New Electrophysiologic Features and Catheter Ablation of Atrioventricular and Atriofascicular Accessory Pathways:

Catheter Ablation for Mahaim Pathways. Introduction : Several modalities of catheter ablation have been proposed to eliminate Mahaim pathway conduction. However, limited research has been reported on the electrophysiologic nature of this pathway in its entity.
Methods and Results : In seven patients, electrophysiologic study was performed, and radiofrequency energy was applied to investigate the electrophysiologic clues for successful ablation. In all seven patients, the Mahaim pathway was diagnosed as a right-sided atriofascicular or atrioventricular pathway with decremental properties. In two patients, two different kinds of electrograms were recorded through the ablation catheter positioned at the Mahaim pathway location: one was suggestive of conduction over the decremental portion, demonstrating a dulled potential; and the other of nondecremental conduction, demonstrating a spiked potential. All but one of the Mahaim pathways were eliminated successfully at the atrial origin where the spiked Mahaim potential was recorded. Radiofrequency energy application was performed at the slow potential site resulting in failure to eliminate the conduction over the Mahaim pathway. Conduction block at the site between the slow and fast potential recording sites was provoked by intravenous administration of adenosine, concomitant with a decrease in the amplitude of the Mahaim potential. In one patient, the clinical arrhythmia was a sustained monomorphic ventricular tachycardia originating from the ventricular end of the Mahaim fiber.
Conclusion : The identification of Mahaim spiked potentials may be the optimal method to permit their successful ablation. Detailed electrophysiologic assessment is indispensable for successful ablation of tachycardias associated with Mahaim fibers because tachycardias unassociated with Mahaim fibers can occur despite complete elimination of the Mahaim fiber.     

EFFECT OF POSTOPERATIVE EXTRADURAL MORPHINE ON ADH SECRETION

The effect of extradural morphine on antidiuretic hormone (ADH)secretion was assessed for the first 6 h after surgery in threegroups of patients. Surgery was conducted under extradural bupivacaine:thereafter patients in group I (n = 6) received further injectionsof bupivacaine, patients in group II (n = 6) received an extraduralinjection of morphine and in patients in group III (n = 5) bothbupivacaine and morphine, were administered extradurally. Ingroup I, plasma ADH values remained unchanged throughout thestudy. In contrast, in the two groups of patients receivingextradural morphine a delayed and stepwise increase in plasmaADH concentration was documented. These results indicate thatextradural morphine induces ADH secretion and suggest that thiseffect is the consequence of the migration of morphine to thebrainstem.     

A Case of Granular Lymphocyte Proliferation with T-Cell Phenotype

Immunological studies were conducted on a case of granular lymphocytosiswith benign clinical feature. A 60-year-old Japanese woman wasfound incidentally to have lymphocytosis when she had a commoncold. A complete blood count showed 47,200 leukocyte per mm³with 82% granular lymphocytes, 8% small lymphocytes and others.Hemoglobin was 11.5 g/dl and platelet count was 365 x 10³/mm³. Surface marker study revealed erythrocyte-rosettes 94%. Leu-159%, Leu-2a 70%, Leu-3a 14%, Leu-4 98%, Leu-7 57%, Leu-11 5%,HLA-DR 92%, BA-2 6%, common ALL antigen 4%, and surface immunoglobulin2%. These results suggest granular lymphocyte proliferationwith T-cell phenotype. Natural killer activity was 4.5%, butit was elevated to 11.4% after interleukin-2 stimulation by2 days' culture. Human T-cell lymphotropic virus-I antibodywas absent. No lymphadenopathy and no hepatosplenomegaly wereseen, except for bone marrow infiltration of granular lymphocytes.The patient has been in good health without any acute distress.The leukocyte count has gradually decreased to l2,300/mm³ with79% lymphocytes in 6 months of follow-up without any therapy. This case is suggestive of benign lymphocytosis, although similarcases have been reported previously as chronic lymphocytic leukemiawith T-cell marker and/or natural killer function.     

Proliferative fasciitis of the forearm: Case report with immunohistochemical, ultrastructural and DNA ploidy studies and a review of the literature

A case of prollferative fasclitis arising In the left forearm of a 56-year-old man was examined. The lesion was preceded by blunt trauma, measured 1.5 times 1.3 times 1.0 cm, was poorly circumscribed and appeared white to light gray on the cut surface. Light microscopic examinations revealed that spindle cells and giant cells with one or two nuclei and abundant basophllic cytoplasm ware arranged without any organized patterns In collagenous stroma. Ultrastructurally, well-developed rough endoplasmic reticulum separated by varying amounts of fine to course fibrillar materials was detected in the giant cells. Only vimentin lmmunoreactivity was detected In both spindle and gtant cells. The Ki-67 labeling Index of spindle cells was 35% but that of giant cells was less than 5%, and this reflects the quiescent or slow-growing features of these giant cells in proliferative fasclitis. DNA content of the calls, which was examined by Image cytometry, demonstrated diploidy In both spindle (DNA Index = 1.01) and glant (DNA Index = 1.09) calls.     

