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A 17-year old boy with hypertrophic obstructive cardiomyopathy (HOCM) developed repeated short runs of self terminating ventricular tachycardia 12 hours after starting oral verapamil, which was substituted for propranolol therapy. It is suggested that alterations in sympathetic tone induced by changing from a beta-blocker to a calcium antagonist might have increased myocardial irritability thus favouring genesis of severe ventricular arrhythmias. Verapamil is often considered to be more effective than propranolol in the treatment of HOCM. However, if propranolol is replaced by verapamil one has to take account of the possibility of serious arrhythmias as demonstrated by our case. [ABSTRACT FROM PUBLISHER]

The three oligosaccharide octyl-S-glycosides Man-α1,6-Man-α1,4-GlcNH(2)-α1,S-Octyl (19), Man-α1,6-(Gal-α1,3)Man-α1,4-GlcNH(2)-α1,S-Octyl (27) and Man-α1,2-Man-α1,6-(Gal-α1,3)Man-α1,4-GlcNH(2)-α1,S-Octyl (37), related to the GPI anchor of Trypanosoma brucei were prepared by a stepwise and block-wise approach from octyl 2-azido-2-deoxy-3,6-di-O-benzyl-1-thio-α-D-glucopyranoside (8) and octyl 2-O-benzoyl-4,6-O-(1,1,3,3-tetraisopropyl-1,3-disiloxane-1,3-diyl)-1-thio-α-D-mannopyransoside (9). Glucosamine derivative 8 was obtained from 1,3,4,6-tetra-O-acetyl-2-azido-2-desoxy-β-D-glucopyranose (1) in five steps. Mannoside 9 was converted into the corresponding imidate 12 and coupled with 8 to give disaccharide octyl-S-glycoside 13 which was further mannosylated to afford trisaccharide 19 upon deprotection. Likewise, mannoside 9 was galactosylated, converted into the corresponding imidate and coupled with 8 to give trisaccharide 25. Mannosylation of the latter afforded tetrasaccharide 27 upon deprotection. Condensation of 25 with disaccharide imidate 35 gave, upon deprotection of the intermediates, the corresponding pentasaccharide octyl-S-glycoside 37. Saccharides 19, 27 and 37 are suitable substrates for studying the enzymatic glycosylation pattern of the GPI anchor of T. brucei., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Results in 503 patients with germ cell testicular tumors treated between 1982 and 1992 were analyzed. A follow-up program for germ cell tumors is presented which is related to the individual risk of tumor relapse. The overall relapse rate was 7%, of which 82% had recurrent tumor within 1 year after treatment. A low risk of relapse (3-5%) is seen in patients with seminoma stage I and radiation and, usually, in early-stage patients treated with polychemotherapy. A moderate risk of relapse (6-11%) is observed in patients with non-seminoma stage I and lymphadenectomy without chemotherapy. Seminoma without radiation and non-seminoma without lymphadenectomy in clinical stage I, non-seminoma stage IIa and IIb without adjuvant chemotherapy after lymphadenectomy, and primary high tumor mass present a high risk of relapse (> 11%). Tumor recurrence is localized mainly in lung and retroperitoneum. Most important in the follow-up are tumor marker and chest X-ray. During the first year examinations should take place every 3 months in the low-risk group and every 2 months in the moderate and high risk group. Computer tomography is only required in high-risk patients. Usually a 3-year follow-up is sufficient.

Between 1980 and 1990, 670 testicular examinations were performed. Testicular palpation and ultrasonography were carried out. A total of 588 patients (87.8%) had malignant testicular tumors; 82 patients (12.2%) were found to have nongerminal testicular and paratesticular tumors. Intraoperative frozen section histology and tumor size determined the subsequent procedure. In cases of epidermal cysts, adenomatoid tumors and fibrous pseudotumors, the testicle was preserved in the majority of cases. Leydig's cell tumor, Sertoli's cell tumor and dermoid cysts were removed together with the testicle because it was not clear if they were benign. During the postoperative follow-up period, there was no evidence of local recurrence or metastases in any of the patients.

In female adolescents with pulmonary embolism such as in the presented 19 year old patient oral contraceptives have to be considered as an etiologic factor. It is important to consider this diagnosis even in that age group. The diagnosis can be verified by intravenous digital subtraction angiography.