Biatrial Epicardial Pacing Prevents Atrial Fibrillation and Confers Hemodynamic Benefits After Coronary Artery Bypass Surgery

Biatrial pacing (BIP) can be more effective than standard right atrial pacing (RAP) in preventing atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG). However, the mechanisms and hemodynamic benefits of BIP have not been studied in detail. This study examined the efficacy and hemodynamic benefits conferred by overdrive epicardial BIP in preventing post-CABG AF. After undergoing CABG, 72 patients (mean age = 66 ± 12 years, 48 men) were randomly assigned to triggered BIP (BIP-AAT; n = 50) versus single RAP (RAP-AAI; n = 22). The hemodynamic effects of BIP were measured by right heart catheterization and echocardiography. The patients were monitored for 8.8 ± 2.4 days after CABG to detect episodes of AF. The incidence of AF was significantly lower in the BIP-AAT group (22.0%) than in the RAP-AAI group (59.1%, P < 0.01). Cardiac output was significantly higher and pulmonary artery wedge pressure (PAWP) significantly lower during BIP-AAT than during RAP-AAI. The E-wave (65.2 ± 37.8 vs 57.8 ± 37.8 cm/s, P < 0.05) was significantly higher during BIP-AAT, and the interval between atrial pacing spike and the end of A-wave (241 ± 18.4 vs 286 ± 17.2 ms, P < 0.001) was significantly shorter during BIP-AAT than during RAP-AAI. Triggered BIP was well tolerated and significantly reduced the incidence of post-CABG AF compared to single-site RAP. The hemodynamic improvements conferred by BIP-AAT were due to a shortening of the inter-atrial conduction delay and greater contribution of left atrial contraction. These hemodynamic benefits may play a role in lowering intra-atrial pressure and in preventing AF.     

Enhancing Effects of Unsaturated Fatty Acids with Various Structures on the Permeation of Indomethacin through Rat Skin

Effects of straight-chain, cis-type, unsaturated fatty acids with various structures (alkyl chain lengths, numbers of double bonds, position of double bonds and cis- and trans-positional isomers) on the skin permeation of indomethacin were examined by using rat skins in-vitro. Furthermore, the disordering degrees of the intercellular lipid domain in the stratum corneum, which were treated with preparations of unsaturated fatty acids, were measured by the Fourier transform infrared (FT-IR) method using excised rabbit ear skins. Unsaturated fatty acids enhanced the permeation of indomethacin through rat skins. These permeation-enhancing effects by unsaturated fatty acids were affected by changes of their alkyl chain length from C₁₄ to C₂₂. The lag-times on the permeation of indomethacin were shortened by unsaturated fatty acids in the following order: C₂₀ = C₁₈ = C₂₂ < C₁₆ < C₁₄. These fluxes were increased by unsaturated fatty acids in the following order: C₂₀ > C₂₂ = C₁₈ = C₁₃ > C₁₄. Therefore, gondoic acid (cis-11-eicosenoic acid; C₂₀H₃₈O₂) mostly enhanced the skin permeation of indomethacin. However, the enhancing effects of unsaturated fatty acids (C₁₈ chain) were not affected by their differences of position and numbers of double bonds. These permeation-enhancing effects which were evaluated by flux were related to the degrees of wave-number shift in the frequency of the antisymmetric CH bond stretching absorbance (near 2920 cm^?1) on FT-IR spectra of the fatty acid-treated stratum corneum. Therefore, the perturbation increase of lipid domain in the stratum corneum by these fatty acids probably was the cause of the enhancing effects of permeation of indomethacin.     

A case of X-linked α-thalassemia/mental retardation syndrome: Analysis of hemoglobin by an automated glycated hemoglobin analyzer

A 5-year-old male patient with X-linked α-thalassemia/mental retardation syndrome is reported. He showed multiple minor anomalies including characteristic facial abnormalities, α-thalassemia, severe mental retardation, and hypogonadism. Analysis of his hemoglobin by high performance liquid chromatography using an automated glycated hemoglobin analyzer revealed an abnormal peak. Identification of an abnormal peak by an automated glycated hemoglobin analyzer will aid in the diagnosis of patients with X-linked α-thalassemia/mental retardation syndrome.     

