Mediguide-Assisted Transseptal Puncture without Echocardiographic Guidance.

BACKGROUND: First description of a technique for left atrium transseptal puncture (TSP) with minimal radiation exposure by using the nonfluoroscopic MediGuide™ tracking system (MG; St. Jude Medical, St. Paul, MN, USA) without the assistance of intracardiac echocardiography. METHODS: This study included 31 consecutive patients with atrial fibrillation undergoing an MG-assisted percutaneous catheter ablation procedure. A Brockenbrough transseptal needle (BRK) is connected to a standard pressure transducer through a two-input valve. Then, an MG-enabled guidewire is inserted so that its tip exactly matches the BRK's distal tip. After the acquisition of two short radioscopic cine-loops we are able to trace the needle tip on the MG screen, performing the usual TSP maneuver but without fluoroscopy. Successful left atrium access is confirmed by noticing the change in the pressure curve and by advancing the guidewire into the left pulmonary veins. As a control group, 31 matched patients who underwent atrial fibrillation ablation with fluoroscopically guided, pressure-monitored TSP were included. RESULTS: Sixty-two MG-assisted TSP attempts were performed; all but two were successfully accomplished without changing to the conventional technique (96.7%). The mean total fluoroscopy time, until the double transseptal access was performed, was 26.65 ± 37.97 seconds in the MG group and 129.13 ± 37.77 seconds in the conventional-TSP group (P < 0.001). No major complications occurred during any of the procedures. CONCLUSION: This new technique for TSP using MG is feasible and can be performed with minimal radiation exposure without the need for additional imaging techniques, achieving a significant reduction of fluoroscopy time.

[Diabetic foot, a severe complication]. / El pie diabético, una grave complicación.

In this research project, the authors carried out a prospective descriptive study over a nine month period on 74 diabetic patients checked into the Vascular Surgery Ward at the Ramón y Cajal Hospital. The authors have compiled and analysed the diverse risk factors and variables which can bear an influence on this pathology; to do so, the authors collected the necessary data by means of a personal interview, medical records, analytical tests and readings as well as a direct inspection of the lesions. Among the results obtained, the authors emphasize the long average hospital stay, the poor control of their glycemia upon hospitalisation and the percentage of important ampulations these patients underwent; the authors were unable to corroborate other results present in articles consulted such as the relationship between the variables for years a patient had been suffering diabetes and the degree of the lesion on the Wagner scale.