Reduced activation of epidermal phosphorylase in the lesions of psoriasis

The percentage activation of the enzyme phosphorylase in extracts prepared from the epidermis of psoriatic lesions was found to be significantly lower than normal. This observation lends strong support to the concept of a reduced level of cyclic AMP in the lesion of this disease.     

Clinical Benefit of Dual Chamber Pacing in Hypertrophic Cardiomyopathy: A Case Report

This case study presents evidence that angioplasty and dual chamber pacing can be used as a therapeutic alternative to coronary artery bypass grafting and myectomy. The following case report describes this treatment option in a patient with hypertrophic Cardiomyopathy and ischemic heart disease who refused surgery. A severe coronary lesion was successfully treated with percutaneous transluminal coronary angioplasty (PTCA), Subsequent deterioration of the patient's clinical status occurred, yet a repeat heart catheterization revealed no angiographic changes from the PTCA. The left ventricular outflow gradient was 97 mmHg despite optimizing medical therapy. Temporary pacing leads were inserted and the patient was DDD paced at 70 ppm while measuring the LVgradient at varying A V intervals. Significant reduction of the outflow tract gradient occurred at all A V intervals tested. Although the pressure gradient decreased during VVI pacing, atrial contribution was necessary to achieve the desired hemodynamic benefit. A permanent DDDR pacemaker was implanted with satisfactory clinical results.     

Extrathoracic Metastatic Thymoma A Case Report

A case of malignant thymoma who developed an extrathoracic metastatic lesion in the lumbar vertebra three years later, is presented. Radiotherapy can be used effectively in the local control of this disease as well as in the metastatic lesions.     

EFFECT OF ACUTE AND CHRONIC NEUROLEPTIC THERAPY ON SERUM PROLACTIN LEVELS IN MEN AND WOMEN OF DIFFERENT AGE GROUPS

A single fasting level of serum prolactin was measured in each of sixty control subjects and eighty-three psychiatric patients of both sexes who had been on neuroleptic therapy for 2-4 weeks (acute treatment) or at least 5 years (chronic treatment) and who were aged either 17-45 or 48-85 years. All groups of patients had significantly higher mean prolactin levels than controls. Gender, age group of women, and exposure to acute or chronic treatment were significant variables determining the magnitude of neuroleptic-induced elevation of prolactin. In some of the groups, dose, duration of chronic therapy, and concomitant administration of anticholinergic drugs also influenced prolactin levels. Whereas all acutely treated women had prolactin values above the control range, one out of twelve (8.3%) of the women aged 17-45 years and six out of fourteen (42.9%) of the women aged 48-85 years who were under chronic treatment had normal values. Normal prolactin levels were also found in five out of sixteen (31.2%) of the acutely treated and nine out of twenty-four (37.5%) of the chronically treated men aged 17-85 years.     

Pathways to Blood Coagulation Product I Formation

The basic reagent used was an eluate obtained from barium sulfate usedto adsorb various sera. When this eluate was prepared from normal rabbitserum, it responded to treatment with coagulants from adsorbed plasma,with Stypven, or with 25 per cent sodium citrate to give products withsimilar if not identical properties. With each preparation a stable complexformed with cephalin which withstood washing, was relatively heat-stable,was inactivated by adsorbed serum, and which required factor V for optimalprothrombin conversion. In eluates prepared from human serum, normalactivation occurred in the absence of factor IX, but was defective in theabsence of factor X. A preparation of factor X purified by DEAE cellulosechromatography was activated by 25 per cent sodium citrate. It is suggestedthat product I, the product of Stypven activation, and autoprothrombin Crepresent similar or identical reagents; it is further suggested that factor Xis their common precursor.

Submitted on November 7, 1962 Accepted on January 23, 1963     

Short‐ and Long‐Term Prognostic Value of the TIMI Risk Score after Primary Percutaneous Coronary Intervention for ST‐segment Elevation Myocardial Infarction

Objectives

We investigated the short‐ and long‐term predictive value of the TIMI risk score regarding mortality for patients treated with primary percutaneous coronary intervention (PPCI) for ST‐elevation myocardial infarction (STEMI).

Background

Data on the long‐term predictive value of the TIMI risk score is sparse.

