Acquired long QT syndrome with torsade de pointes in a patient with primary hypothyroidism

A case of 78 year-old woman with primary hypothyroidism and atrial fibrillation treated with sotalol, complicated with cardiac arrest due to ventricular fibrillation (VF) and torsade de pointes (TdP) is presented. The QT interval was prolonged to 660 msec. Episodes of polymorphic ventricular tachycardia and VF recurred. Lidocaine, tosylate bretylate and betabloker successfully eliminated VF but short-lasting episodes of TdP were still present. Increased doses of hormonal substitution with thyroid hormones successfully eliminated malignant ventricular arrhythmias and normalised QT interval to 430 msec.     

The effects of fatness and fat distribution on respiratory functions

Background: Inverse relationships between respiratory function and indices of obesity and fat distribution have been reported, but it remains unclear which measure of obesity shows the strongest relationship with lung function.

Aim: The study assessed the effect of fatness and fat distribution on respiratory function.

Subjects and methods: A sample of 423 males and 509 females aged 40–50 years were examined in the Silesian Centre for Preventive Medicine, DOLMED, in Wroc?aw in 1995. The strength of influence of height, body mass index (BMI), wait-to-hip ratio (WHR) and abdominal and subscapular skinfolds upon forced vital capacity (FVC) and forced expiratory volume in a 1-s expiration (FEV₁) was assessed by multiple regression analysis.

Results: In males, FVC was strongly positively associated with height and BMI, but negatively associated with subscapular and abdominal skinfolds, WHR, and smoking. FEV₁ showed a positive relationship with height, BMI and WHR. In females, both FVC and FEV₁ showed significant positive associations with height, negative ones with subscapular skinfold, and no association with either WHR or abdominal skinfold. In males, respiratory function is affected to a similar extent by fat in the abdominal region and by fatness of the chest. In females, fatness of the thorax has the strongest relationship with respiratory function.

Conclusion: Fatness tends to impair respiratory function in both sexes but these effects show a different pattern in males and females. In males, respiratory functions are significantly, and to a similar extant, affected by fatness in the abdominal region, both subcutaneous and visceral, and by fatness on the chest. In females, it is primarily subcutaneous fat on the upper thorax that affects respiratory functions, while visceral and subcutaneous abdominal fatness play little or no role.     

High curability via intensive reinduction chemotherapy and stem cell transplantation in young adults with relapsed acute lymphoblastic leukemia in Sweden 2003-2007

Background A minority of patients with adult acute lymphoblastic leukemia who relapse are rescued. The aim of this population-based study was to assess the results of reinduction treatment and allogeneic stem cell transplantation in patients in second complete remission. DESIGN AND METHODS: Between 2003-2007, 76 adults (<66 years) with relapsed acute lymphoblastic leukemia (Burkitt's leukemia excluded) were prospectively reported to The Swedish Adult Acute Leukemia Registry and later evaluated. RESULTS: Reinduction with: (i) mitoxantrone, etoposide, and cytarabine (MEA); (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor (FLAG-Asp); and (iii) cytarabine, betamethasone, cyclophosphamide, daunorubicin, and vincristine (ABCDV) resulted in complete remission in 6/9 (67%), 10/16 (63%) and 9/21 (43%) of the patients, respectively. Allogeneic stem cell transplantation was performed during second complete remission in 29 patients. Multivariate analysis regarding overall survival after relapse revealed that age over 35 years at diagnosis and relapse within 18 months were negative prognostic factors. Overall survival rates at 3 and 5 years were 22% (95% CI: 13-32) and 15% (95% CI: 7-24). Of 19 patients less than 35 years at diagnosis who underwent allogeneic stem cell transplantation in second remission, ten (53%) are still alive at a median of 5.5 years (range, 4.2-8.3) after relapse, whereas all patients over 35 years old at diagnosis have died. Conclusions Allogeneic stem cell transplantation remains the treatment of choice for young adults with relapsed acute lymphoblastic leukemia. Both (i) mitoxantrone, etoposide, and cytarabine and (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor seem effective as reinduction treatments and should be further evaluated. New salvage strategies are needed, especially for patients over 35 years old at diagnosis.     

