Flecainide‐Associated Bradycardia‐Dependent Torsade de Pointes: Another Potential Mechanism of Proarrhythmia

Although flecainide has a risk of proarrhythmia in patients with structural heart disease, its mechanism has been mainly ascribed to use‐dependency and a rapid ventricular response to organized atrial tachyarrhythmias or to ventricular tachycardia. We present a patient who experienced recurrent syncope due to bradycardia‐dependent torsade de pointes (TdP) associated with flecainide‐related bradycardia and QT prolongation. Bradycardia‐dependent TdP with QT prolongation can be considered as one of mechanisms of flecainide‐induced proarrhythmia.     

Coexistence of palmoplantar lichen planus and lupus erythematosus with response to treatment using acitretin

Lichen planus and lupus erythematosus may occur as an overlap syndrome. Here we report the clinical characteristics of a 49-year-old man with palmoplantar lichen planus and lupus erythematosus. He showed a remarkable clinical response to treatment with acitretin, which resulted in prolonged remission of the disorder.     

脑梗塞患者铁与丙二醛和超氧化物歧化酶及胰岛素抵抗的关系

目的 :探讨脑梗塞 (CI)患者铁浓度 ,特别是红细胞铁 (EFe)与丙二醛 (MDA)、超氧化物歧化酶 (SOD)及胰岛素抵抗 (INSR)的关系。方法 :随机选择 30例CI患者为病变组 ,2 5例健康正常人为对照组 ,采用原子吸收分光光度法、硫代巴比妥酸 (TBA)比色法、化学比色法、己糖激酶法、放射免疫法对比分析两组的EFe、血清铁(SFe)、MDA、SOD、空腹血糖 (EPG)、空腹胰岛素 (FINS)水平 ,并采用Inl(FPG×FINS)计算胰岛素敏感性指数(ISI)。结果 :与正常组比较 ,CI患者EFe明显降低 (P <0 0 5 ) ,SFe明显增高且差异显著 (P <0 0 1) ;EFe/SFe明显降低 (P <0 0 5 ) ,MDA明显增高 (P <0 0 5 ) ,SOD明显降低 (P <0 0 5 ) ,ISI明显增高 (P <0 0 5 )。相关性研究表明 ,EFe/SFe与MDA呈负相关 (P <0 0 1) ,与SOD呈正相关 (P <0 0 1) ,与ISI呈负相关 (P <0 0 1) ;SFe与MDA呈正相关 (P <0 0 1) ,与SOD呈负相关 (P <0 0 1) ,与ISI呈正相关 (P <0 0 1)。结论 :CI患者存在EFe降低 ,SFe增高 ,EFe/SFe降低 ,此过程可能与自由基清除率降低、INSR有关。     

THE IMPORTANCE OF PITUITARY TUMOUR SIZE IN PATIENTS WITH HYPERPROLACTINAEMIA IN RELATION TO HORMONAL VARIABLES AND EXTRASELLAR EXTENSION OF TUMOUR

In sixty-two patients with hyperprolactinaemia and a pituitary tumour (without growth hormone excess) we studied the importance of the size of the sella turcica plus extrasellar tissue (if present) in relation to the prevalence of extrasellar extension and impaired hormonal reserve. A lateral tumour area, V of 3 cm², turned out to be a critical value both in the development of extrasellar extension of the pituitary adenoma as well as in the development of insufficiency of the pituitary-gonadal, -thyroidal and -adrenal axis. Extrasellar extension occurred in 44% of the patients. Below the value of 3 cm² (n= 36) there was only one patient with radiologically detectable significant suprasellar extension. Above the value of 3 cm² twenty-four out of twenty-six patients had significant extrasellar extensions at radiological and perimetrical examination. Taking the size of the sella only, extrasellar extension occurred in one third of the cases with a sellar size between 2 and 3 cm². There was a strongly positive correlation between (log) tumour size and (log) basal prolactin level (P < 0·0005). LH, FSH, TSH and ACTH secretion were evaluated by the consecutive administration of LHRH, TRH and metyrapone. Negative correlations were observed between (log) pituitary tumour size and (log) basal LH, FSH and TSH (respectively P < 0·005, P < 0·005, P < 0·025) and between (log) tumour size and (log) Δ LH, Δ FSH, Δ TSH and the plasma Compound S concentration after metyrapone (respectively P < 0·0005, P < 0·005, P < 0·01, P < 0·025). Again the value of the index of tumour size (3 cm²) proved to be critical. Above 3 cm² a highly significant increase in the incidence of insufficient responses to the stimuli mentioned was observed. Pituitary tumour size may be one of the most important indices used in the management of patients with hyperprolactinaemia and a pituitary tumour.     

Experience with intracoronary streptokinase in 36 patients with acute evolving myocardial infarction

Acute angiography was performed in 36 consecutive patients withevolving myocardial infarction admitted within 3 h after onsetof symptoms. No fatal complication occurred. Angiography revealeda total occlusion in 32 patients (89%), a subtotal stenosisin three (8%), and a 90% stenosis in one patient (3%). Anteriorinfarction was exclusively related to left anterior descending,and inferior infarction to right coronary or circumflex obstruction.After identification of the ‘infarct-vessel’, nifedipine10 mg was administered sublingually. In no patient was anterogradeflow affected with this treatment. In 35 patients an attempt to lyse clot was made with intracoronarystreptokinase; an infusion of 2000–4000 U/min, precededby a bolus of 10 000–20 000 U was infused into the ‘infarct-vessel’. In 26 patients (74%) reperfusion was achieved, two combinedwith guidewire perforation. The mean duration of onset of symptomsto reperfusion was 3.6 h (range 1.8–5.6). The mean durationof lysis was 1.2 h (range 0.3–3), and the mean dosageof streptokinase was 200 000 U (50 000–400 000 U]. In25 out of 26 patients (96%) a high degree of obstruction remainedimmediately after lysis and at repeat angiography 6–8weeks after the acute event. Despite treatment with aspirin200 mg daily and nifedipine 30 mg daily four re-occlusions occurred.Coronary bypass surgery was performed electively in five patients. Thus, we conclude that in patients with evolving myocardialinfarction, the infarct-vessel can be recanalized in 74% ofpatients by intracoronary streptokinase. The true benefit ofthis treatment must await a controlled study.