An early onset of acute renal failure in a young woman with obesity and infertility who underwent gastric balloon positioning. A case report.

INTRODUCTION: Although intragastric balloons have been in use for several years to achieve weight reduction in obese patients, acute renal failure after gastric balloon positioning is reported in few studies CASE REPORT: A 32-year-old white infertile woman undergone Bioenterics Intragastric Balloon (BIB) positioning in an attempt to weight loss and improve her fertility status. After only six days of persisting vomiting acute renal failure was found. A complete recovery of renal function was obtained after 14 days. CONCLUSION: Acute renal failure was due to persistent vomiting leading to dehydration. Physicians involved in BIB patients management must consider the possibility of major complications in all hyperemetic subjects. BIB removal, with a concomitant intravenous fluid replacement and minerals or vitamins supplementation has to be taken into account as an emergency procedure.

Safety and efficacy of saphenectomy in elderly patients.

AIM: The aim of this study is to evaluate safety and efficacy of saphenactomy in elderly patients. PATIENTS AND METHODS: A total of 358 patients with varicose veins of the lower limbs treated between January 2001 and December 2011. 213 of these were patients under 65 years old and 145 patients were over this age. We have evaluated short- and long-term complications to compare the results among young and elderly patients. RESULTS: Postoperative complications that occurred were: infection, haematoma, nerve injury (paresthesia and pain) and deep vein thrombosis. Although a trend towards better results was observed among the young patients, no significant differences were shown in our experience. CONCLUSION: Elective saphenectomy has a good outcome also in the elderly patients. The slightly higher rate of complications that occurred in older patients is not significant and does not support advising against the use of this surgical approach in the elderly. So in our opinion saphenectomy is quite safe and feasible also in patients over 65 years.

The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis.

We carried out a systematic review of the literature to identify the association between the use of drain and the incidence of infections and recurrences after surgery. MEDLINE, SCOPUS and ISI databases were searched up to September 2012. The two outcomes of this meta-analysis were wound infection and recurrence. Postoperative wound infection occurred in 50 of the 604 (8.28 %) patients who underwent drainage and in 68 of the 598 (11.4 %) patients who did not, with a resulting odds ratio (OR) of 0.71 (95 % CI: 0.48-1.03). Recurrence of pilonidal sinus occurred in 41 of the 604 (6.79 %) patients who underwent drainage and in 50 of the 598 (8.36 %) patients who did not, with a resulting OR of 0.80 (95 % CI: 0.52-1.23). The results suggest that, despite a trend toward a reduction in infectious complications and recurrence, drainage was not associated with a better outcome. However, because of the present literature's limitations, further studies are needed to address this issue.

[Criteria of localization of the bundle of Kent]. / Critères de localisation des faisceaux de Kent.

The high success rate (> 90%) of radiofrequency ablation of accessory pathways is related to accurate mapping. This determines the site of the accessory pathway and the best target for ablation with the object of reducing the number of applications and the associated morbidity. Analysis of the surface ECG is the first step of localisation of a Kent bundle. Different algorithms may be used based on the correlation between the polarity of the delta wave, of the QRS and the site of the accessory pathway confirmed at surgery or during radiofrequency ablation procedures. Some of the recent algorithms allow localisation of certain postero-septal or sub-epicardial pathways, the ablation of which can only be accomplished via the coronary sinus or one of its branches, or in an abnormally dilated coronary sinus, the so-called diverticulum. A relatively accurate localisation of the accessory pathway from the surface ECG reduces the duration of an ablation procedure and may economise the need for left-sided catheterisation. However, the endocavitary electrogrammes determine the precise target of ablation whether this be the ventricular or atrial pole of the bundle of Kent. The association of the criteria obtained by bipolar and unipolar recordings in sinus rhythm, during pacing or reentrant tachycardia enables accurate localisation in the majority of cases. Ablation of some pathways may be more complex because of their site or the presence of associated congenital or acquired cardiac disease which alters the anatomical or electrical markers. In these cases, the electrical criteria, especially those of the surface ECG may be erroneous and non invasive investigations such as Doppler echocardiography, isotopic ventriculography with phase analysis are most valuable with a positive predictive value of over 90%.

[Value of cibenzoline in the preventive treatment of recurrent atrial arrhythmia]. / Intérêt de la cibenzoline dans le traitement préventif des arythmies auriculaires récidivantes.

Cibenzoline is a Vaughan-Williams class I anti-arrhythmic with properties intermediate between subclasses IA and IC which limit the incidence of proarrhythmic effects. These specific properties of the drug facilitate the prescription of cibenzoline in cardiology, particularly for the prevention of recurrent atrial arrhythmia: fibrillation, flutter, atrial tachycardia. This study demonstrates that cibenzoline is effective in these indications, since only 23% of the patients had relapsed after 6 months. This efficacy, combined with the good tolerance of the treatment, makes it possible to recommend the prescription of cibenzoline as a first-line treatment for the prevention of atrial arrhythmia. It represents an effective and safe option.

