Laser Extraction of a Trapped Infected Port Catheter in a Child Using Existing Experience from Pacemaker and ICD Lead Removal

A 9‐year‐old girl presented with systemic infection related to a Port‐a‐Cath system (PAC); therefore, the urgent removal of the PAC was indicated. However, the catheter was trapped and not extractable by conventional means. Using existing comprehensive experience in the removal of pacemaker and implantable cardioverter defibrillator leads, the entrapped PAC was successfully extracted by laser technique, thus avoiding open heart surgery. (PACE 2011; e9–e10)     

Experiments on the Primary Acidity of the Gastric Juice

1.The problem of the magnitude of the “primary acidity” of the parietal secretion of the stomach has been reinvestigated with a new, improved method. Its essential part consists in the utilization of the acid buffering power of glycocol combined with the employment of that substance as a “volume indicator”. With this method the acidity reducing diffusion processes are abolished and reliable volume measurements can also be carried out. 2.Experiments have been performed on cats and, in the main, on Heidenhain pouch dogs. In the latter case continuous, intravenous histamine injection has been used as a gastric acid stimulant which yields constant, controlable outputs of HC1 secretion. 3.The primary acidity (found by dividing the amount of titrable acid by the volume increment of an instilled, “isotonic” glycocol solution) has now been found to be variable and can be unexpectedly high. It ranges between 170 and about 350 mN. There is a definite relationship between the primary acidity value and the rate of secretion: The lower the secretion rate, the higher is the primary acidity. 4.The significance of the findings are discussed.     

Predictive Capability of Left Atrial Size Measured by CT,TEE, and TTE for Recurrence of Atrial Fibrillation Following Radiofrequency Catheter Ablation

Background: Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) has been well established and is in part related to left atrial (LA) size. The purpose of this study was to assess the predictive capability of LA diameter (LAD) and LA volume (LAV) by echocardiography and computed tomography (CT) to determine success in patients undergoing RFCA of AF. Methods: Eighty‐eight patients with paroxysmal or persistent AF who had undergone RFCA and had a prior transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and CT were enrolled in the study. TTE LADs and LV ejection fraction as well as TEE LADs and LAVs in three views were recorded. CT LAVs were also recorded. Clinical parameters prior to ablation as well as at 1‐year follow‐up were assessed. Results: A total of 40 (45%) patients with paroxysmal AF and 48 (55%) patients with persistent AF were analyzed. Paroxysmal AF patients had a RFCA success rate of 88% at 1 year with persistent AF patients having a 52% success rate (P < 0.001). A CT‐derived LAV ≥ 117 cc was associated with an odds ratio (OR) for recurrence of 4.8 (95% confidence interval [CI]=[1.4–16.4], P = 0.01) while a LAV ≥130 cc was associated with an OR for recurrence of 22.0 (95% CI =[2.5–191.0], P = 0.005) after adjustment for persistent AF. Conclusions: LA dimensions and AF type are highly predictive of AF recurrence following RFCA. LAV by CT has significant predictive benefit over standard LADs in severely enlarged atria even after adjustment for AF type. (PACE 2010; 532–540)