[Periprocedural management of anticoagulation in patients undergoing atrial fibrillation ablation]. / Anticoagulation péri-interventionnelle lors d'ablation de fibrillation auriculaire.

Catheter ablation of atrial fibrillation (AF) has been increasingly performed and has become a standard of care treatment option for drug-refractory symptomatic patients. However, this procedure has been associated with major complications, like thromboembolic or bleeding events. Optimal periprocedural anticoagulation strategy is essential for minimizing these complications. In this article, we review current anticoagulation strategies, including use of oral anticoagulation with Vit-K-Antagonists, as well as use of direct oral anticoagulants in the periprocedural settings of AF ablation.

Structural, optical and electrical properties of nitrogen ion implanted ZnO nanorods.

This study examined the micro-structural and electrical properties of N+-ion-implanted ZnO nanorods. Nitrogen ions with energies of 10-90 keV and beam fluxes of 10(13)-10(16) ions/cm2 were implanted on vertically-aligned ZnO nanorods. Energy dispersive X-ray spectroscopy measurements showed that N+ ions were spread uniformly over the nanorods. Extended X-ray absorption fine structure measurements revealed that the implanted N+s had partially substituted for the oxygen sites. Photoluminescence measurements showed a neutral-donor bound exciton peak at 3.36 eV and a two-electron-satellite peak at 3.33 eV independent of the ion energy and flux. The I-V characteristic curves showed that the current density was not changed by the N+ ion energy and flux much. These results strongly suggested that the N ions substituted for the oxygen sites were neutral.

Gland-preserving surgery for pleomorphic adenoma in the submandibular gland.

BACKGROUND: Removal of tumours arising in the submandibular gland (SMG) usually involves excision of the entire gland. This prospective study evaluated the efficacy of gland-preserving surgery in patients with benign SMG tumours. METHODS: Twenty consecutive patients with pleomorphic adenomas in the SMG underwent local excision of tumours with limited tumour-free margins and preservation of the remnant glandular tissues. All patients had salivary scintigraphy before and 6 months after surgery, with ultrasonography 2 years after operation. Complications, operating time, salivary function and rates of tumour recurrence were evaluated. RESULTS: The mean operating time was 28 min, and no patient had neurological complications. After surgery, the function of the affected gland was equal to that of the unaffected gland. All patients had symmetrical facial contours without defects in the operated submandibular triangle. None of the patients had evidence of tumour recurrence on ultrasonographic examination and regular clinical examination at a median of 36 months after surgery. CONCLUSION: Gland-preserving surgery in patients with benign SMG tumours preserves salivation, and reduces surgical morbidity and operating time, with good cosmesis but without compromising local control.

Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma.

PURPOSE: To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outcomes of patients receiving such treatment. METHODS AND MATERIALS: We analyzed 137 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemotherapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radiation therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow-up for surviving patients was 48 months. RESULTS: The 5-year overall survival (OS) rates were 71% for the CT/RT group and 59% for the RT group (p = 0.04). The 5-year actuarial disease-free survival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT/RT group. The 5-year freedom from distant metastasis rates were 84% for the CT/RT group and 66% for the RT group (p = 0.01). The incidence of locoregional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09) CONCLUSION: While not providing conclusive evidence, historical evidence from this institution suggests that neoadjuvant chemotherapy significantly improves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma.

Human ectopic fascioliasis in the cecum.

A case of ectopic human Fasciola spp. infection in the cecal wall is reported. The patient, a 27-year-old Korean woman, resident in Seoul, Korea, presented with nausea, vomiting, and epigastric tenderness. One week later a palpable mass was discovered in the right iliac fossa. A clinical diagnosis of a carcinoma of the colon was made and the patient underwent a cecal resection. The mass proved to be an inflammatory reaction containing numerous tracts made by the migrating fluke, Fasciola sp.

Technetium-99m-ECD brain SPECT in cerebral palsy: comparison with MRI.

UNLABELLED: Hypoxic brain injury is one of the major causes of cerebral palsy. Therefore, this study was performed to evaluate cerebral perfusion impairments in these patients using 99mTc-ECD brain SPECT. METHODS: Fifty-one patients (31 boys, 20 girls; age range 6 mo to 6 yr, 11 mo) with clinical manifestations of cerebral palsy underwent brain SPECT after intravenous injection of 99mTc-ECD. The clinical subtypes of cerebral palsy were spastic diplegia (n = 35), spastic quadriplegia (n = 11), spastic hemiparesis (n = 2), choreoathetoid (n = 2) and mixed (n = 1). Transaxial, coronal and sagittal images obtained with a brain-dedicated annular crystal gamma camera were qualitatively analyzed and compared with the findings of magnetic resonance imaging (MRI). RESULTS: In SPECT, thalamic hypoperfusion was seen in all patients except one (98%), followed by hypoperfusion in the temporal lobe (52.9%, n = 27), basal ganglia (41.2%, n = 21), cerebellum (39.2%, n = 20) and extratemporal cortices (21.6%, n = 11). However, MR imaging demonstrated thalamic abnormality in seven (13.7%), basal ganglia in two (3.9%), extratemporal cortical defect in five (9.8%) and cerebellar atrophy in one (1.9%). Instead, white matter changes such as periventricular leukomalacia or ischemia (56.9%, n = 25) and thinning of corpus callosum (49%, n = 25) were the major findings. CONCLUSION: Brain SPECT is useful in the diagnosis of cerebral palsy and is more sensitive in the detection of cortical, subcortical nuclei and cerebellar abnormalities. MRI is superior in the detection of white matter changes.

Radiotherapy of germinomas involving the basal ganglia and thalamus.

