No abstract

Pacing and implantable cardioverter-defibrillator leads can safely, effectively, and predictably be extracted. Open-heart extractions can be limited to special cases. The results indicate that the traditional policy of abandoning redundant leads, instead of removing them, may be obsolete in many patients.

Haloperidol, olanzapine and risperidone are superior to aripiprazole, quetiapine and ziprasidone for the acute treatment of psychosis in hospitalised patients with schizophrenia, schizoaffective disorder or schizophreniform disorder.

SUMMARY A right ventricular endomyocardial biopsy specimen from a 30-year-old male with chronic progressive external ophthalmoplegia, retinal pigmentation and complete atrioventricular block (KearnsSayre syndrome) was examined in the electron microscope. There was a proliferation of mitochondria between the myofibrils and beneath the sarcolemma. Many of the mitochondria showed morphologic abnormalities not previously described in this condition. There were associated accumulations of glycogen. A CPEO, but the pathophysiologic relationships between syndromes including CPEO are obscure. Although some clinical descriptions suggest cardiac involvement in CPEO, the first confirmed report is that of Sandifer,4 whose patient had histologically proved ocular myopathy, an apical systolic murmur and an ECG that showed an irregular bradycardia as low as 20 beats/min, absence of P waves and QRS prolongation. In 1958 Kearns and Sayre5 described two cases of the syndrome that bears their name, which is characterized by CPEO, atypical retinitis pigmentosa and atrioventricular (AV) block. Kearns6 later reviewed the condition and described nine cases, including pathologic examination of the heart at autopsy in one patient. These and subsequent case reports show that cardiac conduction defects may precede the development of potentially fatal complete AV block in young patients. The pathologic nature of the cardiac condition is unclear and the few reports of examination by gross inspection or light microscopy show no specific abnormality. However, electron microscopy of a myocardial biopsy specimen in a

Coronary embolism is an uncommon but distinct clinical entity. It can be diagnosed clinically, and should be suspected when acute myocardial infarction occurs in association with an underlying condition which predisposes to embolism. The most common are valvular heart disease, a prosthetic heart valve, infective endocarditis, cardiomyopathy with mural thrombus and arrhythmia. The diagnosis may be obscured by atypical symptoms and transient ECG changes. The diagnosis is supported by the demonstration of normal coronary arteries by selective coronary arteriography. Treatment with long-term anticoagulants may prevent further emboli. Additional antiplatelet drugs are also necessary in patients with prosthetic heart valves.