Atrio-hisian fibers anatomy and electrophysiology.

Introduction: In this case, electrophysiology and histology could be studied in the same heart. Clinical investigation, clinical electrophysiology, and postmortem serial histological sections of the septum were analyzed.

Methods: A patient with repeated seizures and a short PR interval with narrow QRS complex underwent electrophysiologic studies.

Combined nerve and muscle biopsy in the diagnosis of vasculitic neuropathy. A 16-year retrospective study of 202 cases.

We reviewed 202 biopsies performed on patients with suspected vasculitic neuropathy, of which 24 Churg-Strauss cases are studied separately. Specimens from the superficial peroneal nerve and peroneus brevis muscle were taken simultaneously by one incision. Without taking into account constitutional signs, systemic involvement was present in 131 patients, whereas the remaining 47 corresponded to non-systemic patients with lesions limited to peripheral nervous system and adjoining muscles.

Charcot-Marie-Tooth disease type 1A: clinicopathological correlations in 24 patients.

We examined nerve biopsies from 24 patients with Charcot-Marie-Tooth disease type 1A (CMT1A) and proven 17p11.2-12 duplication. There were seven males and 17 females with a mean age of 27.

Peripheral nerve biopsy study in 19 cases with 17p11.2 deletion.

In most cases of hereditary neuropathy with liability to pressure palsy (HNPP) the diagnosis is now assessed by molecular detection of 17p11.2 deletion. However, the family history may be missing and the clinical presentation is not always informative.

Amyloid neuropathy: a retrospective study of 35 peripheral nerve biopsies.

We performed a retrospective study of 35 peripheral nerve biopsies (PNBs) with amyloid deposits in the endoneurium. In every case, nerve lesions were studied on paraffin-embedded fragments (PEFs) and by ultrastructural examination (USE). In addition, muscle fragments were taken and embedded in paraffin.

Crow-Fukase (POEMS) syndrome: a study of peripheral nerve biopsy in five new cases.

The pathogenesis of Crow-Fukase (POEMS) syndrome is not well known, and in some cases, a definite diagnosis is difficult to establish. Nerve fibers have been studied in about 120 peripheral nerve biopsies (PNBs), and a mixture of axonal and demyelinating lesions were found in most of them. We report five new cases of Crow-Fukase (POEMS) syndrome with ultrastructural examination of their PNBs.

Uncompacted myelin lamellae in peripheral nerve biopsy.

Since 1979, the authors have studied 49 peripheral nerve biopsies presenting uncompacted myelin lamellae (UML). Based on the ultrastructural pattern of UML they propose a 3-category classification. The first category includes cases displaying regular UML, which was observed in 43 cases; it was more frequent in 9 cases with polyneuropathy organomegaly endocrinopathy m-protein skin changes (POEMS) syndrome as well as in 1 case of Charcot-Marie-Tooth 1B with a novel point mutation in the P0 gene.

Chronic inflammatory demyelinating polyneuropathy: immunopathological and ultrastructural study of peripheral nerve biopsy in 42 cases.

The authors recently reexamined the peripheral nerve biopsies from 42 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). There were 27 males and 15 females, aged from 9 to 84 years, and 13 had relapses. No patient had vasculitis, monoclonal gammopathy, tumor, diabetes mellitus, Lyme disease, familial neuropathy, HIV, or any other immune deficiency.

Intracellular pH regulation in ventral horn neurones cultured from embryonic rat spinal cord.

Intracellular pH was measured with the pH-sensitive fluorescent probe BCECF in spinal cord neurones cultured from rat embryos. At an external pH of 7.3, the average steady-state pHi was 7.

The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans.

Background: This study determined the histological features of the atrial myocardium connecting the coronary sinus and the left atrium in humans.

Methods And Results: Ten necropsied hearts were studied by performing serial longitudinal sections parallel to the long axis of the coronary sinus that extended its full length using a large microtome. In all specimens, the venous wall of the coronary sinus was surrounded by a cuff of striated muscle extending 40+/-8 mm from the ostium.

Optimizing the hemodynamic performance of the DDD pacemaker: impact of the atrioventricular delay on the pulmonary venous flow pattern.

Unlabelled: This study evaluated the impact of the atrioventricular delay (AVD) on the pulmonary venous flow pattern (PVFP).

Methods: Transthoracic Doppler PVFP were obtained during atrial and ventricular pacing at a fixed rate of 70 beats/min in 20 patients equipped with a DDD pacemaker, diastolic dysfunction linked to an impaired relaxation, a mean ejection fraction of 49%, and AV block. Two subgroups were analyzed equally: group I: seven patients with a normal ejection fraction and group II: 13 patients with decreased ejection fraction.

[Variability of heart rate after heart surgery under extracorporeal circulation: aortocoronary bypass or aortic valve replacement].

The study of heart rate variability allows analysis of modulations of heart rate by the sympathetic vagal system. The authors studied the course of sinus variability by 24-hour Holter monitoring preoperatively, and on the 6th and 42nd postoperative day, in 25 patients undergoing coronary bypass graft (group I) and 10 patients undergoing aortic valve replacement (group II). Surgery was performed under cardiopulmonary bypass with selective antegrade cold crystalloid cardioplegia.

[Supraventricular arrhythmia after pneumonectomy. Apropos of 100 cases and review of the literature].

