Effects of adenosine on transmembrane potential and sarcolemmal Na+-K+ ATPase activity of human atrial myocardium

Adenosine effects on the transmembrane potential characteristics and the sarcolemmal Na+-K+ ATPase activity of human atrial myocardium were studied in tissue from 20 patients who were divided into 2 groups based on the maximum diastolic potentials (MDP) greater than or less than -60 mV. Group A consisted of 10 patients with MDP of 70.84 +/- 4.20 mV and Na+-K+ ATPase activity of 15.37 +/- 0.46 mumole Pi/mg/hr. Ten patients with MDP of 44.54 +/- 6.24 mV and Na+-K+ ATPase activity of 12.55 +/- 0.42 mumole Pi/mg/hr were included in group B. Adenosine had no effects on the electrophysiological properties and the sarcolemmal Na+-K+ ATPase activity of atrial myocardium at concentrations below 1 X 10(-5) M in either group. Adenosine resulted in mildly altered atrial transmembranes potentials without significant effect on Na+-K+ ATPase activity at concentrations between 1 X 10(-5) M and 5 X 10(-4) M. However, a significant reduction of transmembrane potentials and an apparent inhibition of Na+-K+ ATPase activity were observed only in tissue from group B. These results suggest that: 1) adenosine has no effect on the electrophysiological properties and the sarcolemmal Na+-K+ ATPase activity of human atrial myocardium at physiological concentrations; 2) adenosine induced inhibition of the sarcolemmal Na+-K+ ATPase activity in slow channel-dependent atrial tissues may be a mechanism responsible for the alterations of transmembrane potentials under unphysiological conditions; and 3) adenosine contributes to the genesis of cardiac arrhythmias during acute myocardial ischemia, which can reduce transmembrane potentials of the myocardial cells and may increase the myocardial adenosine level above its effective concentration.

Usefulness of intravenous diltiazem in predicting subsequent electrophysiologic and clinical responses to oral diltiazem

Diltiazem, 0.25 mg/kg, was given intravenously during induced tachycardias in 6 patients with atrioventricular (AV) nodal reentrant tachycardia (group I) and in 24 patients with AV reentrant tachycardia incorporating a retrogradely conducting accessory pathway (group II). In all 6 group I and in 15 of 24 group II patients, tachycardias terminated within 1 minute after diltiazem administration, with a weak link in the anterograde direction. In 3 other patients in group II, tachycardias were terminated by a premature ventricular complex within 1 minute. In the remaining 6 patients in group II, in whom tachycardias failed to terminate, rates of tachycardias decreased as a result of suppression of anterograde AV nodal conduction by diltiazem. Electrophysiologic studies were performed subsequently 2 hours after the third dose of 90 mg of diltiazem, which was given orally at 8-hour intervals. In 18 responders to intravenous diltiazem who were subjected to oral diltiazem testing, sustained supraventricular tachycardia (SVT) could be induced in only 2. Of the 6 nonresponders, sustained tachycardias could not be induced in 3. Twelve patients, including 11 responders and 1 nonresponder to intravenous diltiazem who responded to oral diltiazem testing, were discharged with oral diltiazem therapy, 90 mg every 8 hours, with follow-up periods of 2 to 13 months (mean 7 +/- 4 [+/- standard deviation]). The frequency of recurrent SVT decreased significantly; 8 patients were free of tachycardias and 4 had occasional recurrences of SVT that required no hospital visit. In conclusion, intravenous diltiazem is effective in terminating SVT. Termination of SVT by intravenous diltiazem predicts subsequent electrophysiologic and clinical responses to oral diltiazem.

Malignant fibrous histiocytoma at site of metal implant

The occurrence of malignant tumors at the site of metal implants is rare. The significance of this association is not settled. Its implications, however, are serious. A malignant fibrous histiocytoma arising at the site of an implant done 14 years ago for traumatic fracture of the femur in a 44-year-old man is reported. Previous reports are briefly summarized.

Structure of Marek's disease virus DNA: detailed restriction enzyme map

Purified virion DNA (120 X 10(6) molecular weight [MW]) of Marek's disease virus strain GA was cleaved with BamHI restriction endonuclease, and 27 out of the 29 fragments were cloned into bacterial plasmids. Restriction maps for BamHI, BglI, and SmaI endonucleases were constructed. The genomic structure of Marek's disease virus DNA was found to be similar to that of herpes simplex virus types 1 and 2. A long unique region (75 X 10(6) MW, located at 10 X 10(6) to 85 X 10(6) MW [10-85] from the left end of the genome), which was subdivided into segment 1 (22 X 10(6) MW, located at 10-32) and segment 2 (51 X 10(6) MW, located at 34-85) by direct repeats (32-34), was flanked by a long terminal region (10 X 10(6) MW, located at 0-10) and a long inverted region (10 X 10(6) MW, located at 85-95). A short unique region (8 X 10(6) MW, located at 103-111) was flanked by a short terminal region (8 X 10(6) MW, located at 111-119) and a short inverted region (8 X 10(6) MW, located at 95-103). The direct repeat fragments (0.9 X 10(6) could be isolated by cleavage with SmaI. The right terminal end was found to be heterogenous .

