The Origin of Epicardial Ventricular Tachycardia Revealed by Entrainment From a Permanent Epicardial Left Ventricular Pacing Lead

Entrainment From Left Ventricular Pacing Lead. Recognizing ventricular tachycardias (VTs) that require epicardial ablation is desirable, but challenging when prior surgery prevents percutaneous epicardial mapping. This patient had cardiomyopathy, prior cardiac surgery, and VT that failed endocardial ablation. Observing that the Bi‐V implantable cardioverter defibrillator (ICD), left ventricular (LV) lead was epicardial to the area of infarct scar, it was used to pace during VT. Entrainment with concealed fusion with long stimulus to QRS interval, consistent with an epicardial VT circuit, was observed. Surgical cryoablation targeting the area around the LV lead eliminated VT. Thus pacing maneuvers from permanent epicardial leads can occasionally help identify an epicardial VT origin. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1293‐1295, November 2010)     

Cutting Balloon Angioplasty for a Restenosis Lesion at the Distal Anastomosis of a Saphenous Vein Graft

We successfully performed cutting balloon angioplasty for a restenotic lesion involving the distal saphenous vein graft (SVG) anastomosis that had developed within 1 month after conventional balloon angioplasty. We considered that cutting balloon angioplasty, which has been considered to produce less vascular injury, could be a viable choice for the treatment of a lesion at the distal anastomosis of an SVG.     

Regulatory mechanism of bombesin on gastrin release

Bombesin has been demonstrated to stimulate gastrin release by an atropine-resistant mechanism. In the present study, the effects of truncal vagotomy and chemical sympathectomy on the gastrin release by exogenous and endogenous bombesin using rat antral mucosa in tissue culture were studied. Exogenous bombesin 10^-8 mol/l significantly stimulated gastrin release. The stimulation of gastrin release by bombesin was abolished by truncal vagotomy, but not altered by chemical sympathectomy. Bombesin antiserum inhibited gastrin release by blocking the effect of endogenous bombesin. The inhibition of gastrin release by bombesin antiserum was abolished by truncal vagotomy, but not altered by chemical sympathectomy. In addition, the concentrations of bombesin-like immunoreactivity in antral mucosa were not altered by truncal vagotomy. These results suggest that the mechanism of gastrin release by bombesin is influenced by non-cholinergic local nerves under vagal control.     

Diagnosis and Ablation of Multiform Fascicular Tachycardia

Ablation Multiform Fascicular Tachycardia . Introduction: Fascicular tachycardia (FT) is an uncommon cause of monomorphic sustained ventricular tachycardia (VT). We describe 6 cases of FT with multiform QRS morphologies. Methods and Results : Six of 823 consecutive VT cases were retrospectively analyzed and found attributable to FT with multiform QRS patterns, with 3 cases exhibiting narrow QRS VT as well. All underwent electrophysiology study including fascicular potential mapping, entrainment pacing, and electroanatomic mapping. The first 3 cases describe similar multiform VT patterns with successful ablation in the upper mid septum. Initially, a right bundle branch block (RBBB) VT with superior axis was induced. Radiofrequency catheter ablation (RFCA) targeting the left posterior fascicle (LPF) resulted in a second VT with RBBB inferior axis. RFCA in the upper septum just apical to the LBB potential abolished VT in all cases. Cases 4 and 5 showed RBBB VT with alternating fascicular block compatible with upper septal dependent VT, resulting in bundle branch reentrant VT (BBRT) after ablation of LPF and left anterior fascicle (LAF). Finally, Cases 5 and 6 demonstrated spontaneous shift in QRS morphology during VT, implicating participation of a third fascicle. In Case 6, successful ablation was achieved over the proximal LAF, likely representing insertion of the auxiliary fascicle near the proximal LAF. Conclusions : Multiform FTs show a reentrant mechanism using multiple fascicular branches. We hypothesize that retrograde conduction over the septal fascicle produces alternate fascicular patterns as well as narrow VT forms. Ablation of the respective fascicle was successful in abolishing FT but does not preclude development of BBRT unless septal fascicle is targeted and ablated. (J Cardiovasc Electrophysiol, Vol. 24, pp. 297‐304, March 2013)     

Concentration gradient of oxalate from cortex to papilla in rat kidney

BACKGROUND: The kidney eliminates the major fraction of plasma oxalate. It is well known that oxalate is freely filtered by glomeruli and secreted by the proximal tubules. However, the renal handling of oxalate in distal nephrons, which is considered as playing an important role in stone formation, remains obscure. METHODS: At 15-180 min after intravenous injection of 14C-oxalate to rats, the intrarenal localization of radioactivity was quantitatively measured by the radioluminographic method using a bioimaging analyzer. Tissue radioactivity was compared with plasma, and urinary radioactivities were measured by a liquid scintillation counter. The control study was conducted with 14C-inulin. RESULTS: The radioactivity of 14C-oxalate in the papilla was 10 times greater than in the cortex and eight times greater than in the medulla 180 min after injection when almost no radioactivity was present in the urine. In contrast, the radioactivity of 14C-inulin was nine times less in the papilla than in the cortex at the same time. CONCLUSION: Oxalate remains in the renal papilla for an extended period. This accumulation of oxalate may be attributed to calcium oxalate crystal fixation along the deep nephron which is considered to be the first step of stone formation.     

