Advances in Catheter Ablation use of Unipolar Electrograms

Ventricular tachycardia in man can be eliminated by relatively small lesions in the reentrant circuit. This report includes a review of available energy sources, and methods for localizing arrhythmias. Methods to assure contact and prevent perforation using low frequency electrograms are presented including the new finding of reverse ST deflection with contact. Experience with laser energy in dogs showed discrete homogenous lesions. When compared with DC shock the animals showed far less arrhythmia and the lack of far field effect greatly reduced echo abnomalities in the post shock period. Studies with radiofrequency show ability to produce localized lesions similar to the laser but with a more flexible catheter. Localization requires a correlation of techniques including pacemapping, activation maps and pacing during tachycardia. Early activation (< −60 ms) at times 180–320 ms, with comparable pace to QRS during tachycardia with no change in morphology best localized the slow zone of the reentrant circuit. The low frequency unipolar electrogram from the tip and immediately proximal electrode revealed contact with ST deviation. The distal deviation was always greater than the proximal RV free wall and posterior basal produced depression rather than elevation of the electrogram. While the mechanism of ST reversal with contact is not understood and may relate to the type of indifferent reference used (Wilson central terminal), the ST depression reveals the same information about contact that elevation does in most other areas of the heart studied in our patients.     

Cutaneous calcinosis in erythromelanosis follicularis faciei et colli

A case of erythromelanosis follicularis faciei et colli is described which showed deposition of calcium in the lesional skin on the face.     

AIDS and anaesthesia

The Acquired Immune Deficiency Syndrome (AIDS) is a group of conditions which is reaching epidemic proportions. It is caused by a virus new to man, with an as yet poorly understood natural history, ominous prognosis and no known cure. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed AIDS patients and asymptomatic carriers in the fields of resuscitation, intensive therapy and theatre anaesthesia. The misunderstanding of AIDS is as extensive as the literature on the subject and a review of the current knowledge of the disease relevant to the anaesthetist is pertinent.     

Immunohistochemical analysis of Fas and FLIP in prostate cancers

Fas‐mediated apoptosis is considered a principal pathway for apoptosis induction in normal and cancer cells. Expression of Fas has been reported in prostate tissues several times, but the data were not consistent. Expression of FLICE‐like inhibitory protein (FLIP), an inhibitor of Fas‐mediated apoptosis, has not been studied by immunohistochemistry in prostate tissues. The aim of this study is to explore whether alterations of Fas and FLIP expression occur in prostate cancer tissues. We analyzed the expression of Fas and FLIP in 107 prostate adenocarcinoma tissues by immunohistochemistry using a tissue microarray approach. Normal glandular cells of the prostates strongly expressed both Fas and FLIP proteins. Prostate intraepithelial neoplasm also showed a strong Fas immunoreacitity. Fas expression was strongly positive in 60 cancers (56.1%), but the remaining 47 cancers showed no (6.5%) or markedly decreased (37.4%) Fas immunostaining compared with the normal glandular cells of the same patients. By contrast, FLIP expression was strong in most (103/107; 96.3%) of the cancers, and only four cancers (3.7%) showed decreased immunoreactivities compared with the normal cells. The decreased expression of Fas was not associated with pathologic characteristics, including FLIP expression, size of the cancers, age, Gleason score and stage. The decreased expression of Fas in a large fraction of prostate cancers compared with their normal cells suggested that loss of Fas expression might play a role in tumorigenesis in some prostate cancers possibly by inhibiting apoptosis mediated by Fas.     

Case of dystrophic calcinosis cutis in epidermal cyst arising from verrucous epidermal nevus

Dystrophic calcinosis cutis is diagnosed when calcium is deposited into previously damaged tissue by connective tissue disease, panniculitis, pseudoxanthoma elasticum or trauma. We report a case of dystrophic calcinosis cutis arising from the lesion of an epidermal cyst on the verrucous epidermal nevus. A 20‐year‐old woman presented with a polypoid pinkish tumor on a brownish, verrucous plaque. Histopathological findings of the pinkish tumor showed calcium deposits as amorphous, basophilic material lining the true epidermis in the upper dermis, which were compatible with dystrophic calcinosis cutis and the plaque was diagnosed as a verrucous epidermal nevus.     

Improvement of juvenile dermatomyositis with calcinosis universalis after treatment with intravenous immunoglobulin

Juvenile dermatomyositis is a chronic multisystemic disease. It is believed to be of autoimmune aetiology and is characterized by the presence of vasculitis affecting striated muscle and skin. Calcinosis occurs in about 40% of cases. We report a case of a 10‐year‐old girl diagnosed with juvenile dermatomyositis who presented with difficulty in walking and inability to completely extend the four extremities due to calcinosis universalis. Calcinosis had progressed despite a 3‐year administration of diltiazem, hydroxychloroquine, aluminium hydroxide, cyclosporin, and probenecid. The introduction of monthly intravenous immunoglobulin therapy for 15 months lessened disease activity, and markedly regressed calcinosis, and improved functional outcome.     

CYSTICERCOSIS CELLULOSAE IN MAhT WITH SPECIAL REFERENCE TO INVOLVEMENT OF CENTRAL NERVOUS SYSTFM

In China human tapeworm infestation was known in ancient times, since the famous Pen Ts''ao, the Chinese Classical Herbal, written about 1,500 B.C., contains records of tapeworms and their treatment. In modern times a Report of the Research Committee of the China Missionary Medical Association published in igio(I) states that a medi- cal officer in Tsingtao saw during a period of eight years between 1899 and 1907 thirteen cases of Taenia solium and twenty-eight cases of T. saginaia among European residents. It is difficult to be certain that these casos were of local origin. The Same report contains records of tapeworms (species not specified) from other parts of China, one case from each of the provinces of Chihli (Hopei), Hunan and Chekiang, three cases from Peking (Peiping) and three cases from Hankow, and also the entry "tapeworms not common; variety T. soliunn" for Man- churia. In 1912 Clark (z) reported a case of T. solium in the province of Yunnan and remarked that taenia infestation was common in that province.