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Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution
- Part of
- Thomas Huang, Edward O’Leary, Mark E. Alexander, Laura Bevilacqua, Francis Fynn-Thompson, Elizabeth S. DeWitt, Vassilios J. Bezzerides, Douglas Y. Mah
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 9 / September 2022
- Published online by Cambridge University Press:
- 28 October 2021, pp. 1440-1445
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- Article
- Export citation
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Introduction:
Reflex-mediated syncope occurs in 15% of children and young adults. In rare instances, pacemakers are required to treat syncopal episodes associated with transient sinus pauses or atrioventricular block. This study describes a single centre experience in the use of permanent pacemakers to treat syncope in children and young adults.
Materials and methods:Patients with significant pre-syncope or syncope and pacemaker implantation from 1978 to 2018 were reviewed. Data collected included the age of presentation, method of diagnosis, underlying rhythm disturbance, age at implant, type of pacemaker implanted, procedural complications and subsequent symptoms.
Results:Fifty patients were identified. Median age at time of the first syncopal episode was 10.2 (range 0.3–20.4) years, with a median implant age of 14.9 (0.9–34.3) years. Significant sinus bradycardia/pauses were the predominant reason for pacemaker implant (54%), followed by high-grade atrioventricular block (30%). Four (8%) patients had both sinus pauses and atrioventricular block documented. The majority of patients had dual-chamber pacemakers implanted (58%), followed by ventricular pacemakers (38%). Median follow-up was 6.7 (0.4–33.0) years. Post-implant, 4 (8%) patients continued to have syncope, 7 (14%) had complete resolution of their symptoms, and the remaining reported a decrease in their pre-syncopal episodes and no further syncope. Twelve (24%) patients had complications, including two infections and eight lead malfunctions.
Conclusions:Paediatric patients with reflex-mediated syncope can be treated with pacing. Complication rates are high (24%); as such, permanent pacemakers should be reserved only for those in whom asystole from sinus pauses or atrioventricular block has been well documented.
12 - Keratitis
- from Part III - Clinical syndromes: eye
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- By Elmer Y. Tu, University of Illinois Eye and Ear Infirmary, Francis S. Mah, Scripps Health, Jules Baum, Harvard Medical School
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 88-96
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- Chapter
- Export citation
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Summary
Keratitis is an ocular emergency that can lead to severe visual disability and requires prompt diagnosis and treatment. Sequelae can vary in severity from little or no visual loss to corneal scarring, perforation, endophthalmitis, and loss of the eye. Although the corneal surface is awash with microorganisms of the normal flora, an intact corneal epithelium and ocular defense mechanism serve to prevent infection in the normal eye. Although some organisms such as Neisseria gonorrhoeae, Neisseria meningitidis, Corynebacterium diptheriae, Listeria, and Shigella can penetrate an intact epithelium, all others require damage to the epithelial layer to invade the cornea. Several risk factors predispose the cornea to infection. Dry eyes from Sjogren syndrome, Stevens–Johnson syndrome, or vitamin A deficiency can result in bacterial keratitis. Prolonged corneal exposure from ectropion, lagophthalmos, or proptosis can lead to secondary infection. Entropion and trichiasis resulting in epithelial defects put the cornea at risk. Neurotropic keratopathy from cranial neuropathy, prior herpes simplex, or zoster infections predispose to secondary infections. Some systemic conditions such as chronic alcoholism, severe malnutrition, immunosuppressive drug use, immunodeficiency syndromes, and malignancy can impair immune defenses and allow infection by unusual organisms. Prior ocular surgery such as penetrating keratoplasty or refractive procedures is also a risk factor. Trauma is a common predisposing factor of bacterial keratitis, especially for patients at the extremes of age and in developing countries. Injury to the corneal surface and stroma allows invasion of normal flora as well as organisms harbored by foreign bodies.
Contact lens wear is the most common established risk factor for bacterial keratitis in developed countries. All types of contact lenses have been linked to infection, with extended-wear soft lenses conferring greater risk than daily wear hard or soft lenses. Corneal changes from contact lens use include an induced hypoxic and hypercapnic state promoting epithelial cell derangement and allowing bacterial invasion. Contact lenses also induce dry eye and corneal hypesthesia. Overnight rigid gas-permeable lens use for orthokeratology has also been associated with bacterial keratitis, but with a disproportionately high incidence of Acanthamoeba keratitis.
12 - Keratitis
- from Part III - Clinical Syndromes – Eye
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- By Francis S. Mah, University of Geneva, Jules Baum, Tufts University School of Medicine
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 87-96
-
- Chapter
- Export citation
-
Summary
Keratitis can lead to severe visual disability and requires prompt diagnosis and treatment. Sequelae can vary in severity from corneal scarring to perforation, endophthalmitis, and loss of the eye. Although the corneal surface is awash with microorganisms of the normal flora, an intact corneal epithelium and ocular defense mechanism serve to prevent infection in the normal eye. Although some organisms such as Neisseria gonorrhoeae, Neisseria meningitides, Corynebacterium diptheriae, Listeria, and Shigella can penetrate an intact epithelium, all others require damage to the epithelial layer to invade the cornea. Several risk factors predispose the cornea to infection. Dry eyes from Sjogren syndrome, Stevens-Johnson syndrome, or vitamin A deficiency can result in bacterial keratitis. Prolonged corneal exposure from ectropion, lagophthalmos or proptosis can lead to secondary infection. Entropion and trichiaisis resulting in epithelial defects put the cornea at risk. Neurotrophic keratopathy from cranial neuropathy, prior herpes simplex, or zoster infections predispose to secondary infections. Some systemic conditions such as chronic alcoholism, severe malnutrition, immunosuppressive drug use, immunodeficiency syndromes, and malignancy can impair immune defenses and allow infection by unusual organisms. Prior ocular surgery such as penetrating keratoplasty or refractive procedures are also risk factors. Trauma is a common predisposing factor of bacterial keratitis, especially for patients at the extremes of age and in developing countries. Injury to the corneal surface and stroma allows invasion of normal flora as well as organisms harbored by foreign bodies.