[Drug-induced malignant arrhythmias. IT prevents lethal drug mixtures]. / Medikamentös induzierte maligne Arrhythmien. EDV-Prävention verhindert tödliche Mixturen.

We report a case of nearly fatal ventricular tachyarrhythmia type Torsade de pointes caused by medication-induced prolongation of QTc duration (methadone, ondansetron, escitalopram). The etiology, pathophysiology, and trigger mechanisms of such malignant arrhythmias are discussed. In order to prevent similar iatrogenic complications in the future, we networked the qtdrug database with our medication interaction control program and installed an automatic electronic warning system for the physicians in charge in case of a digitally recorded prolonged QTc duration.

[72-year-old man with syncope and left hemiparesis]. / 72-jähriger Patient mit Synkope und linksseitiger Hemisymptomatik.

A 72-year-old man was admitted with left hemiparesis after a painless syncope with suspected ischemic stroke. So far he was a healthy man without any cardiovascular risk factors. A computed tomography scan of the head did not show any abnormal findings. In the clinical evaluation we revealed pulse deficits in the left-sided extremities and the blood pressure of the left arm was not measurable. The final diagnosis was an acute aortic dissection, beginning in the proximal portion of the ascending aorta, leading to the iliacal arteries. The patient was transferred and surgery was performed immediately with success. Painless acute aortic dissection presenting only with neurologic symptoms made the correct diagnosis extremely difficult. Correct diagnosis, however, is essential, otherwise thrombolytic therapy - indicated for acute-stage cerebral infarction - would have been performed, probably with a fatal outcome.

The vascularization of the pituitary gland of the chicken (Gallus domesticus). A scanning electron microscope study of vascular corrosion casts.

Microvascular corrosion casts of the pituitary gland of one to nine-day-old chickens (Gallus domesticus, white leghorn hybrids) were analysed with the scanning electron microscope. Results show that the chicken median eminence is supplied by branches of the infundibular and the neural-lobe arteries. They form a flat two-dimensional primary capillary plexus, which lacks any capillary loops and is continuous with the plexus in the neural lobe. The capillaries occupy about 60% of the total area of the median eminence. A subependymal plexus is present, showing no contact with the plexus of the median eminence. The chicken neural lobe consists of many hollow buds. These buds are supplied by branches of the neural-lobe artery, which gives rise to a two-dimensional capillary meshwork similar to that of the median eminence. An anterior group of portal vessels, comprising 14-16 vessels with a mean diameter of 37 microns, and a posterior group of portal vessels, comprising 2-4 shorter and slightly thinner vessels, arise from the median eminence are the sole blood supply for the adenohypophysis (distal lobe). Anterior portal vessels supply the cephalic lobe and the most rostral area of the caudal lobe, and posterior portal vessels supply the caudal lobe of the distal lobe. There are no short portal vessels connecting the neural lobe with the distal lobe. The (sinusoidal) capillary bed of the distal lobe is laminated. The chicken hypophysis drains into the cavernous sinus, which empties into the cerebral carotid veins. Within the period studied (days 1-9 after hatching) no age-related changes were found.