A Case of Pacemaker Lead Fracture Associated with Thoracic Outlet Syndrome

A pacemaker lead fracture in the left subclavian vein was caused by compression of the clavicle and the first rib; subsequent coil elongation at the same site on the right side was observed in the replacement lead in a patient with thoracic outlet syndrome. Venography showed narrowing of the subclavian vein at the site where the lead abnormalities were observed. This case illustrates that a lead in the subclavian vein can be easily damaged when a patient has thoracic outlet syndrome.     

Prognostic value of nuclear area index in patients with bladder cancer

BACKGROUND: To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear morphometric parameter expressed as the mean nuclear area (MNA) ratio of cancer to normal transitional cells in patients with bladder cancer, who have undergone radical cystectomy. METHODS: Measurements of the nuclear areas of cancer and normal transitional cells were carried out on the histological slides of 73 patients with bladder cancer. The clinical usefulness of MNA, NAI, grade, and TNM categories for the prediction of the cause-specific survival of the patients was examined. RESULTS: The median values of MNA and NAI in the 73 patients were 39 micro m2 and 1.2, respectively. Cause-specific survival rates of the patients were calculated according to stage (T1-2 vs T3-4), grade (grade 2 vs grade 3), MNA (<39 micro m2 vs>/=39 micro m2) and NAI value (<1.2 vs>/=1.2). Using univariate analysis, all these parameters were statistically significant prognostic factors. However, by multivariate analysis, NAI was the only independent variable for the survival of the patients (P < 0.01). Cause-specific survival rates of patients with NAI values of less than 1.2 were significantly higher than those with NAI values of 1.2 or more, in both grade 2 and grade 3 tumors. CONCLUSIONS: These results suggest that NAI could provide improved prognostic information for patients with bladder cancer.     

Runaway Pacemaker. A Case Report with a Runaway Rate of 2100 ppm

A case of runaway pulse generator is described. A Vitalith C-23 developed runaway on the 13th postoperative day, without any preceding changes in the rate or amplitude of the pulse generator spike. The rate of runaway was 2100 pulses per minute (ppm), one of the highest rates ever reported. The ventricle was not captured by the runaway pulse generator, but was paced effectively by a temporary demand pacemaker (Medtronic 5880A) which was left in case of displacement of the implanted pacing lead. The reasons why the temporary pacemaker was not inhibited are discussed.     

无牙颌患者戴不同厚度的上腭托对连续发[n]音时下颌位置的影响

目的:研究不同厚度的上腭托对无牙颌患者连续发[n]音时下颌位置的影响。方法:10名无牙颌患者,平均年龄为76.4岁。每一个患者按照随机原则,在不戴上腭托(对照组)和分别戴用3 mm、5 mm的上腭托时,用K7下颌运动轨迹描记仪记录下颌的位置,包括连续发[n]音4 s时下颌的位置和下颌息止颌位。结果:不戴上腭托(对照组)连续发[n]音时,垂直向的颌间距离的平均值为(1.69±1.26)mm,前后向的平均值为(1.74±1.18)mm,戴入实验上腭托后,在垂直向和水平向的颌间距离都稍有增加,但差异无统计学意义。不戴实验上腭托(即对照组)的息止颌位时,在垂直方向和水平方向的颌间距离的平均值分别是(2.91±2.28)mm和(2.56±1.88)mm,戴入实验上腭托后,在垂直向和水平向的颌间距离都稍有减小,即戴3 mm上腭托分别为(2.52±1.88)mm和(2.46±1.64)mm;戴5 mm上腭托的颌间距离分别为(2.45±1.70)mm和(2.22±1.31)mm,但差异无统计学意义。结论:总义齿患者连续发[n]音时,戴不同厚度的上腭托对下颌的颌间距离没有显著影响;总义齿患者戴不同厚度的上腭托对下颌息止颌位没有明显影响。     

MORPHOMETRY FOR MICROVESSELS IN EARLY GASTRIC CANCER BY NARROW BAND IMAGING‐EQUIPPED MAGNIFYING ENDOSCOPY

Background and Aim: Microvascular architecture is a variable characterizing early gastric cancer (EGC) against the background. The aims of the present study were to measure morphological variables of the microvessels and to compare the variables between EGC and the background. Methods: Narrow band imaging (NBI)‐equipped magnifying endoscopic pictures from 32 patients with EGC were used. The endoscopic pictures were taken under maximal magnification and processed for the microvessels in an in‐focus area after correction of image distortion. The segmented microvessels were numbered for microvessel density (counts/mm²) and vascular bed area (% ratio of vascular bed against the region of interest). The microvessels were further processed for a set of skeletonized pixels to count the characteristic points, including end‐points, crossing points, branching points and connecting points. Results: Microvessels in cancer were found to have a significantly larger connected point number (20.5 ± 6.1, P = 0.0002) than those in the background (17.4 ± 3.9). Numbers of the end‐points and branching points were found to be significantly larger in cancer than in the background (end‐points 3.6 ± 0.7 for cancer vs 3.3 ± 0.4 for background, P = 0.0005; branching points 0.8 ± 0.4 for cancer vs 0.7 ± 0.2 for background, P = 0.0014). However, microvessel density, vascular bed area and mean diameter did not significantly differ between cancer and the background. Conclusion: This finding can be considered to reflect the reported observation of an irregular vascular pattern in gastric cancer. This method may provide a means for microvessel morphometry, regardless of the organ studied.     

Radiofrequency Catheter Ablation of Left Ventricular Outflow Tract Tachycardia from the Coronary Cusp: A New Approach to the Tachycardia Focus

INTRODUCTION: Idiopathic ventricular tachycardia (VT) originating from the left ventricular outflow tract (LVOT) is rare. Previously reported were two cases of LVOT tachycardia which were treated with radiofrequency (RF) catheter ablation through endocardial aortomitral continuity. We report here a case of a repetitive LVOT tachycardia in which the QRS morphology during VT exhibited an atypical left bundle branch block and inferior axis. Pace mapping revealed that the origin of this VT was very close to the left sinus of Valsalva. Transcoronary cusp RF catheter ablation abolished the VT in this patient and is a new approach for the treatment of this kind of VT. The application of this approach to the other types of VT has yet to be determined.     

Sequential Ablation of Orthodromic Atrioventricular Tachycardia and Ectopic Atrial Tachycardia with a Single Application of Radiofrequency Energy

KOMIYA, N., et al. : Sequential Ablation of Orthodromic Atrioventricular Tachycardia and Ectopic Atrial Tachycardia with a Single Application of Radiofrequency Energy . A 62-year-old woman with Wolff-Parkinson-White syndrome had two types of tachycardia; ectopic AT and orthodromic-type AVRT. A radiofrequency application 2 cm inside the coronary sinus ostium eliminated ectopic AT and accessory pathway conduction at once. (PACE 2003; 26[Pt. I]:108–109)