The present study investigated the effect of tumor necrosis factor (TNF)-␣ on myocardial energy metabolism as estimated by myocardial oxygen consumption (MV O2). MV O2 of electrically stimulated isolated trabeculae of right ventricular Wistar rat myocardium was analyzed using a Clark-type oxygen probe. After the initial data collection in the absence of TNF-␣, measurements were repeated after TNF-␣ stimulation. In separate experiments, pretreatment with the nitric oxide (NO) synthase inhibitor N G -nitro-L-arginine methyl ester (L-NAME) or the ceramidase inhibitor n-oleoylethanolamine (NOE) was done to investigate NO/sphingosine-related effects. TNF-␣ impaired myocardial economy at increasing stimulation frequencies without altering baseline MV O2. Incubation with TNF-␣ in the presence of L-NAME further impaired myocardial economy. NOE preincubation abrogated the TNF-␣ effect on myocardial economy. Moreover, the negative inotropic effect of TNF-␣ was observed in NOE-pretreated but not L-NAME-pretreated muscle fibers. Exogenous sphingosine mimicked the TNF-␣ effect on mechanics and energetics. We conclude that TNF-␣ impairs the economy of chemomechanical energy transduction primarily through a sphingosine-mediated pathway. cytokines; nitric oxide; myocardial energy metabolism; tumor necrosis factor-␣

Multimodality treatment including surgery was safe and led to considerable survival. R0 resection was the only factor extending survival. It could be achieved in most patients and was associated with a low risk of locoregional relapse. Prospective randomized controlled studies are needed to define best practice in stage IA-IIIB SCLC.

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A 31-year-old patient presented with chronic cough and thoracic pain. A pulmonary mass was seen on chest x-ray, and pulmonary segmental resection was done. Histopathologically, a pulmonary abscess cavity due to actinomycosis was found. Three months later, recurrence of actinomycosis at the thoracic wall was observed. Antibiotic therapy with penicillin was administered. Five months later, with the patient receiving continued antibiotic therapy, a thoracic wall abscess and fistula was diagnosed. Four weeks after abscess drainage and repeat intravenous antibiotic therapy, the patient was symptom-free and had remained symptom-free at 10 months of follow-up.