Cardiac dimensions and motion shortly after mitral valve surgery

We studied 71 adult patients echocardiographically both before and 2-16 days (mean 8 days) after mitral valve surgery to systematically evaluate the early postoperative changes in cardiac dimensions and motion. The patients were divided into 4 groups: group I with predominant mitral stenosis (MS) (26 patients), group II with predominant mitral insufficiency (MI) (12 patients), group III with MS + MI (16 patients) and group IV with combined mitral and aortic valvular disease (17 patients). After operation the left atrial dimension at endsystole decreased (mean +/- standard deviation, 56 +/- 12 mm vs 46 +/- 11 mm, p less than 0.001), but did not completely normalize in the majority of patients. The left ventricular dimension at enddiastole decreased in group II from 67 +/- 12 mm to 54 +/- 5 mm (p less than 0.01) and in group IV from 59 +/- 13 mm to 54 +/- 13 mm (p less than 0.01), but increased in group I from 43 +/- 8 mm to 46 +/- 9 mm (p less than 0.05). Mitral EF slope increased from 15 +/- 11 mm/sec to 52 +/- 20 mm/sec (p less than 0.001) after commissurotomy, and decreased from 136 +/- 61 mm/sec to 66 +/- 30 mm/sec (p less than 0.05) after annuloplasty. However, the postoperative means were subnormal in these subgroups. Paradoxical or hypokinetic septal motion occurred in 5/71 (7%) before and 50/71 (70%) after operation. We conclude that: 1) partial normalization of cardiac dimensions and subnormal mitral EF slopes shortly after mitral valve surgery suggest a residual pressure gradient across the mitral valve as well as partial irreversibility of the heart after longstanding mechanical overloading, and 2) postoperative abnormal septal motion, which may be caused by pericardiotomy, can occur after any type of open heart surgery.

Fetus-in-fetu: report of a case

A case of fetus-in- fetu is reported. It occurred in an 8-week-old Korean boy who had been born by cesarean section due to abdominal distension. The fetus-in- fetu was connected to the superior mesenteric artery and consisted of two masses, apparently representing two portions of an acardiac monster. There was an amniotic membrane covering both masses, and the umbilical cord clearly was identifiable. One mass included the brain, eye, trachea, salivary glands, thyroid, pancreas, spleen, etc., while the other mass contained extremity bones, vertebrae, testis, adrenals, and intestinal loops. This is probably a case of separated fetus-in- fetu that showed unusually well-developed internal organs.

Impulse responses of automaticity in the Purkinje fiber

We examined the effects of brief current pulses on the pacemaker oscillations of the Purkinje fiber using the model of McAllister , Noble, and Tsien (1975. J. Physiol. [Lond.]. 251:1-57). This model was used to construct phase-response curves for brief electric stimuli to find "black holes," where rhythmic activity of the Purkinje fiber ceases. In our computer simulation, a brief current stimulus of the right magnitude and timing annihilated oscillations in membrane potential. The model also revealed a sequence of alternating periodic and chaotic regimes as the strength of a steady bias current is varied. We compared the results of our computer simulations with experimental work on Purkinje fibers and pointed out the importance of modeling results of this kind for understanding cardiac arrhythmias.

Recording of auditory evoked potentials in man using chronic subdural electrodes

With the aid of chronic subdural electrodes we have been able to record from the posterior banks of the sylvian fissure, auditory evoked potentials (AEPs) that had morphologies and peak latencies compatible with the primary AEPs described by Celesia and Puletti (1969). These AEPs had amplitudes that were not only affected by the side of stimulus presentation but were maximal in an area close to the primary auditory cortex. The AEPs also displayed an extremely steep spatial gradient and were not altered by pentobarbitone sodium and nitrous oxide anaesthesia. Together, these properties suggest that these subdurally recorded potentials are near-field evoked potentials from the primary auditory cortex. The focal nature of these potentials also allows them to be used as effective electrophysiological tools for localization of the primary auditory cortex in patients.

