Double potentials along the ablation line as a guide to radiofrequency ablation of typical atrial flutter.

OBJECTIVES: The purpose of this study was to determine the characteristics of double potentials (DPs) that are helpful in guiding ablation within the cavo-tricuspid isthmus. BACKGROUND: Double potentials have been considered a reliable criterion of cavo-tricuspid isthmus block in patients undergoing radiofrequency ablation of typical atrial flutter (AFL). However, the minimal degree of separation of the two components of DPs needed to indicate complete block has not been well defined. METHODS: Radiofrequency ablation was performed in 30 patients with isthmus-dependent AFL. Bipolar electrograms were recorded along the ablation line during proximal coronary sinus pacing at sites at which radiofrequency ablation resulted in incomplete or complete isthmus block. RESULTS: Double potentials were observed at 42% of recording sites when there was incomplete isthmus block, compared with 100% of recording sites when the block was complete. The mean intervals separating the two components of DPs were 65 +/- 21 ms and 135 +/- 30 ms during incomplete and complete block, respectively (p < 0.001). An interval separating the two components of DPs (DP(1-2) interval) <90 ms was always associated with a local gap, whereas a DP(1-2) interval > or =110 ms was always associated with local block. When the DP(1-2) interval was between 90 and 110 ms, an isoelectric segment within the DP and a negative polarity in the second component of the DP were helpful in indicating local isthmus block. A DP(1-2) interval > or =90 ms with a maximal variation of 15 ms along the entire ablation line was an indicator of complete block in the cavo-tricuspid isthmus. CONCLUSIONS: Detailed analysis of DPs is helpful in identifying gaps in the ablation line and in distinguishing complete from incomplete isthmus block in patients undergoing radiofrequency ablation of typical AFL.

Left ventricular epicardial outflow tract tachycardia: a new distinct subgroup of outflow tract tachycardia.

The present study investigated the incidence and ECG characteristics of ventricular tachycardias (VTs) originating from the left ventricular (LV) epicardium. Thirty-one consecutive patients with VT or premature ventricular contraction originating from the outflow tract (OT-VT) underwent catheter ablation. Twenty-one OT-VTs were ablated from the endocardium in the right ventricular (RV) OT and 3 were ablated from the endocardium in the LVOT. In the remaining 7 patients, 4 (13%) OT-VTs were LV epicardial in origin, and 1 of these was ablated from the left sinus of Valsalva. The ECG characteristics of OT-VT of epicardial origin included prominent tall R-waves in the inferior leads, an R-wave in V1 and an S-wave in V2, precordial R-wave transition in V2-4, a deep QS-wave in aVL, and no S-wave in V6. In addition, there was an atypical left bundle branch block morphology with an inferior axis. These findings were observed during pacing from several sites in the LV epicardium. Furthermore, pacing from the left sinus of Valsalva caused a relatively tall R in V1, deep S-wave in V2 and a tall R-wave with a shallow S-wave in V3, as well as tall R-waves in the inferior leads, which represented intermediate characteristics between RV endocardial OT-VT and LV endocardial OT-VT. In conclusion, OT-VT originating from the LV epicardium is not uncommon and has characteristic ECG findings. Some of them can be ablated from the left sinus of Valsalva.

Gastric distension-induced pyloric relaxation: central nervous system regulation and effects of acute hyperglycaemia in the rat.

1. The pylorus plays an important role in the regulation of gastric emptying. In addition to the autonomic neuropathy associated with long-standing diabetes, acute hyperglycaemia per se has effects on gastric emptying. In this study, the role of the central nervous system in modulating the effects of hyperglycaemia on gastric distension-induced pyloric relaxation was investigated. 2. Gastric distension-induced pyloric relaxation was significantly reduced by subdiaphragmatic vagotomy, hexamethonium (20 mg kg(-1)) and N (G)-nitro-L-arginine methyl ester (L-NAME; 10 mg kg(-1)), a nitric oxide synthase (NOS) biosynthesis inhibitor, in anaesthetized rats. In contrast, neither splanchnectomy nor guanethidine (5 mg kg(-1)) had an effect. 3. An intravenous (I.V.) infusion of D-glucose (20 %) for 30 min, which increased blood glucose concentrations from 5.4 to 12.8 mM, significantly inhibited gastric distension-induced pyloric relaxation. 4. An intracerebroventricular (I.C.V.) injection of D-glucose (3 micromol) also significantly inhibited gastric distension-induced pyloric relaxation without affecting peripheral blood glucose concentrations. 5. I.V. infusion of D-glucose significantly elevated hypothalamic neuropeptide Y (NPY) concentrations. 6. Intracerebroventricular (I.C.V.) administration of NPY (0.03--3 nmol) and a Y1 receptor agonist, [leu(31), pro(34)] NPY (0.03--3 nmol), significantly inhibited gastric distension-induced pyloric relaxation in a dose-dependent manner. 7. I.C.V. administration of a Y1 receptor antagonist, BIBP 3226 (30 nmol), and of a NPY antibody (titre 1:24 000, 3 microl) abolished the inhibitory effects of hyperglycaemia on gastric distension-induced pyloric relaxation. 8. Taken together, these findings suggest that gastric distension-induced pyloric relaxation is mediated via a vago-vagal reflex and NO release. Acute hyperglycaemia stimulates hypothalamic NPY release, which, acting through the Y1 receptor, inhibits gastric distension-induced pyloric relaxation in rats exposed to acute elevations in blood glucose concentrations.

[Thoracoscopic pleural biopsy under local anesthesia using a 2 mm laparoscope].

Thoracoscopy is indicated in patients with undiagnosed effusion after conventional methods. It has been usually performed under general anesthesia or using a thoracoscope with a thoracoscope with a diameter over 5 mm. However, it is an invasive diagnostic technique. We evaluated the feasibility of thoracoscopic pleural biopsy under local anesthesia using a 2 mm laparoscope. Six patients with a pleural effusion of unknown etiology after conventional methods, underwent thoracoscopy under local anesthesia. A 2 mm laparoscope and biopsy forceps (2 mm Minisite, United States Surgical Corp., USA) was used in all patients. Pleural fluid was removed, and the thoracic cavity was inspected. Thoracoscopic intercostal blocks were performed with 1% lidocaine, and then a biopsy was performed. The biopsy specimen was sent for histopathology. Three patients were shown to have carcinomatous pleurisy, two of them with localized lesions less than 10 mm. In the remaining three patients, non-specific diagnoses were made, but long-term follow-up revealed no malignant pleural disease. Although the pictures obtained using a 2 mm laparoscope were inferior in quality, they were adequate for the detection of malignant lesions in the pleural cavity. There were no procedure-related complications. These findings suggest that thoracoscopy using a 2 mm laparoscope is (1) a useful diagnostic tool in cases of pleural malignancy; (2) a minimally invasive method with the advantage of being easily performed under local anesthesia. Thus, thoracoscopic pleural biopsy using a 2 mm laparoscope appears to be useful for undiagnosed pleural effusion.

The restoration of the antitumor T cell response from stress-induced suppression using a traditional Chinese herbal medicine Hochu-ekki-to (TJ-41:Bu-Zhong-Yi-Qi-Tang).

We previously reported that restraint stress impairs the antitumor immune responses through its suppressive effect on the Th1-type cytokine production from CD4+ T cells. In this study, we investigated a potential of Hochu-ekki-to (TJ-41:Bu-Zhong-Yi-Qi-Tang) to restore stress-induced immunosuppression. The oral administration of TJ-41 was able to improve a decreased cellularity in the lymph node and spleen and to improve an inhibition of tumor-specific Th1-type cytokine production, both of which were induced by repeated restraint stress in tumor-bearing mice. The oral administration of TJ-41 also induced a partial recovery of the antitumor cytolytic activity in the stress-burdened tumor-bearing mice. More importantly, the growth of tumors in stress-burdened preimmunized mice was obviously inhibited by TJ-41, and resulted in tumor-free state in 75% of the mice. Regarding the mechanisms by which TJ-41 restored the antitumor responses in stress-burdened mice, we found that the serum levels of corticosterone and interleukin-12 were normalized by TJ-41. In addition, the expression of CD80 and CD86, which both decreased in the stress-burdened mice, was restored to the normal level by TJ-41. Taken together, our results indicate that the oral administration of TJ-41 is able to restore the antitumor T cell responses in stress-burdened tumor-bearing mice by normalizing the serum corticosterone, interleukin-12 and the expression of costimulatory molecules.

A case of human adjuvant disease after augmentation rhinoplasty.

Human adjuvant disease (HAD) is an autoimmune syndrome which is caused by prolonged hypersensitization of injected foreign materials. Usually, this occurs after mammary augmentation with foreign materials. We report a rare case of HAD after rhinoplasty with silicone injection. Thirty years ago, the patient underwent augmentation rhinoplasty with silicone injection. We removed the silicone and grafted the area with fascia lata. After the operation, local and systemic symptoms improved.

[Effect of coix seed on the changes in peripheral lymphocyte subsets].

Coix seed has been used in patients with verruca vulgaris and verruca planae juveniles, which have been considered to be induced by viral infection. Moreover, coixenolide, component in the seeds of coix, was reported to show anti-tumor activity. Possibly coix seed may have some influence on the cytotoxic activity of peripheral lymphocytes but there has been no data on this. Then we investigated the changes in number of cytotoxic lymphoid cells in seven volunteers before, during (four weeks) and after taking six coix seed tablets. Lymphocyte subsets were analyzed with monoclonal antibodies using a flow cytometer. The level of CD3+CD56+ (MHC-non restricted cytotoxic T cells) markedly increased at four weeks (before 1.9 +/- 0.5% vs four weeks 4.2 +/- 0.7%, p less than 0.01). The level of CD16+CD57- (the mature, most active natural killer cells) increased at three weeks (before 4.5 +/- 0.8% vs three weeks 5.2 +/- 0.8%, p less than 0.05). The level of CD3-CD56+ (natural killer cells) and the level of CD16+CD57+ (the variable active natural killer cells) decreased at one week and returned to normal level thereafter (before 13.7 +/- 2.1% vs one week 11.2 +/- 1.5%, p less than 0.05; before 8.8 +/- 1.5% vs one week 6.9 +/- 1.3%, p less than 0.05, respectively). These results indicate that coix seed modulate the peripheral blood lymphocyte subsets and may be effective to virus disease through the enhancement of cytotoxic activity.

Changes of eye-blink activities during hypnotic state.

Three experiments were conducted to examine eye-blink activity during the hypnotic state. The results were as follows: (1) eye-blink rate was dramatically reduced during the hypnotic as compared to the nonhypnotic state, (2) blink-rate variability between events (for example, the task and rest period) was smaller under the hypnotic than under the nonhypnotic state, (3) decrements, after induction of hypnosis, were observed in all aspects of blink-wave attributes (amplitude, duration, slope, and area). These findings can be interpreted in terms of the facilitation of motor inhibition by hypnosis.