Hyperemic myocardial blood flow in patients with atrial fibrillation before and after catheter ablation: A dynamic stress CT perfusion study.

BACKGROUND: Atrial fibrillation (AF) patients without coronary artery stenosis often show clinical evidence of ischemia. However myocardial perfusion in AF patients has been poorly studied. The purposes of this study were to investigate altered hyperemic myocardial blood flow (MBF) in patients with AF compared with risk-matched controls in sinus rhythm (SR), and to evaluate hyperemic MBF before and after catheter ablation using dynamic CT perfusion. METHODS: Hyperemic MBF was quantified in 87 patients with AF (44 paroxysmal, 43 persistent) scheduled for catheter ablation using dynamic CT perfusion, and compared with hyperemic MBF in 87 risk-matched controls in SR. Follow-up CT after ablation was performed in 49 AF patients. RESULTS: Prior to ablation, hyperemic MBF of patients in AF during the CT (1.29 ± 0.34 ml/mg/min) was significantly lower than in patients in SR (1.49 ± 0.26 ml/g/min, p = 0.002) or matched controls (1.65 ± 0.32 ml/g/min, p < 0.001); no significant difference was seen between patients in SR during the CT and matched controls (vs. 1.50 ± 0.31 ml/g/min, p = 0.815). In patients in AF during the pre-ablation CT (n = 24), hyperemic MBF significantly increased after ablation from 1.30 ± 0.35 to 1.53 ± 0.17 ml/g/min (p = 0.004); whereas in patients in SR during the pre-ablation CT (n = 25), hyperemic MBF did not change significantly after ablation (from 1.46 ± 0.26 to 1.49 ± 0.27 ml/g/min, p = 0.499). CONCLUSION: In the current study using stress perfusion CT, hyperemic MBF in patients with AF during pre-ablation CT was significantly lower than that in risk-matched controls, and improved significantly after restoration of SR by catheter ablation, indicating that MBF abnormalities in AF patients are caused primarily by AF itself.

The seamless integration of three-dimensional rotational angiography images into electroanatomical mapping systems to guide catheter ablation of atrial fibrillation.

It is important to visually confirm radiofrequency ablation lesions during atrial fibrillation (AF) ablation for procedural efficiency, which requires the integration of a three-dimensional (3D) left atrial image reconstructed from computed tomography (CT) or a magnetic resonance imaging. However, an EP Navigator allows seamless integration of 3D anatomy obtained through 3D rotational angiography (3D-ATG) into an electroanatomical mapping system. We hypothesized that 3D-ATG can be used during AF ablation while significantly reducing the effective dose (ED) and without compromising image morphology compared to a 3D-CT image. Organ dose was measured at 37 points with a radiophotoluminescence glass dosimeter inserted in an anthropomorphic Rando Phantom. The ED was calculated by multiplying the organ dose by the tissue weighting factor. The dose-area product (DAP)-to-ED conversion factor was calculated by measuring the DAP during radiation exposure. The ED for the CT examination was estimated from the dose-length product with a conversion factor of 0.014. ED was calculated from DAP measurements in 114 patients undergoing AF ablation using 3D-ATG. The DAP-to-ED conversion factor for 3D-ATG was 2.4 × 10-4 mSv/mGy cm2 in our hospital. The mean DAP for all patients was 7777 ± 1488 mGy cm2 for the 3D-ATG of the left atrium. The corresponding ED for 3D-ATG was 1.9 ± 0.4 mSv. The ED for CT examinations was 13.6 ± 4.2 mSv (P < 0.001). 3D-ATG can be used during AF ablation while significantly reducing the ED and without compromising image morphology.

[Consideration of the Work Content of the Clinic Pharmacist and Its Usefulness].

"Medical teams"have been promoted in the home care setting. For the pharmacist, it is possible to maintain the safety and improve the quality of medical care by working with a multidisciplinary team. The arrangement of the pharmacist with the clinic is specified in Article 18 of the Medical Care Law, but there is no medical treatment fee for the clinic pharmacist. We examined the work content and usefulness of the clinic pharmacist. The work content was to participate in visiting consultation, introduce pharmacotherapy management based on the clinic pharmacist's working protocol, propose prescriptions, provide drug information service, and cooperate with insurance pharmacy pharmacists. Because the pharmacist was working in the clinic, he or she was able to actively intervene in drug treatment. Intervention in medication requires organizing and gathering information, which is difficult in the position of the insurance pharmacy pharmacist. The fact that the clinic pharmacist assumes this role and works with insurance pharmacy pharmacists makes it possible to maintain the safety and improve the quality of medical care.

A fatal case of necrotizing fasciitis due to bacterial translocation of Klebsiella oxytoca.

We report a 73-year-old man with hepatocellular cell carcinoma who had eruptions on and severe pain in the lower leg. Within several hours, the patient's skin lesions had progressed markedly. Magnetic resonance imaging findings were consistent with necrotizing fasciitis. Klebsiella oxytoca was isolated from cultures of biopsy samples taken from the leg. The resulting DNA fingerprint pattern revealed that the enteric bacterium was the same as that obtained from the biopsy samples taken from the leg. Furthermore, a dendrogram showed that genetic proximity between samples was extremely high. These results confirmed that translocation of Klebsiella oxytoca as an enteric pathogen caused the necrotizing fasciitis in this patient.

[Location of extraprostatic extension and positive surgical margin in radical prostatectomy specimens].

BACKGROUND: Extraprostatic extension and positive surgical margin increase a risk of treatment failure after radical prostatectomy in patients with localized prostate cancer. We analyzed the location of extraprostatic extension and positive surgical margin in radical prostatectomy specimens. MATERIALS AND METHODS: In 104 radical prostatectomy cases the location of the extraprostatic extension (EPE) and/or positive surgical margin (PSM) were studied using step-sectioned specimens. RESULTS: In 54 cases EPE and/or PSM were recognized. In 34 of 38 cases (89.5%) with EPE, the EPE was identified at lateral, posterolateral and/or posterior portions in base and/or middle of the prostate. Particularly, in 31 cases (81.6%) the EPE was found posterolaterally. Only in 5 of these 34 cases (14.7%) PSM resulted from the EPE. When 35 cases with PSM were evaluated, the PSM occurred apically in 22 (62.9%) and anteriorly in 11 (31.4%). Only in 4 cases (14.3%) PSM was caused by EPE of apical and/or anterior portions. CONCLUSIONS: The majority of EPE were observed at the posterolateral portion of the prostatic base and/or middle. However, PSM were frequently identified apically and/or anteriorly. These findings suggest that modifications of surgical technique of apical dissection might reduce the frequency of PSM.