Biochemical analysis and electron microscopy of human mitral valve collagen in patients with various etiologies of mitral valve diseases

Biochemical analyses and electron microscopy of mitral valve collagen were carried out in 29 patients with various mitral valve diseases. They were divided into 3 groups: (1) rheumatic heart disease (15 patients), (2) isolated rupture of chordae tendineae (8 patients), and (3) floppy mitral valve (6 patients). Normal mitral valves obtained at necropsy from 6 patients who died from extracardiac causes were used for control observations. Results of the electrophoretic analysis of the collagen of normal and diseased valves showed that all valves contained collagen types I, III, and AB collagen with similar electrophoretic patterns. Electron microscopic observations and comparisons of the segment-long-spacing crystallites of each type of collagen revealed similar band patterns, irrespective of the normal or diseased valves sources. It is concluded that the composition and primary molecular structure of mitral valve collagen are usually not altered in a wide variety of disease processes affecting the mitral valve.

On the mechanism of spiking and bursting in excitable cells

A mathematical model previously developed to explain beta-cell membrane potential oscillations has been modified to accommodate the external variation of K+, Na+ and Ca2+ concentrations. Our model, which is applicable to excitable cells, incorporates the barrier kinetics. Hodgkin-Huxley-type gating mechanism, and an electrogenic Na+-K+ pump. Numerical solutions of our model are in agreement with many of the experimental results reported in the literature on excitable cells.

Scanning and transmission electron microscopic studies on isolated ruptures of chordae tendineae

Electron microscopic studies of chordae tendineae of the mitral valve were carried out in 17 patients who underwent mitral valve replacement due to a spontaneously isolated rupture of chordae tendineae. The normal chordae, used as the control group, were obtained at autopsy from 5 patients who died from extracardiac causes and were compared with the ruptured chordae. In all patients with chordal rupture, scanning electron microscopy showed perforations of the chordae tendineae, with extensive desquamation and disruption of the endothelial cells and wide-spread destruction of the collagen fiber bundles in the central collagenous core. These pathological findings were not observed in the normal chordae from the control group. Transmission electron microscopy showed that the ruptured chordae were characterized by heterogeneous collagen fibrils with intrinsic structural alterations and disorganization in fibril arrangement. There was a wide variation in the diameters of collagen fibrils which always showed abnormal morphology, with abnormally large, peculiarly shaped fibrils. Apparent loss and/or a disordered arrangement of the typical periodicity of the fibrils were frequently observed. In addition, various degrees of degenerative changes of collagen tissue were often present. These abnormalities were never seen in the fibrils of the normal chordae, and were observed consistently in both the fibrils of the ruptured chordae and in the macroscopically intact chordae in the group with spontaneous rupture of chordae tendineae. These results suggest that a defective organization of collagen into fibrils and fibers, associated with secondary degeneration of collagen within the central collagenous core of the chordae tendineae, are important pathogenetic mechanisms for spontaneously isolated ruptures of chordae tendineae.

Chediak-Higashi syndrome in a Chinese infant

Chediak-Higashi syndrome in Chinese has not been previously reported in the English literature. A 14-month Chinese girl who presented with partial oculocutaneous albinism and Pseudomonas infection was found to have the classical intracytoplasmic inclusion bodies in the leucocytes by light and electron microscopy. Other characteristic features typical of this syndrome included hepatosplenomegaly, defective chemotaxis, and coarse but sparse melanin granules in hair shaft. She was also found to have hypertriglyceridaemia, a rare lipid abnormality occasionally reported in children suffering from this syndrome. Despite vigorous therapy with high dose ascorbate, corticosteroid and intravenous antibiotics, she died in the accelerated phase of Pseudomonas septicaemia.

Failure of uptake of radiocolloid by the femoral heads: a diagnostic problem: concise communication

One hundred six patients had the area of the femoral head scintigraphed after completion of a Tc-99m sulfur colloid liver scan. In 47 (45%), there was no visible activity in the femoral heads. This was somewhat age-related. All six individuals in the 11- to 19-yr age group showed femoral-head uptake of radiocolloid, but only 37% of those 70 to 79 yr old revealed such accumulation. The finding that less than one half of adults had uptake of radiocolloid in the femoral heads was consistent with results of three smaller series of patients (larger dose of radiocolloid, use of a different preparation of sulfur colloid, and use of In-III chloride). We conclude that not all adults take up radiocolloid in the femoral heads, and that lack of such uptake is not necessarily abnormal. Use of radiocolloid accumulation to gauge femoral-head vascularity may be more limited than previously appreciated, although right-left asymmetry might be of some diagnostic assistance.