Atrial Flutter with 1:1 Atrioventricular Conduction Caused by Propafenone

We describe a case of 1:1 atrial flutter in a patient with coronary disease taking propafenone. In atrial flutter, the atrial rate is usually about 300 beciis/min with 2:1 AV conduction and a ventricular rate of 150 beats/min. Class IA antiarrhythmic drugs, especially quinidine and disopyramide, may cause 1:1 AV response because they reduce atrial rate and are vagolytic. However, propafenone is a Class IC agent and has no anticholinergic properties, and the occurrence of 1:1 AV conduction at a rate of about 250 beats/min is an important side, effect that, although uncommon, should be recognized.     

A New Acceleration Driven Pacemaker: Rate Modulation Versus Normal Sinus Rhythm—Comparison During Treadmill Exercise

The pocing rate response of a new acceleration driven pulse generator (SWING 100, SORIN BIOMEDICA) was compared with simultaneous normal sinus rhythm (NSR) during two different treadmill exercises. This pacemaker has a gravitational acceleration sensor able to discriminate between physical activities and vibrations. Six healthy volunteers (three male, three female; aged 21.7 ± 4,3 years), with the pacemaker strapped to their right infraclavicular area, performed each test three times with different rise response curve (RRC) each time: fast, normal, and slow. The fall response curve used was the same as the rising one during each test. Pacing rates were recorded using the VEGA analyzer (SORIN BIOMEDICA) and compared with simultaneous NSR recorded by a 7-channel ECG recorder (MINGOGRAF 7, SIEMENS), During all tests immediate (within seconds) rapid increase in pacemaker rate was seen up to about 60 seconds, then a slower increase followed thereafter. The mean correlation between pacing rates and NSR during the Bruce tests were 0.7941 ± 0.10, 0.8562 ± 0.14, and 0.8292 ± 0.07; during the discontinous tests 0.7292 ± 0.16, 0.7233 ± 0.10, and 0.7480 ± 0.11 for fast, normal, and slow RRC, respectively. Each 30 seconds, nonsignificant differences were present between pacing rate and NSR during all the discontinuous tests; similar responses were observed only during the first two stages of Bruce tests after which NSR was significantly higher than pacemaker rates. The speed of rise to upper rate was the main difference between the different programs (fast, normal, and slow). The discontinuous tests showed that the pacemaker responds more to speed than to grade. In conclusion, the Swing pacemaker is easy to use and program, fast, reliable, and is able to mimic the normal sinus behavior especially during discontinuous activities.     

Long‐standing ulcerative colitis complicated by right subclavian artery occlusion and upper limbs arteriolitis with digital ischemia

A 48‐year‐old male patient with long‐standing ulcerative colitis since February 2001 which was diagnosed by endoscopy, developed acute digital ischemia affecting both hands with fixed colour changes in the left index finger which was followed shortly by digital ulceration. Magnetic resonance angiography (MRA) of both upper limbs showed evidence of vasculitis affecting digital arterioles on both sided and right subclavian occlusion. The patient received pulse methylprednisolone followed by cyclophosphamide pulse therapy, the latter continuing on a monthly basis for 6 months with appreciable improvement and remission of the vasculitic process; follow‐up MRA showed reperfusion of the previously occluded subcalvian artery. To the authors’ knowledge vasculitis complicating the course of ulcerative colitis is a rare association and is only sporadically reported in the literature. This rare entity should be diagnosed early and aggressively treated; MRA is a very promising diagnostic tool that is suitable for both diagnosis and follow‐up of patients with this rare entity.     

Bilateral masseteric contractile activity in unilateral gum chewing: differential calculus

SUMMARY Twelve healthy subjects performed 10 s, 15 s, 20 s, and 25 s of right-sided and, subsequently, left-sided gum chewing. The contractile activities of the ipsilateral (chewing side) and contralateral (non-chewing side) masseter muscles, mainly the concentric contractions of the phase of jaw closing and the isometric contractions of the phase of dental occlusion, were recorded through cumulative surface electromyography (EMG). A linear function (y = ax + b) described the association between an increase in the duration (x) of unilateral gum chewing and the cumulative EMG (y) of both the ipsilateral and the contralateral masseter muscle, and because of different slopes (a) of the two straight lines a geometric function (y = aqx) described the progressively larger differences between the paired and straight lines. When differential calculus was applied to the exponential functions, it became evident that the chewing forces generated by the ipsilateral masseter muscle continually exceeded those generated by the contralateral masseter muscle, and that the positive work (force x distance) produced by the concentric contractions of the ipsilateral masseter muscle continually exceeded that produced by the concentric contractions of the contralateral masseter muscle. It was inferred that mechanophysical work plays a major role if clinical muscle fatigue develops during prolonged unilateral gum chewing.     