Outbreak of acute glomerulonephritis in children: Observed association with the T1 subtype of group A streptococcal infection in Northern Kyushu,Japan

Group A streptococcal infection is associated with the occurrence of acute glomerulonephritis (AGN) and rheumatic fever (RF). A surveillance study in the Saga area, in northern Kyushu, Japan, showed a small variation in the reported number of group A streptococcal infections in the period 1988–94. However, of the AGN cases reported in this period, more than half were observed in 1992. In order to examine whether some change had occurred in the serotype distribution of Streptococcus pyogenes during the period, patients in the Saga area diagnosed as having group A streptococcal infection and patients with AGN or RF were analyzed. Serological T-typing of S. pyogenes was carried out for patients with group A streptococcal infections, and the association between the occurrence of AGN or RF and the distribution of each different T subtype was analyzed. M-typing of S. pyogenes was also carried out and the correlation between T and M types was examined. From 1988 to 1994, the annual number of patients with group A streptococcal infections in the Saga area showed a small variation, range 65–100 patients/year. Of the 42 patients with AGN and three with RF observed in this period, 27 with AGN (64%) and one with RF (33.3%) were detected in 1992. Only the T1 subtype increased in 1992; the other T subtypes showed little variation in incidence. The number of patients with the T1 subtype was significantly correlated with the occurrence of AGN by regression analysis (P < 0.01). Of the 170 subjects tested for both T and M subtypes, 44 of the 45 T1-typed subjects had the M1 protein. Our epidemiological study suggested that the T1 subtype of streptococcal infection was associated with an outbreak of AGN in 1992 in the Saga area.     

Acute Pheochromocytoma: A Case Report and Review of the Literature

A case of pheochromocytoma ending in fatal cardiac arrhythmiasduring conservative treatment with an -adrenergic blocker isdescribed. The patient had a pheochromocytoma of a child's headsize on the right adrenal gland which could not be removed threeyears earlier because of surgical difficulty. After a 2-yr favorableperiod maintained by oral administration of phenoxy-benzamine,she was caught in a hypertensive crisis triggered by routinehouse work. On admission as an emergency case, striking changesin the electrocardiogram such as marked prolongation of theQ-T interval and wide symmetrically inverted T-waves developedin spite of intravenous infusion of phentolamine and propranolol.Eventually, she died in an irreversible shock from ventricularfibrillation. Urinary output of adrenalin and noradrenalin onthe last day was 1,160 and 2,278 µg/day, respectively. We reviewed other cases reported in the Japanese literatureand emphasized that catecholamine-induced cardiomyopathy mayplay an important role in the catastrophic terminal events ina patient bearing pheochromocytoma.     

Pharmacological Studies on Puerariae flos III: Protective Effects of Kakkalide on Ethanol-induced Lethality and Acute Hepatic Injury in Mice

Kakkalide, one of the major isoflavonoid components of Puerariae flos, has been investigated for its effect on ethanol-induced intoxication and on hepatic injury, including hyperglycaemia, in mice. Kakkalide reduced mortality associated with administration of ethanol. At doses of 100 and 200 mg kg^? the effect of kakkalide was significant. The same dose of kakkalide prevented increased serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase activity. At a dose of 200 mg kg^? it also counteracted ethanol-induced elevation of glucose levels. These results suggest that kakkalide might be useful for counteracting the effects of alcohol and might be effective for treating hepatic injury.     

A Case of Adult T-cell Leukemia Associated With Hypercalcemia

This case study concerns a 56-year-old man who exhibited hypercalcemiadue to T-cell leukemia. The leukemic cell was identified tobe of T-cell origin by the method of routine T- and B-cell markers(E rosette and EAC rosette formation). Hypercalcemic crisisoccurred in conjunction with an increase in leukemic cells.X-ray studies revealed no apparent skeletal bone destructionsby metastasis of leukemic cells, but showed cortical erosionof the phalanges of the hands. Hypophosphatemia and decreasedtubular reabsorption of phosphates were also observed. However,immunoreactive parathyroid hormone (iPTH) in his serum was notdetected. The serum calcium concentration returned to its normallevel in the coincidental improvement of the leukemia afterresponding to chemotherapy. In order to test whether the leukemiccells produce an active substance or not, studies were carriedout in vitro, that is, culture mediums were obtained from leukemiccells incubated for 24 hours and injected into chicks, and theirserum calcium concentrations were measured. Significant elevationsin the calcium level were found when compared with controls.No iPTH was detectable in the culture medium. It was concludedthat the hypercalcemia in this patient could be due to a humoralfactor (or factors) other than iPTH, which was produced by T-leukemiccells.     

Serum Carcinoembryonic Antigen Levels in Patients with Apudoma

Previous reports of elevated carcinoembryonic antigen (CEA)levels in sera from patients with medullary carcinoma of thethyroid (MCT) prompted us to determine whether or not tumorsnow recognized as apudomas, other than MCT, can produce theantigen, because of the common origin tumors, the neural crest. Together with sera from patients with sporadic MCT (2) and Sipple'ssyndrome (4), we collected sera from patients with other typesof apudomas—pheochromocytoma (11), neuroblastoma (5),pancreatic islet-cell tumor (2) and parathyroid adenoma (2)—andmeasured CEA by radioimmunoassay. Like previous investigators,we found increased levels of CEA in patients with MCT, eithersporadic or Sipple's syndrome. However, other apudoma patientsshowed normal or only slightly increased CEA levels. Our findingsindicate that CEA production is not a feature common to allapudomas. The specificity of CEA is not affected and its assayis a valuable procedure for the diagnosis and follow-up of MCT.