Torsades de pointes: a case with multiple variables.

Torsades de pointes is a polymorphic ventricular tachycardia that displays a unique electrocardiographic feature of twisting of the mean electrical axis of QRS complexes around an isoelectric line on the surface electrocardiogram. It is associated with long QT syndrome and has many precipitating mechanisms, etiologic factors, and treatment options. This report presents a case of torsades de pointes that was precipitated by multiple factors and required many treatment modalities. The patient in this case exhibited features of both congenital and acquired types of long QT syndrome.

Immunological study in pleural effusion.

Thirty patients of pleural effusion (25 tubercular, 5 malignant) were studied for enumeration of T and B cell percentage in pleural fluid (PF) and peripheral blood (PB) along with estimation of IgG, IgA and IgM. Ten healthy subjects were taken as controls. T cell percentage was significantly low and B cell percentage high in the PB of patients with effusion compared with controls. Comparing malignancy and tuberculosis patients it was seen that in both T cells in PF were higher and B cells lower compared with their respective values in PB. Significantly increased percentage of T cells in PF indicates either an active sequestration in PF or the presence of suppressor adherent cells in PB. However, T and B cell percentage in PB and PF were not significantly different in the two study groups. PB immunoglobulin (IgG, IgA, IgM) levels in patients were higher as compared to those in the controls, without significant difference in their levels in the two study groups. Ratio of PF/PB values for various immunoglobulins was less than unity but a cut-off point of 0.6 for IgG & IgA and 0.5 for IgM worked out as pointer for differentiating between malignant and tubercular effusions.