Unusual Features of Right and Left Idiopathic Ventricular Tachycardia Aholished hy Radiofrequency Catheter Ablation

Two unusual cases are presented with idiopathic right and left ventricular tachycardia(IVT) with intriguing clinical and electrophysiological characteristics. The first patient with a sustained IVT of right ventricular outflow tract origin, and an electrophysiological mechanism suggesting reentry, had been resuscitated from cardiac arrest. The second patient had an IVT with a left bundle branch block morphology, which originated from the basal-septal region of the left ventricle(left ventricular outflow tract tachycardia). Both patients were cured with radiofrequency catheter ablation, guided by endocardial activation sequence and pace mapping.     

Soluble interleukin-6 receptor (sIL-6R), a new prognostic factor in multiple myeloma

sIL-6R is a 55 kD soluble molecule mediating the interleukin-6 (IL-6) signal through the IL-6 receptor-associated transmembrane signal transducer, gp130. It has recently been suggested that sIL-6R serum levels may reflect disease severity in multiple myeloma (MM). We determined sIL-6R serum levels in 25 normal controls (NC) and in 80 MM patients at diagnosis and during the course of the disease. Measurements were done by ELISA. In NC, sIL-6R levels ranged from 14 to 40 ng/ml (median 28 ng/ml) whereas in MM patients the range was 10–200 ng/ml (median 38 ng/ml) ( P  < 0.01). 61 patients entered remission and 19 were resistant. Median sIL-6R value at diagnosis was 36 ng/ml (10–120) in responding patients, and 82 ng/ml (20–200) in non-responding patients ( P  < 0.001). During a follow-up from 12 to 89 months, sIL-6R values remained more or less stable in most patients. High sIL-6R levels correlated with poor survival.     

Disorders of the Autonomic Nervous System in Patients With Brugada Syndrome: A Pilot Study

Autonomic Disorders in Brugada Syndrome . Introduction: The aim of this study was to examine autonomic disorders in patients with Brugada syndrome by performing a cardiac sympathetic innervation evaluation, a head‐up tilt‐test (HUT) and heart rate variability (HRV) analysis. Methods and Results: We enrolled 20 patients with Brugada syndrome (mean age 42.5 ± 8.8 years), 9 with spontaneous and 11 with an induced type 1 electrocardiogram (ECG) in the setting of symptoms and 20 age‐matched controls. All subjects underwent a HUT with parallel measurements of plasma catecholamines and cortisol, a ¹²³I‐metaiodobenzylguanidine single photon emission tomography, and HRV evaluation. Ten control subjects participated in the innervation portion of the study. The tilt‐test with clomipramine challenge was positive in 15 of 20 (75%) patients (7 spontaneous, 8 induced) and in 1 in controls (P < 0.01). A sympathoadrenal imbalance was shown in positive tests. The pattern of innervation in all groups was heterogenic and similar to controls with a trend towards lower measurements in patients with a spontaneous type 1 ECG and a positive HUT. HRV analysis did not reveal any significant differences during day and night. Four patients (20%) had sustained ventricular arrhythmias during a follow‐up of 31.1 ± 8.6 months, but no correlations with innervation or response to tilting were found. Conclusion: A high susceptibility to vasovagal syncope was observed in patients with Brugada syndrome, which could be disease‐related symptoms. Conversely, sympathetic innervation was observed to follow a physiological, heterogenic pattern; however, these factors did not have prognostic value for life‐threatening arrhythmias. (J Cardiovasc Electrophysiol, Vol. pp. 773‐780, July 2010)     

Immunohistochemical evaluation of nm23-H1 gene product in transitional cell carcinoma of the bladder

The expression of the nm23-H₁ gene has been suggested to have an inverse association with metastases in certain tumours. The aim of this study was to investigate the relationship of nm23-H₁ immunohistochemical expression with pathological tumour variables and survival in a series of transitional cell carcinomas (TCCs) of the bladder. Formalin-fixed, paraffin-embedded archival tissue from 87 carcinomas (T_a-T₁ 45 cases) and T₂-T₄ (42 cases) was immunostained (Strept ABC/ HRP) with the NDPK-A monoclonal antibody (NDPK-A) against nm23-H₁ protein. The tumours had already been evaluated for immuno-expression of p53 protein. In addition, DNA analysis was performed by flow cytometry. Results were analysed using the linear trend in proportions test, the Fisher's exact test and multivariate analysis. Paradoxically, advanced tumour stage showed significant correlation with nm23-H₁ immunopositivity in muscle invasive TCCs (P_t = 0.01). Patients with nm23-H₁ positive, muscle invasive TCCs had a worse prognosis at a level of suggestive statistical significance (P_F = 0.08). In multivariate analysis, using a Cox's proportional hazards survival model with six variables, tumour grade, disease stage and synchronous p53 and nm23-H₁ detection showed significant correlation with poor patient survival ( P  = 0.014, P  = 0.049 and P  = 0.05, respectively).     

A Fast and Reliable Algorithm to Localize Accessory Pathways Based on the Polarity of the QRS Complex on the Surface ECG During Sinus Rhythm

d 'AVILA, A., et al .: A Fast and Reliable Algorithm to Localize Accessory Pathways Based on the Polarity of the QRS Complex on the Surface ECG During Sinus Rhythm . Background: Many criteria have been published to localize accessory pathways from the 12-lead EGG during sinus rhythm. This study analyzed whether the localization of an accessory pathway could be predicted by using the polarity of the QRS complex during sinus rhythm on the surface ECG, instead of the delta wave polarity as used in many reports. Methods: The ECGs of 140 patients with an overt and single accessory pathway were evaluated. Eight localizations were taken into account. The precise location was previously known from successful radiofrequency ablation sites. Results: In 128 patients (92%), the new algorithm allowed an accurate diagnosis of the site of implantation of the accessory pathway. Conclusion: Analysis of the polarity of the QRS complex on five electrocardiographic leads provides an easy, fast and reliable way to localize accessory pathways during sinus rhythm.     

Inappropriate Sinus Tachycardia Following Radiofrequency Ablation of AV Nodal Tachycardia: Incidence and Clinical Significance

The incidence and consequences of inappropriate sinus tachycardia following modification of the AV nodal area with radiofrequency energy were prospectively studied in a consecutive series of 118 patients. Twelve (10%) patients developed this complication, which persisted less than 1 week in all but three patients. Inappropriate sinus tachycardia was only observed after fast pathway ablation. Only four patients required temporary treatment with a beta blocker.     

Effect of Aminoethylpyrroles on Carrageenan-induced Inflammation and on Lipid Peroxidation in Rats: Some Structural Aspects

Abstract— Nine 3-(2-aminoethyl)pyrrole derivatives were investigated as anti-inflammatory agents in the carrageenan-induced rat paw oedema model and as antioxidants in the non-enzymatic lipid peroxidation assay. It was found that the derivatives which were substituted with a p-toluenesulphonyl group exhibited considerable anti-inflammatory activity and some also showed antioxidant properties. However, the presence of a p-toluenesulphonyl group did not invariably lead to activity. A structural feature which was essential for both activities was the aminoethyl side chain. Although a relationship between the antiinflammatory and the antioxidant activities was not apparent, the combination of these properties could be useful.     

The effect of citric acid treatment on periodontal healing after replantation of permanent teeth

The aim of this study was to evaluate the effect of surface demineralization on the healing of 120 replanted teeth in fifteen 8- to 16-month-old dogs. Replanted teeth were divided into two groups (A and B). In group A, teeth were replanted following planing of the entire root surface. In group B, teeth were replanted following planing and surface demineralization with citric acid. Replanted teeth were splinted for 7 days, and observation periods were 3, 14 and 56 days. A total of 95 teeth and their surrounding tissues were examined histologically under a light microscope. Histological examination of specimens 3 days after replantation revealed that initial reunion between the root and the alveolar periodontal ligament fibres was via a fibrin-like network in both groups. Fourteen days after replantation histological observations showed superior healing in group B with regard to epithelial condition, periodontal ligament fibre reattachment to the root surface, resorption and functional arrangement of the periodontal ligament fibres. By 56 days after replantation, healing was superior in group A; group B was characterized by severe inflammatory and replacement resorption. These results indicated that surface demineralization had an initial positive effect, but later led to impaired healing.