[High malignant B-cell non-Hodgkin lymphoma of the heart: intravital diagnosis by transesophageal echocardiography controlled biopsy]. / Hochmalignes B-Zell-Non-Hodgkin-Lymphom des Herzens: intravitale Diagnose durch transösophageale Echokardiographie-gesteuerte Biopsie.

We report about a 66-year old patient with Non-Q-wave infarction in coronary artery two-vessel disease. During an echo- and transesophageal multiplane echocardiography preoperatively before a coronary artery bypass surgery a right atrium septal tumor of unknown form was discovered. The computerized axial tomography (CAT) and nuclear magnetic resonance (NMR) scans did not demonstrate extracardiac pathologic findings. A transesophageal echocardiography-guided biopsy of the right atrial septum over the vena femoralis and the right atrium enabled intra vitam a very early diagnosis of high malignant B-cell Non-Hodgkin-lymphoma without the need for thoracotomy. The diagnosis was confirmed histopathologically and immunohistochemically and early treatment with cytostatic therapy could begin. To our knowledge the transesophageal echocardiography-guided biopsy has never been described in the worldwide literature.

Adrenoceptors in cardiac ventricular muscle and changes in duration of action potential caused by noradrenaline and isoprenaline.

1. On guinea-pig papillary muscle we investigated whether a prolonging effect of noradrenaline on the duration of the cardiac ventricular action potential (AP) is attributable to an action on beta-adrenoceptors. 2. Propranolol (5 X 10(-6) M), which itself shortens AP (at 90% repolarization level), inhibits both effects of noradrenaline on the AP, i.e. the sustained prolongation by low concentrations (10(-7)--10(-6)M) and the steady-state shortening which follows an initial prolongation by a high concentration (10(-5)M). In the presence of propranolol, the prlonging effect of noradrenaline is shifted to higher concentrations (10(-6)--10(-5)M). This prolongation of AP duration does not exceed the prior shortening effect by propranolol; it is not prevented by 10(-5)M phentolamine. 3. Phentolamine, which itself prolongs AP duration, inhibits neither the initial prolongation nor the steady-state shortening of the AP by 10(-5)M noradrenaline. Instead, the biphasic change in AP duration as well as the positive inotropic effect of 10(-5)M noradrenaline are enhanced in the presence of 3Z10(-6)M phentolamine. 4. The effect of isoprenaline on the duration of AP qualitatively resembles that of noradrenaline. In a concentration of 10(-8)M, isoprenaline produces a sustained prolongation of the AP; concentrations of 10(-7)M and 10(-6)M cause an initial prolongation which is followed by a steady-state shortening. These effects are inhibited by propranolol. 5. It is concluded that not only the steady-state shortening effect on AP duration by 10(-5)M noradrenaline but also the prolongation of AP, induced by lower noradrenaline concentrations (10(-7)--10(-6)M), are mediated solely by an action on beta-adrenoceptors.

Cardiac action potential and inotropic effect of noradrenaline and calcium.

1. Noradrenaline biphasically affects the duration of the action potential (AP) of guinea-pig cardiac ventricular muscle. Low concentrations (10-7M) prolong the AP duration, while high (10-5M) concentrations shorten it after an initial prolongation. The extent of the AP-prolonging effect is more marked at low (0.3 and 0.6 mM) than at high (2.4 or 4.8 mM) extracellular calcium concentrations. When the concentration of noradrenaline is cumulatively increased, the AP duration is always transiently prolonged, even if the AP is shortened in the second phase of the preceding noradrenaline effect. 2. The AP-prolonging effect begins immediately after the addition of noradrenaline. The positive inotropic effect does not appear until the maximum of the AP-prolonging phase has been reached. Its continued rise and amximum always occur during the subsequent phase of AP-shortening. 3. In essential aspects the effect of noradrenaline on AP duration and contractile force resembles the effect of an increase in [Ca-2+]o:AP duration is changed biphasically by noradrenaline in the same way as by an increase in [Ca-2+]o: in both cases an increase in force of contraction is related only to the AP-shortening effect. - But, unlike noradrenaline, calcium at concentrations higher than 1.2mM produces no transitory initial prolongation of AP duration. And, whereas higher concentrations of calcium shorten the plateau-phase of the AP in particular, noradrenaline has the most pronounced shortening effect on the late rapid repolarisation-phase of the AP. 4. The similarity of some of the effects of noradrenaline and calcium (i.e., prolongation of AP at low [Ca-2+]o: parallelism of positive inotropic effect and AP-shortening effect) indicated ahat at least part of the noradrenaline effect on the AP is the expression of an enhancement of calcium influx. For the effect of noradrenaline which is unlike that of calcium (i.e., prolongation of the relative plateau duration and transient prolongation of AP duration at high [Ca-2+]o), an additional influence on the membrane property must be assumed.