Herpes simplex virus type‐2 in Egyptian patients with bladder cancer or cystitis

Badawi H, Ahmed H, Aboul Fadl L, Helmi A, Fam N, Diab M, Ismail A, Badawi A, Saber M. Herpes simplex virus type‐2 in Egyptian patients with bladder cancer or cystitis. APMIS 2010; 118: 37–44. The present study was designed to investigate the prevalence of herpes simplex virus type‐2 (HSV‐2) in Egyptian patients with bladder cancer or cystitis and to evaluate the performance of different diagnostic HSV‐2 assays. The study included 50 patients: 27 with bladder cancer (group I), 23 with cystitis (group II) and 20 subjects as controls (group III). HSV‐2 DNA was detected using polymerase chain reaction (PCR) on bladder tissue and buffy coat cells (BCC). Electron microscopic studies (EMS) on BCC and ELISAs for IgM, IgG and specific glycoprotein G‐2 (gG‐2) IgG were performed. HSV‐2 DNA was detected by PCR on bladder tissue biopsies in 29.6% and 21.7% of group I and II respectively and it was also detected by PCR on BCC in 22.2% and 21.7% of group I and II respectively. EMS revealed HSV like particles in 16.6% of cases. IgG, specific gG‐2 IgG and IgM were detected in 30%, 16% and 6% of cases respectively. The different assays were evaluated in relation to PCR on bladder tissue biopsies. The gG‐2‐based ELISA and EMS on BCC were found to be highly specific (97.3% and 100% respectively), with similar low sensitivity of ≈54%. PCR on BCC was the most sensitive assay. The association of HSV‐2 with bladder cancer is suggested especially in schistosomal patients.     

Percutaneous Mitral Commissurotomy in Acute Pulmonary Edema

From January 1994 to July 1998, percutaneous mitral commissurotomy was performed in 520 patients. Of these patients, 7 (4 men and 3 women aged 31 ± 5.6 years) were dilated in an emergency situation of intractable pulmonary edema caused by severe mitral stenosis. Three patients required mechanical ventilatory support. Percutaneous mitral commissurotomy was performed with the Inoue balloon. The dilatation of the valve was undertaken even though the echocardiographic score of the valve was high. Percutaneous mitral commissurotomy resulted in an increase in the mitral valve area from 0.72 ± 0.18 cm² to 1.95 ± 0.18 cm² (P = 0.011) with a concomitant reduction in pulmonary artery systolic pressure from 82.5 ± 16.4 mmHg to 46.7 ± 11.6 mmHg (P = 0.018). One patient died (he had two cardiac arrests before the dilatation). During follow-up (mean 18 months), one patient presented with a restenosis, one an aggravation of mitral insuflciency grade, and four were in NYHA functional Class II. Thus, percutaneous mitral commissurotomy can be considered as a treatment of choice in patients with intractable pulmonary edema caused by severe mitral stenosis.     

Suppressive Therapy for Radiation-Associated Nodular Thyroid Disease: Double-Blind Study With T3 and Desiccated Thyroid

A thyroid screening program for individuals who had irradiationto the head and neck areas was started at Roswell Park MemorialInstitute in February 1977 and by June 1979, 1,071 patientswere seen in the clinic. Three hundred and ninety-six patientswere found to have palpable abnormalities of the thyroid, andfollowing pretreatment evaluation, suppressive therapy withtriiodothyronine (T3) (50 µ/day) or DT (desiccated thyroid)(1 20 mg/day) was administered in a double-blind fashion. Twohundred fifty patients with nodular disease completed 6 mo oftreatment and are analyzed in this paper. Pretreatment thyroidfunction tests showed that two patients had hypothyroidism witha high thyroid-stimulating hormone (TSH) and a low thyroxinelevel. A high incidence of thyroid autoantibodies was also notedand surgical findings confirmed a high incidence of chronicthyroiditis. Complete disappearance of the nodules was seenin 29% of the patients, and in addition, 38% of the patientswere seen to have significant shrinkage of the nodules, indicatingthat radiation-associated thyroid nodules were as sensitiveto the thyroactive agents as nonirradiated nodular thyroid disease.There was little difference in the response rate between T3and DT. Both agents suppressed circulating TSH levels to anunmeasurable level in 76% of the patients. There was no correlationbetween scan findings and response rates. Thyroid carcinomawas found in 19% of the patients who underwent surgery; althoughall were well-differentiated carcinomas, two-thirds of the patientsalready had evidence of dissemination and/or invasion suggestingthe aggressive nature of postirradiation thyroid carcinoma.     

Early Afterdepolarization Formation in Cardiac Myocyte:

Early Afterdepolarization Formation, introduction: Early afterdepolarizations (EADs) are among the mechanisms proposed to underlie ventricular arrhythmias. Sea anemone toxin, ATXII, known to delay Na inactivation and to induce plateau level voltage oscillations, was used to study the formation of EADs. Methods and Results: Action potential and membrane currents were studied in rat ventricular myocytes using whole cell current and voltage clamp techniques. Phase plane trajectories were generated by plotting membrane potential (V) versus the first time derivative of membrane potential (dV/dt). Under current clamp conditions, ATXII (40 nM) consistently prolonged the action potential and induced EADs. The EADs developed at a plateau voltage between -10 and -40 mV. Calcium channel blockers, verapamil 10 μM and cobalt 4 μM, and the sarcoplasmic reticulum modulator, ryanodine (1 μM) did not antagonize ATXII effects on the action potential and EADs. However, Na channel blockers, tetrodotoxin 0.3μM and lidocaine 40μM. and rapid stimulation consistently shortened the prolonged action potential and suppressed EADs. Under voltage clamp conditions in the presence of ATXII, a slowly decaying inward current followed the fast inward current during depolarizing pulses. Membrane currents flowing at or later than 100 msec after the test pulse were analyzed. The control isochronal current-voltage (I-V) curves showed no late inward currents. In the presence of ATXII, all the isochronal I-V curves showed an inward current that was more prominent between -40 and 0 mV. The ATXII-induced current at the 100-msec isochronc activated at a potential of approximately -60 mV, peaked at about -20 mV, and reversed at +40 mV consistent with the Na current I-V curve. The isochronal I-V curves obtained after lidocaine superfusion resembled those of the control. The phase plane trajectory of the action potential obtained with ATXII showed an oscillatory behavior corresponding to the t AD range of potential; within this voltage range, the isochronal I-V curves were shown to cross the abscissa three times instead of once. Conclusion: These results suggest that, in this experimental model, neither sarcolemmal L-type Ca current nor sarcoplasmic reticulum Ca release plays a significant role in the genesis of ATXII-induced EADs. EADs are generated by a voltage-dependent balance between a markedly prolonged Na inward current and K outward currents within the voltage plateau range of the action potential hut not by Ca current reactivation and inactivation.     

Three-Dimensional Echocardiographic Assessment of Aortic Dissection

In the present study, we report our experience of using three-dimensional reconstruction of transesophageal two-dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).