Prognostic value of nuclear area index in patients with bladder cancer

BACKGROUND: To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear morphometric parameter expressed as the mean nuclear area (MNA) ratio of cancer to normal transitional cells in patients with bladder cancer, who have undergone radical cystectomy. METHODS: Measurements of the nuclear areas of cancer and normal transitional cells were carried out on the histological slides of 73 patients with bladder cancer. The clinical usefulness of MNA, NAI, grade, and TNM categories for the prediction of the cause-specific survival of the patients was examined. RESULTS: The median values of MNA and NAI in the 73 patients were 39 micro m2 and 1.2, respectively. Cause-specific survival rates of the patients were calculated according to stage (T1-2 vs T3-4), grade (grade 2 vs grade 3), MNA (<39 micro m2 vs>/=39 micro m2) and NAI value (<1.2 vs>/=1.2). Using univariate analysis, all these parameters were statistically significant prognostic factors. However, by multivariate analysis, NAI was the only independent variable for the survival of the patients (P < 0.01). Cause-specific survival rates of patients with NAI values of less than 1.2 were significantly higher than those with NAI values of 1.2 or more, in both grade 2 and grade 3 tumors. CONCLUSIONS: These results suggest that NAI could provide improved prognostic information for patients with bladder cancer.     

The Characteristics of an Abnormal Electrogram on the Atrialized Right Ventricle in a Patient with Ebstein's Anomaly

Catheter ablation with the use of radiofrequency energy has been used as a treatment for atrioventricular reciprocating tachycardia in patients with Ebstein's anomaly. However, the success rate in these patients is generally low. We experienced a case in which the decision regarding precise accessory pathway (AP) localization was impaired by the presence of an abnormal electrogram in the atrialized right ventricle (ARV) in a patient with Ebstein's anomaly. After the AP conduction was abolished, the abnormal electrogram was observed behind the ventricular wave in the ARV during sinus rhythm. Furthermore, the interval between ventricular potential and the abnormal electrogram observed in the proximal ARV was longer than that in the distal ARV. We suggest that the abnormal electrogram might represent delayed local ventricular activation, and that the potential conduction might be impaired in the ARV.     

Immunolocalization of oestrogen and progesterone receptors in prostatic hyperplasia and carcinoma

Oestrogen receptors and progesterone receptors were immunolocalized in 19 patients with benign prostatic hyperplasia and in 26 patients with prostatic carcinoma. Immunohistochemistry was performed on tissue that had been fixed in 8% paraformaldehyde and then paraffin-embedded, using microwave irradiation for antigen retrieval. Oestrogen receptor expression was observed exclusively in the stromal cells of six out of 26 (23%) patients with prostatic carcinoma, but in none of the cells of patients with benign prostatic hyperplasia. Progesterone receptor expression was detected in 16 of 19 (84%) and 17 of 19 (89%) of the epithelial cells and stromal cells of patients with benign prostatic hyperplasia, respectively. In patients with prostatic carcinoma, progesterone receptor immunoreactivity was observed in 12 of 20 (46%) and 20 of 26 (77%) of the carcinoma and stromal cells of prostatic carcinoma, respectively. The ratio of epithelial cells with progesterone receptor immunoreactivity corresponded well with that of stromal cells with immunoreactivity in patients with benign prostatic hyperplasia. However, the ratio of stromal cells with progesterone receptor immunoreactivity was much higher than that in carcinoma cells in patients with prostatic carcinoma. Immunolocalization patterns or the ratio of the cells with progesterone receptor immunoreactivity did not significantly correlate with histological differentiation or patient's age in carcinoma cases. However, patients with advanced surgical stages of disease demonstrated a significantly smaller number of carcinoma and stromal cells with progesterone immunoreactivity in patients with prostatic carcinoma. These results suggest that oestrogens do not have a direct effect on the biological behaviour of benign prostatic hyperplasia and prostatic carcinoma, but that progesterone appears to play a role in the pathogenesis of benign prostatic hyperplasia and prostatic carcinoma.     

DEMONSTRATION OF PITUITARY TISSUE WITH 6 CELLS IMMUNOREACTIVE TO PITUITARY HORMONES IN A SACROCOCCYGEAL TERATOMA

A sacrococcygeal teratoma, containing mature-appearing anterior pituitary tissue, was first reported with the result of an immunohistochemical analysis for pituitary hormones. All kinds of adenohypophyseal endocrine cells were demonstrated in the anterior pituitary tissue in this teratoma. This study revealed that the anterior pituitary tissue being contained together with nerve tissues in a sacrococcygeal mature teratoma has the capacity to produce at least six anterior pituitary hormones.