Direct Angiography of the Coronary Sinus: Impact on Left Posteroseptal Accessory Pathway Ablation

The purpose of this study was to determine the incidence and types of venous branches and anomalies in posteroseptal accessory pathways (APs) and whether these findings are indicative for successful ablation sites. Some posteroseptal APs may be located epicardially, or may be associated with venous anomalies or related to the middle cardiac vein. These APs account for many of the failures encountered during endocardial ablation. Direct coronary sinus (CS) angiography was performed in 43 consecutive patients with left posteroseptal APs (n - 23) and in 20 patients with A V nodal reentrant tachycardia prior to catheter ablation. In 14 (61%) of 23 APs, a venous branch or an anomaly of the CS was found in the posteroseptal region (6 with middle cardiac vein, 2 with other ventricular venous branches, and 6 had a diverticulum). Eleven (48%) of 23 APs were successfully abolished from within that demonstrated venous system, with a median of four radio frequency impulses. In the remaining 12 (52%) patients, ablation was attempted from the endocardial site of the mitral annulus. Repeat angiography after energy delivery revealed no major complications in any patient. One (5%) patient with AV nodal reentrant tachycardia had evidence of a CS anomaly (P < 0.01). Various types of venous branches and anomalies are associated with the majority of patients with left posteroseptal APs. The APs are directly related to these complex findings, and AP conduction can easily be eliminated from within the venous branches. CS angiography is suggested prior to catheter ablation of left posteroseptal APs to facilitate the ablation procedure.     

Effects of Air Abrasion and Acid Etching on the Microleakage of Preventive Class I Resin Restorations: An In Vitro Study

Abstract: Purpose: To evaluate the effects of air abrasion, acid etching, and the combination of both procedures on the microleakage of preventive Class I resin restorations.
Materials and Methods: Eighty-four extracted human molar teeth were randomly assigned to seven groups with 12 teeth each. Occlusal fissures were opened with a diamond bur and etched with phosphoric acid (groups I and VI); prepared with a diamond bur without etching (group VII); air abraded with the KCP 1000, using SO-pm aluminum oxide particles without etching (group 11), and with phosphoric acid etching (group 111); or air abraded with 27-pm aluminum oxide particles without etching (group IV), and with phosphoric acid etching (group V). Preparations were filled with a low-viscosity resin composite (Liquicoat, groups I to V) or with a low-viscosity poly acid-modified resin composite (PrimaFlow, groups VI and VII). Six teeth in each group were thermo-cycled (5°-55°C, 2500 cycles). Dye penetration (methylene blue) was evaluated in ordinal scale.
Results: The number of non-thermocycled and thermocycled specimens revealing no microleakage was as follows: group I, 6 and 1; group II, 2 and 2; group III, 4 and 3; group IVY 0 and 0; group V, 1 and 0; group VI, 3 and 2; and group VII, 0 and 0, respectively. No significant differences existed between the thermocycled specimens and non-thermocycled specimens, except within group I.     

Loss of Late Potentials After Radiofrequency Catheter Ablation of Recurrent Ventricular Tachycardia in a Patient with Right Bundle Branch Block

The case of a patient with a history of myocardial infarction and recurrent ventricular tachycardia undergoing attempted radiofrequency catheter ahlation with loss of late potentials is described. Prior to energy delivery fractionated, late activation could be found using the signal-averaged ECC despite the presence of a right bundle branch block. After successful catheter ablation, the clinical ventricular tachycardia was no longer inducible and the signal-averaged ECG, recorded the next day, showed marked changes indicating loss of late potentials. Our report emphasizes the possibility of late potential recordings despite the presence of bundle branch block.     

