Idiopathic Ventricular Arrhythmias Detected by an Implantable Loop Recorder in a Child with Exercise-Induced Syncope

Syncope is common in the general population. Despite extensive evaluation, including tilt-table testing and electrophysiologic studies, approximately 30% of cases of recurrent syncope remain unexplained. An implantable loop recorder can be used for diagnosis when recurrent syncope has an idiopathic cause. We present the case of a 9-year-old boy who had a history of recurrent, exercise-induced syncope. Results of physical examination and noninvasive diagnostic testing were inconclusive, and an electrophysiologic study revealed no inducible supraventricular or ventricular arrhythmias. Sixteen months after an implantable loop recorder was placed, the patient had a syncopal episode while swimming in a pool. Cardiopulmonary resuscitation was performed, and data from the loop recorder revealed polymorphic ventricular tachycardia and ventricular fibrillation. A cardioverter-defibrillator was subsequently implanted.Implantable loop recorders can play an important role in the diagnosis of life-threatening arrhythmias in children whose syncope is otherwise unexplained.Key words: Arrhythmias, cardiac/diagnosis; child; electrocardiography, ambulatory/instrumentation/methods; information storage & retrieval/methods; monitoring, physiologic/methods; prostheses and implants; syncope/diagnosis/etiology/therapySyncope, near-syncope, and palpitations are common in children. Although these events are typically benign, they can cause anxiety and concern. Young age and the presence of congenital cardiac problems or ion-channel abnormalities tend to increase the suspicion of severe heart disease. Other factors are syncope''s association with exertion or palpitations, or a family history of sudden cardiac death (SCD).^1–3 Determining the underlying cause is important when evaluating risks and selecting appropriate therapy; however, it can be difficult to pinpoint the cause of syncope in children.⁴ In many cases, physical examination and careful investigation of personal and family medical histories can suffice. The next diagnostic steps involve electrocardiography (ECG), echocardiography, Holter monitoring, stress testing, and sometimes tilt-table testing. Particularly in patients with structural heart disease, arrhythmia can lead to cardiac syncope and necessitate an invasive electrophysiologic (EP) study or catheter ablation.^3,4 Sometimes, however, neither of these can help to determine the mechanism of syncope.An implantable loop recorder (ILR) is a medical device that can monitor heart rhythm for a long time (up to 3 years) and record diagnostic information during syncopal episodes.^4–6 It is implanted in subcutaneous tissue, typically in the pectoral area. The ILR has proved to be effective in monitoring syncope in adults; however, there is less information on its use in children.^6,7 We present the case of a child who had recurrent exercise-induced syncopal episodes, and we describe the role of an ILR in the patient''s diagnosis and treatment.     

Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases

Objective

The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis.

Methods

Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively.

Results

Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6–48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients.

Conclusion

Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.     

Response to trastuzumab and investigation of expression profiles of matrix metalloproteinase-related proteins in primary breast cancer stem cells

Clinical and Experimental Medicine - Breast cancer (BC) is the leading cause of cancer deaths in women. One of the reasons for the failure of BC treatment is reportedly the ineffectiveness of...     

Asprosin: a novel peptide hormone related to insulin resistance in women with polycystic ovary syndrome

Asprosin associated with insulin resistance is a newly discovered peptide hormone. The peptide promotes hepatic glucose production. Polycystic ovary syndrome (PCOS) is a metabolic disorder. Insulin resistance plays a vital role in the pathogenesis of the disease. The aim of this study was to discover the association between insulin resistance and asprosin in women with PCOS. We recruited 78 subjects with PCOS and 78 age-matched and body mass index (BMI)-matched controls into this cross-sectional study. Circulating asprosin levels were validated using ELISA method. We also determined metabolic and hormonal parameters of the involved subjects. We found that circulating asprosin levels were elevated in women with PCOS with respect to controls. Asprosin levels showed a positive correlation with insulin resistance, BMI, and free androgen index (FAI). Moreover, subjects with the highest tertile of asprosin levels represented increased odds of having PCOS as compared to those subjects with the lowest tertile asprosin levels. Increased asprosin levels resulted to high possibility of having PCOS risk associated with insulin resistance.     

Comparison of 25-OH vitamin D levels between children with upper and those with lower extremity fractures: A prospective case-control study

Objective:The aims of this study were (1) to compare 25-OH vitamin D levels between children with upper and those with lower extremity fractures and (2) to determine whether 25-OH D insufficiency prevalence is increased compared to healthy controls.Methods:This is a prospective case–control study for 12 months. The study was conducted with children aged 5-18 years, including 60 children with non-displaced, impaction type upper extremity and lower extremity fractures resulted from low-energy trauma. In addition, 60 healthy children were included as controls. In all participants, risk factors for low bone mineral density were assessed and serum 25(OH)D levels were measured. Vitamin D levels were compared among groups.Results:Vitamin D deficiency (25-OH D <20) was 14.8 times (OR= 95% CI= 5.61 - 39.8) and 2.9 times (OR= 95% CI= 1.46-5.75) higher in patients with upper and lower extremity fractures, respectively. In the upper extremity fracture group, serum 25-OH D level was considered deficient (25-OH D level = <20 ng/mL) in 91.6% (55/60). In comparison, it was considered as insufficient (serum 25-OH D level = 20-30 ng/mL in 8.3% (5/60) of the patients. In the lower extremity fracture group, serum 25(OH)D level was considered as deficient in 75.0% (45/60), while it was considered as insufficient in 25.0% (15/60) of the patients. In the control group, serum 25-OH D level was considered deficient in 10.0% (6/60), while it was considered insufficient in 61.6% (37/60) of subjects. The 25-OH D deficiency and insufficiency were more common in the whole fracture group (upper plus lower extremity fracture groups) when compared to healthy controls.Conclusion:This study has shown that hypovitaminosis D is associated with an increased risk for fracture in the pediatric population, and the fracture risk is higher in upper extremity fractures than in lower extremity fractures. In children with fractures, routine vitamin D evaluation should be considered.Level of Evidence: Level III, Diagnostic Study     

Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study

The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.     

The effect of rural and urban life on peritonitis rates in chronic peritoneal patients

BackgroundIt has been reported that living far from the peritoneal dialysis (PD) unit is a risk factor for peritonitis. Considering that PD units are urban located; the question of whether living in a rural area compared to an urban area is a risk factor for peritonitis has arisen.MethodsFrom March 2010 to August 2020, 335 episodes of peritonitis in 202 PD patients followed in a single center were evaluated retrospectively. People living in areas with a population <1000 were defined as living in rural areas regardless of their distance from the PD center. Cox regression analysis was used to identify independent factors associated with peritonitis.ResultsA total of 202 PD patients were followed during 791 patient-years (mean follow-up of 3.9 years per patient). Total patients had 335 episodes of peritonitis and the rate of peritonitis was 0.42 episodes per year (episodes/patient-year). Cox regression analysis revealed that living environment (urban vs. rural) was not a risk factor for peritonitis (p = 0.57).ConclusionsIn Turkey, we report that living in a rural area in our region is not a risk factor for peritonitis. It is not the right approach for both the physician and the patient to be reluctant in the choice of PD due to the concern of peritonitis in rural areas.     

Angio-Seal Used as a Bailout for Incomplete Hemostasis After Dual Perclose ProGlide Deployment in Transcatheter Aortic Valve Implantation

BackgroundThe failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice.MethodsThis research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared.ResultsNo significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044).ConclusionFinding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure.