Three hundred and fifty-three consecutive patients with permanent transvenous pacemakers.

The safety and convenience of the transvenous approach to long-term endocardial pacing are well established, but its principal drawback is electrode displacement. The reported incidence of this complication varies between 3.0% to 36.7%, and is highest in the early post-implantation period before endocardial fixation of the electrode tip. Recently Brewster and Evans determined that the electrode displacement rate in 21 published series averaged 14.3%. However, the Inter Society Committee on Heart Diseases (ICHD) report on pacemakers states that a rate of early displacement greater than 5% calls for a critical review of results. The training and expertise of the persons inserting the pacemaker electrodes undoubtedly are major factors which determine the proper transvenous placement of permanent cardiac electrodes. This paper deals with our clinical experience of 353 patients who received permanent transvenous pacemakers during the period September 1, 1974 through March 1, 1979, with emphasis on problems and complications encountered and overall results.

[Intestinal secretory IgA and bacterial antigens in oral administration]. / IgA secretorie intestinali ed antigeni batterici somministrati per via orale.

The proposed technique for purification and concentration of secretory IgA has been applied to intestinal wash fluids obtained by clisma from 15 patients under bacterial extracts treated (COLOPTENE-DEBAT). The collected data show that the technique is suitable for routinary use and the bacterial extracts do increase the amount of IgA in the intestinal contents.

His bundle electrograms in 51 patients requiring permanent transvenous pacemakers.

Fifty-one patients required the implantation of a Cordis Omnis-Stanicor permanent pacemaker. His bundle electrograms studies, which included right atrial pacing and sinoatrial (SA) node postsuppression recovery times, were performed prior to the implantations. Pacing and sensing thresholds were obtained in all patients. Syncope or episodes of dizziness were the presenting symptoms in virtually every patient. Twenty-eight of the 51 patients had the sick sinus syndrome. Only nine patients were in complete heart block, and an additional nine were in second-degree heart block. The His bundle electrogram technique was not particularly helpful in selecting the potential pacemaker candidate. The symptomatic patient with second- or third-degree heart block requires a pacemaker. In the sick sinus syndrome, the His bundle electrogram was a disappointing tool in detecting abnormalities. In chronic bundle branch block, the His bundle electrogram appears to play a major role. A prolonged H-V interval in a symptomatic patient, in whom a specific noncardiac cause cannot be identified, signifies that a pacemaker is required.

Aneurysm of a polar renal artery.

A patient with a saccular aneurysm arising from the left superior polar renal artery is presented together with a review of two further reports from the literature. The importance of selective arteriography and the interpretation of the "naked calyx" sign in the diagnosis of supernumerary renal arteries has been emphasized. We feel that this is the only report of an aneurysm of a polar artery successfully treated by excision and end-to-end arterial anastomosis.