CREUTZFELDT-JACOB DISEASE: A GOLGI STUDY

A cerebral biopsy of a patient with Creutzfeldt-Jacob (C-J) disease was examined with the Golgi method. Distortion of soma and neuronal processes associated with vacuolization of the neuropil was observed. The main findings were decreased numbers of basal dendrites and of branches of the apical dendrite of the pyramidal cells, marked loss of synaptic spines, and varicosities in the proximal segment of some apical and basal dendrites. These changes, though non-specific, may be interpreted as the result of deafferentation, although primary reactions related to C-J disease cannot be ruled out. These changes underline the intense disruption of intracortical connections which takes place in this condition in addition to the neuronal loss.     

The laminate capillary and its wall of multiple basement membranes

Cutaneous telangiectatic vessels from two cases of unilateral dermatomal superficial telangiectasia were shown under electron microscopy to be venular capillaries with thick walls composed of multiple basement membranes. We suggest that this special capillary structure, seen in a variety of telangiectatic and disease states, should be called the 'laminate capillary'.     

Left Atrial Voltage during Atrial Fibrillation in Paroxysmal and Persistent Atrial Fibrillation Patients

Background: Left atrial (LA) endocardial voltage characteristics assessed during atrial fibrillation (AF) have not been previously compared in different AF types. This study was aimed at investigating the LA voltages and volumes in patients with paroxysmal and persistent AF. Methods: LA electroanatomic voltage maps acquired during AF were compared between consecutive patients without major structural heart disease undergoing first catheter ablation for paroxysmal AF (n = 100) or persistent AF (n = 100). The groups were comparable in baseline clinical characteristics. Results: Patients with persistent AF presented with lower median LA voltage (median 0.41, interquartile range [IQR] 0.31–0.51 mV versus median 0.99, IQR 0.47–1.56 mV; P < 0.001), and maximum LA voltage (4.07 ± 1.76 vs 6.42 ± 2.16 mV; P < 0.001). They also had a higher proportion of the LA points exhibiting voltage <0.2 mV (30 ± 20 vs 12 ± 11%; P < 0.001) and voltage 0.2–1.0 mV (55 ± 15 vs 42 ± 19%; P < 0.001). They further displayed higher LA volume/body surface area (75 ± 16 vs 58 ± 13 mL/m²; P < 0.001). In the multivariate regression model, both LA voltage (P < 10^?9) and LA volume (P < 10^?5) were significant determinants of AF type. Conclusion: Patients with persistent AF had significantly lower LA voltage compared with patients with paroxysmal AF even after adjustment for differences in indexed LA volume. LA voltage represents an independent covariate of clinical manifestation of AF. (PACE 2010; 541–548)