ATP sparing effect of isoflurane during ischaemia and reperfusion of the canine heart

Sustained dysfunction of myocardial contractility after shortperiods of coronary artery occlusion and reperfusion has beentermed "stunned myocardium". Isoflurane may improve the recoveryof regional myocardial contractility in stunned myocardium.The purpose of the present study was to determine if isofluraneprevents depletion of high energy phosphates after myocardialischaemia-reperfusion and if the reduction in cardiac work duringisoflurane anaesthesia contributes to the preservation of highenergy phosphate metabolism in an acute canine model. Mongreldogs were allocated to one of three groups: controls, anaesthetizedwith urethane and chloralose; ISO group, isoflurane administeredbefore ischaemia; and ISOc group, heart rate and mean arterialpressure controlled to approximately match baseline values.The left anterior descending (LAD) coronary artery was occludedfor 15 min and then reperfused for 60 min during 1.5% end-tidalisoflurane anaesthesia. Full thickness samples of myocardiumwere obtained from the reperfused area (supplied by the LAD)and the non-ischaemic area (supplied by the left circumflexcoronary artery). The concentrations of adenosine monophosphate(AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP),creatine phosphate (CP) and lactate in the endocardial portionof the myocardium were measured. Arterial pressure, aortic flowin the ascending aorta and rate-pressure product decreased significantlyafter isoflurane. Although the concentration of ATP of the reperfusedarea in the control group showed a significant reduction 60mm after reperfusion, the ISO and ISOc groups had significantlygreater concentrations. Isoflurane anaesthesia maintained myocardialhigh energy phosphate metabolism in reperfused myocardium. Weconclude that the reduction in cardiac work played only a minorrole in the ATP-sparing effect of isoflurane. (Br. J. Anaesth.1995; 74: 563–568)     

Atrial Electrograms and Activation Sequences in the Transition Between Atrial Fibrillation and Atrial Flutter

Transition Between Atrial Fibrillation and Flutter. Introduction: The eletrophysiologic mechanism of atrial fibrillation (AF) has a wide spectrum, and it seems that some atrial regions are essential for the occurrence of a particular type of AF. We focused on one type of AF: AF associated with typical atrial flutter (AFI), which was right atrial (RA) arrhythmia, and sought to investigate intra-atrial electrograms and activation sequences in the transition between AF and AFL.
Methods and Results: Intra-atrial electrograms and activation sequences in the R.A free wall and the septum were evaluated in the transition between AF and AFL in seven patients without organic heart disease (all men; mean age 57 ± 11 years). In five episodes of the conversion of AFL into AF, the AFL cycle length was shortened (from 211 ± 6 msec in stable AFL to 190 ± 15 msec before the conversion, P, 0.001). Interruption of the AFL wavefront and an abrupt activation sequential change induced by a premature atrial impulse resulted in fractionation and disorganization of the septal electrograms. During sustained AF, septal electrograms were persistently fractionated with disorganized activation sequences. However, the RA free-wall electrograms were organized, and the activation sequence was predominantly craniocaudal rather than caudocranial throughout AF. In 12 episodes of the conversion of AF into AFL, the AF cycle length measured in the RA free wall increased (from 165 ± 26 msec at the onset of AF to 180 ± 24 msec before the conversion, P, 0.001). AFL resumed when fractionated septal electrograms were separated and organized to the caudocranial direction, despite the RA free-wall electrograms remaining discrete and sharp with an isoelectric line.
Conclusion: Changes of the electrogram and activation sequence in the atrial septum played an important role in the transition between AF and AFL.     

A Case of Neonatal McCune-Albright Syndrome with Cushing Syndrome and Hyperthyroidism

ABSTRACT. We describe a female newborn infant with McCune-Albright syndrome. In addition to the cutaneous pigmentation, she had apparent manifestations of hyperthyroidism and Cushing syndrome since birth. X-ray examinations showed many scattered lucencies in multiple bones. Endocrinological findings were as follows: serum T4 276 nmol/l; free T4 125 pmol/l; TSH <1 mU/l; serum cortisol >2210 nmol/l; plasma ACTH < 10 pg/ml; urinary free cortisol 865 nmol/day; estradiol 0.36 nmol/l. Regardless of treatment with antithyroid drugs and an inhibitor of 3β-hydroxysteroid dehydrogenase, the patient died of cardiac failure at the age of 4 months. Autopsy findings included a follicle cyst in the right ovary and multinodular hyperplasia in the thyroid and both adrenals. To our knowledge such a severe neonatal form of McCune-Albright syndrome has not been described in the literature.     

Characterization of mucin in the hepatic bile of patients with intrahepatic pigment stones

To investigate the relationship between biliary mucin and ductular stone formation, mucin was isolated from hepatic bile using gel filtration on Sepharose CL-4B. The bile was obtained from 14 patients with stones in various sites of the biliary tract. The hexose content in the excluded fraction was significantly higher in patients with intrahepatic ductular stones (68.7 +/- 20.5 micrograms/mL; mean +/- s.d.) than in those with gall-bladder stones or extrahepatic ductular stones (23.8 +/- 8.1 micrograms/mL, 33.3 +/- 9.5 micrograms/mL; P less than 0.05), suggesting a higher concentration of mucin in the bile of patients with intrahepatic ductular stones. Ion-exchange chromatography on DEAE-Sephacel showed that most mucin from each material was negatively charged and electrophoretic studies indicated that it was composed mainly of high molecular weight (greater than 10(6)), sulfated glycoprotein. These results suggested that the mucin content of hepatic bile might have an important relation to the development of intrahepatic ductular stones.     

Characteristics of the cellular composition, especially the lymphocyte sub-populations of bronchoalveolar lavage fluid from patients with summer-type hypersensitivity pneumonitis

The pathogenesis of summer-type hypersensitivity pneumonitis, which often occurs in Japan, was examined by analysing the cell profile, especially the lymphocyte sub-populations, of bronchoalveolar lavage fluid from these patients: twenty-two normal volunteers and fourteen patients with localized lung cancer as controls. Lymphocyte sub-populations were determined by the micro-testplate method. In the bronchial fluid of the summer hypersensitivity group, the total cell number was much higher (five to ten times) than in the control groups, and the percentage of lymphocytes reached 84-2 + 5.1 (mean + s.e. mean); the percentage of T lymphocytes was significantly increased (95.6 + 1.0), but that of B lymphocytes (3.2 + 0.6) was similar to that of the control groups, though the absolute numbers of B and T lymphocytes were higher than in the control groups. In the peripheral blood of the summer hypersensitivity group, the percentage of B lymphocytes was significantly higher than that found in the normal volunteers, but that of T lymphocytes was not increased. Cellular changes in bronchial fluid were more evident than changes seen by X-ray examination and are considered to be a good parameter of the severity of hypersensitivity pneumonitis. It is considered that cell-mediated immunity as well as the Arthus reaction may be intimately related to the pathogenesis of summer-type hypersensitivity pneumonitis.