Incidence and characteristics of transient St-segment elevation during transseptal puncture.

PURPOSE: Delineate retrospectively and prospectively the incidence and characteristics of transient ST-segment elevation during transseptal puncture. METHODS: The study retrospectively evaluated 307 patients from January 1, 2015, to December 31, 2017, and prospectively evaluated 231 patients from January 1, 2018, to July 31, 2019. RESULTS: The presence of ST-segment elevation was significantly higher in the prospective sample than in the retrospective sample (5.2% vs. 1.3%, p < 0.05). Between the two groups, there was no significant difference in age, sex, comorbidities, left atrial volume index, and the etiology of atrial fibrillation among patients with ST-segment alteration. In all patients, the ST-segment elevation was observed in the inferior wall derivations, except for one patient with ST elevation in lead I, AVL, V1-V4 during the septal puncture, associated with sinus bradycardia and reversed hypotension with intravenous fluids. Comparative analysis of the systolic and diastolic arterial pressure and the minimum heart rate during the phenomenon demonstrated more severity in the retrospectively evaluated population than in the prospective population. There was a significant association between the occurrence of ST-segment elevation > 2 mm and the presence of symptoms. In these patients, coronary angiography showed no alterations. Atropine was administered to one patient who presented with junctional bradycardia after the puncture. This medication reversed the situation. CONCLUSION: ST-segment elevation is a short-term phenomenon that can occur during transseptal catheterization without clinically evident symptoms. The catheter ablation procedure can be safely concluded despite the occurrence of the phenomenon.

Fast food arthritis--a clinico-pathologic study of post-Salmonella reactive arthritis.

OBJECTIVE: To study the clinical presentation, immunogenetics, and serum immune response to lipopolysaccharide (LPS) in a cohort of patients with post-Salmonella reactive arthritis (ReA). METHODS: A validate ReA screening questionnaire (Quest 2) was mailed to 919 individuals reporting symptoms of gastroenteritis to the health department after eating at a single restaurant. Three hundred twenty-one persons returned questionnaires; 170 reported symptoms outside the gastrointestinal tract; 23 of those 170 reporting persistent joint symptoms were seen 4 to 16 weeks after the outbreak and 5 of the 23 were seen in followup 12 to 20 weeks later. Clinical features, HLA Class I typing, serum soluble CD8 levels, and serum antibodies to gram negative LPS by ELISA were determined. RESULTS: Joint complaints were reported more frequently by individuals with a longer duration of diarrhea. Upper extremity joints were frequently involved, and 66% reported one or more extraarticular symptoms of Reiter's syndrome. Three of 5 typed individuals were HLA-B27 positive, including 3 of the 4 most severely involved. Serum soluble CD8 levels correlated poorly with disease activity measured either clinically or by C-reactive protein. Antibodies to Klebsiella and Shigella LPS rose over time, while antibodies to Salmonella LPS fell. CONCLUSION: The clinical picture of post-Salmonella ReA is less stereotyped than often assumed, although severity correlated with HLA-B27 status. The association of joint symptoms with duration of diarrhea and the kinetics of the anti-LPS antibody response support the hypothesis that abnormal gut permeability plays a role in the pathogenesis of post-Salmonella ReA.

Effect of adrenaline on plasma concentrations of bupivacaine following intra-articular injection of bupivacaine for knee arthroscopy.

We administered 0.5% bupivacaine 30 ml either with or without adrenaline 5 micrograms ml-1 randomly to 16 healthy outpatients, to determine the efficacy of local and intra-articular local anaesthesia for knee arthroscopy and whether or not adrenaline should be added to intra-articular bupivacaine. Bupivacaine concentrations were measured in plasma obtained 15, 30, 45 and 60 min after intra-articular injection. Patients receiving bupivacaine with adrenaline had significantly smaller plasma concentrations of bupivacaine at all times than did patients receiving plain bupivacaine. The maximal concentrations of bupivacaine in the plain group (median 515 ng ml-1, range 46-875 ng ml-1) were greater than those in the adrenaline group (median 33 ng ml-1, range 7-125 ng ml-1) (P = 0.001). All patients found the anaesthetic satisfactory. We conclude that intra-articular/local anaesthesia is satisfactory for outpatient arthroscopic surgery, and that adrenaline should probably be added to bupivacaine before intra-articular injection.

1-O-alkyl-linked glycerophospholipids of human neutrophils: distribution of arachidonate and other acyl residues in the ether-linked and diacyl species.

This study was done to determine whether human neutrophils contain sufficient 1-O-alkyl-2-acyl-sn-glycero-3-phosphocholine to support the synthesis of platelet activating factor by a deacylation-reacylation mechanism, and to examine the relative distribution of arachidonate among the 1,2-diacyl, 1-O-alkyl-2-acyl, and the 1-O-alk-1'-enyl-2-acyl classes of choline- and ethanolamine-containing phospholipids. The predominant phospholipid species of human neutrophils were choline-containing glycerophospholipids (41%), ethanolamine-containing glycerophospholipids (39%), and sphingomyelin (14%), with smaller quantities of phosphatidylserine (4%) and phosphatidylinositol (1%). The choline-linked fraction contained high amounts of 1-O-alkyl-2-acyl-X (44%) and 1,2-diacyl-sn-glycero-3-phosphocholine (47%), and a lesser amount of 1-O-alk-1'-enyl-2-acyl-sn-glycero-3-phosphocholine (9%). In contrast, the ethanolamine-linked fraction contained a large amount of 1-O-alk-1'-enyl-2-acyl-sn-glycero-3-phosphoethanolamine (66%), and lower levels of the 1,2-diacyl (24%) and 1-O-alkyl-2-acyl (10%) species. The major 1-O-alkyl and 1-O-alk-1'-enyl ether chains found in the choline and ethanolamine phospholipid pools were 16:0, 18:0, 18:1, and 20:0. The predominant fatty acyl residues found in the 1,2-diacyl and the sn-2 position of the 1-O-alkyl-2-acyl and 1-O-alk-1'-enyl-2-acyl choline and ethanolamine glycerophospholipids were 16:0, 18:0, 18:1, 18:2, and 20:4.(ABSTRACT TRUNCATED AT 250 WORDS)