TWO STEP CURRENT INCREASES IN GLOW DISCHARGE DEVELOPMENT IN NEON FILLED DIODE AT 4 mbar

Abstract. The results are presented of investigating temporal and spatial development of electrical glow discharge in a neo

Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTAT‐CHF

No abstract available

The role of cardiac pacing therapy in the management of carotid sinus syndrome

Introduction. Carotid sinus syndrome is characterized by a hypersensitive carotid sinus and syncope. Although we have clear guidelines for the diagnosis and treatment of carotid sinus syndrome, the efficacy of pacing therapy with this indication has not been the subject of many studies. Objective. This study aimed to assess the efficacy and safety of pacing therapy in the treatment of patients with carotid sinus syndrome and to determine the factors contributing to symptoms recurrence after pacemaker implantation. Methods. This study was retrospective and included 32 patients in whom a pacemaker was implanted due to carotid sinus syndrome at the Pacemaker Center, Clinical Center of Serbia, between April 2005 and April 2012. Carotid sinus massage and head-up tilt test (HUTT) were performed to select patients with cardioinhibitory and mixed type carotid sinus syndrome, who were enrolled to the study. Results. The mean age of patients was 65.6±11.5 years and 20 (62.5%) were men. The mean follow-up period was 4.3±1.9 years. HUTT was performed in 3 (9.4%) patients. Twenty-seven (84.4%) patients presented with cardioinhibitory and 5 (15.6%) with mixed type of carotid sinus syndrome. After pacemaker implantation, 22 (68.7%) patients had no further symptoms, 8 (25.0%) had syncope and 2 (6.3%) presyncope. The mixed type of the disease (HR 3.1; 95% CI 1.4-5.1; p=0.021) and implantation of pacemaker in VVI mode (HR 1.8; 95%CI 1.1-3.2; p=0.034) were independent predictors of symptoms recurrence. There were 3 (9.4%) perioperative surgical complications. Conclusion. Pacemaker therapy is an effective and safe treatment for patients with carotid sinus syndrome. As predictors of symptoms persistence after pacemaker implantation in our population, we identified the implantation of pacemaker in VVI mode and the mixed type of carotid sinus syndrome

Sentinel node biopsy in the breast cancer: Possibility of the avoidance of axillary node dissection

(Conclusion) This researching, and many others, indicates that in certain patients (especially T1a and T1b), under precise criteria, when SN metastases are not present, axillary dissection in the breast cancer (10, 22) and all its consequences (lymphoedeama, numbness, pain, limited movement in the shoulder joint) could be avoided. We should remember that nowadays at least 50% of women undergo axillary nodes dissection within the breast cancer operative treatment because of histopathologically negative nodes

TWO STEP CURRENT INCREASES IN GLOW DISCHARGE DEVELOPMENT IN NEON FILLED DIODE AT 4 mbar UDC 537.52; 533.9

Abstract. The results are presented of investigating temporal and spatial development of electrical glow discharge in a neon filled tube under 4mbar pressure. Linear increasing voltage (at 5 V/s increasing voltage rate) is applied to the gas diode. Time dependence of 585.2 nm line light emitted from negative glow is observed from various positions in the diode during formation of electrical discharge. The results show that the development of glow discharge starts in the gap, and propagates to the cathode and in the space around and behind the cathode. An unexpected two-step current rise is found. In the stationary regime, most of the emitted light occupied the cathode carrier rod. This indicates the position where the secondary electron emission is intensive. It corresponds to the second step in the current increase app. 3 ms after the breakdown has already taken place. It is assumed that this step originates from different surface characteristics of the rode material. The analysis of time dependencies of the current and light from the negative glow, from different positions in the gas diode, suggests that the observation of deexcitation processes in gas can be used for determination of early discharge formative processes, as well as processes that lead to the stationary regime in the gas diode tube

Is pacemaker therapy the right key to patients with vasovagal syncope?

