highly resistant to radiation therapy.The abdominal mass which developed in the course of the diseasewas diagnosed as a tumor formed of ATL cells, and VEPA (vincristine,endoxan, prednisolone and adriamycin) was administered withmarked success.     

Abrupt Heart Rate Fallings in a Patient with Biventricular Pacing: Latent Risk for Exacerbation of Heart Failure

This case report describes abrupt heart rate fallings below the lower pacing rate limit in a patient with cardiac resynchronization therapy (CRT). Interrogated information including stored episodes or data regarding the lead did not show any device problems and only simultaneous intracardiac electrogram revealed the cause, T‐wave oversensing during biventricular pacing. At this moment, CRT has become an established modality for patients with severe heart failure. However, bradycardia below the lower rate limit during biventricular pacing due to T‐wave oversensing would exacerbate heart failure in patients with CRT. We should notice this latent risk and correct the malfunction immediately. (PACE 2010; 1–4)     

A Case of Melanosis Duodeni in Which Pigmentation Disappeared After the Discontinuation of Hydralazine Administration

Abstract: The endoscopic examination of the duodenum of a 70-year-old man who had received hydralazine for a long period showed a marked pigmentation of the duodenal mucosa. However, this pigmentation disappeared within three months after the discontinuation of hydralazine administration. Histological and electron microscopic examinations, as well as electron-probe X-ray analysis of this patient demonstrated that the pigment was not true melanin, but some substance containing Fe and S. The medications which our patient received were those which were also used in 54 cases reported in the literature. Our results indicated that hydralazine was the causative agent of the pigmentation present in this patient, and that not all drugs with a benzene ring as was previously thought were the cause of the pigmentation. Hypertension, gastrointestinal hemorrhage, renal insufficiency and anemia also seemed to be factors involved in pigmentation of the duodenum.