Characteristics of Bifocal Pacing:

Bifocal RIGHT ventricular stimulation (BRIGHT) is an ongoing, randomized, single-blind, crossover study of atrial synchronized bi-right ventricular (RV) pacing in patients in New York Heart Association heart failure functional class III, a left ventricular ejection fraction <35%, left bundle branch block and QRS complexes ≥120 ms. This analysis compared the electrical and handling characteristics, and the complications of pacing at the RV apex (Ap) with passive, versus RV outflow tract (OT) with active fixation leads. A mean of 1.6 ± 0.9 and 2.2 ± 2.0 attempts were needed to position the Ap and OT leads, respectively (ns). R-wave amplitudes at Ap versus OT were 23 ± 13 mV versus 14 ± 8 mV (n = 36, P < 0.001). R-wave amplitudes at the Ap remained stable between implant and M7. R-wave amplitudes at the OT could not be measured after implantation. In two patients, atrioventricular block occurred during active fixation at the OT. Conduction recovered spontaneously within 4 months. Ventricular fibrillation was induced in one patient during manipulation of an Ap lead in the RV. Marked differences were found between leads positioned in the OT versus Ap, partly related to the difference in lead design. Mean R-wave amplitude was higher at the Ap that at the OT. Ease and success rate of lead implant was similar in both positions.     

Successful Rotational Atherectomy of Mid-Saphenous Vein Graft Lesions

Rotational atherectomy has long been regarded as contraindicated for stenotic lesions within the body of saphenous vein grafts. So far, reports of rotational atherectomy in vein grafts have been concerned with ostial and distal anastomotic lesions. We report the first two cases of the successful use of the Rotablator for discrete lesions of mid-saphenous vein grafts. No complications were encountered. One patient is doing well 6 months after the procedure, and the other patient continues to do well more than 1 yearlater.     

Improvement of myocardial perfusion after thrombolysis assessed by thallium-201 exercise scintigraphy

The effects of recanalization by early intracoronary streptokinasein acute myocardial infarction on myocardial perfusion werestudied in a subset of 236 out of 533 patients enrolled in aprospective multicentre trial, randomly allocated to eitherconventional treatment or to thrombolysis. Maximal symptom-limitedthallium-201 stress testing was performed nine to 14 (median12) weeks after the acute event in 236 patients with a firstmyocardial infarction, of whom 108 patients were allocated toconventional treatment and 128 patients to thromolysis. Three-viewthallium exercise and redistribution scintigrams were dividedinto eight segments. The number of normal thallium segmentsat redistribution was 5.3±1.6 (mean±SD) in thecontrol group and 5.8±1.6 in the thrombolysis group (P<0.01), indicating increased myocardial perfusion after earlythrombolytic treatment. This beneficial effect was particularlyevident in patients with a first anterior infraction with 4.8±1.6normal thallium segments in the control group and 5.9±1.6normal segments in the thrombolysis group (P <0.001). Therewas no difference in residual ischaemia during exercise betweenthe control and the thrombolysis group either in the patientswith anterior or in those with inferior infarction. It is concluded that early thrombolysis within 4 h after onsetof symptoms, in some of the patients followed by angioplastyor coronary artery bypass surgery, leads to sustained improvementof myocardial perfusion at rest without excessive ischaemiaduring exercise, particularly in patients with acute anteriorinfarction.     

Allergy to olive pollen: T-cell response from olive allergic patients is restricted by DR7-DQ2 antigens

Backgound We have recently described the association between the IgE antibody response to Ole e I (the major antigen from olive tree pollen) and the DR7-DQ2 haplotype in a Spanish population. Objeectivc and methods Due to the linkage disequilibrium between DR7 and DQ2, and thus the dillicult distinction between the role of these two antigens in the T-cell activation response, we decided to solve this question by two approaches: 1. The study of another ethnic group, individuals of Arabic origin, with a presumably distinct disequilibrium linkage between DR and DQ antigens. Genomic DNA typing was performed in 46 subjects (allergic and non-allergic) by Restriction Fragment Length Polytnotphism (RFLP) and results showed that patients with specific IgE antibodies α-Ole e I, were DR7 and or DQ2. These data show a similar restriction pattern to those previously described for Spanish patients. The phenolypic frequency of DR7 antigen is significantly greater than in the non-allergic population, with a corrected P(PJ value of O.O.3 2 The analysis of the genetic requirements of Ole e I response, using T-cell lines speific for this antigen. This was first carried out by blocking the proliferative response of these T-cell lines with specific anti-human HLA class II antibodies and then testing the genetic restriction of this response using a panel of histoeompatible and histoincompatible Antigen Presenting Cells (APCs). Both experiments corroborate the hypothesis that DR7 and DQ2 are implicated in the recognition o(Ole e I.     

