Interaction of an implanted pacemaker with a transesophageal atrial pacemaker: report of a case

We report an interaction of a transesophageal atrial pacemaker (TAP) with a permanently implanted pacemaker in a cardiac patient who had undergone ablative therapy for atrial tachyarrhythmia 5 years earlier. The patient’s permanent A-V pacemaker was completely inhibited by the TAP, and there was loss of ventricular contractions and blood pressure. The patient required epicardial A-V pacing to overcome the programmed heart rate of 76 bpm. We describe alternative methods to epicardial pacing. We also recommend close inspection of the chest radiograph, which often can reveal the serial numbers of the implanted pacemaker, as a means of identifying the device’s functions and programming.     

Percutaneous radiofrequency trigeminal rhizotomy in a patient with an implanted cardiac pacemaker

Percutaneous radiofrequency ablation is a frequently used treatment for trigeminal neuralgia. Radiofrequency is another potential source of electromagnetic interference to implanted cardiac pacemakers. Our patient had a permanent pacemaker and underwent the procedure without incident.     

Infection at the site of implanted materials with and without preadhered bacteria

A study was undertaken to examine the role of bacterial adherence in the development of infection at the site of an implant. The amount of in vitro adherence of Staphylococcus epidermidis was greatest for stainless steel, followed by polymethylmethacrylate and commercially pure titanium, and was least for polymethylmethacrylate with gentamicin. These materials then were preincubated with S. epidermidis and implanted. The number of organisms that were isolated and the rate of infection followed the same pattern as that in the in vitro studies. Materials that were not preincubated with bacteria also were implanted and bacteria were injected into the site. The number of organisms isolated from the site and the rate of infection were lower than those for the preincubated materials, but the trend was the same as in both the in vitro and the in vivo studies. The rates of infection and colonization correlated with the propensity for the organisms to adhere to a given material. Materials colonized with S. epidermidis at the time of implantation caused a high rate of infection. The ability of organisms to adhere to a material in vitro is correlated with their propensity to cause biomaterial-based infection.     

Breast cancer in males]

Until 1971 13 cases of breast cancer in men were observed in our service. In the world literature it accounts for 1% of all cancer of the breast; in our series we have found 4% of all breast cancer. Men present themselves for treatment later and with more advanced local signs than women. In our series, the greatest number of cases occurs near the seventies in men, which is about twenty years later than in women. The etiology is remained unknown, but Klinefelter's disease seems to be a risk for breast cancer. If there are no metastasis, we prefer in our service the surgical treatment as unique treatment. If possible the operation of Patey is realised, but sometimes we have to do a simple mastectomy only as a safe alternative for poor risk patient. In case of metastatic breast cancer the adjuvant treatment was X-ray therapy, chemotherapy and in some of our cases hormonotherapy. We do not have any experience with suppressive hormonal therapy such as orchiectomy or adrenalectomy. Most of the authors think that prognosis of breast cancer in males is worse than in women; the constant central localization of the tumour may be an explanation for that. The fate of women with central lesions is as poor as in males.     

Intragastric migration of a pacemaker implanted in the pleural space.

We have encountered a 12-year-old boy with a pacemaker implanted in the left pleural space during early infancy that migrated into the stomach through the diaphragm due to severe scoliosis and occult infection. The intrathoracic implantation of a pacemaker in an infant should be assessed more carefully, taking the volume of the unit into consideration, because of this potentially life-threatening complication.     

Breast cancer: an overview

Depending on one's viewpoint and appraisal of studies and statistics, breast cancer is viewed with optimism, pessimism, enthusiasm, or disappointment. Each opinion is substantiated by ample data that support differing views. This article will review some of the unresolved issues in the management of breast cancer, including etiology, diagnosis, and treatment. These issues are discussed at length in the articles that follow.     

Breast cancer screening in surgical patients]

Between January and August 1996, 304 patients of the Department of General and Abdominal Surgery of the University of Mainz who were at least 40 year old, were interviewed about their breast cancer screening behavior. The aim of our investigation was to evaluate the attitude of the target population to breast screening and the value of breast palpation, completed with mammography, during the women's treatment in hospital. 168 (55%) of the interviewed women reported that they had a yearly clinical breast examination in the past. All patients underwent a clinical breast examination. 185 (60%) did not have a mammography in the past or within the past 2 years. These women were offered a mammographic examination during their treatment in the hospital. The investigation revealed one invasive breast cancer. 13 patients had abnormal mammographic or sonographic findings. Our investigation shows, that the compliance of the target population for breast cancer screening is low. Therefore it is necessary to point out the value of breast cancer prevention with clinical examination and mammography also for patients treated in the hospital for an other disease. Every female patient should undergo breast examination. But early detection of breast cancer before micrometastases have occurred is only possible by mammography.     

Laser-assist during extraction of chronically implanted pacemaker and defibrillator leads

Background. Extraction of chronically implanted pacing and defibrillator leads has historically been difficult, occasionally requiring open surgical procedures. The purpose of this study was to evaluate the efficacy, safety, and potential need for percutaneous laser-assisted sheath techniques for extraction of chronically implanted leads.

Methods. From January 1999 to August 2001, 128 consecutive patients underwent extraction of 229 leads (138 pacing, 91 defibrillator) in the operating room 61 ± 44 (mean ± standard deviation) months after implantation. Common indications included erosion or pocket infection (41%), lead dysfunction (30%), and sepsis (13%).

Results. Laser techniques were used for 56% ± 4% (104 of 186) of long-term (implanted for more than 1 year) leads, compared with only 16% ± 6% (7 of 43) of short-term (implanted for less than 1 year) leads (p < 0.001). For infected leads, laser was used in 53% ± 5% (49 of 92) with erosion or pocket infections, compared with only 3% ± 4% (1 of 29) with sepsis (p < 0.001). Extraction was complete in 88%, near complete (retained tip) in 10%, and incomplete in 2%. Two patients required a later percutaneous femoral venous approach to remove mobile retained segments, but no patients required cardiac surgery for extraction. Complications included sternotomy for subclavian vein injury (1), chest tube for caval perforation (1), innominate vein thrombosis (1), and partial clavicle removal for subclavian vein repair (2). There were no procedure-related deaths.

Conclusions. Laser-assisted lead extraction is safe, but it is best performed in the operating room; it should be available for long-term leads, except when they are grossly infected, producing sepsis. Laser techniques have essentially eliminated the need for open surgical removal of retained leads.