Left superior vena cava isolation in patients undergoing pulmonary vein antrum isolation: impact on atrial fibrillation recurrence.

BACKGROUND: A persistent left superior vena cava (SVC) can be an arrhythmogenic source in patients with atrial fibrillation (AF) through connections from the coronary sinus (CS) and the left atrium (LA). The left SVC can be electrically isolated. However, little clinical data about the impact of left SVC disconnection on AF outcome are available. We report on six patients with left SVC and recurrent AF. OBJECTIVES: The purpose of this study was to assess the impact of left SVC isolation on AF recurrence. METHODS: Six patients (4 men and 2 women; age 50 +/- 6.4 years) with symptomatic drug-refractory AF and persistent left SVC presented to our laboratory for treatment. Four of the patients had left SVC isolation only because there was no conduction recovery in the pulmonary veins (PVs) after several previous procedures. RESULTS: Conduction between the left SVC and the CS and LA was documented, as was spontaneous ectopies in three patients that degenerated into AF in one patient. Isolation of the left SVC was successful in all patients. Isolation was relatively easy to perform (10.25 +/- 1.6 minutes), with no complications. After follow-up of 13 +/- 7.4 months, all patients were in sinus rhythm and free from AF without antiarrhythmic drugs. CONCLUSION: This study stresses the importance of looking for unusual sources of AF in patients presenting for repeat procedures or in those in whom the PVs have been ruled out as a source triggering AF. We present clinical evidence that in patients with AF and left SVC, isolation of the PVs only may not be sufficient to suppress AF. Thus, diagnosis and isolation of the left SVC appears critical to preventing AF recurrence in patients with AF when ablation is considered.     

Dega osteotomy for the management of developmental dysplasia of the hip in children aged 2–8?years: results of 58 consecutive osteotomies after 13–25?years of follow-up

PurposeDevelopmental dysplasia of the hip (DDH) is a term used to cover a broad spectrum of anomalies ranging from mild dysplasia to high-riding dislocations. We report the management of DDH in children using the Dega osteotomy and their long-term follow-up.MethodsFifty-eight hips from 48 children younger than 8 years treated using the Dega osteotomy between January 1988 and October 2000 were included in this multcenter study. Both prospective (41 hips) and retrospective (17 hips) cases were included, and follow-up was for a minimum of 13 years. Radiographs were made preoperatively, immediately postoperatively, after 6 weeks or at removal of the spica cast if any, at 6-month intervals and/or as indicated for 3 years postoperatively and then on annual basis until the last follow-up. A single-cut computed tomographic scan was performed for all prospective patients. Special attention was paid to the predictive measures of hip arthrosis and the survival of the hip after Dega osteotomy. ResultsThe final clinical outcome was favorable in 44 hips (75.9 %). Eleven hips needed a second surgery (acetabuloplasty and/or arthroplasty) during the follow-up period.Conclusions In our pediatric patient population the Dega osteotomy proved to be an adequate measure for the management of this complex condition. The worst complication was avascular necrosis, and all of the affected hips ended with failure (pain, another surgery, or both).     

The Avon Patellofemoral Joint Replacement: Mid-Term Prospective Results from an Independent Centre

Background

Approximately 10% of patients with osteoarthritis (OA) of the knee have unicompartmental OA confined to the patellofemoral joint (PFJ). The main surgical options are total knee replacement (TKR) and PFJ replacement (PFJR). PFJR has a number of advantages over TKR, including being less invasive, preserving the unaffected parts of the knee, allowing faster recovery and better range of motion and function. We report our prospective mid-term results of the Avon PFJR for established isolated PFJ arthritis in 61 consecutive procedures.

Methods

Sixty-one Avon PFJRs were performed in 57 patients. The outcome measures were the new Oxford knee score (OKS), Hungerford and Kenna score (HKS), and Crosby Insall knee scores. Only patients with severe isolated PFJ OA were included. The diagnosis was based on a combination of clinical, radiological and, where available, arthroscopic findings.

Results

Mean follow-up was 5.09 years (range, 12 to 124 years). There were 2 revisions in the first 5 years. The median HKS score was 80 (interquartile range, 70 to 95) and the mean OKS was 31.8 (± standard deviation, 8.7) at 5 years. These were significantly better (p < 0.001) than the preoperative scores.

Conclusions

The Avon prosthesis gives good functional outcomes in the medium term and survives well. Our data support other studies in the literature and is the largest independent prospective study to date.     