Differential expression of miR‐21, miR‐125b and miR‐191 in breast cancer tissue

Aims: To develop new biomarkers for early detection and to inform effective clinical management of breast cancer. Methods: Real‐time polymerase chain reaction was used to profile microRNA (miRNA) in tumor tissue from 50 breast cancer patients using non‐tumor breast tissue from each patient as a control. We have focussed on three miRNA; miR‐21, miR‐125b and miR‐191, all of which have been implicated in breast cancer with either proven or predicted target genes involved in critical cancer‐associated cellular pathways. Results: Upregulation of miR‐21 and miR‐191 and downregulation of miR‐125b, was found in breast cancer tissue. Combined expression analysis of miR‐125b/miR‐191 increased sensitivity to 100% and specificity to 94% while miR‐21/miR‐191 increased to 92% and 100%, respectively. Therefore, combination of two miRNA gives a better prediction than individual miRNA. Conclusions: We could differentiate between breast cancer and adjacent non‐tumor breast tissue as a control with a high degree of sensitivity and specificity in the Mexican population using a combined expression analysis of only two miRNA. These observations, although a proof of principle finding at this time, show that a combined expression profile of two miRNA (miR‐125b/miR‐191 and miR‐21/miR‐191) can discriminate between breast cancer and non‐tumor tissue with high specificity and sensitivity.     

Right Ventricular Outflow Tract Tumor Mimicking a Thrombus in the Main Pulmonary Artery

Primary sarcomas of the pulmonary artery and right 'ventricle are rare, and their presentation is unusual in clinical practice; therefore, their diagnosis is often missed or delayed. The progression of the obstruction from the outflow tract of the right ventricle to the pulmonary artery resembles massive pulmonary embolism. We present a case of one of these tumors which mimicked transesophageal echocardiography (TEE), a massive pulmonary embolism. We conclude that TEE represents a non-invasive method of diagnosis and evaluation when the suspicion is massive pulmonary thromboembolism or a heart tumor.     

Platelet serotonin content and plasma tryptophan in peri- and postmenopausal women: variations with plasma oestrogen levels and depressive symptoms

Platelet serotonin content was measured by high pressure liquid chromatography in 56 peri- and postmenopausal women, in order to study variations of this parameter with hormonal status and depressive mood symptoms. Clinical symptoms were assessed by a self-report depression symptom scale (CES-D of NIMH). Thirty-eight women with a score of 16 or more were considered as presenting depressive symptoms (mean score +/- SD = 28.8 +/- 10.5), while the others formed the control group (n = 18, score = 4.4 +/- 4.2). Platelet serotonin contents were significantly lower in the 'depressed' group (0.302 +/- 0.010 vs. 0.366 +/- 0.020 nmol 10(-8) platelets, means + SEM, P less than 0.001 by Mann-Whitney U-test). In 'depressed' women who had been treated for one or more depressive episodes, platelet 5-HT contents (0.283 +/- 0.023, n = 18, P less than 0.01) were significantly lower with respect to controls. In patients without previous episodes of depression, serotonin expressed in nmol 10(-8) platelets did not differ significantly from controls but serotonin expressed in nmol ml-1 of blood was slightly lower than control values (0.890 +/- 0.085, n = 20 vs. 1.088 +/- 0.090 nmol ml-1, n = 18, P less than 0.02). Platelet serotonin content was positively correlated to plasma oestrone and oestradiol concentrations among the control group but not in the 'depressed' group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lupus Erythematosus-Like Lesions by Voriconazole in an Infant with Chronic Granulomatous Disease

Abstract:  We report the first case of lupus-like lesions in an infant with chronic granulomatous disease during the treatment with voriconazole for chronic invasive aspergillosis. The lesions disappeared with termination of the treatment.