Intrinsic and extrinsic sinus node dysfunction: diagnostic problems.

Based on clinical and experimental experience, pacemaker dysfunction in sick sinus syndrome can be differentiated into intrinsic and extrinsic. Sinus node activity is characterized electrophysiologically by automaticity, recovery and sinoatrial conduction. The automaticity of the sinus pacemaker cell groups and sinus recovery can be differentiated properly under experimental conditions. Studies of the electrophysiological characteristics have shown the basic functional parameters to be normal in extrinsic-autonomic sinus dysfunction. Diagnosis is either based on clinical observation or on the data of Holter monitoring, the electrophysiological methods being inadequate for diagnosing this neurovegetative form of sick sinus syndrome. On the other hand, intrinsic sinus dysfunction can be diagnosed by electrophysiological tests. If completed by complex pharmacological studies, in this organic form of sick sinus syndrome, even the severity of the intrinsic injuries can be assessed quantitatively. The above division provides a basis for selection and evaluation of the differential diagnostic procedures, while information on the aetiopathology of sinus dysfunction and on the degree of the functional injuries of the electrophysiological structure of the heart provides an adequate basis for therapy.

Sino-atrial dissociation: evidence by intracardiac recordings in man and by microelectrode studies on isolated rabbit atrium.

The electrophysiologic mechanisms of sinus dysfunction have recently been determined by direct recordings of the sinus node electrogram. The association of various degrees of abnormalities in the formation of the impulse within the sinus node and of sinoatrial conduction block, represents the pathophysiological substrate of the mechanism of sinus node dysfunction. The purpose of this work is to present clinical and experimental data supporting the concept of sinus node isolation. In our clinical case, the sinus node was probably intact despite aspects of sinus node dysfunction on the surface ECG. Sinus node electrograms were recorded with a sinoatrial conduction time of 100 ms (normal values in our laboratory: 83 ms +/- 38 ms). Atrial mapping demonstrated that the area depolarized by the sinus node involved a 2 cm2 zone surrounding it. This perisinusal activity could not be recorded on the surface ECG. Both exit and entry blocks in the sinus node were demonstrated. Our experimental data showed a total desynchronization between the electrical activity of the sinus node and that of the atrium under hypoxic conditions. Both types of cases demonstrated that an atrial dysrhythmia was coexisting with regular sinus activity. From these data we concluded that a sinus node free from any pathological involvement could be associated with severe symptoms of sinus node dysfunction on the surface ECG.

[Intra-sinus echo: demonstration using direct intracavitary recording of the sinus potential]. / Echo intrasinusal: démonstration par enregistrement direct du potentiel sinusal par voie endocavitaire.

The authors searched for intra-sinusal echos during electrophysiological investigation of 53 patients (41 men, 12 women, average age: 61 +/- 12 years). Cycles of sinus echos were recorded in 8 patients (15 per cent). The period during which sinus echos could be recorded was 125 ms (average 40.6 +/- 34 ms). Indirect assessment of sinus node function in patients with sinus echos was normal (corrected sinus node recovery time, estimated atrio-sino atrial conduction times using Narula's technique). A valid and reproducible direct recording of the sinus node potential was only possible in one patient. In this case the echo cycles were provoked by stimulation periods of between 440 and 320 ms (echo zone of 120 ms). All the echos obtained were preceded by a sinus node potential with a different duration and morphology to that observed during basal sinus cycles (respective sino-atrial conduction times 105 and 115 ms). In this patient we were also able to induce sinus echos after a single extrastimulus during the spontaneous rhythm. the echo zone was 130 ms and with a shorter coupling interval (310 ms) two successive sinus echos were recorded. The demonstration of intrasinusal echos by direct recording of the sinus node potential supports the experimental data of Allessie and Bonke on isolated right atrial tissues of the rabbit. Improvements in the technique of endocavitary direct recording of the sinus node potential in man should complete this data by showing the possibility of sinoatrial tachycardias due to reentry.

[Sinoatrial and intra-atrial conductive disorders. The value of recording the sinus node potential]. / Troubles conductifs sino-auriculaire et intra-auriculaire. Intérêt de l'enregistrement du potentiel sinusal.

