We report our experience with a modified mini-maze procedure and pulmonary vein isolation using radiofrequency energy for treating persistent atrial fibrillation during coronary artery bypass grafting (CABG).
Ninety-five patients with persistent atrial fibrillation and coronary heart disease underwent open heart surgery combined with intraoperative irrigated radiofrequency ablation. Patients were randomized into the following three groups: CABG and irrigated radiofrequency pulmonary vein isolation (CABG+PVI, n = 31); CABG and an irrigated radiofrequency modified mini-maze procedure (CABG+MM, n = 30); and isolated CABG (CABG alone, n = 34). All patients received implantable loop recorders.
No reoperation and no hospital mortality were recorded. Mean follow-up was 14.4 ± 9.7 months. The implantable loop recorder-determined freedom from atrial fibrillation was 80% in the CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone group.
Patients with concomitant atrial fibrillation and coronary heart disease may benefit from intraoperative ablation to prevent relapse of arrhythmia.
Between June 1, 1976 and Mar. 31, 1983, the Sunnybrook Medical Centre Regional Trauma Unit in Toronto, Ont., admitted 145 patients with liver trauma; of these, 141 (97%) had sustained blunt liver trauma. Of 113 patients who underwent open peritoneal lavage, 112 had a true-positive lavage. Resuscitation was successful in 137 patients and 134 of these underwent laparotomy. Seventy-nine (59%) of the 134 patients required only minor surgical treatment; the other 55 (41%) required major surgical procedures. The overall mortality was 32% (47 of 145). Eight patients died during resuscitation but only one of them died of liver hemorrhage. Of the 39 patients who died after admission, the cause of death was head injury in 22, while 6 died of liver hemorrhage and 11 of other causes. Overall, liver hemorrhage was the cause of death in 15% of cases (7 of 47).
Center for Excellence in Atrial Fibrillation and EP Research-KU Cardiovascular Research Institute, Bloch Heart Rhythm Center, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS 66160, USA. firstname.lastname@example.org
Higher current density at the proximal end of a six-hole catheter is not irrigated and thus could lead to uneven heating and possibly coagulum and charring. This study tested a novel 12-hole irrigated catheter with six additional holes at the proximal end that provides more uniform cooling during atrial flutter (AFL) ablation.
A total of 188 patients (28 females, 66?±?11 years) were treated for typical AFL at 22 sites in the USA and Canada using Cool Path Duo at 50 W and 45 °C at an irrigation rate of 13 ml/min. The results were compared to historical data from an AFL study which used a six-hole catheter with similar design.
A total of 2,725 RF lesions were applied in 188 patients with a mean RF duration of 18.2?±?11.7 min per procedure. Procedural success was achieved in 96.3 % (181 of 188) acutely and 98.3 % (173 of 176) patients at 3 months. Steam pops occurred in 0.6 % of lesions (15 of 2,725) without coagulum or charring… Compared to the six-hole irrigated tip catheter, the Cool Path Duo catheter delivered more power (33.8?±?5.9 vs. 29.7?±?5.2 W, p?
The aim of the study was to compare the accuracy of self-administered vaginal tampon (VT) specimens for the detection of human papillomaviruses (HPVs) with that of cervicovaginal lavage specimens (CVL). Two hundred seventy-four paired VT and CVL specimens were collected prospectively from women at risk of sexually transmitted diseases. Specimens were treated and amplified with the polymerase chain reaction (PCR). Each woman served as her own control. One hundred and forty-four of 272 (52.9%) CVLs and 159 of 271 (58.7%) VTs contained HPV DNA sequences (correlation of 88%). The sensitivity and specificity of vaginal tampons reached 93.9% (138/147) and 80.5% (99/123), respectively. HPV typing results were concordant for 99 negative paired samples and 114 paired samples positive for the same type(s) (correlation of 78.9%). It is concluded that these sampling methods collect cells from different areas of the genital epithelium, highlighting the importance of further assessment of the comparative predictive value of HPV detection in each sample.
