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First Procedure (first + procedure)

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Medical Sciences	80%

Selected Abstracts

Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure

ECHOCARDIOGRAPHY, Issue 7 2010
Nuran Yaz, lu M.D.
Background: The widespread use of percutaneous mitral commissurotomy (PMC) has led to an increase in restenosis cases. The data regarding follow-up results of repeat PMC are quite limited. The aim of this retrospective analysis is to evaluate the immediate and midterm results of the second PMC, in patients with symptomatic mitral restenosis after a succesful first procedure. Methods: Twenty patients (95% female, mean age 37 ± 4 years) who have undergone a second PMC, 6.3 ± 2.5 years after a first successful intervention built the study group. All were in sinus rhythm, with a mean Wilkins score of 8.5 ± 1.2. Results: The valve area increased from 1.2 ± 0.2 to 1.9 ± 0.2 cm2 and mean gradient decreased from 10.5 ± 3.4 to 6.1 ± 1.1 mmHg. There were no complications except for a transient embolic event without sequela (5%) and two cases (10%) of severe mitral regurgitation. The immediate success rate was 90%. The mean follow-up was 70 ± 29 months (36,156 months). The 5-year restenosis and intervention (repeat PMC or valve replacement) rates were 9.1 ± 5.2% and 3.6 ± 3.3%, respectively. The intervention free 5-year survival in good functional capacity (New York Heart Association [NYHA] I,II) was 95.1 ± 5.5% and restenosis and intervention free 5-year survival with good functional capacity was 89.7 ± 6.8%. Conclusions: Although from a limited number of selected patients, these findings indicate that repeat PMC is a safe and effective method, with follow-up results similar to a first intervention and should be considered as the first therapeutic option in suitable patients. (Echocardiography 2010;27:765-769) [source]

Gross and Microscopic Findings in Patients Submitted to Nonablative Full-Face Resurfacing Using Intense Pulsed Light: A Preliminary Study

DERMATOLOGIC SURGERY, Issue 8 2002
Enrique Hernández-Pérez MD
background. Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL. objective. To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL. methods. Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used. results. All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness. conclusion. Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime. [source]

Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure

Triggering Pulmonary Veins: A Paradoxical Predictor for Atrial Fibrillation Recurrence After PV Isolation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010
YVES DE GREEF M.D.
Triggering Pulmonary Veins and Recurrence After Ablation.,Purpose: To identify procedural parameters predicting recurrence of atrial fibrillation (AF) after a first circumferential pulmonary vein isolation (CPVI). Methods: One hundred seventy-one patients undergoing CARTO-guided CPVI for recurrent AF with a left atrial (LA) diameter <45 mm were studied. Follow-up (symptoms and 7-day Holter) was performed at 1 and 3 months and every 3 months thereafter. Clinical and procedural characteristics between successful patients and patients undergoing repeat ablation were compared. In addition, procedural parameters of the first procedure were compared with parameters during repeat ablation. Results: After first CPVI, 80% of patients were free of AF without antiarrhythmic drugs after a follow-up (FU) of 28 ± 11 months (N = 136). Thirty-five patients (20%) had recurrence of AF of which 25 underwent repeat ablation (N = 25). Clinical characteristics did not differ between the successful and repeat group. A triggering vein during the index procedure was significantly more observed in the repeat group (56% vs 11%, P < 0.001). At repeat ablation, 2.6 ± 1.2 veins per patient were reconnected. Whereas there was no preferential reconnecting PV, all PVs triggering at index were reconnected (100%). Conclusions: (1) In patients with symptomatic recurrent AF, the presence of a triggering pulmonary vein during ablation is a paradoxical predictor for AF recurrence after PV isolation. (2) The consistent finding of reconnection of the triggering PV at repeat ablation, suggests that, in these patients, the triggering PV is the culprit vein and that reconnection invariably results in clinical AF recurrence. (3) The present study advocates a strategy of even more stringent PV isolation in case of a triggering PV. (J Cardiovasc Electrophysiol, Vol. 21, pp. 381,388, April 2010) [source]