Direct recording of the sinus node potential in the bipolar mode using two electrodes of a quadripolar recording catheter positioned in the region of the sinus node at the junction of the superior vena cava to the right atrium was performed in 24 patients. Asynchronous overdrive atrial pacing was carried out using Strauss 'technique. Pharmacological denervation was carried out using intravenous propranolol (0,02 mg/kg) and atropine (0,04 mg/kg) using Jose's technique. An intravenous injection of a bolus of 20 mg of ATP was given in 3 cases. The sinus potential was identified by morphological criteria and confirmed after carotid sinus compression and atrial extrastimuli to exclude artefacts, especially the end of ventricular repolarisation of the preceding complex. The sinoatrial conduction time measured directly under basal conditions was considered normal when within 80 to 150 ms. Direct measurement of the sinus potential in the diagnosis of sinus node dysfunction seems to be less useful than the indirect techniques. On the other hand, it does confirm the diagnosis of sinoatrial block: five cases of special interest are described; in four cases the degree of sinoatrial block was variable: a significant increase of sinoatrial conduction time under basal conditions in 1 case; paroxysmal 3rd degree sinoatrial block revealed by programmed atrial stimulation in 2 cases; 2nd degree 2/1 sinoatrial block after injection of ATP in which the direct sinoatrial conduction time and sinus node function had been considered to be normal (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical use of a new myocardial electrode.

Prior to clinical use, this new myocardial stimulating electrode was studied in animals in order to test its electrical and mechanical reliability. The Telectronics 030.168 electrode consists of a conductor constructed of 3 stainless steel wires. Its present surface area is 25 mm and its length is 10 mm. The device is easily inserted into the myocardium with a suture and needle and is held in place with a surgical clip. We report observations on 42 patients made over an average follow-up period of 14.6 months. There were no surgical complications and there was no operative mortality. Calculated as an average of recorded electrical measurements, the stimulating threshold was 1.03 volts and 2.40 mA at 500 ms. None of the patients have required further surgery and no malfunctions have been discovered.

Electrophysiological classification of normal and pathological sinus node function.

The sympathetic and parasympathetic neurological cardiac effects were blocked with atropine and propranolol. The intrinsic heart rate (IHR) was determined and rapid atrial pacing (RAP) was carried out before and after administration of the drugs. The primary and secondary postpacing parameters were examined in both circumstances. Normal (n = 31) and pathological (n = 20) cases were differentiated on the basis of the IHR. In the secondary phase (PPC 2-10) after autonomic blockade returned to the basic frequency was of exponential character in the great majority of normal IHR cases. Anomalies may appear in both the primary and secondary phases. They are of different types: one of them concerns the recovery time; another electrophysiological anomaly occurs when there is no return to the predrive normal cycle length after pharmacological neurotomy. In the secondary phase there may appear sinoauricular blocks. They may depend on or appear independently of the effect of the vegetative nervous system. The new test allows a physiopathological classification of normal and pathological sinus node function.

Synchronized and desynchronized sinus node activity.

In certain cases because of sinus arrhythmia and/or anarchic return and postreturn cycles caused by premature atrial stimulation, the sinoatrial conduction time cannot be calculated since a chaotic postextrasystolic pattern appears. We examined 49 patients with a history and ECG signs suggesting sinus node dysfunction by programmed extrastimulation method as proposed by Strauss et al. prior to and after pharmacologic autonomic blockade (with propranolol 0.2 mg/kg body weight and atropine sulfate 0.04 mg/kg intravenously). Patients with normal intrinsic heart rate (IHR) (n = 31) showed chaotic postextrasystolic responses in 38%, which in every case could be eliminated by autonomic blockade, resulting in a clear I and II phase with a well estimated intrinsic conduction time. Patients with pathologic IHR (n = 18) gave chaotic responses in 22% which after drug testing increased up to 72%. The chaotic postextrasystolic patterns are to be interpreted as the desynchronization of the sinus potentials, while plateau (phase II) as functional integrity, synchronized activity of the sinus node, dependent on the momentaneous balance of the autonomous tone, and on the integrity of the pacemaker cells. The desynchronized chaotic responses are considered on one hand as a dystonic neurovegetative electrophysiologic characteristic, on the other hand as a primary extrastimulation parameter of the intrinsic sinus node dysfunction.

Part of the autonomous nervous system in the development of chaotic post-extrasystolic pictures. Electrophysiological and pharmacological studies of 49 cases.

The interpretation of post-extrasystolic parameters and their significance is discussed. Programmed extrastimulation according to Strauss was carried out in 49 cases, before and after atropine and propranolol administration. The result was a computable sinoauricular conduction time (SACT), a chaotic picture, or an ascending line without plateau. The patients were selected on basis of their intrinsic heart rates (IHR). If the total SACT exceeded 250 ms, the chaotic post-extrasystolic picture and the ascending 1st phase without plateau were considered pathologic, then after drug testing the ratio of pathologic parameters decreased from 54 to 22% in cases with normal IHR. Including cases with pathologic IHR the ratio increased from 55 to 90%, especially in asynchronous chaotic pictures. After drug testing the chaotic forms were always replaced by a plateau in cases with normal IHR, but in pathologic ones the chaotic picture appeared to be a dominant electrophysiological parameter. It follows that the autonomous nervous system has its part in the development of chaotic post-extrasystolic pictures. A plateau in the post-extrasystolic curve could mean a functional organization and synchronism rather than a conduction disturbance; to the latter a high-level plateau would correspond.