Evaluation of the defibrillation threshold in atrial fibrillation by transoesophageal cardioversion using a biphasic impulse

INTRODUCTION: Recurrent atrial fibrillation (AF) in the setting of haemodynamic disturbances requires frequently repeated cardioversions, which is associated with the risk of myocardial damage. It is thus necessary to identify methods which can minimise the cardioverter impulse energy. AIM: To define the defibrillation threshold in recent-onset AF using a biphasic impulse, following an infusion of magnesium, potassium, and amiodarone. METHODS: Transoesophageal cardioversion was performed in 32 patients with AF lasting < or =48 hours, in whom prior administration of 40 mEq K+, 4.0 g MgSO4 and 300 mg amiodarone did not restore sinus rhythm. Cardioversion was performed under short intravenous anaesthesia using a biphasic impulse travelling from a multi-annular oesophageal electrode to two electrodes on the anterior chest wall. The initial energy was set to 1 J, which was subsequently increased according to the following protocol: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 40, 50 and 70 J. RESULTS: Electrical cardioversion following the administration of electrolytes and amiodarone restored sinus rhythm in all the patients (100% efficacy). The mean defibrillation threshold was 12.9+/-14.3 J, with a minimal effective energy of 1 J and a maximum effective energy of 70 J. The defibrillation threshold was in the range from 1 to 10 J in 75% of the patients. The mean cumulative energy transferred between electrodes during evaluation of the defibrillation threshold was 39.7 J (SD, 38.8). CONCLUSIONS: Transoesophageal cardioversion using a low-energy (mean, 12.9 J; range, 1-70 J) biphasic impulse, following the intravenous administration of potassium chloride and amiodarone, was 100% effective in restoring sinus rhythm in AF.     

From implantable cardioverter-defibrillator to cardiac resynchronization therapy with the use of epicardial left ventricular lead. The evolution of the treatment of post inflammatory heart failure--a case report

The authors present a case of a 77-year-old man with heart failure in the course of dilated cardiomyopathy (DCM) and atrial fibrillation (AF), after implantation of an automatic cardioverter-defibrillator (ICD) due to recurrent symptomatic ventricular tachycardia (VT). Addition of cardiac resynchronization therapy (CRT) was decided due to the heart-failure dependent intensification of the arrhythmia and poststimulation enlargement of QRS. CRT was led to withdraw patient's arrhythmia and to improvement of the general condition of the patient for approximately one year. After the arrhythmia reoccurred due to dislocation of the electrode in the coronary sinus with loss of left ventricle stimulation. Multiple attempts at restoration of resynchronization function via a transvenous approach failed. The patient was qualified for implantation of an epicardial left ventricle electrode. The surgery was combined with a planned exchange of ICD-CRT. Basing on a 6-month observation period an improvement heart performance and general state of health have been observed. No arrhythmic event has been noted in device memory. Performed procedures are picturing the evolution of in pacing techniques and automatic defibrillation in Poland over recent years.     

Ventricular fibrillation in a patient with three accessory pathways, Ebstein anomaly and intermittent long QT interval. RF ablation and electrophysiologic considerations

We present a case of a 19-year old man with minor Ebstein's anomaly, intermittent long QT interval and WPW syndrome in whom atrial fibrillation, degenerating into ventricular fibrillation was the first symptom. QRS complex morphologies during atrial fibrillation revealed the presence of three accessory pathways (septal, right inferior paraseptal and antero-inferior). Immediately after resuscitation the patient was treated with amiodarone, which resulted in a significant prolongation of QT interval to 700 ms. After RF ablation of accessory pathways patient remains asymptomatic during 6-month follow up, however QTc interval is about 500 ms.     

Nanotechnology for cancer diagnostics: promises and challenges

Despite recent progress in the treatment of cancer, the majority of cases are still diagnosed only after tumors have metastasized, leaving the patient with a grim prognosis. However, there may be an opportunity to drastically reduce the burden of cancer, if the disease can be detected early enough. Nanotechnology is in a unique position to transform cancer diagnostics and to produce a new generation of biosensors and medical imaging techniques with higher sensitivity and precision of recognition. This review examines the in vitro and in vivo diagnostic applications of nanoparticles, and other nanodevices that are likely to have an impact on the field in the future. Future developments that may lead to the realization of multifunctional detection and treatment nanoparticle platforms are also discussed.     

Dynamic correction of scapholunate instability using ECRB tendon transfer

Background. Instability of the wrist, leading to the appearance of a fissure between the scaphoid and lunate bones (SLD), is generally attributed to damage of the scapholunate ligaments (SLIL). However, repair of the SLIL does not give a good outcome. SLD recurs in many cases, despite correct reconstruction. The structures of the joint may be exposed to further overloading and damage, with all the attendant consequences. Material and methods. This article presents the preliminary results of the operative treatment of 7 cases of scapholunate instability. Partial ECRB transfer to the distal pole of the scaphoid was performed. The DASH form was used for outcome assessment. Results. Better alignment and dynamic stabilisation of the scaphoid were achieved. All patients had less pain and better grip strength without limitation of wrist flexion. Conclusions. Preliminary treatment outcomes after dynamic transfer of the ECRB tendon using the method described here are encouraging. Our observations indicate that the dynamic stabilization of rotatory instability of the scaphoid bone can be recommended in cases of predynamic and dynamic scapho-lunate instability.     

