Right Coronary Artery Occlusion During RF Ablation of Typical Atrial Flutter

RCA Occlusion During RF Ablation . Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus‐dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication. (J Cardiovasc Electrophysiol, Vol. pp. 818‐821, July 2010)     

Endovascular Abdominal Aortic Aneurysm Repair by Interventional Cardiologists—A Community‐Based Experience

Introduction: Endovascular repair of abdominal aortic aneurysm (AAA) is a relatively recent technology. In comparison to the conventional open surgical treatment for AAA, endovascular AAA repair (EVAR) combines a less‐invasive approach with lower morbidity and mortality. There have been few studies regarding the performance of this procedure in a community‐based setting. We report our experience of EVAR performed primarily by interventional cardiologists in a community hospital. Methods: In our community hospital setting, between September 2005 and November 2007, we included all patients who underwent EVAR by interventional cardiologists, with available on‐site vascular surgical support. Clinical and serial computed angiographic imaging outcomes were followed by a retrospective chart review. Data collection tools included demographic and clinical characteristics, anatomical aneurysm features, length of stay, peri‐ and postprocedural complications, and mortality. Results: A total of 71 consecutive patients had EVAR attempted. The endovascular stent placement was successful in 67 (93%) patients. Thirty‐day mortality in this study was 1 of 71 (1.4%). All four procedural failures and the single periprocedural mortality occurred in women. Mean follow‐up was 12 months. There were a total of six mortalities and among these four were women (P ≤ 0.001); however, multivariate analysis revealed loss of significant difference in mortality (P = 0.16). Major complications following EVAR were noted in 10 of 71 (14%) patients. Conclusion: EVAR can be successfully performed by experienced interventional cardiologists with vascular surgical support in a community‐based setting. In our experience, there is acceptable rate of complications and mortality in a carefully selected patient population. (J Interven Cardiol 2010;23:485–490)     

A Pilot Study of Prasugrel Followed by Post‐Procedural Maintenance with Clopidogrel in Patients Receiving Percutaneous Coronary Intervention

Background

Dual anti‐platelet therapy including clopidogrel or prasugrel is standard of care for patients receiving stents. Prasugrel has quicker onset so it can be loaded later than clopidogrel with greater efficacy. However, prasugrel is much more expensive than clopidogrel.

Objectives

To describe the incidence of 30‐day death from cardiovascular causes, myocardial infarction, unstable angina requiring intervention, and minor and major bleeding in patients loaded with 60 mg of prasugrel prior to percutaneous coronary intervention (PCI) and then continued on 75 mg of clopidogrel daily after the procedure.

Methods

We reviewed sequential medical records of 102 patients (Mean age: 67.8, male 68.6%, smokers: 22.6%, BMI: 29.5%, hypertension: 90.2%, DM: 33.3%, average ejection fraction: 49.7%) who underwent PCI (3.9% STEMI, 12.7% NSTEMI, 35.3% unstable angina and 48.1% electively) at Baylor University Medical Center between October 2009 and December 2011 who were loaded with prasugrel 60 mg prior to procedure, and then continued on 75 mg clopidogrel daily.

Results

None of the patients died or experienced a myocardial infarction (MI) within 30 days of the procedure. Three patients experienced unstable angina requiring intervention but none had in‐stent thrombosis or restenosis on repeat angiography. None of the patients experienced a major bleeding event. One patient developed a gastrointestinal bleed which did not require blood transfusion and the bleeding it resolved on discontinuation of the clopidogrel.

Conclusion

In this retrospective pilot study, a strategy of loading patients needing PCI with prasugrel 60 mg immediately prior to coronary intervention, then continuation of anti‐platelet therapy with 75 mg clopidogrel daily was safe and effective. (J Interven Cardiol 2013;26:38–42)

     

结核性脑膜炎类赫氏反应21例临床分析

赫氏反应是指驱梅治疗中病灶暂时性恶化反应。部分结核病人在强有力的抗痨药物作用下亦可发生类赫氏反应的现象,称为类赫氏反应。主要表现为原发结核病灶增大,出现新病灶,突然昏迷、意识不清、抽搐。     

Expression of vascular endothelial growth factor-C in human hepatocellular carcinoma

Background/Aims: Vascular endothelial growth factor‐C (VEGF‐C) is thought to be an important factor in tumor angiogenesis/lymphangiogenesis, but its role in hepatocellular carcinoma (HCC) has not yet been fully investigated. Methods: We immunohistochemically examined VEGF‐C expression in surgically resected tissues of 90 HCC. Results: In the 78 HCC with a single histological grade, VEGF‐C expression was significantly stronger in poorly differentiated HCC than in well‐ (P = 0.003) or moderately differentiated HCC (P = 0.0002). A ‘nodule‐in‐nodule’ case presented VEGF‐A expression in the well‐differentiated component and VEGF‐C expression in the moderately–poorly differentiated component. According to nodular diameter, VEGF‐C expression was significantly higher in nodules of 3.0 cm or larger (P = 0.0263). Extrahepatic metastases seen in seven cases expressed VEGF‐C. In 20 of the 28 cases who were able to be followed up, the frequency of intrahepatic recurrence tended to be higher and extrahepatic metastasis was significantly higher in the cases who had VEGF‐C expression in the tumor casts of the intrahepatic portal/hepatic vein branches than other cases without the expression (P = 0.0139). Disease‐free survival time tended to be shorter in cases with VEGF‐C expression in tumor casts of the portal/hepatic vein than in those without VEGF‐C expression (P = 0.053; log–rank test). Conclusions: VEGF‐C expression is related to the progression of HCC, and VEGF‐C expression in tumor casts of the intrahepatic portal/hepatic vein is considered to be a factor indicating recurrence/metastasis sites.     

A study of the educational and research priorities of registered nurses in rural Australia

This study set out to identify the educational and research priorities of registered nurses practising in rural and remote areas of Australia. It included two groups of participants, one which identified as rural and another which identified as remote. The findings for the rural cohort in the study are presented in this article. Research participants represented a national sample. The Delphi method was used to obtain the most reliable consensus of the nurse participants. In the final phase of the study, 13 high priorities were identified. Study findings highlight perceived needs for clinical nursing research and continuing education for nurses practising in rural Australia.