Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy Defibrillators Due to Weakened Header Bond

Malfunction of Subpectorally Implanted Cardiac Resynchronization Therapy . Background: Implantable cardioverter defibrillator (ICD) implantation has increased significantly over the last 10 years. Concerns about the safety and reliability of ICD systems have been raised, with premature lead failure and battery malfunctions accounting for the majority of reported adverse events. We describe the unique mode of presentation, diagnosis, and management of cardiac resynchronization therapy defibrillators (CRT‐D) malfunctions that were caused by weakened bonding between the generator and header. Methods and Results: Between June 2008 and December 2009, 22 Teligen? ICDs and 24 Cognis? CRT‐Ds were implanted subpectorally at our institution, until a product advisory was issued. Of 24 Cognis? CRT‐D implants, 3 patients presented with CRT‐D malfunctions. All our cases presented with initially intermittent and then persisting increases in shock lead impedance, associated with nonphysiological noise in the shock electrogram channels. These issues were rectified by generator change. Postexplant laboratory analysis confirmed inadequate bonding between device header and titanium casing in all cases, resulting in loosening and rocking of the header followed by fatigue‐induced fracture of the shock circuitry. Conclusion: Weakened bonding between the header and generator casing of subpectorally implanted CRT‐Ds can result in fractures and malfunction of the HV circuit. Physicians monitoring patients with devices affected by the product advisory should remain vigilant in order to diagnose and manage similar device malfunction expediently. (J Cardiovasc Electrophysiol, Vol. 24, pp. 351‐355, March 2013)     

The sitting position in neurosurgical anaesthesia: a survey of British practice in 1991

A postal survey of 160 members of the Neurosurgical Anaesthetists'Travelling Club was conducted in 1991 to investigate the currentuse of the sitting position in neurosurgery. There was a 78%response rate; at least one reply was received from every neurosurgicalcentre in the UK. Patients were placed normally in the sittingposition for posterior fossa surgery in eight (20%) of the centres,compared with 19 (53%) in 1981. For posterior cervical spinalsurgery, only three (7%) centres routinely used the sittingposition, compared with 11(31%) in 1981. Thus in the period1981%1991, the number of neurosurgical centres using the sittingposition routinely, decreased by more than 50%. Current techniquesof ventilation and monitoring for the sitting position are discussedbriefly.      

Sinus Node Reentrant Tachycardia

This review article discusses the electrophysiological basis of sinus node reentry, clinical features of sinus node reentry, and the management of this uncommon tachycardia with drugs and ablative therapy. It also proposes the use of the term "sinoatrial reentrant tachycardia" for this form of tachycardia.     

NASPE POLICY STATEMENT The NASPE* BPEG** Defibrillator Code

BERNSTEIN, A.D., et al .: The NASPE/BPEG Defibrillator Code. A new generic code, patterned after and compatible with the NASPE/BPEG Generic Pacemaker Code (NBG Code) was adopted by the NASPE Board of Trustees on January 23, 1993. It was developed by the NASPE Mode Code Committee, including members of the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). It is abbreviated as the NBD (for NASPE/BPEG Defibrillator) Code. It is intended for describing the capabilities and operation of implanted cardioverter defibrillators (ICDs) in conversation, record keeping, and device labeling, and incorporates four positions designating: (1) shock location; (2) antitachycardia pacing location; (3) means of tachycardia detection; and (4) antibradycardia pacing location. An additional Short Form, intended only for use in conversation, was defined as a concise means of distinguishing devices capable of shock alone, shock plus antibradycardia pacing, and shock plus antitachycardia and antibradycardia pacing. (PACE, Vol. 16, September 1993)     

Clinical significance of anismus in encopresis

Treatments designed to relieve paradoxical contraction of the anal sphincters during defecation (anismus) have had limited success in children with encopresis. This has raised doubts as to the clinical relevance of this diagnosis in childhood as anorectal dysfunction. Our aim was to determine whether, in patients who had treatment-resistant encopresis, the presence of electromyographic anismus was associated with increased faecal retention. Sixty-eight children with soiling (mean age 8.7 ± 2.06 years) were assessed by clinical examination, abdominal radiography and then with anorectal manometry. Patients with electromyographic anismus (n= 32; 47%) had significantly increased radiographic rectal faecal retention and were significantly less likely to be able to defecate water-filled balloons. There were no significant differences in response to prior therapy, history of primary encopresis, behavioural adjustment or in sociodemographic data. Our results suggest that electromyographic anismus is associated with obstructed defecation and faecal retention.     

Fluorescence of Megakaryocytes in Idiopathic Thrombocytopenic Purpura (ITP) Stained with Fluorescent Antiglobulin Serum

1. A technic is described for the direct and indirect visualization of affinitybetween fluorescein labeled antiglobulin serum and megakaryocytes.

2. Fluorescent megakaryocytes have been found with this technic in themarrow of some patients with chronic ITP, but not in acute ITP. It was possiple to confer fluorescence on normal megakaryocytes by incubating themwith sera from patients with chronic ITP, and from a woman who had a childwith neonatal thrombocytopenia.

3. Similar reactions were noted in three patients with systemic lupuserythematosus.

4. These findings indicate adherence of a humoral substance (antibody?)for megakaryocytes, which may have etiologic significance in chronic ITP.

Submitted on August 16, 1961 Accepted on February 23, 1962     

THE PREFERRED CONFORMATIONS OF PROTECTED HOMODI-TO HOMOHEPTAMETHIONINE PEPTIDES A 1H N.M.R. Study in Deuterochloroform Medium

Detailed analyses of the conformations of the homo-oligopeptide series, Boc-(L-Met)_n-OMe n = 2–7, in deuterochloroform have been carried out with proton n.m.r. and IR spectroscopy. Well-resolved high field n.m.r. spectra with assignments for the NH and α-CH resonances of these homo-methionine peptides are presented. Extensive n.m.r. concentration-dependent chemical shift studies are combined with IR results to delineate the involvement of the various methionine NH protons in intra- and/or intermolecular hydrogen bonding. N.m.r. chemical shift dependencies with temperature and solvent, DMSO-d₆, are used to explore the strength of the hydrogen bonds for the various oligopeptides. At low concentrations, where peptide aggregation is absent, the dipeptide is found to be disordered. The tetra- to heptapeptides possess intramolecular hydrogen bonded seven-membered rings at internal residues. The number of internal rings and the oligopeptide self-association increase with increasing peptide chainlength. At intermediate concentrations associations of peptide molecules with folded structures occur with initial association at the C-terminal region. At high concentrations, “in-register” associated extended β structures are formed.     

A CASE OF GASTRIC DUPLICATION IN AN ADULT

A case of extensive gastric duplication in an adult is presented, illustrating one of the two common symptoms, and emphasising that surgical excision, where possible, Is the treatment of choice.     

Placental protein 12 (PP12): a new test for the prediction of the small-for-gestational-age infant

Summary. The circulating levels of placental protein 12 (PP12) and placental lactogen (hPL) were measured in 501 women between 36 and 41 weeks gestation. There was a significant positive association between hPL levels and infant birthweight and a significant negative association in the case of PP12 levels. The clinical efficiency of elevated PP12 levels in the prediction of low-birthweight infant at term compared favourably with that of reduced hPL levels.