Reasons for diagnostic difficulties in spinal defects and deformations in children and adolescents

Background. The growing spine is vulnerable to pathological processes in the bony, muscular or nervous tissue of the spine, with symptoms that include disturbances of the spinal axis in both planes. The clinical picture often corresponds to idiopathic scoliosis. Radiographic examinations done routinely mostly do not show any pathology in the initial period of disease growth. The aim of our study was to present diagnostic problems in children and adolescents treated "routinely" with the diagnosis of a posture defect or scoliosis. Material and methods. The material included 25 girls and boys mistakenly diagnosed and treated for scoliosis, while the hidden etiology delayed proper treatment. Results. In 12 cases the reason for deformity was osteoid osteoma of the spine, in 2 cases astrocytoma, in 2 others, meningioma, and in the others, hidden congenital defects of the vertebrae. In most cases, scoliosis were diagnosed due to a misleadingly typical clinical picture. All the examined patients needed surgical treatment. In cancer processes, the clinical diagnosis was confirmed by histopathologic examination. Conclusions. These examples of defects and deformities of spine caused by hidden pathological process indicate the necessity of thorough evaluation of every posture deformity in children and adolescents. Early diagnosis and surgical removal of the cause of deformity in all cases led to inhibition of the tumor or reduction of spinal deformity. Our observations indicate the risk of mass screening examinations, after which selected children are referred for treatment without diagnosis. Such therapeutic mistakes can be dangerous and delay proper treatment.     

Clinical and radiological evaluation of Smith's fractures with buttress plate stabilization

Background. This study was a retrospective follow-up evaluation of clinical and radiological outcome in Smith's fractures in 38 patients treated in the Orthopedics and Traumatology Department at the Skubiszewski University Medical School in the years 1986-2005. Material and methods. The group consisted of 24 women and 14 men 15 to 74 years of age (ave. 48). All patients were treated with open reduction and distal fragment stabilization with buttress plate. There were 9 transverse type 1 fractures, 14 palmar lip type 2 fractures, and 15 type 3 fractures with oblique fracture line, according to the Thomas classification. Results. Follow-up examinations were performed on 32 patients. There were: 10 excellent outcomes, 10 good, and 12 fair according to the Gartland score. Post-traumatic osteoarthritis developed in all patients with inadequate intraarticalar fracture reduction. Conclusions. Volar displaced fractures of the distal radius need preoperative examination and operative planning. Stabilization of the distal fragment with buttress plate is reliable and gives fracture healing without loss of reduction.     

CD4+CD25+ T regulatory cells inhibit cytotoxic activity of CTL and NK cells in humans-impact of immunosenescence

We hypothesized that advanced age and medical conditions had an impact on the accumulation of CD4+CD25+ T regulatory cells (Treg), which in turn could deteriorate cytotoxic activity of CD8+ T and NK cells. Volunteers were divided according to the Senieur Protocol into healthy young and elderly and non-healthy young and elderly subjects. The numbers of Treg cells in peripheral blood, their influence on CD8+ T and NK cells and production of IL2 as well as apoptosis intensity of Treg cells were measured. The number of Treg cells was higher in both elderly groups than in respective young ones. Compared to healthy subjects, those with medical conditions were revealed to have higher numbers of Treg cells. In addition, the highest accumulation of Treg cells in non-healthy elderly could be a result of their resistance to undergo apoptosis. The frequency of Treg cells correlated inversely with the activity of autologous cytotoxic cells in PBMC and production of IL2 by autologous CD4+CD25- Th cells. Thus, these parameters were the most highly decreased in non-healthy subjects, notably in the elderly. However, these parameters improved in the cultures of pure sorted cells. The only subset capable of decreasing them to the levels noted in PBMC when added back was Treg cells, which proved the link between the number of Treg cells, cytotoxic activity and production of IL2. Concluding, we found that Treg accumulated as a result of ageing and/or medical conditions were capable of decreasing cytotoxic activity of CD8+ T and NK cells and production of IL2.     

Coronary x-ray angiographic reconstruction and image orientation

We have developed an interactive geometric method for 3D reconstruction of the coronary arteries using multiple single-plane angiographic views with arbitrary orientations. Epipolar planes and epipolar lines are employed to trace corresponding vessel segments on these views. These points are utilized to reconstruct 3D vessel centerlines. The accuracy of the reconstruction is assessed using: (1) near-intersection distances of the rays that connect x-ray sources with projected points, (2) distances between traced and projected centerlines. These same two measures enter into a fitness function for a genetic search algorithm (GA) employed to orient the angiographic image planes automatically in 3D avoiding local minima in the search for optimized parameters. Furthermore, the GA utilizes traced vessel shapes (as opposed to isolated anchor points) to assist the optimization process. Differences between two-view and multiview reconstructions are evaluated. Vessel radii are measured and used to render the coronary tree in 3D as a surface. Reconstruction fidelity is demonstrated via (1) virtual phantom, (2) real phantom, and (3) patient data sets, the latter two of which utilize the GA. These simulated and measured angiograms illustrate that the vessel center-lines are reconstructed in 3D with accuracy below 1 mm. The reconstruction method is thus accurate compared to typical vessel dimensions of 1-3 mm. The methods presented should enable a combined interpretation of the severity of coronary artery stenoses and the hemodynamic impact on myocardial perfusion in patients with coronary artery disease.