Supraventricular arrhythmias are frequently observed in pneumonectomy surgery. We retrospectively studied a series of 100 consecutive patients undergoing pneumonectomy for cancer between 1994 and 1996. We found 24% of significant supraventricular arrhythmias, corresponding to atrial fibrillation in 75% of cases, occurring in 80% of cases until the third postoperative day.

Cultured rat sensory neurones express functional tachykinin receptor subtypes 1, 2 and 3.

The neuropeptide substance P (SP) is known to play a key role in peripheral nociceptive processes. We investigated the in vitro pharmacological characteristics of functional tachykinin receptors expressed in dorsal root ganglia (DRG) sensory neurones by analysing intracellular free calcium concentration changes induced after stimulation by SP or specific tachykinin agonists. We observed that about 37% of the tested neurones were responsive to either SP or an NK1-, NK2- or NK3-specific agonist.

[Lesions caused by techniques of endocavitary ablation using high frequency currents: anatomo-pathological aspects].

Anatomopathological studies have considerably increased our understanding of the ablative technique by radiofrequency current. They have provided information on the nature, extent and time dependency of the lesions induced. Despite variable results according to whether the experiments were performed in vitro or in vivo, a correlation has been observed between the volumes of the lesions and the energies used.

[Role of the conditions of recording and analysis of the atrial signal on the results of ECG signal averaged P wave].

Several studies have shown that high amplification and averaging of the electrocardiographic P wave may soon enable better identification of people at high risk of paroxysmal atrial fibrillation. The results of this technique are closely dependent on the conditions of recording and analysis of the atrial signal but this factor has not been widely appreciated. The authors, therefore, undertook a study of the reliability of the manual method of measuring P wave duration, the influence of the filters used and the level of background noise on the 3 parameters of analysis: the duration of the P wave (DUR), the root mean square of the amplitude of the terminal 20 milliseconds (RMS20) and the integral under the P curve (IN).

[Triple aneurysm of the Valsalva sinus complicated by right coronary occlusion: apropos of a case and review of the literature].

We report a case of aneurysm of all three aortic sinuses. The patient suffered from both cardiac failure and angina pectoris. The diagnosis, suggested by echocardiography, was confirmed by magnetic resonance imaging (MRI) which showed marqued dilatation of all three aortic sinuses.

[Comparative thrombotic risk of two contrast agents in coronary angiography].

The thrombogenic risk of contrast agents in coronary angiography is still a topical issue, particularly in comparisons between ionic and nonionic contrast agents. As a complement to a preliminary study, the repercussions on sensitive markers of haemostasis were investigated in vivo in 38 patients undergoing a standard cardiac catheterisation. After randomization, an ionic low osmolality contrast agent (Ioxaglate 320) was used in 19 patients and a nonionic low osmolality contrast agent (Iopromide 370) was used in another 19 patients, according to an identical protocol.

[Antiarrhythmic treatment after reduction of atrial fibrillation by external shock].

Among the drugs recommended to prevent recurrences of atrial fibrillation after external electric shock, antiarrhythmic agents of classes Ia (quinidine, disopyramide), Ic (cibenzoline, flecainide, propafenone) and III (sotalol) seem to have the same effectiveness in maintaining the sinus rhythm in about 50 percent of the cases after 6 months and one year. Amiodarone, seldom used as first-line treatment, appears to be the most effective drug. The percentage of side-effects requiring discontinuation of treatment is the same for all drugs (about 10 percent).

[Signal averaged electrocardiogram of the P wave after reduction of permanent atrial fibrillation. A comparison with results obtained in healthy subjects and in patients with atrial fibrillation].

Signal averaging of the ECG P wave is a recent technique used for obtaining predictive and prognostic information in atrial arrhythmias. There have been few publications of its evaluation in this setting. The authors report their results of temporal analysis of the P wave of patients who had undergone electrical cardioversion of atrial fibrillation (group 3, n = 22 patients) and compared them with those of a control group without atrial arrhythmias (group 1, n = 25 patients).

[Ventricular tachycardia of dilated cardiomyopathies].

Patients with dilated cardiomyopathy often have unsustained VT (15 to 60% of cases) but sustained VT is much less common (0 to 10% of cases). The predictive value of sudden death of VT in Holter monitoring is not unanimously accepted. Therefore, it appears that, in patients with non-symptomatic VT, it is the degree of left ventricular dysfunction which is the best predictive factor of mortality because Holter monitoring, signal averaged ECG and programmed stimulation have a low positive predictive value although their cumulated negative predictive value seems to be very good.

[Simultaneous prescription of digoxin and an anti-arrhythmia agent, is it dangerous?].

Many anti-arrhythmic drugs modify the pharmacokinetics of digoxin and increase serum levels. This possibility is considered for the majority of main anti-arrhythmics on the basis of a review of the literature. Quinidine, propafenone, flecainide, amiodarone and verapamil increase blood digoxin levels, sometimes to twice their baseline values.

[Drug treatments of atrial fibrillation].

Atrial fibrillation is a daily cardiological problem which poses three types of questions, which, though old, are only partially mastered: anticoagulation, reduction and prevention of recurrence. It is a potent source of embolism. The risk is the greatest in patients with rheumatic valvular disease when the fibrillation is recent and when underlying cardiac disease is uncompensated.