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)     

First‐In‐Man Experience With a New 7F Vascular Closure Device (EXOSEAL™): The 7F ECLIPSE Study

Objective: This feasibility study examined safety and effectiveness of the new EXOSEAL? Vascular Closure Device (VCD) designed to promote hemostasis and early ambulation after percutaneous procedures. Background: Most VCDs currently approved by the United States FDA have been associated with significantly shorter time‐to‐hemostasis (TTH) and time‐to‐ambulation (TTA) compared to standard manual or mechanical compression, but their ease of use, patient comfort during deployment, and safety profiles are variable. Methods: Patients underwent diagnostic or interventional procedures using 7F introducer sheaths. Primary safety endpoint was the 30‐day combined rate of access‐related complications and primary effectiveness endpoints were TTH and TTA. Results: Sixty patients were enrolled prospectively (mean age 63.3 ± 11.3 year, 17% diabetics). Device and procedural success was achieved in 92% and 93%, respectively. Mean TTH and TTA was 3.2 ± 3.0 minutes and 3.0 ± 6.2 hours, respectively. No deaths or serious access‐related adverse events occurred. A ≥6 cm access‐site hematoma was the only adverse event, observed in 3 patients. Conclusions: Use of the 7F EXOSEAL? VCD was associated with short TTH and TTA, as well as low rates of procedural and 30‐day access‐related complications. (J Interven Cardiol 2012;25:518–525)     

Our experience with 23 consecutive patients on gemcitabine/carboplatin chemotherapy for treatment of metastasized transitional cell carcinoma of the urothelium

AIM: To evaluate the activity and toxicity of gemcitabine plus carboplatin in patients with metastatic transitional cell carcinoma (TCC) of the urothelium. METHODS: Twenty-three consecutive patients (from February 1999 to January 2002) with metastatic TCC and no prior chemotherapy were referred to our institution. Each patient was treated with gemcitabine (1000 mg/m2) on Days 1 and 8 and carboplatin (area under curve, 4.5) on Day 1. Cycles were repeated every 21 days until tumor progression or severe toxicity was seen, or for a maximum of six cycles. Median age of the patients was 68 years (range 47-82). The median Eastern Cooperative Oncology Group (ECOG) performance score was one and the median creatinine clearance rate was 56 mL/min (range 31-94). RESULTS: The overall response rate was 60.8%, with five of the 23 patients achieving a complete response, and nine showing a partial response. Median time to tumor progression (TTP) was 7.8 months, with a median survival of 15.4 months and a 1-year survival probability of 56%. Most of the complications from toxicity were hematological. CONCLUSIONS: Gemcitabine plus carboplatin is active in the treatment of metastatic urothelial cancer in those patients new to chemotherapy and has an acceptable safety profile. The potential clinical benefit of this novel combination in the treatment of transitional cell carcinoma warrants further testing in Phase III studies.     

Stereological estimation of the volume weighted mean volumes of alveoli and acinar pathways in the rat lung to characterise alterations after ischaemia/reperfusion

The aim of this study was to characterise pulmonary reimplantation injury in isolated, perfused rat lungs following 2 h of cold ischaemia, and 50 min. of in vitro reperfusion. The effects of 2 differently composed lung preservation solutions (low potassium Euro-Collins and Celsior; each n=5) were examined in comparison with untreated, nonischaemic control lungs (n=3). After fixation by vascular perfusion and tissue collection by systematic random sampling, the volume weighted mean volume (_v) of alveoli and acinar pathways was estimated by light microscopic stereology using the method of point sampled intercepts in plastic embedded, Azan-stained material. Significantly higher _v of alveoli and acinar paths was found in the Celsior group than in Euro-Collins preserved lungs. However, in the controls the size of acinar pathways was similar to Celsior preserved lungs whereas alveolar size was comparable to preservation with Euro-Collins. The between-animal coefficient of variation of alveoli was very low in controls and Celsior preserved but higher in the Euro-Collins group. Size distribution of alveoli and acinar paths in 15 size classes was largely homogeneous in all groups tested. In the Euro-Collins group the fractions of both class 1-alveoli and class 1-acinar paths significantly exceeded those of the other groups. Widely expanded alveoli (size classes 13–15) only occurred after preservation with Celsior whereas wider acinar paths (size class 15) were found in the Celsior group and in the controls. It is concluded that lung preservation with low-potassium Euro-Collins and Celsior solutions may act differently on distinct spaces in the distal gas-exchange regions of lungs. This may be due to selective effects on pulmonary surfactant activity and on elastic tissue elements in the alveolar ducts, respectively. Additionally, the method of point sampled intercepts is considered to be an efficient tool to evaluate the effects of different preservation solutions on lung parenchyma.