Clinical improvement after physical training in patient with severe postinfarction heart failure, who underwent prosthetic heart valve implantation and numerous coronary interventional procedures

The case of patient with advanced congestive heart failure, NYHA III, of ischaemic and valvular aetiology and concomitant diseases is presented. Introduction of 6-month, controlled physical training resulted in improvement of health status, exercise performance, ventilation and left ventricular function. Quality of life got significantly better. This aspect of treatment should be considered in majority of patients with heart failure.     

Effects of C-reactive protein on human pulmonary vascular cells in chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by proximal pulmonary vascular obstruction by thrombo-fibrotic material, the origin of which has not been elucidated. Enhanced inflammation could contribute to persistent obstruction by impairing pulmonary vascular cell function in CTEPH. We investigated C-reactive protein (CRP) effects on pulmonary vascular cell function in vitro. Primary cultures of proximal pulmonary endothelial cells (ECs) and smooth muscle cells (SMCs) from CTEPH and nonthromboembolic pulmonary hypertension (PH) patients were established. Recombinant CRP effects on mitogenic activity, adhesion capacity, endothelin-1 and von Willebrand factor (vWF) secretion and intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule-1 expression were investigated in ECs and/or SMCs. Expression of the CRP receptor, lectin-like oxidised low-density lipoprotein receptor (LOX)-1, was evaluated in proximal pulmonary arterial tissue and cells by Western blotting and immunofluorescence. CRP increased CTEPH-SMC proliferation by 250%. CRP increased adhesion capacity, endothelin-1 and vWF secretion by CTEPH-ECs by 37%, 129% and 694%, respectively. CRP-induced adhesion of CTEPH-ECs to monocytes was mediated by ICAM-1. CRP had no effect on cells from nonthromboembolic PH patients, probably because of overexpression of LOX-1 in CTEPH. Local expression of CRP was detected in ECs and SMCs within pulmonary arterial tissue. CRP may contribute to persistent obstruction of proximal pulmonary arteries in CTEPH by promoting vascular remodelling, endothelial dysfunction and in situ thrombosis.     

Antibodies to hepatitis B virus surface antigen and interleukin 12 and interleukin 18 gene polymorphisms in hemodialysis patients

ABSTRACT: BACKGROUND: The interleukin (IL)18 rs360719 CC genotype is associated with the development of antibodies to hepatitis B virus surface antigen (anti-HBs) in hemodialysis (HD) patients. IL18 shares biological properties with IL12 in promoting the T-hepler 1 (Th1) system. We studied whether polymorphisms in the IL12A 3` untranslated region (UTR) and IL12B 3`UTR may contribute to anti-HBs development (titre [greater than or equal to] 10 IU/L) in HD patients either individually or jointly with the IL18 polymorphism. METHODS: In 518 HD patients and 240 controls the IL12A rs568408 3'UTR G > A polymorphism was genotyped by high-resolution melting curve analysis. Polymerase chain reaction restriction fragment length polymorphism was used to detect the IL12B rs3212227 3'UTR A > C and IL18 -1297 T > C rs360719 polymorphisms. The associations between the IL12A, IL12B and IL18 genotypes and the risk of impaired anti-HBs development were estimated by computing the odds ratios and their 95 % confidence intervals using logistic regression analysis. RESULTS: In the logistic regression analysis, the higher frequency of rs360719 CC individually (2.9 % in 207 patients without anti-HBs development vs 8.0 % in 311 patients with anti-HBs development, p = 0.009) and of rs360719 CC combined with rs568408 GG (p = 0.048), rs568408 GA (p = 0.035), rs568408 GG/AA (p = 0.034) or rs3212227 AA (p = 0.046) was associated with an increased chance for the development of anti-HBs in HD patients. Patients bearing both rs568408 AA and rs360719 TT had a 10.9-fold or 8.9-fold lower chance, respectively, to develop anti-HBs compared with those carrying any other genotype (p = 0.005) or those who had both wild-type rs568408 GG and rs360719 TT (p = 0.011). Carriers of both rs3212227 CC and rs360719 TC had a 4.6-fold lower chance for anti-HBs development than carriers of any other genotype (p = 0.042). CONCLUSION: Development of anti-HBs in HD patients is associated with gene polymorphisms of interleukins involved in the Th1 system.