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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. In the endoneurium, perivascular inflammatory cell infiltrates were present in only one case, but scattered histiocytes marked by KP1 on paraffin-embedded fragments were present in every case and there were no T-lymphocytes. At ultrastructural examination macrophage-associated demyelination was observed in 17 cases, of which 6 had relapses separated by intervals of several months or years. Axonal lesions without associated primary demyelination were observed in 4 cases and 3 of these had relapses. Thirty-two patients had mixed lesions of demyelination and axonal involvement. This study confirms other recent data indicating that in all cases of CIDP, macrophages are present in the endoneurium. Macrophage-associated demyelination is the characteristic feature of demyelinating forms. On the other hand, isolated primary axonal forms, which have been known since 1989, are relatively frequent and prone to relapses. [ABSTRACT FROM AUTHOR]

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. Three different AVDs were studied: short (50 ms), intermediate (150 ms), and long (250 ms). Results: As the AVD increased, the diastolic filling time and the peak atrial reverse flow wave decreased (P < 0.001). There was a decreasing D wave and no significant change in the peak velocity of the S wave. The S wave became biphasic in all patients at the longest AVD of 250 ms. The systolic (S) velocity time integral (VTI) of the pulmonary wave and the systolic/total PVF-VTI ratio increased significantly (P < 0.001). A similar response was seen in both group of patients. Conclusions: These data correlated the AVD with PVFP, supplying critical systolic information completing the diastolic data obtained from mitral Doppler patterns. These systolic measurements were especially useful for patients with heart failure and a DDD pacemaker, in order to obtain the longest diastolic filling time at the lowest atrial pressure. [ABSTRACT FROM AUTHOR]

Endocardial catheter fulguration has been recently proposed for treatment of arrhythmias originating within the right atrium. In this study the authors attempted to use this technique in eight patients with paroxysmal common atrial flutter. Numerous antiarrhythmic agents failed to prevent recurrences of the episodes, which occurred frequently over periods of at least 4 months. In every procedure, we used a 7F quadripolar catheter electrode introduced via the subclavian vein into the lower part of the right atrium. The two distal electrodes allowed the recording of bipolar double potentials where the critical slow pathway of the reentrant circuit was localized. A unipolar electrogram recording by the tip electrode gave us the location of the area to be ablated when this electrogram was in complete concordance with a small step in the descending part of the F waves in II, III and aVF. This step corresponded to the very depolarization of the reentry area. A DC shock of 100 to 120 J was delivered between the tip electrode and a paddle applied to the left chest wall. Sinus rhythm resumed instantaneously. No mechanical or electrical complications were noted. Three patients are free of relapses without antiarrhythmic drugs (follow-up: 24 to 17 months); three others are also free of relapses, but antiarrhythmic agents were required for treatment of other supraventricular dysrhythmias (follow-up: 3 to 17 months); atrial flutter recurred within several days and persisted in spite of two more procedures in two patients. We conclude that endocardial catheter fulguration of paroxysmal and recurrent atrial flutter seems to be effective therapy. Nevertheless, more experience is required in order to confirm these results. [ABSTRACT FROM AUTHOR]

Peripheral nerve biopsies (PNB) from four children suffering from subacute or chronic inflammatory demyelinating polyneuropathy were studied by electron microscopy. Remyelinating features with onion bulb formations, inflammatory cell infiltrates and active demyelinating lesions were strongly suggestive of the disease. In the first case, a second PNB, performed after 7 months of severe subacute course, showed a striking evolution of the lesions. In the second case and in spite of severe neurological symptoms, the PNB was almost normal, suggesting that inflammatory lesions were mainly located in the proximal parts of the nerve. No signs of active demyelination could be seen in the third case but onion bulb formations and inflammatory cell infiltrates were present. In the fourth case, characteristic lesions of active demyelination were associated with a history of familial polyneuropathy; this association suggests an auto-immune process in certain kindreds with hereditary motor and sensory neuropathy. [ABSTRACT FROM AUTHOR]

Idiopathic polyradiculoneuropathy with primary axonal lesions is rarely encountered. Two cases are reported with a chronic relapsing course and a fatal outcome. Neuropathological examination of biopsied peripheral nerve in the two patients and in a necropsy case showed loss of myelinated fibres, but neither active demyelination nor inflammatory cells were observed. Acute and chronic relapsing axonal polyradiculoneuropathies appear to be two clinical forms of a peculiar entity different from GBS. [ABSTRACT FROM AUTHOR]

The atrio-His bundle tracts are very rare; only two have been found in 687 hearts studied histologically. These tracts have a similar appearance to those of the atrioventricular bundle and form a complete bypass of the atrioventricular node. In their presence the electrocardiogram may show a short or normal PR interval. They may be responsible for some cases of very rapid ventricular response to supraventricular arrhythmias. [ABSTRACT FROM PUBLISHER]