Insertable Loop Recorder in Unmasking the Cause of Syncope

SIMANTIRAKIS, E.N., et al. : Insertable Loop Recorder in Unmasking the Cause of Syncope. During the last few years closed loop recorders are being used increasingly in the investigation of unexplained syncope. Our patient had a 5-year history of pre- and syncopal episodes in which the usual invasive and noninvasive tests were nondiagnostic. Finally, a loop recorder was implanted that revealed the cause of the syncope a few days after implantation: a fast, sustained, ventricular tachycardia originating from the right ventricular outflow tract. Loop recorders will undoubtedly contribute toward the decrease in the percentage of undiagnosed syncope cases and possibly to the reduction of the investigation cost.     

Sigmoidorectal (Mainz II) pouch for continent urinary diversion in bladder cancer

BACKGROUND: We aimed to assess the feasibility, safety, and outcome of the sigmoidorectal (Mainz II) pouch for urinary diversion in patients with invasive bladder cancer. METHODS: Twenty-nine patients (25 men and four women), aged 65-76 years, who had undergone radical cystectomy and the sigmoidorectal pouch procedure for invasive bladder cancer were included in this study. Postoperative evaluations included metabolic testing, standard laboratory screening, renal ultrasonography, pouchography, and intravenous urography or pouchoscopy when indicated. RESULTS: The median operative time was 175 min. Urine leakage was encountered in two patients (6.8%), deep vein thrombosis in one (3.4%), and ileus necessitating surgery in another one. Two patients developed pyelonephritis due to ureterocolonic stricture, which was treated with antegrade balloon dilatation. No local relapses of bladder cancer were found. All patients were continent during the day, but one patient was occasionally incontinent during the night. In the long term, six patients (20.6%) developed metastatic disease, and five patients (17.2%) died because of cancer-related causes. Overall survival was 100, 96 and 60% at 1, 2 and 3 years after the operation, respectively. The mean survival was 36.8 +/- 1.9 months, which was statistically significantly associated with the M stage (P < 0.001), but not with the T (P = 0.091) or N (P = 0.081) stages. CONCLUSIONS: The sigmoidorectal (Mainz II) pouch seems to be a feasible, safe and effective method for continent urinary diversion. It is able to provide good quality of life, and ensure good overall survival rates.     

Short-term and long-term effects of chewing training on occlusal perception of thickness

Abstract – The aim of this study was to investigate the short-term and long-term effects of functional stimuli, induced by intense chewing and by prolonged systematic chewing training, on the response of occlusal perception of thickness. The material comprised 25 young adults divided into an experimental group (17) and a control group (8). The occlusal perception of thickness was tested by successively placing different thicknesses of aluminum foil between five pairs of occluding teeth, i.e. right and left second premolars and canines and one pair of the central incisors. The experimental group was tested 2 wk before the start of the experiment and at the start and the end of the experiment, i.e., after 4 wk systematic chewing training, and before and after 30 min intense chewing. The control group was tested on the same occasions but without performing any special chewing activity. The discrimination threshold increased in most of the subjects after 30 min of chewing, both before and after the 28-day training period. This threshold increase was found in all groups of teeth tested. No changes were found in the discrimination threshold of the teeth tested after 28 days of chewing training. In the controls no differences were found between the recording occasions. Since no statistically significant differences were observed between the groups of teeth tested, the changes in the threshold of occlusal perception after intense chewing may reflect the influence of receptors other than periodontal, for example those in TMJ and muscles, which are involved in the control of other neuromuscular mechanisms such as those that control the postural position of the mandible.     

