Left atrial catheter ablation (LACA) is an established therapeutic approach to abolish symptomatic atrial fibrillation (AF).
Based on the prospective MACPAF study (clinicaltrials.gov NCT01061931) we report the rate of ischemic brain lesions postablation and their impact on cognitive function.
Patients with symptomatic paroxysmal AF were randomized to LACA using the Arctic Front® or the HD Mesh Ablator® catheter. All patients underwent brain MRI at 3 Tesla, neurological, and neuropsychological examinations within 48 hours prior and after the ablation procedure.
There was no clinically evident stroke in 37 patients (mean age 62.4 ± 8.4 years; 41% female; median CHADS2 score 1 [IQR 0-2]) after LACA but high-resolution diffusion-weighted imaging (DWI) detected new ischemic lesions in 15 (41%) patients after LACA. Four (27%) of the HD Mesh Ablator® patients and 11 (50%) of the Arctic Front® patients suffered a silent ischemic lesion (P = 0.19). In these 15 patients, there was a nonsignificant trend toward lower cardiac ejection fraction (P = 0.07) and AF episodes during LACA (P = 0.09), while activated clotting time levels, number of energy applications, periprocedural electrocardioversion or CHADS(2) score had no impact. Lesion volumes varied from 5 to 150 mm(3) and 1 to 5 lesions were detected per patient. However, acute brain lesions had no effect on cognitive performance immediately after LACA. Of the DWI lesions postablation 82% were not detectable on FLAIR images 6-9 months postablation.
According to 3 Tesla high-resolution DWI, ischemic brain lesions after LACA were common but not associated with impaired cognitive function after the ablation procedure.
The results of a retrospective survey of 48 patients submitted to neurosurgery for medically intractable epilepsy are presented. Twenty-eight patients were treated with selective amygdalohippocampectomy, one with temporal lobe resection, 12 with anterior callosotomy and seven with a total callosotomy. Of the amygdalohippocampectomized patients and the one with temporal lobe resection (n = 29), 52% were seizure free, 17% experienced rare seizures, 7% had a worthwhile improvement while 24% observed no worthwhile improvement (follow-up time 6 to 36 months). Of the callosotomized patients, 11% were free from generalized seizures, 69% had a significant seizure reduction and 18% experienced no worthwhile improvement. The observed neurological complications were: one patient had hemianopia, one had superior quadrant anopia, four developed unilateral anosmia and one complete anosmia. The callosotomized patients, with two exceptions, were all mentally and physically handicapped. In the callosotomy group, two patients died, one from a intracerebral hematoma three months after the operation and another patient seven months postoperatively from unknown causes.
Abdominoperineal resection for distal rectal cancer is associated with a higher recurrence rate and a poorer overall prognosis than anterior resection. In order to improve the outcome, a more extensive procedure - extralevator abdominoperineal resection - has been introduced. There are, however, currently no prospective or registry-based studies on the effect of this new procedure on local recurrence rates.
Abdominoperineal extralevator resection (APER) is a registry-based Swedish study investigating local recurrence rate three years postoperatively in the entire population of Swedish patients who underwent abdominoperineal resection or extralevator abdominoperineal resection in the 2007-2009-period. In addition to local recurrence rates, the study also investigates the functional and quality-of-life-related outcome 3-4 years postoperatively in the entire study population.
Distal rectal cancer is a surgical and oncological challenge. The APER study will be able to compare the two operative techniques (standard abdominoperineal resection or extralevator abdominoperineal resection) in terms of oncological and functional outcome.
The trial is registered at ClinicalTrials.gov, identifier NCT01296984.
To assess the development of adjacent level degeneration (ALD) and index level facet arthropathy (FA) in patients treated with disc prosthesis compared with patients treated with rehabilitation.
There is controversy about the natural history of disc degeneration and the development of ALD and FA in patients who undergo disc prosthesis surgery.
The study included 116 patients with a history of low back pain for at least 1 year, Oswestry Disability Index 30 points or more, and degenerative changes in 1 or 2 lower lumbar spine levels. Magnetic resonance imaging was performed before treatment and at the 2-year follow-up. ALD and index level FA were determined on the basis of the majority assessment of 3, independent, experienced radiologists. ALD was assessed by evaluating Modic changes, posterior high intensity zone in the disc, nucleus pulposus signal, disc height, disc contour, and FA. Data were analyzed with Fischer exact test and t test.
ALD developed with similar frequencies in patients who were (n = 59) and were not (n = 57) treated with surgery. In patients treated with surgery, index level FA appeared or increased in 20 patients (34%) and decreased in 1 patient. In patients treated with rehabilitation, 2 (4%) had new or increased FA at the index/degenerated disc level and 1 had decreased FA (P
Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring almost exclusively in adolescent and young adult males. The tumor is characterized by slow progression, aggressive growth, high vascularization, and increased rate of persistence and recurrence. The aim of this study was to describe a case of giant JNA from our practice and discuss the controversies of surgical treatment of advanced JNA.
A series of 29 consecutive male patients with JNA Fisch grade III and IV was surgically treated in Burdenko Neurosurgical Institute from 2000 until 2008. In the vast majority of cases, endovascular embolization and surgical removal via orbitozygomatic approach were applied.
Gross total resection was achieved in 24 cases (83%). Complications were encountered in eight cases. No mortality was observed. In three patients, the diseases recurred. An illustrative case is described.
Surgical treatment is the basic tactics in management of extensive JNA including endovascular embolization and resection of the tumor. We recommend using orbitozygomatic approach or its modifications in JNA. Radiation therapy may be recommended for patients with small residual tumor.
Experience of performance of pancreatic resection during two years in the clinic was summarized. In 90.4% of patients there was revealed malignant tumor, as a rule, in III-IV stage, complicated by jaundice, gastrointestinal bleeding and ileus. Postoperative complications rate was 28.8%, mortality--9.6%, after proximal pancreatic resection--11.4%. Pancreatic resection, including en bloc procedure, may be performed in the patients relatively securely, with not high complications rate and mortality.
The case records and autopsy protocols of 34 patients, who died from benign diseases of the hepato-pancreato-biliary organs have been analysed. It is concluded that of main importance in the ++thanatogenesis are the following factors: shortcomings in the system of prophylactic medical examination, diagnostic and tactical errors made at prehospital stage of treatment and in a hospital, high incidence of concomitant diseases, late admission to a hospital, elderly and senile age of the majority of patients. A question about importance of the main and competitive causes of death is discussed.
According to the data provided by the Moscow ENT hospitals, the number of resurgery on the middle ear in children rose 3-fold. This is due to frequent failure of antrodrain surgery, higher prevalence of mycotic infection and recurrent inflammation in the middle ear. When planning otic surgery in children it is necessary to take into consideration both the involvement of the middle ear and medical personnel ability to provide proper postoperative care. Resurgery is justified in complicated disease course after primary intervention.
Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient-reported outcomes among ICD patients: (1) compared to a matched healthy population, (2) compared by ICD indication, (3) factors predicting patient-reported outcomes, and (4) if patient-reported outcomes predicted mortality.
The study was a mailed survey to an unselected group of patients 18+ years old receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory.
The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty-three percent of patients had primary prevention indication ICD. Compared to an age- and gender-matched population without disease, the ICD population had worse mental health (55.0 vs 51.7 points) and physical health (52.6 vs 41.9 points). Patients with primary prevention indication had lower levels of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4.17 (1.49; 11.66).
Patients with primary prevention ICD had lower levels of perceived health, quality of life, and more fatigue. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality.