Use of the AutoCapture Pacing System with Implantable Defibrillator Leads

MARENCO, J.P., et al.: Use of the AutoCapture Pacing System with Implantable Defibrillator Leads. Introduction: Previous studies using various bipolar pacemaker leads have shown that the AutoCapture (AC) Pacing System is able to verify ventricular capture and regulate pacing output, increasing patient safety with respect to unexpected threshold changes and potentially prolonging device longevity. An increasing number of patients with implantable cardioverter defibrillators (ICDs) require ventricular pacing that contributes to a shortening of longevity of these systems. This prospective study tested the compatibility of the AC system with bipolar ICD leads. Methods: The AC algorithm was evaluated prior to ICD testing in 30 ICD recipients. A single coil, active fixation, true bipolar ventricular lead was implanted in 21 patients, and a dual coil, passive fixation, integrated bipolar ventricular lead was implanted in 9 patients. A ventricular evoked response sensitivity test and an AC threshold test were performed using a pacemaker with the ventricular AC algorithm. Results: AC was recommended in 22/30 (73.3%) of implants, including 20/21 (95.2%) with the single coil and 2/9 (22.2%) with the dual coil lead. Mean polarization was lower (   1.23 ± 0.95 mV   vs   3.70 ± 2.33 mV, P = 0.013   ) while the mean evoked response was higher (   18.04 ± 8.29 mV   vs   10.13 ± 4.22 mV, P = 0.002   ) with the single coil leads. Conclusion: Automatic threshold tracking using the AC is compatible with ICD leads. Leads with lower polarization and greater evoked response are more likely to result in recommendation of AC use. Use of this system offers the potential for increasing ICD generator longevity and improving patient safety in response to late unexpected threshold increases. (PACE 2003; 26[Pt. II]:471–473)     

凉山州农村未婚青少年偶遇性行为与HIV感染的监测分析

凉山州少数民族地区商业性行为较少,未采取安全措施的偶遇性行为更为常见[1],且存在多性伴现象[2].为探讨凉山州偶遇性行为对HIV传播的影响,2011年凉山州新增设农村未婚青少年人群综合监测哨点,现将结果分析如下.1.对象与方法:按照户籍登记,选择监测点所在县农村辖区内1872名15～25岁常住农村未婚青少年.按距离县城"较远"和"较近"将调查村分为2个层次,采用分层整群抽样方法各抽取5个村,获得知情同意后,对每县10个村共计400名符合入选条件的调查对象进行问卷调查,并采集5 ml静脉血.使用酶免试剂(ELISA-1)进行HIV抗体初筛检测,初筛阳性者使用另一种酶免试剂(ELISA-2)复检,两次检测结果均呈阳性则判定HIV抗体哨点监测阳性.采用EpiData 3.1软件建立数据库并录入数据,SPSS 18.0软件进行数据的描述和分析.     

Transition zone biopsy and prediction of extraprostatic extension at radical prostatectomy

BACKGROUND: There is limited data in the literature that suggests that transition zone (TZ) biopsy might be useful for the prediction of extraprostatic extension (EPE) in clinically localized prostate cancer. We studied the role of TZ biopsy in the prediction of EPE. METHODS: Transition zone biopsies were performed in addition to systematic peripheral zone (PZ) biopsies between November 1995 and December 1999. During this period, 59 patients underwent radical prostatectomy for clinically localized disease. Final pathological results were compared with preoperative clinical and biopsy findings. RESULTS: Of the 59 patients who underwent radical prostatectomy, 46 had cancer only in the PZ cores and 13 had cancer both in the PZ and the TZ cores at the biopsy. Final histopathological results revealed EPE in 19 (32%) patients and positive surgical margins in 22 (37%). In univariate analysis of age, prostate-specific antigen (PSA), mean percentage of positive PZ cores, mean biopsy Gleason score and positive TZ biopsy, there was a significant difference for serum PSA levels (P = 0.021), presence of positive TZ cores (P = 0.018) and percentage of positive PZ cores in patients with and without EPE (P < 0.001). In multivariate analysis, the single independent predictor of EPE was the percentage of positive PZ biopsy cores (P = 0.0227). There was agreement between the side of positive TZ biopsy and EPE in seven of eight patients. CONCLUSION: Taking two TZ cores in addition to peripheral sextant biopsy did not result in better prediction of EPE. The relationship between TZ involvement and the presence of EPE can be investigated further in radical prostatectomy specimens.     

The Effect of Moisture on the Heckel and Energy Analysis of Hydroxypropylmethylcellulose 2208 (HPMC K4M)

The influence of moisture content on the Heckel analysis, energy analysis and strain-rate sensivity of hydroxyproplymethylcellulose 2208 (HPMC K4M) has been evaluated. An increase in moisture content from 0 to 14.9% w/w decreased the mean yield pressure, probably due to a plasticizing effect of moisture which reduced the resistance of particles to deformation. For each moisture content (0, 2.2, 3.8, 5.9, 9.6 and 14.9% w/w), the initial relative density and the extrapolated density from the linear portion of the Heckel plot, tended to decrease with increasing compression speed. Minor changes were observed in the initial relative density due to changes in the moisture content. The strain-rate sensitivity increased from 21.6 to 50.7% as the moisture content increased from 0 to 14.9% w/w, indicating that the plasticity of HPMC increased with increase in moisture content, whereas increase in moisture content from 0 to 14.9% w/w decreased the plastic energy. Increase in compression force or speed of compaction increased both the plastic and elastic energies. An increase in moisture content from 0 to 5.9% w/w slightly reduced the elastic energy but above 5.9% moisture content the elastic energy was unaffected by the moisture content.     