Lack of Delayed Neurotoxic Effect after Tri-o-cresyl Phosphate Treatment in Male Fischer 344 Rats: Biochemical, Neurobehavioral and Neuropathological Studies

Lack of Delayed Neurotoxic Effect after Tri-o-cresyl PhosphateTreatment in Male Fischer 344 Rats: Biochemical, Neurobehavioral,and Neuropathological Studies. SOMKUTI, S. G., TIL-SON, H. A.,BROWN, H. R., CAMPBELL, G. A., LAPADULA, D. M., AND ABOU-DONIA,M. B. (1988). Fundam. Appl. Toxicol. 10, 199-205. Tri-o-cresylphosphate (TOCP), which produces a delayed neurotoxic syndromein humans and some animal species, was given to Fischer 344(F344) male (18 week old) rats to determine if it causes biochemical,sensorimotor, and neuropathological effects. Animals were givenTOCP by gavage in doses ranging from 10 to 100 mg of TOCP/kgdaily for a period of 63 days. The rats were subjected to aseries of neurobehavioral tests including fore- and hindlimbgrip strength, motor activity, tremor, and latency to respondto a thermal stimulus. Central and peripheral nervous tissueswere examined for damage characteristic of organophosphorouscompound-induced delayed neurotoxicity (OPIDN). Brain neurotoxicesterase and acetylcholinesterase activities were inhibitedin a dose-dependent fashion. A group of three chickens treatedwith 100 mg of TOCP/kg/day for 18 days was included as the positivecontrol for enzymatic and histopathological alterations associatedwith OPIDN. Rats showed no consistent neurobehavioral changesor evidence of neuropathological damage in nervous tissues associatedwith treatment. In contrast, chickens treated with TOCP developeddelayed neurotoxicity characterized by ataxia, which progressedto paralysis. These neurological changes included swelling,fragmentation, and degeneration of the axon and myelin in bothcentral and peripheral nervous tissues. This study concludesthat the F344 rat is not sensitive to the delayed neurotoxiceffects of TOCP. When studying OPIDN in rats, care must be exercisedin choosing the experimental animal since some strains, e.g.,F344, are not sensitive.     

Bullous Allergic Contact Dermatitis to Pure Henna in a 3‐Year‐Old Girl

Abstract: Natural henna is known to have a very low allergic potential. We describe here an exceptional case of bullous contact dermatitis caused by pure henna.     

Favourable outcome in sclerotherapy for bleeding oesophageal varices in schistosomiasis: Results in 30 patients

Abstract Thirty consecutive patients with bleeding oesophageal varices secondary to schistosomal liver disease received injection sclerotherapy. These formed a part of a prospective study, to evaluate the role of sclerotherapy in the treatment of bleeding oesophageal varices due to different aetiological factors in patients seen at the Gastroenterology Unit, Riyadh Armed Forces Hospital, Saudi Arabia, between December 1980 and July 1984.
Schistosomiasis is endemic in parts of Saudi Arabia. Sclerotherapy has a special place in schistosomal liver disease as liver function is well preserved in this disease. The new antischistosomal drugs are effective and may halt the progress of the disease. However, in many patients portal hypertension with bleeding oesophageal varices is found at diagnosis. Of the patients with schistosomiasis, 63.3% were Group A Child's Classification. Oesophageal varices have been eradicated in 11 cases during the mean follow-up period of 28 months (range 3-44 months). Four patients were referred for surgery because of bleeding gastric varices, two of whom died following operation. One patient, who was also hepatitis B surface antigen positive, died due to re-bleeding from gastric varices. The remaining 25 patients had no recurrence of bleeding and their liver function remained satisfactory.
Surgical procedures for oesophageal varices in schistosomiasis carry the risk of peri-operative and postoperative morbidity and mortality. In contrast, complications following sclerotherapy are minor compared to surgical procedures and none of our patients had any serious sclerotherapy complications.     

Immediate and 18‐Month Outcome of Balloon Mitral Valvuloplasty: Comparison of Inoue and Multi‐Track System

Aims: To compare the immediate and 18‐month clinical and echocardiographic outcome of Inoue and multi‐track system for balloon mitral valvuloplasty (BMV). Methods: We included 78 consecutive patients with moderate to severe rheumatic mitral stenosis (MS) [mitral valve area (MVA) < 1.5 cm²] and clinically indicated BMV. The first 42 consecutive patients were assigned to Inoue BMV (group I), and the following 36 consecutive patients were assigned to multi‐track system (group M). Clinical and echocardiographic assessment was performed before, immediately after, 3 months after, and 18 months after the procedure. Results: The successful immediate result [MVA > 1.5 cm² and mitral regurgitation (MR) < II/IV] was achieved in 40 (95.23%) patients of group I and 34 (94.44%) patients of group M (P = 0.12). Immediately after BMV, MVA increased from 0.9 ± 0.4 to 1.7 ± 0.5 cm² in group I and from 0.8 ± 0.2 to 1.9 ± 0.3 cm² in group M (P < 0.01). Bilateral commissural splitting was significantly higher in group M (P < 0.01). This was associated with higher incidence of mild commissural mitral regurgitation. There were no significant differences of moderate to severe MR. Both procedure and fluoroscopy time were significantly shorter in group I (P < 0.001). Eighteen‐month clinical and echocardiographic evaluation was available for 66 (84.64%) patients with sustained immediate clinical and echocardiographic improvements. Conclusions: Both Inoue and the multi‐track balloon systems achieved successful immediate and 18‐month results. The multi‐track double balloon system produced significantly larger MVA, with better bilateral commissurotomy, yet with longer procedure and fluoroscopy times. (J Interven Cardiol 2012;25:47–52)