Timing of cranial reconstruction after cranioplasty infections: are we ready for a re-thinking? A comparative analysis of delayed versus immediate cranioplasty after debridement in a series of 48 patients

Neurosurgical Review - The optimal management of cranioplasty infections remains a matter of debate. Most authors have suggested that the infected bone/implant removal is mandatory, combined with...     

LocaLisa catheter navigation reduces fluoroscopy time and dosage in ablation of atrial flutter: a prospective randomized study

INTRODUCTION: Catheter ablation has become a well-established therapy for isthmus-dependent right atrial flutter (AFL). Recently, mapping and ablation of AFL have been performed using sophisticated three-dimensional mapping systems, such as electroanatomic and noncontact mapping systems. The LocaLisa system enables nonfluoroscopic navigation of intracardiac electrode catheters based on impedance changes related to catheter movements in transthoracic current fields. The aim of this randomized prospective study was to compare the efficacy of the LocaLisa system with the conventional mapping/ablation approach for radiofrequency ablation of AFL. METHODS AND RESULTS: Fifty consecutive patients with AFL (39 men and 11 women; age 65 +/- 10 years) were studied. The patients were randomly assigned to undergo radiofrequency ablation guided by a conventional fluoroscopy-based approach (24 patients) or by the LocaLisa system (26 patients). Ablation success rate and documentation of bidirectional isthmus block were 100% in both groups. Compared with fluoroscopy-guided approaches, LocaLisa-guided procedures demonstrated a reduction in total fluoroscopy time from 15.9 +/- 10.6 minutes to 7.5 +/- 6.5 minutes (P < 0.005). Total fluoroscopy dosage was reduced from 21.0 +/- 19.8 to 8.7 +/- 9.5 Gycm2 (P < 0.05). Fluoroscopy time required for ablation was significantly shortened in the LocaLisa group (2.6 +/- 2.6 min) compared with the conventional approach group (11 +/- 10 min, P < 0.0005). In 9 (35%) of 26 patients, the ablation could be performed with a fluoroscopy time < or = 1 minute. There were no significant differences with regard to the number of radiofrequency applications, fluoroscopy time needed for diagnostic reasons, total procedure time, or other ablation data. CONCLUSION: Compared with the conventional approach, the LocaLisa system significantly reduces the fluoroscopy times needed for ablation of typical AFL.     

Inorganic arsenic speciation in soil and groundwater near in-service chromated copper arsenate-treated wood poles

The environmental impact of chromated copper arsenate (CCA)-treated utility poles is linked to the possible soil and groundwater contamination with arsenic. The objective of the present study was to determine the arsenic speciation in soil and groundwater near in-service CCA-treated poles. Arsenite (As[III]) and arsenate (As[V]) concentrations were determined in 29 surface and subsurface soil samples collected near eight CCA-treated wood poles. Temporal variability of total arsenic concentrations and inorganic arsenic speciation was also assessed in groundwater at two sites through four sampling events over a 19-month period. Arsenic speciation was carried out by a solvent extraction method using ammonium pyrrolidine dithiocarbamate-methyl isobutyl ketone, and total arsenic was quantified by inductively coupled plasma/atomic emission spectrometry/hydride generation. Average arsenic concentrations in surface soils immediately adjacent to utility poles ranged from 153+/-49 to 410+/-150 mg/kg but approached background levels (below 5 mg/kg) within 0.50 m from the poles. A positive correlation was found between surface soil As concentration and total Fe content. In subsurface samples (0.50 m), arsenic levels were generally high in sandy soils (up to 223+/-32 mg/kg), moderate in clayey soils (up to 126+/-26 mg/kg), and relatively lower in organic soils (up to 56+/-24 mg/ kg). Arsenic(V) was the predominant arsenic species in surface (>78%) and subsurface soils (>66%). Total arsenic concentrations in groundwater below the clayey site were high and varied widely over time (79-390 microg/L), with 30 to 68% as As(III). Below the utility pole located on the organic site with a high Fe content, lower total arsenic levels (12-33 microg/L) were found, with As(III) ranging from 0 to 100%.     

The efficacy of postoperative bracing after spine surgery for lumbar degenerative diseases: a systematic review

European Spine Journal - Postoperative bracing treatment is widely used after surgery for lumbar degenerative diseases. However, the guidelines are lacking in this regard, and its use is mainly...     

Clinical and psychological outcome after surgery for lumbar spinal stenosis: A prospective observational study with analysis of prognostic factors

Background

The identification of psychological risk factors is important for the selection of patients before spinal surgery. Moreover, the effect of surgical decompression in lumbar spinal stenosis (LSS) on psychological outcome is not previously well analyzed.

Adenosine in the noninvasive diagnosis of dual AV nodal conduction: use as a follow-up parameter after slow pathway ablation in AVNRT

OBJECTIVE: The aim of this study was to evaluate if administration of adenosine during sinus rhythm to patients with PSVT of unknown mechanism is capable to detect dual AV nodal conduction and furthermore to evaluate this diagnostic parameter as a controlling test after slow pathway ablation in AVNRT. METHODS AND RESULTS: Before electrophysiological study 35 consecutive patients with PSVT were given adenosine during sinus rhythm. After radiofrequency ablation the adenosine test was repeated in a subset of 19 patients. The electrophysiological study revealed 19 patients (54%) with typical AVNRT (study group), 10 (29%) with atrioventricular reentry tachycardia (AVRT), 4 (11%) with ectopic atrial tachycardia (EAT) and 2 patients (6%) with inducible atrial flutter (AF) (control group). We observed a sudden increment of the PQ interval of more than 50 msec between two consecutive beats in 15 of 19 patients (79%) in the study group (75+/-35 msec) and in 2 patients (1 with EAT, AF) of the control group (19+/-12 msec) (p<0.001). After slow pathway radiofrequency ablation the sudden increment of PQ interval persisted in 4 of 12 patients (33%) of the study group. Three of these 4 patients had a relapse of AVNRT during a follow-up of 3 months. CONCLUSION: The administration of adenosine during sinus rhythm is an excellent noninvasive diagnostic test for identifying dual AV nodal conduction and additionally for verifying radiofrequency ablation results in patients with AVNRT.