Recurrent ventricular tachycardia due to reentry within the bundle branches.

A case of recurrent ventricular paroxysmal tachycardia in a young man without obvious heart disease is described. Posttachycardiac T-wave inversion followed the arrhythmic episodes. Programmed stimulation of the heart in association with intracardiac recordings showed evidence in favor of reentry within the bundle branches and its divisions during tachycardia. A critical prolongation of the H2-V3 interval preceded each paroxysm of tachycardia.

Ventricular activity during atrial fibrillation. Studies with His bundle electrography.

His bundle electrograms were recorded in 12 patients with atrial fibrillation. In all cases but one, the dominant rhythm was atrial fibrillation. In 1 case the dominant rhythm was fascicular tachycardia due probably to digitalis overdosage. However ventricular, fascicular and junctional beats could be often recognized on His bundle tracings, even when QRS configuration was similar to supraventricular conducted beats due to atrial fibrillation. In the patients in whom sinus rhythm occurred, the H-V interval was unchanged. Although it is admitted that during atrial fibrillation the zone of concealment of A-V conduction is in the A-V nodal area, concealed penetration of atrial impulses in the fascicular system may be encountered in patients not treated with digitalis.

An unusual case of reno-vascular hypertension with multiple arterial stenosis.

A case of juvenile reno-vascular hypertension is presented. Extensive involvement of aorta and its branches was found. The possible inflammatory or congenital origin of the arterial lesion is discussed.

Pseudo-retrograde conduction in complete A-V heart block due to ectopic His bundle activity.

A case with complete A-V heart block in whom retrograde P- waves following some of the ventricular complexes were due to an ectopic junctional activity with the characteristics of parasystole is reported. His bundle electrogram showed an infrahisian block. After administration of 1 mg atropine intravenously the retrograde P- waves were detached from the ventricular automatic complexes and an H' deflection preceded each inverted P- wave with an H'-A' interval of 40 msec.

Bidirectional tachycardia a study of five cases.

Five patients with bidirectional tachycardia due to digitalis toxicity associated with severe organic heart disease were studied. The origin of the abnormal rhythm was established with the aid of His bundle recordings in three cases and by indirect clues in the others two. In three cases the origin of bidirectional tachycardia was suprahisian while in two patients it was infrahisian. In one patient the transition from junctional to ventricular tachycardia could be observed. Bidirectional tachycardia appears to be a complex arrhythmia in which similar electrocardiographic configuration can be due to different mechanism. Digitalis toxicity was often a causal factor.

[Acute cholangiocholecystitis]. / Colangiocolecistita acuta.

In analysis of a group of 48 patients, the authors describe an entity they call acute cholangio-cholecystitis (or acute cholecystitis of choledochal origin) and define it by 4 obligatory criteria: 1. vesicular lesion of acute cholecystitis type; 2. the obstruction of the main bile duct in the direction of its junction with the cystic duct; 3. free duct communication between the gallbladder and the main bile ducts; 4. fluid content (purulent gallbladder) found identical over the whole biliary territory (the gallbladder the main bile ducts the intrahepatic bile ducts). This entity represents 7.6% of the total of acute cholecystitis and was met in 2.8% of the total of the interventions for the main bile ducts obstruction. The deficient biological background of the patients (60% over 60 years old), and other seriousness factors--vesicular destructive lesions associated with biliary peritonitis (7/48), the existence of the duct obstruction, usually calculous (42/48), but also hydatic (3/48) or tumoural (3/48), the multitude and seriousness of the associated lesions are emphasized. The surgery, performed in over 80% emergent cases, was directed to the decomprimation of the main biliary axis to which the increase of the gangrenous cholecyst, treatment of the duct obstructive factor, repair of the internal biliary fistulas, treatment of the consequent peritonitis were added. The results, very often good (71%), were shadowed by a series of complications (29%) which ended in deaths (14.5%). The paper pleads for the early surgery of the lithiasic biliary disease, before the appearance of the inevitable complications.

