Pleomorphous leiomyosarcoma of the mesocolon: a case report.

Leiomyosarcoma is a rare tumor of the smooth muscle, but relatively frequent in the stomach and the small intestine. The mesocolic site is rare. Globally, leiomyosarcoma represents less than 0, 1% of the malignant tumors found in the colon and the anus. Because of the similarities with other digestive tumors, namely mesenchymatous or benign tumors of the smooth muscle, the diagnosis of a pleomorphic sarcoma remains difficult even at the histological stage. Surgery is the mainstay of the therapy. We report a case of leiomyosarcoma of the mesocolon and discuss about its main characteristics in the view of the current literature about this pathological condition.

Transseptal puncture using minimally invasive echocardiography during atrial fibrillation ablation.

AIMS: To assess the usefulness of miniature transoesophageal echocardiography using a 10 F intracardiac probe (ICE-TEE) for transseptal catheterization during atrial fibrillation (AF) ablation. METHODS AND RESULTS: Intracardiac echocardiography probe was used transoesophageally in 79 consecutive patients (56 ± 11 years, 73% male) referred for AF ablation (60% paroxysmal and 38% persistent) to guide transseptal puncture. Transseptal catheterization monitored by ICE-TEE was well tolerated and successfully performed in all patients without any sedation. No mechanical oesophageal complication was noted. Moreover, the mean duration between ICE-TEE probe insertion and successful transseptal puncture was 4.5 min and the mean time of ICE-TEE was 10 min. Finally, no tamponade occurred during the AF ablation procedure. CONCLUSION: Intracardiac echocardiography-TEE is safe and well tolerated for the guidance of transseptal catheterization during AF ablation. Moreover, this technique was performed without requiring any anaesthesia.

Early repolarization electrocardiography pattern with unexplained syncope during training in a young black African non-elite athlete: an accidental finding?

Until recently it was generally thought that early repolarization is benign. But a recent article in the NEJM (Haissaguerre et al.) suggests that some persons with early repolarization may be at risk of life-threatening ventricular tachyarrhythmia. Unexplained syncope or sudden death occurs mostly during sleep. However, some cases of cardiac arrest during exertion have been reported. We report the case of a 39 year-old black African male with early repolarization pattern on electrocardiogram who regularly experienced dizziness (and one episode of transient loss of consciousness) exclusively while exercising. Detailed examination was normal. Under quinidine therapy, he experienced no further episodes. Increasingly reported cases of cardiac arrest in Africans, and significant prevalence of early repolarization in this population, have to be taken into account since the Haissaguerre et al. report. Further evidence of the lethal consequences of this syndrome are needed, bearing in mind that diagnostic tools for life-threatening arrhythmias are often scarce in sub-Saharan Africa.

Importance of contractile reserve for CRT.

AIMS: To assess whether response to cardiac resynchronization therapy (CRT) is related to myocardial viability in the paced left ventricular (LV) region, evaluated by contractile reserve (CR). Non-response to CRT may partly be due to inefficient pacing by the LV lead located in a fibrotic area. METHODS AND RESULTS: Nineteen patients (64 +/- 13 years, 14 men, 9 ischaemic) with severe heart failure (EF = 27 +/- 8%, QRS = 154 +/- 25 ms) were included in the week after device implantation. Stroke volume (SV) and LV dyssynchrony (by Tissue Doppler Imaging) were successively assessed with CRT on and CRT off. Afterwards, CRT device was maintained off during dobutamine infusion to assess CR in the LV-pacing region. LV end-systolic volume (ESV) was assessed after 6 months to quantify reverse remodelling. CR in the paced LV region (n = 10, 5/9 ischaemic and 5/10 non-ischaemic) was correlated to a reduction in LV dyssynchrony under CRT (120 +/- 76 vs. 78 +/- 64 ms, P = 0.02). Conversely, LV dyssynchrony was unchanged (161 +/- 100 vs. 163 +/- 80 ms) without CR. In desynchronized patients (>65 ms, n = 15), increase in SV under CRT and changes in ESV at 6 months were +22 and -18%, respectively, when CR was present and 0% and +9%, respectively, when absent. CONCLUSION: Acute haemodynamic response and reverse remodelling under CRT require viability in the target region of LV lead.