Role of exercise stress test in diagnosis of atrial lead malfunction in permanent pacemakers

Dual chamber pacing has become the most common pacing mode because it is capable of sensing and pacing in both the atrium and ventricle and can track atrial activity. It is least competitive with intrinsic rhythm and it maintains AV sequencing as well as rate adaptation by tracking the normally functioning atria. However the presence of atrial lead has been found to bring on some problems. The aim of this work was to study the role of exercise test as a diagnostic tool in atrial lead malfunction in dual chamber pacemakers and to study the effect of physical exercise on P wave amplitude. This study included thirty Patients, 28 with DDD pacemakers and 2 with VDD pacemakers who were referred for pacemaker follow up at Ain shams university hospital. For inclusion in the study patients should have maintained intrinsic atrial activity and should have an apparently well functioning pacemaker by surface ECG. Patients with sever heart failure, ischemic heart disease and those who were totally dependant on atrial pacing were excluded. After history taking and physical examination, pacemakers were interrogated by the appropriate programmer for measurement of sensing and pacing functions of atrial and ventricular leads in both unipolar and bipolar configurations before and after doing an exercise test according to Bruce protocol. The atrial leads implanted in the studied group were J-shaped screw-in steroid eluting leads in 18 patients, straight screw-in steroid eluting leads in 5 patients, and straight screw-in non steroid eluting leads in 5 patients. Two patients received single lead VDD pace makers. 10 patients had complaints while 20 patients did not have any complaint. Atrial lead malfunction was detected by exercise test in 5 patients, all of them were complaining. Two of these 5 patients [one with VDD and one with DD pacemaker] had true undersensing, two had functional undersensing and one had over sensing. There was no difference in P wave amplitude before and after exercise.:Exercise stress test is a helpful tool in detecting atrial lead malfunction in patients with DDD/VDD pacemakers who have a normal ECG with normal supine atrial lead function and are complaining of dizziness and/or fatigue. lt has a positive predictive value of 100% and a negative predictive value of 80%.In the presence of complaints, [dizziness and/or fatigue], it is a highly specific test to exclude abnormal pacemaker function

Bacterial and non-bacterial prostatitis: detection of chlamydia trachomatis, cytomegalovirus and herpes simplex virus

Eighty-six patients with persistent symptoms of chronic prostatitis were screened for possible aetiological organisms affecting the prostate. Our study entailed a culture of expressed prostatic secretion [EPS] for bacteria. A positive culture was obtained in 40 [46.5%] patients with chronic bacterial prostatitis [CBP]. Forty-six patients [53.5%] were negative for a bacterial culture of EPS and therefore categorized as having non-bacterial prostatitis [NBP]. Immunofluorescence study of the EPS revealed that 12 [26%] out of these 46 patients with non-bacterial prostatitis were positive for Chlamydia trachomatis. Prostatic specimens taken by perineal needle biopsy from all patients with non-bacterial prostatitis were tested for vira antigens by immunoperoxidase study [15.2%] of these prostatic biopsies gave positive results for Cytomegalovirus [CMV] antigen, while 3 [6.5%] showed a positive immunoperoxidase reaction for Herpes Simplex virus type II [HSV-2]. In the remaining 24 [27.8%] patients, no definite organism could be isolated. The results demonstrate that chlamydial and viral prostatitis cover a reasonable group of patients with non-bacterial disease in whom the effort should be directed to eradicating these organisms from the prostate

use of tunica vaginalis in the repair of proximal hypospadias

We herein report on the technique and results of a procedure for proximal hypospadias repair called tunical vaginalis blanket wrap [T.V.B.W.]. This procedure incorporates covering of the neourethra with tunica vaginalis as a pedicled flap at the time of hypospadias repair. The technique was used successfully In 60 boys with proximal hypospadias and 10 with recurrent urethrocutaneous fistula after repair of the fistula. Cosmetic and functional results were excellent in all cases. Complications were limited to meatal stenosis in 3 cases, urethrocutaneous fistula in one case and skin sloughing in 2 cases. Clinical experience with this technique has been satisfactory and has not been associated with complications apart from scrotal haematoma in one patient which resolved spontaneously. The extra-operative time ranged from 10 to 150 minutes. The addition of tunica vaginalis to create a layer completely covering the neourethra appears to reduce the incidence of urethrocutaneous fistula markedly without any harm to the testis