Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up

Abstract Purpose A long-lasting remission of acromegaly after somatostatin analogues (SAs) withdrawal has been described in some series. Our aim was to update the disease evolution after SAs withdrawal in a cohort of acromegalic patients. Methods We retrospectively evaluated 21 acromegalic patients previously included in a multicentre study (Ronchi et al. 2008), updating data at the last follow-up. We added further 8 patients selected for SAs withdrawal between 2008–2018. Pituitary irradiation represented an exclusion criterion. The withdrawal was suggested after at least 9 months of clinical and hormonal disease control. Clinical and biochemical data prior and after SAs withdrawal were analysed. Results In the whole cohort (29 patients) mean age was 50 ± 14.9 years and 72.4% were females. In 69% pituitary surgery was previously performed. Overall, the median time of treatment before SAs withdrawal was 53 months (IQR = 24–84). At the last follow up in 2019, 23/29 patients (79.3%) had a disease relapse after a median time of 6 months (interquartile range or IQR = 3–12) from the drug suspension, while 6/29 (20.7%) were still on remission after 120 months (IQR = 66–150). IGF-1 levels were significantly lower before withdrawal in patients with persistent remission compared to relapsing ones (IGF-1 SDS: -1.5 ± 0.6 vs -0.11 ± 1, p = 0.01). We did not observe any other difference between patients with and without relapse, including SAs formulation, dosage and treatment duration. Conclusion A successful withdrawal of SAs is possible in a subset of well-controlled acromegalic patients and it challenges the concept that medical therapy is a lifelong requirement.

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Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience

Scandinavian Journal of Urology ◽

10.1080/21681805.2021.1885486 ◽

2021 ◽

Vol 55 (2) ◽

pp. 169-176 ◽

Cited By ~ 1

Author(s):

K. Andersen ◽

H. Kobberø ◽

T. B. Pedersen ◽

M. H. Poulsen

Keyword(s):

Overactive Bladder ◽

Nerve Stimulation ◽

Bladder Dysfunction ◽

Tibial Nerve ◽

Percutaneous Tibial Nerve Stimulation ◽

Single Centre ◽

Tibial Nerve Stimulation ◽

Single Centre Experience

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Surgical treatment of children with hyperparathyroidism: Single centre experience

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2014.05.032 ◽

2014 ◽

Vol 49 (11) ◽

pp. 1539-1543 ◽

Cited By ~ 8

Author(s):

S. Alagaratnam ◽

C. Brain ◽

H. Spoudeas ◽

M.T. Dattani ◽

P. Hindmarsh ◽

...

Keyword(s):

Surgical Treatment ◽

Single Centre ◽

Single Centre Experience

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Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

Cardiology in the Young ◽

10.1017/s1047951121004340 ◽

2021 ◽

pp. 1-6

Author(s):

Thomas Huang ◽

Edward O’Leary ◽

Mark E. Alexander ◽

Laura Bevilacqua ◽

Francis Fynn-Thompson ◽

...

Keyword(s):

Young Adults ◽

Atrioventricular Block ◽

Sinus Bradycardia ◽

Pacemaker Implantation ◽

Complication Rates ◽

Single Centre Experience ◽

Procedural Complications ◽

Children And Young Adults ◽

Dual Chamber Pacemakers

Abstract 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.

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Abstract 646: Epicardial Ablation Of Ventricular Tachycardia - A Single Centre Experience

Circulation ◽

10.1161/circ.118.suppl_18.s_592-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Boris Schmidt ◽

KR Julian Chun ◽

Buelent Koektuerk ◽

Feifan Ouyang ◽

Karl-Heinz Kuck

Keyword(s):

Ventricular Tachycardia ◽

Success Rate ◽

Single Centre ◽

Epicardial Ablation ◽

Single Centre Experience ◽

Radiofrequency Current ◽

Acute Success ◽

Procedural Success ◽

Lv Aneurysm

Background: Radiofrequency current ablation (RFA) of ventricular tachycardia (VT) focuses on endocardial (endo) substrates. However, if endo RFA fails, an epi approach is a potential treatment option. We report a single centre experience of epi VT ablation. Patients and Methods: Between 06/2005 and 02/2008 42 pts (14 female, mean age 49 ± 18 years) underwent electroanatomical endo and epi mapping and ablation for intractable VT, syncope or VT storm with multiple ICD discharges. Pts with normal heart (n=7), ischemic cardiomyopathy (ICM; n=8), NICM (n=11), ARVD (n=8), LV-aneurysm (n=7) or sarcoidosis (n=1) were studied. Mean LV ejection fraction was 45±12%. 20/42 had had at least 1 previous ablation attempt for VT (range 1– 4 ablations). Acute success was defined as non-inducibility of the previously inducible VT. Chronic success was defined as recurrence of any VT. Results: Acute procedural success rate was 79% (30/38). In 4 pts VTs were not inducible during EPS. In 28/42 pts endo mapping revealed no pathologic potentials. In 23/38 pts and 7/38 the succesful RFC ablation site was epi and endo, respectively. In 9/38 pts endo ablation failed and VT could only be ablated from epi. Further 7/38 pts needed both endo and epi ablation. In In 4/8 failed ablations epi RFC ablation was impossible due to failed access to target site (adhesions; n=2), close vicinity of a coronary artery (n=1) or the phrenic nerve (n=1). Procedure duration was 263±97 min. Unfortunately, 1 pt died due to perforation of RV and 1 pt had severe hepatic bleeding after epi puncture. One pt died in cardiogenic shock 1 d after the procedure. In 2 pts a sterile pericarditis occurred which resolved without any further intervention. After a median follow-up of 293 days (1–929 days) 53% of pts were alive and free from any VT. Conclusion: In pts with failed endo RFC ablation for VT due to different etiologies epi RFC ablation was acutely successful in 61% of pts with a moderate chronic success rate. However, major complications occured in approximately 5% of pts. Epi mapping should be considered if endo pathologic potentials are absent or if endo ablation failed.

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