Mechanisms of Recurrent Atrial Fibrillation: Comparisons Between Segmental Ostial Versus Circumferential Pulmonary Vein Isolation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2007
LI-WEI LO M.D.
Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV,left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV,LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV,LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV,AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV,LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure. [source]

An automated method for peak detection and matching in large gas chromatography-mass spectrometry data sets

JOURNAL OF CHEMOMETRICS, Issue 8-10 2006
Sarah J. Dixon
Abstract A new approach for peak detection and matching has been developed and applied to two data sets. The first consisted of the Gas Chromatography-Mass Spectrometry (GC-MS) samples of 965 human sweat samples obtained from a population of 197 individuals. The second data set contained 500 synthetic chromatograms, and was generated to validate the peak detection and matching methods. The size of both of the data sets (around 500,000 detectable peaks over all chromatograms in data set 1, and around 100,000 in data set 2) would make it unfeasible to check manually whether peaks are matched. In the method described, the first procedure involves pre-processing the data before carrying out the second procedure of peak detection. The final procedure of peak matching consists of three stages: (a) finding potential target peaks in the full data set over all chromatograms; (b) matching peaks in the chromatograms to these targets to form clusters of spectra associated with each target; (c) merging targets where appropriate. Peak detection and matching were applied to both data sets, and the importance of stage (c) of peak matching described. In addition to the analysis of the synthetic chromatograms, the method was also validated by shuffling the original order of the sweat chromatograms and performing the methods independently on the newly shuffled data. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Block copolymers by chemoenzymatic cascade polymerization: A comparison of consecutive and simultaneous reactions

JOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 14 2006
Matthijs de Geus
Abstract The synthetic parameters for the chemoenzymatic cascade synthesis of block copolymers combining enzymatic ring-opening polymerization (EROP) and atom transfer radical polymerization (ATRP) in one pot were investigated. A detailed analysis of the mutual interactions between the single reaction components revealed that the ATRP catalyst system could have a significant inhibiting effect on the enzyme activity. The inhibition of the enzyme was less pronounced in the presence of multivalent ligands such as dinonyl bipyridine, which thus could be used in this reaction as an ATRP catalyst. Moreover, the choice of the ATRP monomer was investigated. Methyl methacrylate interfered with EROP by transesterification, whereas t -butyl methacrylate was inert. Block copolymers were successfully synthesized with this cascade approach by the activation of ATRP after EROP by the addition of the ATRP catalyst and, with lower block copolymer yields, by the mixing of all the components before the copolymerization. Adetailed kinetic analysis of the reactions and the structure of the block copolymers showed that the first procedure proceeded smoothly to high block copolymer yields, whereas in the latter a noteworthy amount of the poly(t -butyl methacrylate) homopolymer was detected. © 2006 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 44: 4290,4297, 2006 [source]

Risk of upper gastrointestinal bleeding with oral bisphosphonates and non steroidal anti-inflammatory drugs: a case-control study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2009
M. ETMINAN
Summary Background, Gastrointestinal injuries including gastric ulcers have been reported with oral bisphosphonate therapy. However, the risk of the more serious upper gastrointestinal bleeding (UGB) especially in the community setting with these drugs remains unknown. Similarly, the risk of UGB among users of both bisphosphonates and non steroidal anti-inflammatory drugs (NSAIDs) in the community is also unknown. Aim, To explore the risk of more serious UGB among users of bisphosphonates and the risk of UGB among users of both bisphosphonates and NSAIDs in the community. Methods, We conducted a case-control study within a cohort of Quebec residents who had received a revascularization procedure from 1995 to 2004. Cohort members were followed up from the date of their first procedure until the earliest of: (1) study outcome, (2) date of death or (3) end of health care coverage. Cases were defined as those with the first diagnosis of a UGB. For each case, 20 controls were selected and matched to the cases by index date, age and cohort entry. Adjusted odds ratios for current use of bisphosphonates, NSAIDs and co-therapy of both drugs were computed. Results, Within the initial cohort, 3253 incident cases of UGBs and corresponding 65 060 matched controls were identified. The adjusted odds ratio (OR) for UGB by current users of bisphosphonates was 1.01 (95% CI, 0.72,1.43). Current NSAID use was associated with an increased risk of UGB OR = 1.75; 95% CI, 1.53,1.99. The OR for use of bisphosphonates and NSAIDs was elevated OR = 2.00; 95% CI, 1.12,3.57. This risk was still elevated for users of bisphosphonates and COX-2 inhibitors [OR = 2.38 (95% CI, 1.26,4.50)]. Conclusion, We found no evidence of an increase in the risk of UGB among current users of bisphosphonates. The risk of combined NSAID and bisphosphonate therapy was increased, but this risk was not higher than the risk for NSAID users alone. [source]

Ultrastructural characterization of the new NG97ht human-derived glioma cell line using two different electron microscopy technical procedures

MICROSCOPY RESEARCH AND TECHNIQUE, Issue 4 2009
Camila Maria Longo Machado
Abstract On the basis of transmission electron microscopy observations in tumor cell lines, oncologists have made innumerous diagnostic and therapeutical progresses. Following this path, the UNICAMP immunopathologies laboratory established the NG97 cell line derived from a human astrocytoma grade III, which when injected to the athymic nude mouse flank developed a grade IV astrocytoma. In this study, we focused on ultrastructural characterization of the NG97 cells after being recovered from xenotransplant (NG97ht). These cells in culture were assayed by two different electron microscopy procedures to characterize ultrastructures related to grade IV astrocytomas and to observe their structures through cell subcultivation. Additionally, comparative morphological descriptions of different cell passages in these technical procedures could be a useful tool for improving electron microscopy cell lineage protocols. Results from many cell passage observations showed ultrastructural similarities, which suggest malignant and glioblastoma phenotypes. In the first procedure, NG97ht cells were harvested and then incorporated into agarose before subjecting them to electron microscopy protocols, whereas in the second one, monolayer cells grew first on cover slides. Comparison among protocols revealed that organelles, cytoplasmatic extensions, spatial conformation of filopodia, and cell attachment to substrate were more preserved in the second procedure. Furthermore, in this latter procedure, a unique ellipsoidal structure was observed, which was already described when dealing with gliosarcoma cell line elsewhere. Therefore, these analyses demonstrated a morphological characterization of a new NG97ht cell line using electron transmission microscopy. Moreover, it has been shown that the second procedure provides more detailed information compared with the first. Microsc. Res. Tech, 2009. © 2008 Wiley-Liss, Inc. [source]

First time and repeat cardioversion of atrial tachyarrhythmias , a comparison of outcomes

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2010
A. Arya
Summary Introduction:, Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006. Methods:, A total of 770 patients of mean age (SD) 70.1(10.1) underwent 1013 DCCVs (first n = 665, repeat n = 348) for atrial tachyarrhythmias from 1996 to 2006. Time to persistent arrhythmia recurrence was compared between first and multiple DCCV, and the effect of age, gender, presence of heart disease, left atrial size, fractional shortening, arrhythmia duration, anti-arrhythmic drug therapy (AAD) and other concomitant cardiac medication was evaluated using the Kaplan,Meier method and Cox's Proportional-hazards model. Results:, In all, 33% of first and 29% of repeat DCCVs were in sinus rhythm (SR) at 12 months (m). There was no difference in median time to arrhythmia recurrence (SE) between first and multiple procedures: 1.5 ± 0.1 m (1.3,1.7) and 1.5 ± 0.0 m (1.4,1.6) respectively, p = 0.45. AAD use was significantly higher, arrhythmia duration shorter and more diabetic patients underwent repeat procedures. Amiodarone, OR 0.56, p = 0.04, sotalol, OR 0.61, p = 0.02 and arrhythmia duration, < 6 m, OR 0.72, p = 0.03 were independent predictors of improved outcome in first procedures only. In patients undergoing first procedures on amiodarone or sotalol, median time to arrhythmia recurrence was longer and 12 m SR rates higher, 6.0 ± 2.4 m (42%) than those who had a repeat procedure on the same medication, 1.5 ± 0.1 m (33%), p = 0.06. Conclusions:, The efficacy of first and subsequent DCCV procedures is similar, achieving a similar proportion of SR maintenance at 1 year. However, the benefits of AAD therapy are the greatest following first time procedures. Concomitant AAD therapy should be considered for all first time procedures for persistent AF. [source]