["Unknown" ectopic ureteral opening. Experience with 8 clinical cases]

The authors after studying eight different cases of ectopic ureters, try to illustrate the most important points of the diagnostic course in this pathology. In fact, in this field of studies, it is not easy, every time, to define diagnosis by the usual ways of investigation, so the authors describe just those cases which were missed by past clinical evaluations. They want to demonstrate by their experience of work, that it is possible to avoid a wrong diagnosis by an accurate evaluation of the clinical phenomenology, but most of all by a good research and right interpretation of the clinical and radiologic signs, direct and not, of this pathology.

[Primary transitional-cell carcinoma of the male anterior urethra]

Primary carcinomas of the male anterior urethra account for less than 1% of all urological carcinoma. The majority of these neoplasias develop of the posterior part of the urethra (proximal portion). The most common histotype is the squamous-cellular carcinoma. We have only found 4 other published reports of primary transitional carcinoma of the male anterior urethra. The paper discusses the diagnostic and therapeutic procedures employed in these rare cases.

Prognostic significance and evolution of late ventricular potentials in the first year after myocardial infarction: a prospective study

We performed a prospective study of the high-frequency components of the terminal portion of the QRS complex in 220 patients who survived acute myocardial infarction. Signal-averaged electrocardiograms (SA-ECGs) were performed before hospital discharge (16 +/- 6 days) and then serially at regular intervals over the following year. SA-ECGs were processed using a 40 Hz high-pass bidirectional filter. Duration of "filtered" QRS (D-normal value less than 120 ms), duration of the low-amplitude signals (D40 - n.v. less than 39 ms) and last 40 ms voltage of the QRS complex (V40 - n.v. greater than 20 microV) were measured. Late potentials (LPs) were defined as the presence of two or more abnormal values. In addition, 24-hour Holter monitoring was performed in 208 patients and left ventricular ejection fraction (LVEF) was determined by scintigraphy in 111. Sixty-two patients (group 1) had LPs, 158 had normal SA-ECGs (group 2). Spontaneous normalization of SA-ECGs occurred in 20% of patients after 6 months, although the mean values of D, D40 and V40 did not change significantly and the reproducibility was very good for all the indexes during all the follow-up controls. Three patients had sudden death and three presented again with spontaneous, sustained ventricular tachycardia. Five of 62 (8%) group 1 patients had an arrhythmic event compared with one of 158 patients (0.6%) in group 2. The sensitivity of SA-ECGs as a predictor of arrhythmic events was 83% with a specificity of 73%. Patients with subsequent arrhythmic events had longer filtered QRS (133 +/- 19 vs 104 +/- 16 ms; P less than 0.001), longer duration of the low-amplitude signals (54 +/- 15 vs 33 +/- 14 ms; P less than 0.01), and lower voltages in the last 40 ms of the filtered QRS (11 +/- 3 vs 36 +/- 25 microV; P less than 0.02) and, moreover, higher peak CK values and lower LVEF than those without such events. In conclusion, SA-ECGs provide important prognostic information in identifying patients at risk of arrhythmic events after myocardial infarction although dynamic changes of LPs are observed during the first year after myocardial infarction.

[Flecainide and anti-arrhythmia therapy]

Flecainide is a benzenacetamide synthesised about a decade ago and only recently introduced into the treatment of arrhythmias. Its electrophysiological properties place it in Class IC of the anti-arrhythmia drugs. Flecainide has proved useful in the treatment of supraventricular arrhythmias, atrial fibrillation (especially in patients with Wolff-Parkinson-White disease), in reciprocating supraventricular tachycardias and in focal atrial tachycardias. The drug is also extremely effective in ventricular ectopias with a success rate of over 90%. Flecainide is therefore destined to be widely used in the treatment of arrhythmias and is indicated for both supraventricular and ventricular forms, particularly those resistant to other treatment. In addition the biological availability and long half life of Flecainide make it suitable for even very prolonged treatment.

[The electrocardiogram in hypothermia]

Hypothermia is reflected in the electrocardiogram in the form of alterations that permit early recognition of the condition. In fact the electrocardiogram is a more sensitive indicator of temperature than the standard measurements of body temperature used in clinical practice. The various aetiological aspects of hypothermia are described as are its electrocardiographic features.

