Worldwide experience with the robotic navigation system in catheter ablation of atrial fibrillation: methodology, efficacy and safety.

INTRODUCTION: The Hansen Robotic system has been utilized in ablation procedures for atrial fibrillation (AF). However, because of the lack of tactile feedback and the rigidity of the robotic sheath, this approach could result in higher risk of complications. This worldwide survey reports a multicenter experience on the methodology, efficacy, and safety of the Hansen system in AF ablations. METHODS AND RESULTS: A questionnaire addressing questions on patient's demographics, procedural parameters, ablation success rate and safety information was sent to all centers where more than 50 robotic AF ablation cases have been performed. From June 2007 to December 2009, 1,728 procedures were performed at 12 centers utilizing the Hansen robotic navigation technology. The overall complication rate was 4.7% and the success rate was 67.1% after 18 ± 4 months of follow-up. In 5 low volume centers there appeared to be a learning curve of about 50 cases (complication rate 11.2% for the first 50 cases vs 3.7% for the 51-100 cases; P = 0.044) and a trend showing a decrease of complication rate with increasing case volume. However, in the remaining 7 centers no learning curve was present and the complication rate was stable over time (3.7% for the first 50 cases vs 3.6% for the 51st case thereafter; P = 0.942). CONCLUSION: The Hansen robotic system can be used for AF ablation safely. In low volume centers, there appeared to be a learning curve of the first 50 cases after which the complication rate decreased. With a higher case volume, the success rate increased.

Knowledge, attitude and practices regarding leprosy among general practitioners at Hyderabad.

OBJECTIVE: To assess the level of knowledge, social attitude towards patients, and diagnostic and management capabilities of general practitioners (KAP) regarding leprosy, practicing at Hyderabad, Pakistan. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Hyderabad, Sindh, Pakistan, during October to December 2007. METHODOLOGY: A pre-tested and well-structured questionnaire consisting of 54 questions was administered to general practitioners working at various areas in Hyderabad. The questions were grouped under different headings and covered clinical features, common and uncommon presentations, complications, referral practices and stigma. The sum of correct answers marked by doctors was taken to classify the respondents. The doctors who responded correctly for upto 10 questions were assigned level 1 (poor), from 11 to 25: level 2 (average), from 26 to 40: level 3 (good), while those who marked correct answers for more than 40 questions were assigned level 4 (excellent). Chi-square test was used to determine significance at p<0.05. RESULTS: A total of 200 doctors were surveyed. Fourteen doctors (7%) had poor knowledge of disease (number of correct answers less than 10), 32 (16%) had average (number of correct answers between 11 and 25), 140 (70%) doctors good (number of correct answers between 26 and 40) while 14 (7%) had excellent (number of correct answers more than 40) knowledge of the disease. CONCLUSION: There is inconsistency and deficiencies in the knowledge, referral pattern and treatment of leprosy among general practitioners, which needs to be improved by conducting awareness activities.

[Summary of questionnaires on leprosy in Yokohama City area and university hospitals].

We sent a questionnaire to members of Yokohama Medical Association and Departments of University Hospital to get an overview of leprosy patients in the clinic. Yokohama Medical Association: The rate of collection was approximately 47%. Few doctors have taken medical care of Leprosy patients. Half of the doctors will take medical care, but they have little information about Leprosy. Aged doctors do not take medical care compared with young doctors. Departments of University Hospital: The rate of collection was approximately 74%. Doctors in the University Hospitals do not hesitate to take medical care of leprosy patients. Dermatologists actively take medical care and have a chance of getting information about leprosy. It is necessary to give doctors information about leprosy and its history of stigma.

[Leprosy surgery in a bush hospital in Africa: experience in Madagascar]. / La chirurgie de la lèpre dans un hôpital de brousse en Afrique: expérience à Madagascar.

We report our experience of leprosy surgery in terms of feasibility and efficacy in a small hospital of bush in Madagascar during the period of September 1989 to January 1993. Operations of neurolysis, corrections of claw hands by the techniques of Lasso-Zancolli or Van Droogenbroeck, arthrodesis, resections and amputations have been performed. Our results suggest that at least a part of these surgical procedures may be performed by a non specialized medical team, taught on the premises. Thus, the cost of treatment will be low and accessible to more leprosy patients.