Right Atrial Pacemaker Lead Thrombosis Causing Tricuspid Inflow Obstruction

A 75-year-old man was admitted to our hospital with a complaint of progressive dyspnea with effort. The patient had a permanent pacemaker that was implanted 16 years ago. Transesophageal echocardiography revealed a large, mobile mass in the right atrium attaching to the insertion site of the atrial lead at the tricuspid valve level. Because of the size, mobility, and location of the mass, urgent surgical removal was considered. The mass was successfully removed. Histologic examination of the mass demonstrated a partially organized thrombus. The postoperative course was uneventful and the patient's symptoms improved remarkably after operation.     

Clinical and Dermoscopic Characteristics of Melanocytic Nevi in Turkish Children and Their Relationship with Environmental and Constitutional Factors

BACKGROUND/AIM: The number of melanocytic nevi strongly influences risk of melanoma. Researchers have therefore been prompted to study the epidemiology of nevi, particularly in children. Our aim was to determine the clinical and dermoscopic characteristics of melanocytic nevi in Turkish children and their relationship with environmental factors. METHODS: A total of 180 children were randomly included in the study. A survey was applied including age, sex, sunblock use, sunburn history, mother's dressing style, mother's education, and income. Dermoscopic patterns of nevi were noted. RESULTS: A total of 1,173 melanocytic nevi were examined. The mean number of nevi was 6.53+/-7.18. The number of melanocytic nevi significantly increased with age (Pearson r=0.616, p=.001). The most common localization was head and neck. A total of 81.1% of children had never used sunblock, and 57.2% of mothers dressed in the Islamic style. The mean number of melanocytic nevi in children whose mothers dressed in the Islamic style was lower than whose mothers dressed in non-Islamic style (p=.015). Sunblock use increased with mother's education (p=.001) and with income (p=.001). Children with more melanocytic nevi used more sunblock (p=.002), and sunblock use increased with age (p=.026). The most common dermoscopic feature was a globular pattern. CONCLUSION: This study lays the foundation for future studies showing the relationship between nevus phenotype, dermoscopic pattern, and social factors.     

Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly

The pharmacological treatment, mainly based on diuretics, ofisolated systolic hypertension (ISH) has recently been shownto reduce the risk of stroke and coronary heart disease in theelderly. The purpose of this study was to compare the antithypertensiveeffect and tolerability of different drug regimens in elderlysubjects with ISH (systolic blood pressure—SBP —160mmHg and diastolic blood pressure — DBP — <90mmHg). A multicentre, randomized, controlled open trial wasplanned in the general practice setting. Four widely used treatmentschedules were tested: hydrochlorothiazide 25 mg plus amiloride2·5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol50 mg (At) and atenolol 25mg plus chlorthalidone 6·25mg (At+C). After a baseline evaluation, 308 patients (76·3% female,mean age 75·3 ± 7·1 years) were randomizedand followed up for 6 months. After 3 months the drug dosagewas doubled if the systolic blood pressure goal (SBP<160mmHg and SBP reduction of at least 20 mmHg) had not been reachedNinety-four subjects (30·5%) presented contraindicationsto ß-blockers. At the 3rd- and 6th-month visits alltreatment groups, except At, showed a significant reductionin SBP compared to the control group; DBP showed no significantreduction in any group at any time. At the end of the follow-upthe percentage of hypertensives who had reached the BP goalwas 14·6% in the control group, 52·9% in H+Am,54·8% in N, 28·6% in At and 52·2% in At+C.Over two-thirds of the patients on H+Am or N, and about 50%of those on At or At+ C at 6 months were taking the medicationat low dose. The rate of therapy discontinuation due to side effects duringfollow-up was significantly different among the drug regimenstested: 1·9% in the H+Am group compared to 12·5%,19·2% and 14·8% respectively in N, At and At+Cgroups (P<0·05 for H+Am vs At). The proportion ofsubjects who spontaneously reported, mild adverse effects after3 and 6 months of therapy was not signficantly different inthe study groups, even if an excess was observed in the N groupat 3 months. In conclusion, these data suggest that. diuretics are a firstchoice in the treatment of ISH, because of their hypotensiveefficacy and acceptability; nifedipine, if well tolerated, isan effective alternative to diuretics; a high proportion ofelderly patient with ISH present contraindications to ß-blockers,and atenolol has a poor antihypertensive effect.     

Role of blood pressure response to provocative tests in the prediction of hypertension inadolescents

To assess the value of exercise stress testing and of mentalstress as predictors of hypertension, we studied 130 normotensivemales 14–18 years of age. Sixty-five had at least onehypertensive parent (SHT), while 65 had normotensive parents(SNT). Systolic (SBP) and diastolic (DBP) blood pressure, rate-pressureproduct (RPP) and 12-lead ECG were recorded at rest, throughoutthe tests and during the recovery phase.The two groups werenot significantly different at rest for the examined variables.However, the SHT group showed a greater average SBP than theSNT group (198.4±18.7 vs 189.5±14.9 mmHg; P<0.05)at the peak of exercise. A significantly higher proportion ofSHT subjects (40.0% vs 18.5%: P<0.01) had SBP >200 mmHg.No difference in the ECG pattern between the two groups wasobserved.During mental stress, no significant differences inthe examined variables between the two groups were noted, althoughSBP, DBP, HR and RPP were slightly higher in SHT than in SNTsubjects.These data suggest that the SBP response to dynamicexercise may be a good predictor of hypertension in subjectsat risk.