RESUMEN
Left atrial contrast computed tomography (LA-CT) as well as transesophageal echocardiography (TEE) can exclude left atrial appendage (LAA) thrombus, but is sometimes unable to evaluate LAA due to incomplete LAA filling. The aim of the current study was to validate the utility of real-time approach of LA-CT with real-time surveillance of LAA-filling defect (FD). We enrolled consecutive 894 patients with LA-CT studies acquired for catheter ablation and compared the diagnostic accuracy in demonstrating LAA-FD between conventional protocol (N = 474) and novel protocol with real-time surveillance of LAA-FD immediately after the initial scanning and, when necessary, adding delayed scanning in the supine or prone position (N = 420). Primary endpoint was severity of LAA-FD classified into the 3 groups: "Grade-0" for complete filling of contrast, "Grade-1" for incomplete filling of contrast, and "Grade-2" for complete FD of contrast. The prevalence of Grade-1 and Grade-2 FD was 17.3% and 11.2% in conventional protocol, whereas there was no patient with Grade-2 FD, and only 1 patient with Grade-1 FD after the additional scanning in novel protocol. In 5 patients with suspected LAA thrombus both by TEE and Grade-2 FD in LA-CT by the conventional protocol, ablation procedure was canceled due to diagnosis of LAA thrombus. Conversely, 4 patients with suspected LAA thrombus by TEE in novel protocol group was proved to have intact LAA by LA-CT with and without additional scanning. This novel approach with real-time surveillance improved the diagnostic accuracy of LA-CT in detecting LAA-FD, suggesting potential superiority of LA-CT over TEE in excluding LAA thrombus.
Asunto(s)
Apéndice Atrial/patología , Ablación por Catéter , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Apéndice Atrial/fisiopatología , Medios de Contraste , Ecocardiografía Transesofágica/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombosis/patología , Trombosis/terapia , Tomografía Computarizada por Rayos X/normasRESUMEN
Os autores descrevem o método utilizado na preparaçäo do soro antibotulínico tipo E, que näo apresenta reaçäo cruzada com a toxina heteróloga, pela hiperimunizaçäo de equídeos, através do antígeno absorvido pelo alúmen de potássio (sulfato duplo de alumínio e potássio). Empregando o esquema de imunizaçäo anteriormente proposto, conseguiram obter mistura de plasma hiperimunes o qual, após purificado pelo método de Pope, modificado, concentrou até níveis na ordem de 750 a 1.000 UI/ml. Este produto foi diluído convenientemente para que contivesse 500 UI/ml de antitoxina