Adenosquamous Cell Carcinoma of the Colon with Severe Hypercalcemia: --Report of Two Cases--

Two patients with adenosquamous cell carcinoma of the colon,who presented severe hypercalcemia, are reported. Adenosquamouscell carcinoma of the colon is relatively rare, and there wereonly two cases among 1,053 patients who were hospitalized withmalignancy in the large intestine at the National Cancer CenterHospital during the past 18 years. Both of these cases presentedlethal hypercalcemia in the absence of osseous metastasis, andthere were no other patients who had malignant tumors of thelarge intestine and presented hypercalcemia. These observationssuggest that there is a close relationship between the squamouscell component and the occurrence of hypercalcemia, as is observedin the case of lung cancer. Radioimmunoactive parathyroid hormonewas undetectable in the plasma and the tumor tissue in thesetwo cases.     

Immediate and Delayed Cardiac Herniations after Intrapericardial Pneumonectomy--Report of Two Cases

Two cases of cardiac herniation following intrapericardial lungresections were reported. One was a case of a 29-year-old male with adenocarcinoma ofthe right lower lobe and the other was a 43-year-old male withsquamous cell carcinoma of the right upper lobe of the lung. In the former, cardiac herniation occurred in the recovery room.In the latter, it occurred during the second operation repairingbronchial fistula which appeared 20 days after the previousintrapericardial surgery. The time delay in the second casewas due to the unsuitable quality of prosthesis for the pericardialdefect.     

Gastrin-Enhanced Tumor Growth of a Xenotransplantable Human Gastric Carcinoma in Nude Mice

A human tumor line serially transplantable in nude mice, originatingfrom a well-differentiated papillo-tubular adenocarcinoma ofthe stomach, was established. The growth of this tumor was enhancedby daily injection of C-terminal tetrapeptide gastrin into themice. Although there was little difference in histology, thegastrin-stimulated tumor had larger glandular spaces filledwith mucin-like substance than the control tumor. ³H-thymidine uptake of the gastrin stimulated tumor was higherthan that of control, as shown by microradiography and countingof radioactivity in tissue homogenates. The plasma membrane fraction of the tumor revealed positivebinding for gastrin and the cytosol fraction contained cyclicAMP dependent- and independent protein kinases. Incubation oftumor slices with gastrin caused a conformational change inthe enzymes. Therefore we conclude that this G4 tumor line xenotransplantablein nude mice is sensitive to gastrin in its trophic and secretorymechanisms.     

Clinical Trials of a New Anticancer Drug, 1-Hexylcarbamoyl-5-fluorouracil

1-Hexylcarbamoyl-5-fluororacil (HCFU) is a new anticancer drugdiscovered as a derivative of 5-fluorouracil (5-FU). In thisstudy, peculiar types of toxicity such as a hot sensation, pollakisuriaand urgency to defecate appeared in 23% of the patients, whilegastrointestinal, hematological, hepatic and renal toxicitywas very rarely observed. Blood levels of the HCFU fractionand 5-FU were maintained at high concentrations until four hoursafter administration. In a study of 30 evaluable cases withtumors in the various primary sites, good responses were obtainedin an infant with a recurrence of hepatoblastoma and in a patientwith recurrent cancer of the stomach.     

Colo-Rectal Carcinoma in Young Adults

A study of 25 young adults under the age of 29 treated by surgeryfor carcinoma of the large intestine was made to compare with693 older-age group of patients. The incidence of adenocarcinomaof the large intestine in the first thirty years of life was3.5%. At the time of surgery, 64% of the patients had metastaticdisease, and the five-year survival rate for 19 curatively treatedcases was 37%. The coincidental second and third carcinoma ofthe large intestine and the association of familial polyposiscoli were significantly frequent in the younger age group. Onthe other hand, the association of ulcerative colitis or Crohn'sdisease could not be found in either of the group. The highincidence of mucin-producing tumors in the younger group wasalso confirmed. The Cumulative No Evidence of Disease (NED)rate after the curative surgery was lowest among patients ofthe first-three-decade age group and showed; stepwise high valueas the decade of age increased.