Balloon Catheter Fracture During Percutaneous Balloon Pericardial Window Formation—Retrieval of a Dislodged Balloon: A Case Report

During a balloon pericardial window formation we experienced a fracture of the balloon catheter causing dislodgment of the balloon. The balloon remained in the pericardial space. We describe a case report of this uncommon complication and a method for retrieval of the balloon.     

Ventricular Cross Stimulation in a Dual Chamber Pacing System: Phenomenon Analysis

Seven cases of ventricular cross stimulation from a group of 23 patients implanted with DDD devices are presented. In two patients the phenomenon was observed at the moment of DDD programming at nominal values, and in five other patients it was reproduced by increasing the atrial output voltage up to ten volts. In all 23 patients cross stimulation disappeared permanently within 24 hours after implantation. From the onset of cross stimulation to its end, atrial and ventricular threshold voltages were unchanged, while the atrial and ventricular impedances significantly decreased. These results suggest that an important role in the phenomenon occurs by impedance variation at the interface between the pulse generator and body tissue.     

Synthesis of novel (N-farnesyl) amino acids and their incorporation into peptides

N-Alkylation, and particularly N-farnesylation, of bioactive peptides might be of wide interest: first, to increase peptide bioavailability by decreasing their elimination and by favouring their transport through biological membranes; second, to target peptides to cellular membranes; and third, to generate therapeutic double-substrate inhibitors of enzymes such as ras-farnesyltransferase. We report the synthesis of novel N-farnesyl amino acids [(N-Frn) amino acids]. We have synthesized (N-Frn)MetOCH₃, (N-Frn)ValOBz and (N-Frn)PheOCH₃, by alkylation of the corresponding natural amino acid esters. In order to demonstrate the feasibility of the introduction of (N-Frn) amino acids into peptides, we have synthesized representative dipeptide analogs: Cys-(N-Frn)ValOBz, Phe-(N-Frn)ValOBz, Lys-(N-Frn)ValOBz, Phe-(N-Frn)MetOCH₃, Glu-(N-Frn)MetOCH₃, Ser-(N-Frn)MetOCH₃, Trp-(N-Frn)PheOCH₃, and Pro-(N-Frn)PheOCH₃, We also describe the synthesis of the model peptide Cys-Val-Phe-(N-Frn)MetOCH₃, which is derived from the tetrapeptide CysValPheMet inhibitor of human p21ras-farnesyl transferase. © Munksgaard 1996.     

Melanoacanthoma Simulating Pigmented Spitz Nevus: an Unusual Dermoscopy Pitfall

BACKGROUND: The starburst pattern is the dermoscopic hallmark of pigmented Spitz nevus, although it has been rarely observed in melanoma as well. OBJECTIVE: To describe a case of melanoacanthoma simulating pigmented Spitz nevus. MATERIAL AND METHODS: Clinical, dermoscopic, and histopathologic examinations were performed for the occurrence of a 4-mm pigmented skin lesion on the hip of a 38-year-old Caucasian woman. RESULTS: Dermoscopy examination of the lesion disclosed a stereotypical starburst pattern characterized by pigmented streaks symmetrically distributed at the periphery. A preoperative diagnosis of pigmented Spitz nevus was made, and the lesion was excised. However, subsequent histopathologic examination revealed a melanoacanthoma. CONCLUSION: The starburst pattern, although diagnostic for pigmented Spitz nevus, can be rarely observed in other benign or malignant pigmented skin lesions. Accordingly, all lesions in adults exhibiting a starburst pattern or other spitzoid features should be excised for histopathologic evaluation.     

Catheter Induced Distal Intra-Hisian Right Bundle Branch Block in a Patient with Persistent Proximal Intra-Hisian Complete A-V Block

We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.     

Malignant Ventricular Arrhythmias in Chronic Chagasic Myocarditis

We studied 28 cases of chronic chagasic myocarditis (CCM) with frequent ventricular arrhythmias. Two-hundred and three conventional ECGs recorded during 3 months showed ventricular extrasystoles (VE) ranging between 0.2 and 6 per ten beats in 100%; multiform VE in 97.04%; couplets in 79.31%; ventricular tachycardia (VT) in 42.85%; and R on T in 21.67%. A 24-hour continuous recording showed that VE ranged between 3780 and 61733 (mean 16618 ± 2627); muitiform VE and couplets were present in 100% of patients, and VT was present in 78.5%. In 16 patients (group I) the frequency of VE was persistently high, without diurnal variation; 11 patients showed sustained reduction during sieeping hours and only one showed an increase during night sleep (group II). Even in group II, VE never disappeared for periods longer than 10 minutes. In five patients, four 24-hour recordings were obtained at weekly intervals, and in five other patients a second 24-hour recording was performed 10 to 24 months later. The remarkable frequency, persistence and low variability of ventricular arrhythmias in CCM suggest that such arrhythmias can be used as a most stable, reliable, but highly demanding model for testing the efficacy of antiarrhythmic drugs. (PACE, Vol. 5, March-April, 1982)     

Cardiac resynchronization improves heart failure in one patient with Myotonic Dystrophy type 1. A case report

We report an improvement in symptoms of heart failure, a reduced left ventricular dysfunction and induced reverse remodelling in one patient with Myotonic Dystrophy type 1, showing an early onset ventricular dysfunction secondary to a complete left bundle branch block (LBBB) who underwent cardioverter defibrillator CRT (ICD- CRT) implantation.Key words: myotonic dystrophy, cardiac resynchronization therapy, sudden death     

Multiform Ventricular Ectopic Rhythm by Combined Parasystolic and Reentrant Activities

Multiform ventricular ectopic rhythm (MVER), i.e., at least two QRS configurations of ventricular ectopic beats (VEBs), was assessed by 24-hour ambulatory ECG recording in four patients with ventricular parasystole (VP). In two of these four patients, VEBs with fixed coupling to the preceding impulses coexisted with VP beats of different configuration. In case no. 1, the VEBs had an identical coupling interval to sinus bents and VP beats, suggesting a mechanism of reentry elicited from both dominant pacemakers. In case no. 2, an intermittent form of VP due to type II second-degree entrance block was present. In this patient, the VEBs were coupled to sinus beats and to sinus-VP fusion beats and appeared to be dependent on the sinus beats reaching the VP focus. A mechanism of reentry determined by the penetration of sinus beats into the VP area, with prematurity-dependent aberrancy of VEBs, was suggested for the coupled VEBs in this patient. These observations suggest that the coexistence of an automatic ventricular ectopic focus and of a reentrant activity determined by, or elicited from, an area of automaticity may constitute the underlying mechanism of MVER in some patients.