Endometriosis of the urinary tract in women of reproductive age

AIM: We present our experience with diagnosing and treating 22 cases of urinary tract endometriosis in women of reproductive age. PATIENTS AND METHODS: From January 2001 to January 2003, 22 women of reproductive age (mean age 34.8 years) were diagnosed suffering from endometriosis of the urinary tract. We used the Endoscopic Endometriosis Classification (EEC) for assessing the stage of endometriosis. RESULTS: Endometriosis was present in the bladder, the lower third of the ureter, and in a postnephrectomy ureteral stump in 15 (68.1%), six (27.2%) and one (4.5%) cases, respectively. The EEC classification revealed stages I, II, III and IV in four (18.1%), one (4.5%), one (4.5%), and 16 (72.7%) patients, respectively. Urinary symptoms were present in 14 (63.6%) patients. For the treatment of bladder endometriosis, 10 patients underwent partial cystectomy, while the remaining five patients were treated with transurethral resection. In four patients ureterolysis was performed, by laparoscopy in two cases and by open surgery in the other two cases. Ureterectomy and re-implantation with bladder psoas hitching took place in six patients. In the case of endometriosis of the ureteral stump, open surgical excision took place. During the mean follow-up period of 20 months (range 16-40) no long-term complication or relapse was diagnosed. CONCLUSIONS: Bladder and ureteral endometriosis should be considered in women of reproductive age with non-specific urinary tract or abdominal symptoms, and surgical treatment is recommended.     

Nephrectomy for benign disease? A case of isolated renal echinococcosis

Cystic hydatid disease may be found in virtually any organ, although involvement of the urinary tract is relatively uncommon. We report a case of isolated renal hydatid disease presenting with hydatiduria. A short review of the literature regarding diagnosis and management of renal echinococcosis is also presented.     

Oral health status in a group of children and adolescents with myotonic dystrophy type 1 over a 4-year period

Aim.  The aim of this longitudinal study was to evaluate changes in oral health, orofacial function, and dental care in children with myotonic dystrophy type 1 (DM1) in comparison with a control group.
Methods.  Thirty-six DM1 patients and 33 control patients out of originally 37 in each group were examined on two occasions about 4 years apart. Caries, plaque, and gingivitis were registered, mouth opening capacity assessed and the ability to cooperate in dental treatment estimated. Questionnaires concerning different aspects of oral health and care, symptoms of temporomandibular dysfunction (TMD), and dental trauma were also used.
Results.  The DM1-patients, in particular the boys, had significantly more caries, plaque, and gingivitis than the control patients on both occasions and the increase in decayed missing or filled permanent teeth (DMFT) and surfaces (DMFS) was significantly larger. They received more dental care and had lower cooperation ability. Mouth opening capacity and increase of it was significantly lower and symptoms of TMD were significantly more frequent.
Conclusions.  DM1 patients, as they grow older, have increasing amounts of plaque and risk of caries and gingivitis. They have more TMD problems. Behaviour management problems do not seem to decrease with age. Increased prophylactic care is essential for DM1 patients.     

Apparent Acute Reversible Right Ventricular Pacing‐Induced Left Ventricular Dysfunction

Apparent Acute Reversible Right Ventricular Pacing‐Induced Left Ventricular Dysfunction . We report the case of a 70‐year‐old Caucasian male with a dual chamber (right atrium/right ventricle) pacemaker implanted for sinus node dysfunction and not pacemaker (PM) dependent who was found to have an apparent acute worsening of left ventricular (LV) function with right ventricular (RV) apical pacing caused by the mode switch to VVI pacing as battery depletion occurred. LV dysfunction resolved immediately with RV pacing turned off. To our knowledge, this is the first report of this phenomenon. (J Cardiovasc Electrophysiol, Vol. 24, pp. 224‐226, February 2013)     

A General Solution of the Problem of Mixing of Subpopulations and its Application to Risk- and Age-Structured Epidemic Models for the Spread of AIDS

A central aspect in the study of the dynamics of sexually transmitteddiseases is that of mixing. The study of the effects of socialstructure in disease dynamics has received considerable attentionover the last few years as a result of the AIDS epidemic. Inthis paper, we formulate a generalization of the Blythe andCastillo-Chavez social/sexual framework for human interactionsthrough the incorporation of age structure, and derive an explicitexpression in terms of a preference function for the generalsolution to this formulation. We emphasize the role played byproportionate mixing, the only separable solution to this mixingframework, through the discussion of several specific cases,and we formulate an age-structured epidemic model for a singlesexually active homosexual population, stratified by risk andage, with arbitrary risk- and age-dependent mixing as well asvariable infectivity. In the special case of proportionate mixingin age and risk, an explicit expression for the basic reproductivenumber is computed.