Can the levels of nitric oxide in the urine,serum and tumor tissue be putative markers for bladder cancer?

AIM: To determine nitric oxide (NO) levels in serum, urine, tumor tissue and non-malignant adjacent tissue in bladder cancer patients compared with those in patients with a non-neoplastic genitourinary disease and to evaluate postoperative serum and urine NO change. METHODS: Samples was collected in 20 cancer and 41 control patients. Griess reagent was used for NO measurements. RESULTS: Mean age in the cancer and control groups was 64.2 +/- 9.9 and 63.7 +/- 8.9 years, respectively. Preoperatively, urinary infection incidence was not statistically different between groups. There were no significant differences in serum, urine and tissue NO levels in patients with and without infection in both groups. Hematuria was found to not affect urine NO level in the cancer group. Urine NO level was significantly higher than in controls preoperatively, decreased significantly following operation and remained stable after the third month. High serum NO values decreased at the early postoperative period; however, they re-increased in the long-term. No significant differences were observed in the third month in serum and urine NO levels between the patients with (no. 6) and without (no. 14) residual or relapsing tumor. No statistical difference was observed between NO levels in non-malignant adjacent and control tissues. However, tumor tissue NO level was significantly higher than those in the other two. There were no statistical differences in the first and third month serum and urine NO levels between patients who underwent bacillus Calmette-Guérin instillation therapy postoperatively and the patients who took chemotherapy or no further treatment. CONCLUSIONS: Both local and generalized host defense mechanisms seem to function in bladder cancer patients. Although further evaluation with a longer observation period and larger numbers of patients is necessary, results suggest that serum and urine NO levels are not putative and useful markers for bladder cancer.     

Intrapericardial Instillation of Recombinant Tissue Plasminogen Activator: A Case Report

On the 43rd day after open heart surgery, pericardial effusion developed in a patient and resulted in cardiac tamponade. Since the drainage could not be obtained by subxiphoid window technique due to location of fluid and presence of fibrinous adherence and a thrombus in pericardial space, transcatheter intrapericardial recombinant tissue plasminogen activator (tPA) was instilled in the patient. Thus, the intrapericardial fibrinous adherence and the thrombus disappeared, and the effusion was drained efficiently.     

Evaluation of the Relaxant Activity of some United Arab Emirates Plants on Intestinal Smooth Muscle

Although medicinal plants are used as antispasmodic agents in folk medicine there have been no scientific studies of the phytochemical composition and usefulness of these plants for such treatment. Extracts of 23 plants used in the traditional medicine of the United Arab Emirates were tested for their effects on intestinal smooth muscle activity. Most of the plants tested caused stimulation followed by inhibition of the motility of the rabbit jejunum and guinea-pig ileum. The inhibitory effect of plants that had EC50 values < 1 mg was confirmed in-vivo using the gastrointestinal transit time test. These plants were phytochemically screened for their secondary constituents. The effect of Rhazya stricta was investigated, particularly in relation to acetylcholine effect. The results indicated the potential of some of the plants, especially Rhazya stricta, as a source of antispasmodic agents.     

Complete remission of an endometrial carcinoma with bilateral multiple pulmonary and extrapelvic metastases treated by surgery and chemotherapy consisting of paclitaxel and carboplatin

Successful management of a patient with endometrioid type, grade 2 endometrial carcinoma with bilateral multiple pulmonary and extrapelvic abdominal metastases has been reported. A 61-year-old woman with the preoperative diagnosis of stage IVB endometrial carcinoma underwent surgery followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under curve 5). After the sixth course, there were no abnormal findings on chest and abdominal computed tomography. She has no evidence of disease recurrence 24 months after the induction of chemotherapy. Tumor markers are within normal limits. Endometrial carcinoma with pulmonary metastases, especially those with bilateral multiple pulmonary metastases associated with additional extrapulmonary spread can be successfully treated by extensive surgery followed by chemotherapy consisting of paclitaxel and carboplatin.     

Erythropoiesis: Case Report: Congenital Dyserythropoietic Anemia Type II in a Woman Presenting with Jaundice, Anemia, and Splenomegaly

Congenital dyserythropoietic anemias (CDAs) are extremely rare types of hemolytic anemias that share similar morphological findings and are characterized by ineffective erythropoiesis. CDAs are divided into three major groups and few variants. The most frequently encountered type is CDA type II (HEMPAS: Hereditary erythroblastic multinuclearity associated with a positive acidified serum test). We herein report a case of CDA type II, who presents with a mild anemia, jaundice, splenomegaly, cholelithiasis and hemolysis. CDA type II, about 120 cases have been reported so far, has recently been discovered to be due to the defective glycolization of membrane proteins on the erythrocyte progenitors. The responsible gene has been found to be located on the Chromosome 20q only a few years ago.     

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options

Objectives

We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC).

Background

Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature.

Methods

10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm.

Results

The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty‐one of forty‐five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation.

Conclusions

Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction. (J Interven Cardiol 2015;28:305–312)