Irregular sinus parasystole due to intermittency and modulation of parasystolic activity.

A case of intermittent sinus parasystole in which the parasystolic focus is protected from the dominant sinus rhythm only during the second half of its intrinsic cycle is reported. In addition, a modulating (i.e., electronic) effect is often clearly exerted from the dominant rhythm upon the focus during the protected period. Coexistence of both modulation and intermittency in sinus parasystole, as well as a modulating effect limited to the second part of the parasystolic cycle, have not been previously reported.

[Malignant sacrococcygeal teratoma: report of a case of "explosive" intrauterine growth]. / Teratoma maligno sacro-coccigeo a sviluppo addomino-pelvico: descrizione di un caso ad "esplosiva" crescita intrauterina.

An exceptional case of fetal sacrococcygeal teratoma with an exclusive abdominopelvic growth is described. The tumor was not detected on a "routine" ultrasound study obtained at 31 weeks of gestation showing findings of a severe congenital uropathy. It remained unrecognized until the 34 weeks of gestation when the mass began an explosive growth causing a rectouretral fistula. Despite appropriate obstetrical and surgical management the baby died 24 hours later because inadequate pulmonary maturity. The istological findings showing malignant elements such as embryonal carcinomas.

[The allorhythmic distribution of ectopic ventricular beats. Observations on the electrogenesis and dynamics of concealed ventricular extrasystole]. / Distribuzione alloritmica dei battiti ectopici ventricolari. Osservazioni sull'elettrogenesi e sulla dinamicità dell'extrasistolia ventricolare occulta.

BACKGROUND: A regular distribution of ventricular ectopic beats is thought to be a relatively uncommon phenomenon, known as "concealed extrasystole". Several experimental studies suggest that the phenomenon originates from a "protected" ventricular focus. The aim of the present study was to evaluate the 24-hour ECG monitoring incidence of ventricular concealed extrasystole in patients with highly frequent ventricular ectopic beats, looking for signs useful in postulating the electrogenesis of the arrhythmia. METHODS: The 24-hour ECGs of 10 patients (pts) with highly frequent ventricular extrasystoles were analysed, searching for significant sequences in the distribution of ectopic beats (i.e., ectopic beats separated by a number of interectopic sinus beats fulfilling one of the formulas of concealed extrasystole). RESULTS: Five cases (50%) showed an allorhythmic distribution resulting in a prevalent pattern of concealed bigeminy (2n-1) in 3 cases, and concealed trigeminy (3n-1) in 2 cases. The phenomenon, however, showed a dynamic behaviour, alternating the distributions from patterns of concealed bigeminy to concealed trigeminy or less common patterns, and vice versa. The evidence of the pure ectopic cycle and mathematically related interectopic intervals in 2 cases, the variability of coupling intervals, and the presence of fusion beats in the remaining 3 cases, strongly suggests a parasystolic origin of the phenomenon. CONCLUSIONS: The results suggest the following: Concealed extrasystole is a relatively common phenomenon, at least in patients with highly frequent ventricular extrasystoles; the phenomenon, however, is somewhat underestimated due to prevalent quantitative, instead of qualitative, Holter monitoring analyses. Among patients with allorhythmically distributed ventricular extrasystoles, none showed only one pattern of distribution. In fact, each single patient showed two or more patterns throughout the 24-hour recordings. Changes from one pattern to another is governed by several factors, such as sinus heart rate and/or the influence of electrotonic "modulation" upon the ectopic focus. Ventricular extrasystoles with regular allorhythmic distribution show a significantly higher variability of coupling intervals than the others (p = 0.005).

[Arrhythmia in thalassemia major: evaluation of iron chelating therapy by dynamic ECG]. / Aritmie nella talassemia major: valutazione della terapia ferrochelante mediante ECG dinamico.

Arrhythmias and sudden death represent striking features in the natural history of thalassemia major. Antiarrhythmic treatment, however, does not appear to change the clinical course. During recent years the disease's therapeutics approach has undergone a substantial evolution, being more adequate the transfusional regimens as well as more effective the iron chelation therapy through subcutaneous infusion of deferoxamine. The aim of the present study was to determine possible influences exerted by the current treatment upon disease's arrhythmic disorders. Thirty patients of both sexes were enrolled in the study. The age ranged from 9 to 24 years. No congenital or acquired heart diseases were present. Each patient underwent concentrated red cell transfusions (in order to obtain pretransfusional hemoglobin levels of 10-11 g%), and iron-binding therapy through continuous subcutaneous microinjection of deferoxamine 40-50 mg/kg/day (6-8 hours/day, 6 days/week). Patients were divided in 2 groups: the first group (group A) comprising the 16 patients with good therapeutic compliance and regular pharmacological regimen; the second group (Group B) including the remaining poorly compliant 14 patients. The following parameters were analyzed: age, average hemoglobin levels during the last year, total amount of red cell transfusions, ferritin levels, starting age of iron-binding therapy. Moreover, each patient underwent 24-hour ECG Holter monitoring. Age (Group A: 18 +/- 4.6; Group B: 14 +/- 2.7; p < 0.02), total amount of transfusions (Group A: 272 +/- 73; Group B: 211 +/- 44; p < 0.03), and ferritin levels (Group A: 1697 +/- 860; Group B: 2908 +/- 730; p < 0.002) proved to be significantly different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A drug used in traditional medicine: Harpagophytum procumbens DC. III. Effects on hyperkinetic ventricular arrhythmias by reperfusion.

In Langendorff preparations of rat heart, hyperkinetic ventricular arrhythmias (HVA) have been induced by an ischaemic perfusion (coronary flux 0.5 ml/min; pressure 8 mmHg) and following reperfusion at basal conditions (coronary flux 8 ml/min; pressure 50 mmHg). Crude methanolic extracts of Harpagophytum procumbens secondary roots and harpagoside showed a significant, dose-dependent, protective action toward HVA induced by reperfusion.

[Prognostic and therapeutic considerations in intraventricular blocks in acute myocardial infarct]. / Considerazioni prognostiche e terapeutiche sui blocchi intraventricolari in corso d'infarto miocardico acuto.

Intraventricular blocks were observed in 26% of 122 cases of acute myocardial infarction in the Medical Division "S. Angelo Hospital", Messina. Mortality in hospital, which was higher in cases with RBBB + LBBB, LBBB + BAV, above all was caused by myocardial insufficiency. It's Authors' opinion that temporary electrical stimulation is useless in cases with myocardial insufficiency and useful in cases with hemodynamic compensation or with slight decompensation.