What physicians do in case of a failure of the pace-sense part of a defibrillation lead : Survey in Germany, Austria and Switzerland.

BACKGROUND: The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. METHODS: We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. RESULTS: The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. CONCLUSION: Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.

Treatment of 54 traumatic carotid-cavernous fistulas.

A series of 54 traumatic carotid-cavernous fistulas has been treated with detachable balloon catheters. The balloon was introduced through one of three different approaches: the endarterial route; the venous route through the jugular vein, the inferior petrosal sinus, and the cavernous sinus; or surgical exposure of the cavernous sinus; with occlusion of the fistula by a detachable balloon directly positioned in the cavernous sinus. Full follow-up review demonstrated that the carotid blood flow was preserved in 59% of cases. The most frequent complication was a transient oculomotor nerve palsy, which occurred in 20% of cases. In three cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was later found not to be completely occluded, and these patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in two cases and permanent in the other. The results show that the fistula was totally occluded in 53 cases; in the one exception the patient became asymptomatic but had a minimal angiographic leak.

Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions.

Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 postraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.

[Technic for an inflatable and releasable balloon in neurology. Experimental study. Application in man]. / Technique du balloon gonflable et largable en neurologie. Etude expérimentale. Application chez l'homme

We consider our method with an inflatable and releasable balloon to be trustworthy and now applicable to the treatment of carotido-cavernous fistulas; it may not be possible in all cases to pass the ballon on through the fistula and inflate it in the cavernous sinus, but it seems to us so very important to preserve the carotid flow that we think that this should be achieved whenever possible. Certain arterial aneurysms could profit from this technique. We have purposely omitted all diagnostic application of the method which serbinenko has described in his article: selective opacifcation of certain branches of the internal carotid, deliberate temporary occlusion of certain branches to enable the amount of tolerance to be assessed. All these exploratory methods which we are beginning to carry out will form the subject of a later paper.

[Bilateral traumatic carotid-cavernous fistula treated using an inflatable and detachable balloon]. / Fistule carotido-caverneuse traumatique bilatérale traitée par ballonnet gonflable et largable.

The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.

[Rupture of an intracerebral dermoid cyst. Apropos of a case: x-ray computed tomographic aspects]. / Rupture d'un kyste dermoïde intra-cérébral. A propos d'une observation: aspect tomodensitométrique.

We report the C.T. findings of a dermoid cyst communicating with ventricular system and ruptured in the subarachnoid space. A fat-fluid level and calcifications were present on the plain skull X rays.

[Methylprednisolone versus prednisolone methylsulfobenzoate in pemphigoid: a comparative multicenter study]. / Méthylprednisolone versus méthylsulfobenzoate de prednisolone dans la pemphigoïde: étude comparative multicentrique.

Bullous pemphigoid is a bullous skin disease associated with basal membrane antibodies. At present, the first treatment of these lesions is with corticosteroids. In this randomized study we compared the clinical results obtained with methylprednisolone (MePr) in 28 patients and with prednisolone methylsulfobenzoate (MsPr) in 29 patients. Both drugs were administered orally in daily doses of 1 to 1.5 mg/kg bodyweight. Three clinical data were examined: the number of bullous lesions, the intensity of pruritus and the extent of erythema after 5 then 10 days of treatment. After 10 days, the number of bullous lesions had decreased by 83 p. 100 with MePr and by 78 p. 100 with MsPr, and the decrease of pruritus had been significantly more pronounced in the MePr group than in the Ms group (p < 0.05). There had been no difference between treatments in the regression of erythema. Altogether, good results were obtained in 22/28 patients under MsPr (78.6 p. 100) and 18/29 patients under MePr (62.1 p. 100). This raises the question of the value of pharmacokinetic studies not only with these two corticosteroids, but also with prednisone which seems to be better absorbed.

The intravascular treatment of a cavernous fistula caused by rupture of a traumatic carotid trigeminal aneurysm.

The authors report the particular treatment of a traumatic cavernous fistula caused by the rupture of an exceptional lesion: a false aneurysm of the C5 segment of the right carotid artery situated at the origin of a persistent trigeminal artery.

Fibromuscular dysplasia of cervico-cephalic arteries with multiple dissections and a carotid-cavernous fistula. A pathological study.

A rare case of widespread fibromuscular dysplasia (F.M.D.) is reported, involving the cervico-cephalic arteries associated with multiple dissections, saccular aneurysms and a carotid-cavernous fistula. A detailed post-mortem examination revealed FMD involvement of the intracranial vessels, not demonstrated by arteriography.

Inflatable and released balloon technique experimentation in dog -- application in man.

Experimental carotid jugular fistulas have been created in dogs and at a later time obstructed with an inflatable and released balloon. Experimental carotid aneurysms in dogs have also been obstructed with the same procedure. This new technique allows the inflation and release of a balloon in an arteriovenous fistula or in an aneurysm. The present case concerns a human vertebral fistula treated by this technique.

[Treatment of arteriovenous fistulas and of aneurysms using an inflatable and releasable balloon. Experimental principles. Application to man]. / Traitement de fistules artério-veineuses et d'anévrysmes par ballon gonflable et largable. Bases expérimentales. Application à l'homme

The authors have perfected a technique making possible the percutaneous introduction of a balloon filled with hydrosoluble iodine and releasable, either in an arteriovenous fistula or in an aneurysm. Experimental jugulo-carotid fistulae and experimental aneurysms in the dog were treated in this way. The technique has been used in two human patients - one with a traumatic caverno-carotid fistula and the other with a complicated vertebral fistula.