Buruli Ulcer in Traveler from Suriname,South America,to the Netherlands

We report Buruli ulcer in a man in the Netherlands. Phenotyping of samples indicate the Buruli pathogen was acquired in Suriname and activated by trauma on return to the Netherlands. Awareness of this disease by clinicians in non–Buruli ulcer–endemic areas is critical for identification.     

Device interaction between cardiac contractility modulation (CCM) and subcutaneous defibrillator (S-ICD)

Combined implantation of cardiac contractility modulation (CCM) with subcutaneous implantable cardioverter-defibrillator (S-ICD) appears a suitable option to reduce the amount of intracardiac leads and complications for patients. Here we report on a patient with ischemic cardiomyopathy carrying an S-ICD in which a CCM device was implanted. During crosstalk testing post-CCM implantation, the S-ICD misannotated QRS complexes and T waves. The problem was solved through reprogramming the CCM, while preserving S-ICD functionality and improving heart failure symptoms. In conclusion, S-ICD combined with CCM seems to be a good and safe option for patients when device interference is being ruled out.     

Der implantierbare Kardioverter-Defibrillator

Zusammenfassung Die ad?quate Versorgung von Patienten, die bereits einmal einen Herz-Kreislaufstillstand durch tachykarde Arrhythmien überlebt haben, war lange Zeit auf eine Behandlung mit Antiarrhythmika beschr?nkt, wenn der Rhythmusst?rung keine behebbare orga-nische Ursache zugrunde lag. Trotz optimierter Pharmakotherapie sterben 30% dieser Patienten innerhalb von drei Jahren durch eine erneute maligne Arrhythmie. Deshalb wurde in den letzten Jahren die Implanta-tion von automatischen, implantierbaren Kardioverter-Defibrillatoren (ICD) der Standard bei der Versorgung dieser Patienten. Zunehmend werden ICDs auch bei Patienten mit stark erh?htem Risiko für einen pl?tzlichen Herztod ohne überlebten Kreislaufstillstand implantiert, ins-besondere bei Patienten mit Kardio-myopathie oder angeborenen ar-rhythmogenen Anomalien des Herzens. In neuen klinischen Studien konnte bei selektierten Patienten ein deutlicher überlebensvorteil gegen-über der Behandlung mit Anti-arrhythmika gezeigt werden [7]. Die Implantation von ICDs wird bei den neuen transven?sen Systemen ohne Thorakotomie durchgeführt, wodurch das Operationsrisiko wesentlich verringert wurde. Moderne ICDs werden unter den linken M. pectoralis major implantiert, eine mehrpolige Elektrode im rechten Ventrikel dient der Wahrnehmung, der Stimulation und der Schockab-gabe. Die Ger?te sind in weiten Bereichen patientenspezifisch programmierbar und erlauben so eine differenzierte Erkennung und mehrstufige Therapie von ventrikul?ren Tachykardien und Kammerflimmern. Neben der Defibrillation und der synchronisierten Kardioversion stellt die antitachykarde Stimulation eine hocheffektive und für die Patienten angenehme Methode zur Beendigung von langsamen ventrikul?ren Tachykardien dar. Der interne Speicher moderner ICDs dokumentiert nicht nur die Anzahl der Arrhythmien und die abgegebene Therapie, auch intrakardiale EKGs vor und nach den Episoden k?nnen ausgelesen werden. Diese Eigenschaften erlauben heute eine sehr spezifische und individuelle Anpassung der Therapie an die zugrundeliegende Arrhythmie. Eingegangen: 3. September 1997 Akzeptiert: 4. Oktober 1997     

Further characterization of the NB 1 antigen as a variably expressed 56–62 kD GPI-linked glycoprotein of plasma membranes and specific granules of neutrophils

The human neutrophil-specific alloantigen NB1 was identified as a glycosyl-phosphatidylinositol (GPI)-anchored N-glycosylated protein of M(r) 56-62 kD under reducing conditions. Under non-reducing conditions its M(r) was 49-55 kD. This glycoprotein antigen was found to be expressed by only a subpopulation of normal donor neutrophils, and could not be detected on other blood cells. The allotypic epitope recognized by human anti-NB1 IgG was also recognized by the mouse monoclonal antibody 1B5. The percentage of neutrophils stained by these antibodies varied greatly among healthy donors (range 0-100%). When 16 donors were repeatedly tested, the NB1-positive neutrophil fraction appeared to remain remarkably constant over time in most donors, but significant fluctuations were seen in some. NB1 antigen was found to be expressed not only on the plasma membrane, but also intracellularly on the membranes of small vesicles and specific granules. The neutrophils which expressed NB1 antigen on the plasma membrane were the same as those with intracellular expression of this antigen. Crosslinking of NB1 antigen on the plasma membrane with monoclonal antibody 1B5 and goat-anti-mouse Ig resulted in internalization of the complex, while in-vitro stimulation of neutrophils caused an increase of the intensity of plasma membrane staining with anti-NB1, but only of those cells that were positive already prior to stimulation. The NB1 glycoprotein thus appears to identify a distinct subset of neutrophils, the size of which greatly varies among healthy donors. The function of the NB1 glycoprotein remains unclear, but its behaviour upon crosslinking and chemotactic peptide stimulation suggests a possible role as receptor molecule.     

The hidden, nonexchangeable pool of 3,5,3'-triiodothyronine and 3,3',5'-triiodothyronine in man: does it exist?

The validity of estimation of the production rates of T3 and rT3 in man based on noncompartmental analysis of blood-derived data has been questioned owing to incomplete exchangeability of T3 and rT3 between plasma and extrathyroidal tissues in which a local production of these iodothyronines takes place. The possible existence of a nonexchangeable or hidden pool of T3 and rT3 would result in an underestimation of the daily production. By contrast, the production rate of T4 can be estimated reliably using noncompartmental analysis. We have studied 16 women with pretreatment severe hypothyroidism on constant levothyroxine therapy. Simultaneous measurements of T4, T3 and rT3 production rates were performed using bolus injection of radiolabelled iodothyronines. The tracers were isolated from plasma using gel separation/antibody extraction, and production rates were calculated by noncompartmental analysis. Mean (+/- SD) production rate of T4, T3 and rT3 were: 119 +/- 43, 40.0 +/- 22.0 and 54.9 +/- 20.0 nmol.day-1.(70 kg)-1, respectively. Thus 79.5 +/- 7.0% of T4 was deiodinated into T3 and rT3. This leaves 20.5% to other metabolic pathways of T4 and to a possible underestimation of T3 and rT3 production rate. Based on conservative estimates from the literature, the other metabolic pathways of T4 amount: oxidative deamination 1.1%; ether link cleavage 0%; urinary excretion 2.5%; and fecal excretion 14%. Thus, the various metabolic pathways seem to explain 97% of daily produced and degradated T4 in man. Therefore the understimation of T3 and rT3 production rates in man using noncompartmental analysis seems of little if any importance, and existence of a hidden pool of these iodothyronines may be questioned.     

The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins

Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.