PSORIATIC ARTHRITIS IN PSORIATIC PATIENTS

One hundred and eighty patients with psoriasis have been studiedin the Neapolitan area to find the prevalence of arthritis inpsoriasis. Wright and Moll's criteria for the diagnosis of arthritiswere applied. Of 180 psoriatic patients, 62 exhibited arthritis(34.4% of total cases) According to Moll and Wright's five broadclinical forms of arthritis, the following distribution wasfound: poly-articular in 38.7% of arthritic patients, mono-oligoarticularin 16.1%, distal interphalangeal in 7.5%, deforming or mutilansin 2.3% and spondylitic and/or sacro-iliitic in 20.9%. In 14.5%of arthritic patients an overlap of the spondylitic form andperipheral involvement was also found. Stratification by ageof patient populations shows that cutaneous pathology has ahomogeneous distribution in the various age decades, while jointsymptoms are seen maximally in the sixth decade and are absentin the first two decades. The relationship between the onsetof skin lesions and joint pathology demonstrates that skin lesionspreceded arthritis in 64.5% of the cases, whilst arthritis antedatedpsoriasis in only 19.35%. In 16.1% of cases psoriasis and arthritisbegan almost simultaneously. Nail changes were present in 63percnt;of arthritic patients and in 37% of psoriatic subjects withoutarthritis. Furthermore, in 88% of arthritic patients in whomarthritis preceded skin lesions, nail changes antedated theonset of clinically apparent psoriasis. Extra-articular featureswere not found. This absence might be associated with the usualseronegativity for rheumatoid factor in psoriatic arthritis,also confirmed in this survey. KEY WORDS: Psoriatic arthritis, Seronegative arthritis, Psoriasis     

Peroxide-induced conformational transitions of peanut storage protein (arachin)

Several effects of peroxides on protein have been described in the literature. Some of the effects have been ascribed to alterations in protein conformation but this has never been examined directly. This paper describes responses of peanut storage globulin (arachin) to rancid oil and hydrogen peroxide as measured by electrophoretic mobility, antigenicity and circular dichroism of the globulin. Rancid oil and 3% hydrogen peroxide had little effect on these properties but 30% hydrogen peroxide increased the mobility, abolished the antigenicity and reduced the ordered structural modes of the protein. The results indicated that changes in protein conformation do not occur after contact with organoleptically rancid oil or dilute peroxides but do occur with concentrated peroxides.     

SUPPRESSED PROLACTIN BUT NORMAL NEUROPHYSIN LEVELS IN CIGARETTE SMOKING BREAST-FEEDING WOMEN

The hormonal responses to breast-feeding were studied during the first 3 post-partum weeks in ten women smoking more than fifteen cigarettes/day and in a control group. Basal PRL levels were significantly lower in smokers compared with non-smokers, but suckling induced acute increments in serum PRL and oxytocin-linked neurophysin, which were not influenced by smoking. The lactational pattern was normal, but smokers weaned their babies significantly earlier compared with non-smokers. Heavy cigarette smoking women have lower basal PRL levels and this may shorten the period of lactation.     

Combined Left Atrial Appendage Closure and Pacemaker Implant through a Single Right Femoral Vein Access

Left atrial appendage (LAA) closure is indicated in patients with atrial fibrillation (AF) and high bleeding as well as thromboembolic risks. A subgroup of these patients may also present an indication for a single‐chamber permanent pacemaker due to symptomatic low‐rate AF or when “ablate and pace” strategy is indicated for rate control. A miniaturized wireless transcatheter pacing system (TPS) is now available as a single‐chamber permanent pacemaker. This case presents how combined LAA closure and permanent pacemaker implant, by means of TPS, is feasible through a single femoral venous access.     

Abnormal Cardiac Innervation in Patients with Idiopathic Ventricular Fibrillation

BIFFI, M., et al .: Abnormal Cardiac Innervation in Patients with Idiopathic Ventricular Fibrillation. Idiopathic ventricular fibrillation (VF) is diagnosed in up to nearly 10% of survivors of out-of-hospital cardiac arrest. The arrhythmogenic substrate is unknown. This study examined the role of cardiac innervation as a possible contributor to this arrhythmia. Eight patients with idiopathic VF were compared with eight normal subjects (controls) by [¹²³] I metaiodobenzylguanidine SPECT (MIBG), measuring peak uptake, late uptake, and clearance of the nuclear tracer. The left ventricle was divided in 13 segments in the bull's-eye target plot. Peak and late MIBG uptake was increased in the anterolateral segments (2,3,7,8) compared to the inferoposterior and septal segments, in controls and in patients. No difference was observed between controls and patients in the inferoposterior and septal segments. In contrast, a significantly higher MIBG uptake was observed in patients compared to controls in the anterolateral segments (   94 ± 4%   vs   81 ± 11%, P < 0.03   for peak uptake;   94 ± 5%   vs   79 ± 12%, P < 0.01   for late uptake). No difference was observed in MIBG clearance in any segment in either study group. Cardiac sympathetic innervation is highly heterogeneous, though predominant in anterolateral segments in normal subjects. Patients with idiopathic VF exhibit the same distribution, though have a significantly greater density of sympathetic terminals in the anterolateral segments than controls, which may promote ventricular arrhythmias. (PACE 2003; 26[Pt. II]:357–360)     

Conversion of Recent-Onset Atrial Fibrillation to Sinus Rhythm: Effects of Different Drug Protocols

In a population of 417 hospitalized patients, the efficacy and safety of different drug regimens administered to convert atrial fibrillation (AF) of recent anset (≤ 7 days duration) to sinus rhythm were evaluated. All patients were in NYHA Class ≤ 2, and free of heart failure. They were randomly allocated to treatment with placebo in 121 patients; IV amiodarone, 5 mg/kg bolus, followed by 1.8 g/24 hours in 51 patients; IV propafenone, 2 mg/kg bolus, followed by 0.0078 mg/kg/min in 57 patients; p.o. propafenone, 600 mg p.o. in a single dose in 119 patients; and p.o. flecainide, 300 mg p.o. in a single dose in 69 patients. All patients were continuously monitored by Holter ECG, and the number of conversions to sinus rhythm was measured at 1, 3, and 8 hours. Results: (1) IV propafenone resulted in a higher conversion rate within 1 hour compared with the oral loading regimens of propafenone or flecainide, but the conversion rates at 3 and 8 hours were comparable, approximately 75% at 8 hours; 2) IV amiodarone was not different from placebo until 8 hours when it was associated with 57% of conversions; (3) conversion to sinus rhythm at 8 hours was observed in 37% of the placebo treated patients. Serious adverse effects occurred in few patients: two patients treated with flecainide and one treated with IV propafenone experienced left ventricular decompensation; one patient treated with placebo and two treated with flecainide had atrial flutter with rapid ventricular response. In conclusion, single-dose, oral loading with propafenone or flecainide are acceptable alternatives to conventional drug regimens in selected hospitalized patients. In addition, the measure of a placebo effect is mandatory in studies of recent-onset AF.