Introduction. Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial. Objective. This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation. Methods. A retrospective study included 30 patients with pacemaker implanted due to vasovagal syncope in the Pacemaker Center, Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt test was performed to diagnose vasovagal syncope. Patients with cardioinhibitory and mixed type of disease were enrolled in the study. Results. Mean age was 48.1 ± 11.1 years and 18 (60%) patients were men. Mean follow-up period was 5.9 ± 3.0 years. Primarily, implantable loop recorder was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic regression analysis we showed that syncope is statistically more likely to occur after pacemaker implantation in patients with mixed type of vasovagal syncope (p = 0.018). There were two (6.7%) perioperative surgical complications. Conclusion. Pacemaker therapy is a safe treatment for patients with vasovagal syncope, whose efficacy can be improved by strict selection of patients. We showed that symptoms occur statistically more often in patients with mixed type of disease after pacemaker implantation

Transvenous lead placement and its pre-sternal tunneling to the contralateral side as a solution for pacemaker system upgrade in case of the subclavian vein thrombosis

Introduction. Chronic right ventricular pacing can deteriorate cardiac function. Consequently, pacemaker system upgrades are more frequently indicated. These interventions can be hindered by venous thrombosis. In literature, it is rarely described that this problem is resolved by implanting a new lead for left ventricle (LV) stimulation on the opposite side of the previously implanted pacemaker and then subcutaneously transferring it to the old pocket. Case outline. A 75-year-old male patient was hospitalized due to a planned pacemaker upgrade in December 2015. A dual-chamber pacemaker had been implanted due to sinus node dysfunction in 2011. During the previous 18 months he had been complaining about symptoms of heart failure. An upgrade to the cardiac resynchronization therapy (CRT) with a new CRT-P device was indicated due to the LV dilatation with the ejection fraction decrease, clinical deterioration, and the presence of high percentage of ventricular pacing. In October 2015, the mentioned intervention was unsuccessful due to total left subclavian vein thrombosis on the side of the previously implanted pacemaker. Anticoagulation therapy was ordinated and the reevaluation was postponed. During this hospitalization, venography confirmed total left subclavian vein thrombosis despite the anticoagulation therapy. It was decided to implant a new LV lead on the right side and then subcutaneously shift it by pre-sternal tunneling to the previous left prepectoral pocket. The intervention was uneventful. The first controls have shown stable pacemaker parameters. Conclusion. This case report confirms that contralateral lead placement and subcutaneous pre-sternal tunnelling of the lead is feasible and safe in patients with an implanted pacemaker, an indication for system upgrade and ipsilateral vein obstruction

Approach to the treatment of atrial fibrillation in patients with cardiovascular risk profile: Multicentric international study

Introduction. Atrial fibrillation (AF), the most common arrhythmia that requires treatment, does not come out of the focus of researchers. Monitoring its prevalence and effects of therapy is a good guideline approach to the growing population of patients in which this arrhythmia occurs. Objective. The aim of the study was to evaluate the efficacy of treatment of AF and cardiovascular profiles in the observed population. Methods. In this observational, cross-sectional, multicenter, international study, 584 patients in 30 centers in Serbia and Slovenia, older than 18 years and with AF or in sinus rhythm with a history of AF, were included. The assessment of the efficacy of treatment of AF was performed by analyzing the frequency of adequate therapeutic effect of medication in rhythm or frequency control in patients with AF. Results. The results confirmed that the highest incidence of AF duration is more than seven days, and is accompanied by symptoms. Inadequate frequency regulation was registered at 8.9% of patients. Hypertension was registered in two-thirds of all patients, while other cardiovascular risk factors were registered in about one-third of patients. An echocardiographic finding in the group of patients with AF confirms generally adequate left ventricular function with a slightly enlarged left atrium (4.6±0.8 cm). Increasing age and time from the first episode of AF decreases the probability of maintaining sinus rhythm, while symptomatic AF had a positive impact on the presence of sinus rhythm. Propafenone, sotalol and amiodarone showed a statistically significant connection with a positive therapeutic response, while β-blockers had a negative impact on the probability of establishing and maintaining sinus rhythm. Conclusion. Characteristics of therapeutic approaches, risks, comorbidity of patient populations in Slovenia and Serbia correspond to the fullest extent with the recommendations for good clinical practice, which further stresses the need for extensive measures in these regions