Canadian Registry of Implantable Electronic Device Outcomes: Surveillance of High-Voltage Leads

Background

Cardiac implantable electrical devices (CIEDs) are subject to advisories and complications that can result in morbidity and mortality for patients; there is currently no system in Canada to track these.

Postmortem acinar autolysis in rat sublingual gland: a morphometric study

Objective

To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG).

Material and Methods

Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (V_T) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points.

Results

Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42% at 0 h to 75.84% at 24 h postmortem and Vvia decreased from 71.16% to 0% over the same period. For V_Taa and V_Tia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm³ at 0 h to 38.17 mm³ at 12 h, while Vtia showed a decrease from 33.47 mm³ to 0 mm³ between 3-24 h postmortem. Data concerning V_Taa were adjusted by twovariable linear regression, obtaining the equation: y=-3.54 + 3.38x (r²=0.90). The V_Taa growth rate calculated by this equation was 3.38 mm³/h between 0-12 h.

Conclusion

Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h.     

Implantable Cardioverter-Defibrillator Insertion in Congenital Heart Disease Without Transvenous Access to the Heart

Sudden cardiac death is the leading cause of mortality in adults with complex congenital heart disease. Challenges to implanting cardioverter-defibrillators (ICDs) may arise as a result of vascular or intracardiac access issues. For example, conduits may divert systemic venous return to extracardiac structures such as pulmonary arteries or tunnels. Creative approaches to ICD implantation have previously involved subcutaneous arrays, often associated with thoracotomy to implant intrathoracic coils. We describe a patient with complex congenital heart disease and no transvenous access via the superior vena cava in whom ICD implantation involved placement of a coil within the azygos vein.     

Corticosteroid Therapy for Cardiac Sarcoidosis: A Systematic Review

Background

There are no published clinical consensus guidelines or systematic evaluation supporting the use of corticosteroids for the treatment of cardiac sarcoidosis. The purpose of this study was to systematically review the published data on corticosteroid treatment of cardiac sarcoidosis.

Methods

Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and National Institutes of Health Clinical Trials.gov database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular (AV) conduction, left ventricular function, ventricular arrhythmias, and mortality.

Results

A total of 1491 references were retrieved and 10 publications met the inclusion criteria. There were no randomized trials and all publications were of poor to fair quality. In the 10 reports, 257 patients received corticosteroids and 42 patients did not. There were 57 patients with AV conduction disease treated with corticosteroids, with 27/57 (47.4%) improving. In contrast, 16 patients were not treated with corticosteroids and 0/16 improved. Four publications reported on left ventricular function recovery, 2 reported on ventricular arrhythmia burden, and 9 reported on mortality. However, the data quality were too limited to draw conclusions for any of these outcomes.

Conclusions

Our systematic review identified 10 publications reporting outcomes after corticosteroid therapy. The best data relates to AV conduction recovery and corticosteroids appeared to be beneficial. It is not possible to draw clear conclusions about the utility of corticosteroids for the other outcomes. There is a clear need for large multicentre prospective registries and trials in this patient population.     

Prevalence of abnormalities of glucose metabolism in patients with polycystic ovary syndrome

Patients with polycystic ovary syndrome (PCOS) present a higher risk for abnormalities of glucose metabolism (AGM). For to study this in our population, we submitted 85 patients, with body mass index (BMI) of 28.5 +/- 6.6 kg/m(2) and aged 25.5 +/- 5.4 years old, to an oral glucose tolerance test (OGTT), and assessed the impact of BMI on the prevalence of impaired glucose tolerance (IGT) and of diabetes mellitus (DM). The states of glucose tolerance were classified considering fasting plasma glucose (FPG) according to the American Diabetes Association (ADA) criterion and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the ADA criteria, 83.5% classified as normal and 16.5% as with AGM, with 15.3% presenting impaired fasting glucose and 1.2% DM, while according to the WHO criteria, 68.2% were classified as normal and 31.8% as with AGM, with 27.0% of them presenting IGT and 4.8% DM. Seventy-three percent of PCOS patients with IGT by WHO criterion had normal FPG by ADA criterion. The prevalence of AGM for both criteria increased with the body mass index. In conclusion, we found a higher prevalence of AGM in PCOS patients than that found in the general population, being the highest in obese patients. Glycemia at 120 minutes on the OGTT identified more patients with AGM than fasting glycemia. We recommended that the assessment of AGM must be done by the OGTT in all patients with PCOS.     

Bilateral stress fracture of the patellae: a case report

A case of bilateral simultaneous stress fracture of the patella is presented in a 64 year old Marathon runner sustained when he slipped off a curb whilst out walking. This was confirmed on Xray and treated by tension band wiring using the AO technique. He had an excellent result returning to normal function in both knees. This case is unusual since the fractures were not due to osteoporosis, as would be expected in this age group.