[Enterostomy post emergency enterectomy]. / Enterostomia dupa enterectomia în urgenta (previziune tactica sau solutie "de avarie").

This is a clinical approach regarding 43 resection of intestine, performed in emergency condition, terminated as enterostomy, with represent 20% of enterectomyes performed in emergency condition and 1.6% of urgent operations. The decision of enterostomy has been taken in the conditions of peritoneal sepsis, occlusion or the association of the two circumstances. The results are comparatively analyzed between the cases with enterostomy that has been made from the beginning (66% success, 33% gone wrong), and those with enterostomy made at the second intervention (14% success, 86% gone wrong). One discusses problems of leading, technique and post-operating nursing. The intestinal reintegration has been made possible at 16 patients after a timing of three of four weeks.

Manifestation of the Wolff-Parkinson-White syndrome during isoprenaline infusion and carotid sinus massage.

In a patient with transient WPW syndrome the electrocardiographic pattern of preexcitation could repeatedly be induced by carotid sinus massage during isoprenaline infusion. Adrenergic and cholinergic discharge may favor the conduction of the impulse over an accessory nonfunctional A-V bundle.

Right ventricular monophasic action potentials in patients with long QT syndrome.

In 3 patients with the long QT syndrome, one caused by quinidine and 2 of congenital origin, right ventricular monophasic action potentials were excessively prolonged and of varying shapes in different recording sites. In addition, effective refractory periods of the ventricular muscle were abnormally long.

His bundle electrogram during bidirectional tachycardia.

The case is reported of a 66-year-old woman with bidirectional tachycardia caused by digitalis intoxication. His bundle records demonstrated the presence of two foci, one junctional and the other a fascicular one.

Right atrium monophasic action potentials during atrial flutter and fibrillation in man.

Monophasic action potentials recorded in two patients with atrial flutter and one patient with atrial fibrillation showed a nonuniform depolarization of the right atrial wall. In each of the two patients with atrial flutter, there was a site where two separate action potential deflections were recorded for each flutter wave. It was supposed that this was the site of re-entry for a cycling wavelet subsidiary to the main flutter wave. In the patient with atrial fibrillation, three types of electric atrial activity were found: regular activity at 180 per minute similar to that found in flutter, small irregular activity at a rate of 400 per minute, and a mixed type of the former two. The significance of these findings for the mechanism of atrial flutter and fibrillation is discussed.

Ventriculo-atrial conduction associated with ventricular premature beats. Study with his bundle electrography.

In a group of eight patients with ventricular premature beats, ventriculoatrial conduction, with retrograde activation of the His bundle and the atria could be demonstrated by His bundle electrograms in four subjects. All had early ventricular premature beats with coupling indices between 210 and 350 msec. In the other four cases, concealed retrograde conduction could be demonstrated in the A-V nodal area. The ventricular ectopic beats were late, and depending upon the refractory period of the A-V node these extrasystoles were interpolated or followed by compensatory pauses.

Double ventricular parasystole associated with atrial fibrillation.

The case of a 75-year-old man with acute myocardial infarction is presented. Two ventricular parasystolic foci, one in the right bundle branch, the other in the left bundle branch system were demonstrated with the aid of a His bundle recording, in the presence of atrial fibrillation.

Parasystole associated with fixed coupling ventricular ectopic activity.

In 5 patients ventricular parasystole and fixed coupling ectopic beats were recorded. In two cases ventricular parasystole and bigeminism acted intermittently. In one case the spontaneous transition from ventricular parasystole into parasystolic tachycardia with "reverse coupling" and finally to ventricular bigeminy could be illustrated. In all these cases ventricular parasystole and fixed coupling extrasystolic activity seems to be a close related mechanism. In other two cases there was a mathematical relationship between the sinus and parasystolic discharge rate which explained the periodic fixed coupling of ectopic beats. In one of these cases His bundle electrography was helpful in documenting the ventricular origin of ectopic beats.