Coronavirus infection (CVI) was studied in 227 patients hospitalized in the clinic of the Research Institute of Hematology and Transfusiology in 1993-2003 with diagnosed acute and chronic leucosis, multiple myelogenic disease and aplastic anemia. Their blood sera and secretions of the nasal cavity were examined in the indirect hemagglutination (IHA) test with dried standard erythrocyte diagnostic preparations. CVI was shown to be activated in three year cycles in immunodeficient patients, which occurred, respectively, in 66.1, 56.9, 47.8 and 51.6% of cases in the above mentioned groups of patients. In 87% of cases CVI was associated with other respiratory pathogens, the following being prevailed: respiratory syncytial virus (37.9%), parainfluenza virus (32.2%) and Mycoplasma pneumoniae (36.8%). CVI was provoked by such factors as the course of the main disease and specific treatment, previous respiratory infections of other etiology with M. pneumoniae infection playing the leading role (60%). The most severe course of CVI was observed in patients with acute leucosis (in 75% of cases accompanied by lesions of lower respiratory tracts). The use of the highly sensitive IHA test made it possible to determine the potential for both serum and local antibodies production in the patients under observation.
To observe the effect of imaging techniques on the diagnostic pattern of sinusitis in primary care.
A multicentre survey.
14 health centres with varying facilities for clinical imaging.
446 adult patients with a suspicion of acute maxillary sinusitis. Ultrasound or radiography facilities existed in 337 cases while 109 could only be judged clinically. MAIN outcome measures--The use of ultrasound, radiography, laboratory tests, irrigation and control visits. The final number of patients with sinusitis in different facility groups.
When available, ultrasound was used in 82-92% and radiography in 6-32% of cases. The ultrasound finding showed mucosal thickening or was difficult to interpret in every third case; one half of these were interpreted as sinusitis and the rest were considered healthy. In total, sinusitis was diagnosed in 84-88% when ultrasound or radiography only could be used, and in 77% when both techniques were available (p
A questionnaire was sent to all Danish departments performing transurethral resection of the prostate (TUR-P) concerning the use of irrigating fluids and methods to estimate peroperative blood loss and absorption of irrigating fluid. Fifty-six of 60 departments used glycine as an irrigant. Seventeen percent of the departments measured blood loss peroperatively (HemoCue). Only two departments (3%) measured absorption of irrigating fluid quantitatively by the expired breath ethanol method. The other departments estimated blood loss and absorption of irrigant from the colour of the irrigating fluid. From studies of the literature we suggest the use of sorbitol/mannitol as irrigating fluid instead of glycine, as this may have fewer adverse effects, and we recommend quantitative measurements of blood loss and absorption of irrigating fluid to minimise the potentially dangerous consequences of TUR-P.
Comment In: Ugeskr Laeger. 1998 Oct 26;160(44):63669810247
Treatment of recurrent Clostridium difficile infection (CDI) with antibiotics leads to recurrences in up to 50% of patients. We investigated the efficacy of fecal transplantation in treatment of recurrent CDI.
We reviewed records from 70 patients with recurrent CDI who had undergone fecal transplantation. Fecal transplantation was performed at colonoscopy by infusing fresh donor feces into cecum. Before transplantation, the patients had whole-bowel lavage with polyethylene glycol solution. Clinical failure was defined as persistent or recurrent symptoms and signs, and a need for new therapy.
During the first 12 weeks after fecal transplantation, symptoms resolved in all patients who did not have strain 027 C difficile infections. Of 36 patients with 027 C difficile infection, 32 (89%) had a favorable response; all 4 nonresponders had a pre-existing serious condition, caused by a long-lasting diarrheal disease or comorbidity and subsequently died of colitis. During the first year after transplantation, 4 patients with an initial favorable response had a relapse after receiving antibiotics for unrelated causes; 2 were treated successfully with another fecal transplantation and 2 with antibiotics for CDI. Ten patients died of unrelated illnesses within 1 year after transplantation. No immediate complications of fecal transplantation were observed.
Fecal transplantation through colonoscopy seems to be an effective treatment for recurrent CDI and also for recurrent CDI caused by the virulent C difficile 027 strain.