Treatment of superior vena cava obstruction secondary to pacemaker wires with balloon venoplasty and insertion of metallic stents

AIMS

Pacemaker wires can result in stenosis of the superior vena cava and other central veins. The aim of this study is to demonstrate the safety and effectiveness of treating stenoses of the superior vena cava (SVC) and central veins with balloon venoplasty and metallic stent insertion in the presence of cardiac pacemaker wires.

METHODS AND RESULTS

Three patients were referred to the department after developing symptomatic SVC obstruction following implantation of a cardiac pacemaker several years earlier. They were examined with duplex ultrasound and venography, which revealed significant stenoses of the central veins. These patients subsequently underwent endovascular treatment which involved balloon dilation and stent insertion. The treatment was successful in all three patients, without any complications. Long-term patency of up to 4 years is recorded. No pacemaker function dysfunction was encountered.

CONCLUSION

SVC stenting is safe and effective in patients who develop the SVC obstruction after cardiac pacemaker insertion.

The differential diagnosis of toothache from other orofacial pains in clinical practice

BACKGROUND

Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis.

METHODS

A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non-dental cases. A separate prospective study of complex non-dental orofacial pain cases was performed to determine which cases had previously received dental treatment.

RESULTS

Seventy-seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Forty-four (44 per cent) of 100 non-dental orofacial pain patients had previously received either extractions or endodontics.

CONCLUSION

Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.

The relationship between the use of screen-based devices and self-reported sleep quality in adolescents aged 13-19 years in Brunei

BACKGROUND

The widespread use of digital devices among adolescents has raised concerns about the potential impact of screen time on sleep quality. This study aimed to investigate the relationship between screen time and self-reported sleep quality in adolescents.

METHODS

A cross-sectional study was conducted on adolescents (13- to 19-year-olds) using multi-stage cluster sampling with probability proportional to the size of public schools. Data were collected in November 2022 through self-administered questionnaires. The questionnaire collected sociodemographic characteristics, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and screen time on weekdays and weekends using the Screen Time Questionnaire (STQ). A scoring system was used in the PSQI and a global score of more than 5 indicates poor sleep quality. The relationship between screen time and sleep quality was analysed using simple and multiple linear regression.

RESULTS

A total of 547 adolescents participated in the study, with a mean (SD) age of 16.66 (1.54) years. The mean (SD) PSQI score was 5.98 (2.70), and 52% of participants had poor sleep quality. The sleep disturbance component had the highest mean (SD) score at 1.35 (0.5) out of a total score of 3.0. The mean (SD) screen time for a weekday was 537.6 (301.5) minutes, and a weekend day was 725.5 (339.2) minutes. The highest median screen time was spent on smartphones during the whole week. A significant linear relationship was observed between age and PSQI global score (p = 0.008), with a 0.2 increase in PSQI global score for each year increase in age (95% CI: 0.05, 0.35). Being female was also significantly associated with a high PSQI global score (p < 0.001). Additionally, a significant linear relationship was observed between screen time on a weekend and PSQI score (p = 0.032).

CONCLUSIONS

The study found that half of the adolescents had poor sleep quality, which was associated with being female, increased screen time on weekends, and older age. Future research endeavours should focus on conducting longitudinal studies to assess the temporal relationship between screen time and sleep quality.

Clinics in diagnostic imaging (109). Nocardial adrenal abscess

A 34-year-old man presented with a two-month history of intermittent fever and left loin pain. A large left suprarenal mass was detected on computed tomography and magnetic resonance imaging. Blood pressure, serum electrolytes, serum cortisol and urinary catecholamines were normal. Laparoscopic adrenalectomy was planned but the mass was found to be an isolated adrenal abscess due to Nocardiosis. He was later found to have AIDS. The clinical utility of various imaging modalities and management of adrenal cysts are reviewed.