Quantitative Electrocardiographic Analysis in Relation to Renal Function in a Geriatric Population

Abstract Background: There is a frequent association between renal insufficiency and patients with cardiovascular disease, suggesting a common pathogenic mechanism. The electrocardiogram (ECG) is a quick and cheap tool that can detect early cardiac abnormalities. The aim of this study was to quantitatively analyze ECG alterations in relation to renal function of a population of 65 years or older. Methods: A population sample of 1,536 patients aged 65 or older (45.4% male; mean age 75.6±6.0 years) from the judicial district of Toledo, Spain, who had undergone a general medical checkup including an ECG were included. In 996 patients (64.8%) renal function (plasma creatinine and estimated glomerular filtration rate) was assessed and the relationship between ECG alterations and renal function was subsequently evaluated. Results: Only 36% of the ECGs analyzed were considered normal. Significant correlations of heart rate, QRS complex duration, and the frontal plane QRS-T angle with reduced renal function were observed. Other ECG parameters such as voltage, QRS and T wave axes, and QTc interval showed no correlation with renal function. Conclusions: In patients aged 65 years or older with impaired renal function there was a relationship of renal function with certain ECG parameters, which may constitute early markers of renal and cardiac pathology and suggest a common pathogenic mechanism

Multicenter Study of 19 Aortopulmonary Window parathyroid Tumors : The callenge of Embryologic origin

Background Ectopic abnormal parathyroid glands are relatively common in the superior mediastinum but are rarely situated in the aortopulmonary window (APW). The embryological origin of these abnormal parathyroid glands is controversial. The purpose of this investigation was to investigate the embryological origin and the surgical management of abnormal parathyroid glands situated in the APW. Methods The databases of patients operated on for primary, secondary, and tertiary hyperparathyroidism at eight European medical centers with a special interest in endocrine surgery were reviewed to identify those with APW adenomas. Demographic features, localization procedures, and perioperative and pathology findings were documented. The embryological origin was determined based on the number and position of identified parathyroid glands. Results Nineteen (0.24%) APW parathyroid tumors were identified in 7,869 patients who underwent an operation for hyperparathyroidism (HPT) and 181 patients (2.3%) with mediastinal abnormal parathyroid glands. Ten patients had primary, eight had secondary, and one had tertiary HPT. Sixteen patients had undergone previous unsuccessful cervical exploration. In three patients, an APW adenoma was suspected by preoperative localization studies and was cured at the initial operation. Sixteen patients had persistent HPTof whom 15 were reoperated, resulting in 6 failures. Evaluation of 17 patients who had bilateral neck exploration allowed us to determine the most probable origin of the APW parathyroid tumors: 12 were supernumerary, 4 appeared to originate from a superior, and 1 from an inferior gland. Conclusions Abnormal parathyroid glands situated in the APW are rare and usually identified after an unsuccessful cervical exploration. Preoperative imaging of the mediastinum and neck are essential. The origin of these ectopically situated tumors is probably, as suggested by our data, from a supernumerary fifth parathyroid gland or from abnormal migration of a superior parathyroid gland during the embryologic development