The significance of a positive cutaneous immunofluorescence test in systemic lupus erythematosus

Direct cutaneous immunofluorescence microscopical examination of uninvolved skin is an important diagnostic test in systemic lupus erythematosus. Its prognostic significance is undetermined. In twenty-four patients there was an increased incidence of leukopenia, hypocomplementaemia, and LE cells in patients with positive skin immunofluorescence. Positive cutaneous immunofluorescence of uninvolved skin was correlated with the most severe forms of lupus renal disease, membranous glomerulonephritis, and diffuse proliferative glomerulonephritis.     

Low dose azaribine in the treatment of psoriasis

Thirteen patients with severe psoriasis were treated with low dose azaribine (125 mg/kg/day) for 8-week periods. Two patients with generalized pustular psoriasis and four patients with psoriatic arthritis had a good to excellent response. Severe neurotoxicity occurred in four patients, requiring lowering of the dose in three and discontinuance of the drug in one patient. Because of these results, azaribine at 125 mg/kg/day cannot be recommended for plaque-type psoriasis, though it is very effective against generahzed pustular psoriasis and psoriatic arthritis. Of the eleven patients with plaque psoriasis, seven had a good or excellent response initially but subsequently relapsed while on therapy; the other four patients failed to respond to the medication.     

Radiofrequency Catheter Ablation of Sustained Monomorphic Ventricular Tachycardia in Hypertrophic Cardiomyopathy

Monomorphic VT in HCM. Introduction : Incessant monomorphic ventricular tachycardia (VT) with a right bundle branch block morphology and a northwest axis is a rare arrhythmic complication in a patient with hypertrophic cardiomyopathy and apical left ventricular aneurysm.
Methods and Results : The origin of this VT was localized using the following criteria: the presence of entrainment without fusion, equal internals from the stimulus to the beginning of the QRS complex and from the electrogram to the QRS complex during VT, and the first postpacing interval identical to the tachycardia cycle length. Radiofrequency energy applied to the septoapical part of the apical left ventricular aneurysm terminated the tachycardia within 2 seconds.
Conclusion : Using criteria to guide radiofrequency (RF) ablation of VT in patients with coronary artery disease, an incessant monomorphic VT in a patient with hypertrophic cardiomyopathy was successfully ablated.     

Sudden cardiac death and acute pathology of coronary arteries

The pathology of sudden cardiac death still is a matter of controversy,particularly with respect to the state of the coronary arteries.A recent study has shown a high incidence of acute lesions andsuggests a causal relationship. The present study has been designedto verify whether or not acute coronary arterial lesions occurfrequently in patients with sudden cardiac death. Sixteen heartswere available. In each instance the patient had died within6 hours from the onset of myocardial ischaemia. The coronaryarterial system was extensively studied by post-mortem coronaryangiography, decalcification, serial blocking and histologicalsectioning. Acute coronary arterial lesions, defined as plaquefissure, ‘isolated’ plaque haemorrhage and ‘isolatedthrombosis’, were found in 14 of the 16 hearts (87.5%).The total number of acute lesions in the 14 hearts was 28. In9 hearts plaque fissures were present, in 7 ‘isolated’plaque haemorrhages and in 5 an ‘isolated thrombus’.Half of all acute lesions had occurred in an atheroscleroticplaque of pre-existing 50–75% luminal narrowing. The presentstudy endorses the concept that acute coronary arterial lesionsoccur in a high proportion of patients with sudden cardiac death,plaque fissures with intramural haemorrhage and intraluminalthrombosis being the most common abnormality. It is temptingto attribute causal significance to such lesions in patientswith sudden cardiac death.