Transcatheter Non-Acute Retrieval of the Tines-Based Leadless Ventricular Pacemaker.

OBJECTIVES: We report our single-center experience of mid-term to long-term retrieval and reimplantation of a tines-based leadless pacemaker (Micra transcatheter pacing system; TPS). BACKGROUNDS: The TPS is a clinically effective alternative to transvenous single-chamber ventricular pacemakers. Whereas it is currently recommended to abandon the TPS at the end of device life, catheter-based retrieval may be favorable in specific scenarios. METHODS: We report on nine consecutive patients with the implanted TPS who subsequently underwent transcatheter retrieval attempts. The retrieval system consists of the original TPS delivery catheter and an off-the-shelf single-loop 7 mm snare. The procedure was guided by fluoroscopy and intracardiac echocardiography. RESULTS: After an implantation duration of 3.1 ± 2.8 years (range 0.4-9.0), the overall retrieval success rate was 88.9% (8 of 9 patients). The mean procedure time was 89 ± 16 minutes, and fluoroscopy time was 18.0 ± 6.6 min. No procedure-related adverse device events occurred. In the one unsuccessful retrieval, intracardiac echocardiography revealed that the TPS was partially embedded in the ventricular tissue surrounding the leadless pacemaker body in the right ventricle. After retrieval, three patients were reimplanted with a new TPS device. All implantations were successful without complications. CONCLUSIONS: A series of transvenous late retrievals of implanted TPS devices demonstrated safety and feasibility, followed by elective replacement with a new leadless pacing device or conventional transvenous pacing system. This provides a viable end-of-life management alternative to simple abandonment of this leadless pacemaker.

Association between obesity and cancer incidence in the population of the District Sumperk, Czech Republic.

BACKGROUND: Excess body weight was shown to be associated with risk of several types of cancer. In the Czech Republic, malignant tumors are the second leading cause of death. The aim of this study was to assess the association between the most frequent types of cancer and obesity. METHODS: A case-control study was accomplished, using data from the National Cancer Registry and from a preventive oncologic checkup database. Cases were defined as persons from the studied population who developed skin, breast, colorectal, prostate, lung, cervical, endometrial, kidney, ovarian, urinary bladder, stomach, pancreatic, or gallbladder cancers from 1987 to 2002. Controls were cancer-free men and women from the population. Among the cancer patients and healthy controls, proportions of obese, overweight, and nonobese individuals were compared, and odds ratios (OR) were computed. RESULTS: After adjustment for confounders, obese men had a significantly increased risk of colorectal cancer (OR: 2.07, 95% CI: 1.56-2.76) and kidney cancer (OR: 1.92, 95% CI: 1.14-3.24). Obese women were at higher risk of endometrial cancer (OR: 3.25, 95% CI: 1.65-6.37). An inverse association was observed between obesity and lung cancer (in men: OR: 0.49, 95% CI: 0.37-0.66; in women: OR: 0.41, 95% CI: 0.21-0.80). CONCLUSION: Obesity is associated with several frequent types of tumors and represents an important preventable cause of cancer in the population of the District Sumperk, Czech Republic.

Epidemiology of esophageal cancer--an overview article.

BACKGROUND: Esophageal cancer is one of the most serious tumor diseases worldwide, owing to its rapid development and fatal prognosis in most cases. To compare epidemiologic characteristics, data published by the International Agency for Research on Cancer, Lyon, France and data from Masaryk Memorial Cancer Institute, Brno, Czech Republic were used. METHODS: We conducted a search of selected Czech and foreign literature focused on the epidemiology of esophageal cancer and its main risk factors. RESULTS AND CONCLUSION: An overview of esophageal cancer epidemiology is presented. Prevention of esophageal cancer should be based on early detection and surveillance of precancerous lesions, especially of Barrett's esophagus, and attention should also focus on modification of changeable risk factors, including tobacco smoking, alcohol abuse, and ingestion of hot and spicy food. Carefully designed epidemiologic studies, both descriptive and analytical, are required to increase understanding of the complexity of esophageal cancer etiology.

Protection against tetanus in the aged people in the Czech Republic--cross-sectional study.

The aged people belong to most vulnerable group for tetanus infection in terms of their vaccination history, frequency of injuries, which may serve as gate of entry for this infection and declared decrease of general as well as specific immunity. The examinations of the aged people for antitetanus antibodies have been done to assess the immunity against tetanus in this particular group of people in the Czech republic. Blood samples were collected from people living in hostels for senior citizens on the bases of signed informed consent. The study focused on people older than 60 years of age. TETANUS ELISA Genzyme Virotech GmbH kit was used for detection of IgG antibodies against tetanus. The level of >0.1 IU/ml was used as protective level of antibodies. Total number of 341 samples was investigated for antibodies against tetanus. Nonprotective (<0.1 IU/ml) titer of antibodies was found in 9.1% of subjects and 90.9% of people possessed protective titers of antibodies against tetanus. The interval between the last vaccination (or revaccination) against tetanus and collection of blood sample was ascertained in 257 subjects and this interval was 10 years or less in 89.9% of subjects. Geometric mean of titers was calculated for different intervals between the last vaccination and collection of blood sample. There was an increasing trend of geometric mean values found with decreasing interval from the last vaccination. But there were also good values of geometric mean of titers found in subjects vaccinated long before collection of blood (intervals up to 27 years). Due to completely different situation in the Czech Republic, where adult people were repeatedly revaccinated in military service (males), in the employment with higher risk of tetanus infection, in context with treatment of injuries and finally during mass vaccination campaigns, organized in the Czech Republic for all adult people in 1974-1976 and in 1984-1986, even the aged people can reach acceptable immunity against tetanus.

Preventive oncologic check-ups in the District Sumperk, 1975-1986: the description of a database.

From 1975 through 1986, repeated preventive oncologic check-ups were carried out in the District Sumperk. In the course of the check-ups, 49,426 persons were examined. The examinations were aimed at surveillance of initial stadium of cancers as well as at detection of other serious chronic diseases. The results of the check-ups form a large database suitable for a number of epidemiological analyses. In this article, methods of the data collection are described, individual data items are characterized and their summary is presented in tables. Utilization of the database is proposed in specified types of epidemiological studies.

The impact of obesity on cardiovascular disease mortality in the District Sumperk, Czech Republic.

OBJECTIVE: The impact of obesity on cardiovascular mortality in the District Sumperk (C2) is assessed. METHODS: A case-control design was selected to study the impact of obesity on cardiovascular mortality among the population of the District Sumperk, Czech Republic. Exposure to obesity was defined as body-mass index (BMI) higher or equal 30. Men and women with BMI lower than 30 were considered nonexposed. Odds ratios were calculated, comparing the probability of exposure among cases and controls. Cases were defined as persons from the studied population who died between 1987-2004, the cause of death being circulatory system diseases. Controls were persons from the studied population who had not died as to December 31, 2004. RESULTS: Cases were more likely to be obese than controls (OR = 1.68; 95% CI 1.56-1.80). In men OR was 1.56 (95% CI 1.40-1.74), in women OR was 1.89 (95% CI 1.72-2.06). The impact of obesity was decreasing with increasing age. CONCLUSIONS: An increased risk of cardiovascular mortality following exposure to obesity was observed. Younger age groups seem to be the important target population for preventive programmes focusing on treatment of obesity.