[Intra-sinus echo: demonstration using direct intracavitary recording of the sinus potential]

The authors searched for intra-sinusal echos during electrophysiological investigation of 53 patients (41 men, 12 women, average age: 61 +/- 12 years). Cycles of sinus echos were recorded in 8 patients (15 per cent). The period during which sinus echos could be recorded was 125 ms (average 40.6 +/- 34 ms). Indirect assessment of sinus node function in patients with sinus echos was normal (corrected sinus node recovery time, estimated atrio-sino atrial conduction times using Narula's technique). A valid and reproducible direct recording of the sinus node potential was only possible in one patient. In this case the echo cycles were provoked by stimulation periods of between 440 and 320 ms (echo zone of 120 ms). All the echos obtained were preceded by a sinus node potential with a different duration and morphology to that observed during basal sinus cycles (respective sino-atrial conduction times 105 and 115 ms). In this patient we were also able to induce sinus echos after a single extrastimulus during the spontaneous rhythm. the echo zone was 130 ms and with a shorter coupling interval (310 ms) two successive sinus echos were recorded. The demonstration of intrasinusal echos by direct recording of the sinus node potential supports the experimental data of Allessie and Bonke on isolated right atrial tissues of the rabbit. Improvements in the technique of endocavitary direct recording of the sinus node potential in man should complete this data by showing the possibility of sinoatrial tachycardias due to reentry.

[Sinus node electric activity in prolonged atrial pauses in subjects with the sick sinus syndrome]

Sinus node electrogram (SNE) was recorded in 15 patients with sick sinus syndrome (SSS) in which prolonged atrial pauses were observed. The aim of this study was clarify the physiopathological mechanisms underlying atrial pauses as well as to evaluate the sensitivity of sinoatrial conduction time (SACT) directly measured on SNE and of SACT estimated with the indirect Strauss method with respect to the detection of SSS. The following results were obtained: Sinus electrical activity was recorded during atrial pauses (greater than or equal to 2 basic sinus cycle length) in all the 9 patients in which the pauses spontaneously occurred and in the 2 patients in whom the pauses of 2860 and 3190 msec were induced by atrial pacing. In one of these latter two patients, moreover, a complete electrical desynchronization was observed. In the remaining 4 patients in whom, pauses (greater than or equal to 3 sec) were induced by carotid sinus massage of in 3 no sinus electrical activity was detected on SNE while in 1 advanced sinus node desynchronization was observed. Direct sinoatrial conduction time was abnormally prolonged in 6 patients with SSS and indirect sinoatrial conduction time in 9 patients.

[The sinus node electrogram in the evaluation of atrial pauses]

The aim of this study was to establish the electrophysiological mechanism of atrial pauses, defined as a sudden lengthening of atrial cycle greater than or equal to 10% of its basal value. The sinus node electrogram (SNE) was recorded during electrophysiological study in 20 subjects. Satisfactory recordings of 64 pauses were obtained, 25 of which were spontaneous, 16 were induced by short periods of atrial pacing (AP) in normal subjects, whereas 23 atrial pauses were induced with the premature stimulation method. The basal sinus cycle and the one during the spontaneous pauses were measured from the upstroke slope on the SNE. The electrically induced pauses of the sinus cycle were measured from the artifact of the stimulus to the upstroke slope of the SNE of the first post-pacing beat. We have found that: 1-spontaneous atrial pauses correspond to a moderate slowing of the sinus cycle and to a depression of the sinoatrial conduction occasionally up to a second degree sinoatrial block. Only in subjects with sick sinus disease, the atrial pauses are induced by depression of the sinus automatism; 2-in normal subjects the AP results in a sinoatrial conduction delay; 3-the single extrastimulus regularly produces a moderate increase of the sinoatrial conduction time with variable but minimal effects on the sinus node automatism.

Changes of beta-endorphin and Met-enkephalin content in the hypothalamus-pituitary axis induced by aging

The amounts of beta-endorphin- and Met-enkephalin-immunoreactive material are higher in the pituitary of aged rats. However, the aging process decreases the content of beta-endorphin-, but does not affect that of Met-enkephalin-immunoreactive material, in hypothalamus. Thus, it seems that the regulatory mechanisms in the two areas are differentially affected by increasing age. On the other hand, the pituitary increase of these peptides is in line with the assumption that in the elderly the hormonal response to stress is impaired.