A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child

Brain abscess due to Entamoeba histolytica (E. histolytica) may pose a diagnostic problem or a therapeutic challenge, as evidenced by the paucity of papers reporting complete recovery after treatment. An 11-year-old girl presented with progressive drowsiness, diminished movements of the left upper limb, and swallowing problems. Cranial MRI showed multiple, contrast-dense masses with fluid content. She was started on meropenem. Surgical drainage was performed. No bacterial or fungal growth was observed in drainage samples. Entamoeba histolytica trophozoites were detected in the tissue sample. Intravenous metronidazole was started and continued for 6 weeks, at the end of which abscesses were found and to have shrunk considerably. Intravenous therapy was switched to oral metronidazole, which was continued for 2 weeks. She regained all her preexisting abilities. Multiple brain abscesses due to E. histolytica is a very rare occurrence, and histopathologic evaluation is important in diagnosis.Brain abscess, a rare form of Entamoeba histolytica (E. histolytica) infection, is characterized by an abrupt onset of symptoms and rapid progression and early death if untreated. Although many erroneously consider it as a disease of economically-developing countries, brain abscess due to E. histolytica may pose a diagnostic problem or a therapeutic challenge as evidenced by the paucity of papers reporting complete recovery after treatment. Extra-abdominal amebiasis, including cerebral amebic abscess, develops as a complication of hepatic amebiasis, rather than direct dissemination from the intestine. Cerebral amebic abscess disease has an incubation period starting from a few days to several months. As cerebral bacterial infections have a medical profile similar to that of protozoans (including partial muscular weakness, lethargy, and headache) differential diagnosis is difficult. The aim of the current study is to present a case of a brain abscess not associated with hepatic amebiasis.1-3 Multiple brain abscesses due to E. histolytica is a rarely seen occurrence. Serological and histopathological evaluations may prove to be very important in the diagnosis.     

Radiographic assessment of impacted teeth and associated pathosis prevalence: Pattern of occurrence at different ages in Saudi male in Western Saudi Arabia

Objectives:

To assess the prevalence of both impaction and associated pathosis in a Saudi population in Al-Madinah, Saudi Arabia based on digital panoramic radiographs.

Methods:

This study was carried out from December 2013 to February 2015. Panoramic radiographs of 359 male patients attending the Oral Diagnosis Clinics, Faculty of Dentistry, Taibah University, Al-Madinah, Saudi Arabia were reviewed. All images were evaluated to determine the prevalence and pattern of impacted third molars and canines, and associated pathosis.

Results:

Among 359 panoramic radiographs examined, 124 patients had impacted teeth. The impacted mandibular third molars were the most prevalent impacted teeth, 77.6% had class II pattern of impaction. Among the impacted maxillary canines, 75% were mesioangular and among 66 impacted maxillary third molars, 63.6% had class C. Our study showed that 5.8% of Saudi patients had 3 or more impacted teeth, 13.1% had 2 impacted teeth, and 15.6% had one impacted tooth. Associated pathosis was found in 18.2% among impacted maxillary third molars, and 31.5% among impacted mandibular third molars. The incidence of impaction decreases with age.

Conclusion:

The prevalence and pattern of impacted third molars among Saudis are almost similar to other racial populations. The number of missing wisdom increases with age. Although the percentage of pathosis associated with impaction was considerably low, it is essential to carry you regular oral examinations to preserve asymptomatic impacted teeth in good health.As eruption is a complex process, therefore tooth retardation or failure of eruption may arise, so failure of permanent teeth eruption and subsequent impaction is a common dental anomaly.1 Previous literature reported that teeth impaction is a usual incident and many factors affect its prevalence including aging and eruption time.2 Genetic and environmental factors play a role in developmental disturbances. The incidence of impacted teeth is contradictory in different populations and ethnic groups.3 Complications associated with impaction may range from simple problems to serious life threatening problems. Hyperplastic follicular space, subsequent dentigerous cyst or odontogenic keratocyst are the most common simple problems with impaction.4,5 Serious complications involve malignant transformation of cystic wall into squamous cell carcinoma or mucoepidermoid carcinoma. Consequently, life threatening conditions maybe a chain of simple problem such as impaction, which if solved from the beginning would cost less, and would be simple to solve.6 Panoramic radiography is a simple tomographic technique that introduces the panoramic view of the maxillofacial region.7 Radiographic examinations are either digital imaging or conventional. Digital imaging has many advantages versus conventional, such as reduction of radiation exposure, feasibility of image manipulation and analysis, which improves sensitivity and diminishes errors.8 The United States guidelines state that the panoramic radiograph is one of the screening images for Adolescent with Permanent Dentition and Adult, Dentate or Partially Edentulous.9 During our daily oral examinations, we notice poor patient awareness of oral health and its implications in Saudi Arabia. Additionally, there is no present data on the prevalence of impacted teeth, and associated pathologies in the Saudi population in Al-Madinah, Saudi Arabia. The aim of the present study was to determine the prevalence and pattern of occurrence of impacted teeth at different ages based on digital panoramic radiograph. In addition, to report the radiographic features of associated pathologies in a Saudi male population, in order to correlate between impaction and associated pathosis     

A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients

In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy—based on creatinine level, proteinuria and disease activity—was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.