Methods

We used data from 3,609 STEMI patients undergoing PPCI in a high‐volume PCI center in The Netherlands. Cumulative event rates according to TIMI score variables were estimated with the Kaplan‐Meier method and compared with the log‐rank test. The original TIMI risk score was modified based on the availability of the data in the single center registry.

Results

Higher TIMI scores were associated with significantly higher mortality at short‐ and long‐term follow‐up (P < 0.001 for both). Age and Killip Class IV at presentation were significant predictors for both short‐ and long‐term mortality. Patients with an anterior MI, heart frequence >100 beats per minute, or systolic blood pressure <100 mmHG had a worse short‐term prognosis compared to those who had not. However, long‐term mortality was nonsignificantly different. The presence of a history of diabetes/hypertension and weight had only long‐term prognostic value. Time to PPCI did not have any prognostic value.

Conclusions

Our current report shows that the TIMI risk score has both short‐ and long‐term discriminative value. The different variables contained in the TIMI risk score predict short‐term prognosis, others predominantly long‐term mortality, whereas some are predictive for both. (J Interven Cardiol 2013;26:8–13)

     

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence

Modern anatomical and surgical references illustrate perineal muscles all innervated by branches of the pudendal nerve but still organized into anatomically distinct urogenital and anal triangles with muscles inserting onto a central perineal body. However, these conflict with the anatomy commonly encountered during dissection. We used dissections of 43 human cadavers to characterize the anatomical organization of the human perineum and compare our findings to standard references. We found bulbospongiosus and the superficial portion of the external anal sphincter (EAS) were continuous anatomically with a common innervation in 92.3% of specimens. The superficial transverse perineal muscle inserted anterior and lateral to the midline, interdigitating with bulbospongiosus. The three EAS subdivisions were anatomically discontinuous. Additionally, in 89.2% of our sample the inferior rectal nerve emerged as a branch of S3 and S4 distinct from the pudendal nerve and innervated only the subcutaneous EAS. Branches of the perineal nerve innervated bulbospongiosus and the superficial EAS and nerve to levator ani innervated the deep EAS. In conclusion, we empirically demonstrate important and clinically relevant differences with perineal anatomy commonly described in standard texts. First, independent innervation to the three portions of EAS suggests the potential for functional independence. Second, neuromuscular continuity between bulbospongiosus and superficial EAS suggests the possibility of shared or overlapping function of the urogenital and anal triangles. Clin. Anat. 29:1053–1058, 2016. © 2016 Wiley Periodicals, Inc.     

The Effect of Biphasic Defibrillation on the Immediate Pacing Threshold of a Dedicated Bipolar, Steroid-Eluting Lead

It is apparent that pacing threshold increases following an ICD shock, although the degree of change observed is dependent on the method used to assess pacing and the lead design used. We previously demonstrated a rise in postshock pacing threshold using a lead with integrated bipolar pacing in which the distal shocking coil also serves as the pacing anode. In this study, we sought to investigate whether the postshock pacing threshold increased significantly in an endocardial, steroid-eluting lead with dedicated bipolar pacing electrodes. Twenty patients (16 men, 4 women; median age 73, ejection fraction [EF] 0.17-0.58) were studied during pectoral ICD implantation (Medtronic active can model 7221Cx or 7223Cx with model 6932-65 lead). The diastolic pulse width pacing threshold at 1 or 2 V was determined. Pacing rate was set > or = 100/min at twice diastolic threshold output to assess pacing immediately following the first DFT test shock. For subsequent shocks, the output was adjusted to establish postshock thresholds as 1, 2, 3, or 4 times the diastolic threshold. The postshock threshold was defined as the output yielding 100% capture > or = 2.5 seconds following a shock. In 8 of 20 patients (ratio 0.40 +/- 0.11), a rise in the post-shock threshold was shown by failure of consistent capture when pacing at 2 times diastolic threshold > or = 2.5 seconds after a DFT test shock. Two of these patients failed at 3 times threshold, but none failed at 4 x threshold. Five of 12 patients with successful capture of 2 times threshold failed to capture at threshold. The postshock threshold increased by a mean factor of 2.83 +/- 0.83 in the group of patients with a threshold rise. Following ICD shock in an active can, steroid-eluting lead system with dedicated bipolar pacing, the post-shock threshold increases significantly. Our studies suggest a need for postshock pacing to be set at least 4 x threshold regardless of the lead design.