Nine patients with histologically confirmed germinomas of the basal ganglia and thalamus (GBT) were treated by radiotherapy. The average dose of 52.5 Gy was delivered to the tumor bed, 37 Gy to the whole brain and 24.8 Gy to the CNS axis. The local control, which was verified by CT scan, was achieved in all patients. All patients are alive 11 to 96 months after radiotherapy. As with other intracranial germinomas, geminomas of the basal ganglia and thalamus respond well to radiotherapy and the prognosis is good after treatment.

Radiotherapy of intracranial germinomas.

Between 1980 and 1992, 32 patients with intracranial germinomas were treated with radiation. All patients were confirmed histopathologically prior to treatment. Of the 32 intracranial germinomas reviewed, 14 were located in the suprasellar region, 12 in the basal ganglia and thalamus, four in the pineal, and two in both the pineal and suprasellar regions. Three patients had subarachnoid seeding. Craniospinal irradiation was undertaken for 29 patients. The median dose of 54 Gy was delivered to the tumor bed, 36 Gy to the whole brain and 24 Gy to the spinal axis. Five and 10-year survival rates were 96.9 and 96.9%, respectively. Local control was achieved in all patients except one who died of persistent tumor after 2 months following radiotherapy. No intracranial recurrence or spinal metastasis were found. Tumor site did not relate to the prognosis. One patient developed severe intellectual deterioration, three patients had vertebral growth impairment. The present study confirms the excellent result with radiotherapy alone for patients with germinomas.

Enhancement of radiation effect by Ginkgo biloba extract in C3H mouse fibrosarcoma.

BACKGROUND AND PURPOSE: Ginkgo biloba leaf extract (GBE) is known to increase peripheral blood circulation. The hypothesis that GBE may be able to enhance radiosensitivity of tumor by improving tumor blood flow and thus decreasing hypoxic fraction was tested. MATERIALS AND METHODS: Fibrosarcoma (FSaII) growing in C3H mouse leg muscle was used as a tumor model. GBE was given i.p. 1 h before irradiation with or without priming dose given 1 day earlier. Effect on tumor and normal tissue radiation reaction was investigated. RESULTS: Tumor growth delay by radiation was more elongated after two doses (1-day interval) of GBE than after a single dose. Radiation dose for 3-day tumor growth delay was decreased from 12.45 (10.97-13.93) Gy to 6.06 (3.89-8.22) Gy by two doses of GBE [enhancement ratio = 2.06 (1.32-2.79)]. Hypoxic cell fraction was 10.6% (6.3-18.2%) for control, 7.2% (3.8-14.0%) after a single dose (P = 0.18) and 2.7% (1.5-5.0%) after two doses (P < 0.001). Radiation effect on normal tissue, estimated by acute skin reaction and jejunal crypt assay, was not affected by GBE. CONCLUSION: Ginkgo biloba extract enhances radiation effect on tumor without increasing acute normal tissue radiation damage in this model system probably by increasing tumor blood flow and further investigation for this possible radiosensitizer is needed.

Prospective study of microvascular decompression in hemifacial spasm.

OBJECTIVES: Although, in most cases, the symptoms of hemifacial spasm (HFS) disappear immediately after microvascular decompression (MVD), in some cases, they disappear more gradually. The objectives of this study were to observe the time course and the rate of the delayed resolution and to attempt to explain the phenomenon through long-term follow-up of HFS after MVD. METHODS: Two hundred and sixty-one patients with HFS who underwent MVD were followed up to observe clinical changes. Two hundred and twenty-six of the 261 patients were followed up for a duration of 6 months to 2 years, from 1985 to 1995. RESULTS: After the 1st week of the surgery, 61.1% of the patients were rated as having achieved excellent results. When the patients were followed up for more than 6 months, however, the rate improved to 82.7%. The clinical results of HFS after MVD improved significantly with time (P < 0.05). Delayed resolution of HFS was observed in 37.4% of the patients who experienced complete resolution; it was the most important factor for clinical improvement during the follow-up period. Abnormal muscle response immediately after MVD in the operating room was also positively correlated with resolution during the follow-up period (correlation coefficient = 0.3099, P < 0.05). CONCLUSIONS: In conclusion, the clinical picture of HFS after MVD improves with time, and abnormal muscle response can be used as a prognostic indicator for the resolution of HFS during the follow-up period.

Computer-aided design optimization with the use of a fast dose model for linear-accelerator-based stereotactic radiosurgery.

In order to efficiently plan non-spherical radiosurgical targets we have used computer-aided design optimization techniques with a fast dose model. A study of the spatial dose distribution for single or multiple non-coplanar arcs was carried out using a 18 cm diameter spherical head model. The dose distribution generated from the 3D dose computation algorithm can be represented by a simple analytic form. Two analytic dose models were developed to represent the dose for preset multiple non-coplanar arcs or a single arc: spherical and cylindrical. The spherical and cylindrical dose models compute dose quickly for each isocentre and single arc. Our approach then utilizes a computer-aided design optimization (CAD) with the use of two fast approximate dose models to determine the positions of isocentres and arcs. The implementation of CAD with fast dose models was demonstrated. While the fast dose models are only approximations of the true dose distribution, it is shown that this approximate model is sufficient to optimize isocentric position, collimator size and arc positions with CAD.

Adenoid cystic carcinoma of the head and neck.

Adenoid cystic carcinoma of the head and neck is relatively rare and is characterized by slow evolution, multiple recurrences, protracted clinical course, and late distant metastasis. This article presents its peculiar clinical course, response to therapy, and long-term treatment results by analyzing 67 cases treated from 1979 to 1991 at the Seoul (Korea) National University Hospital. The most common primary site was the parotid gland in the major salivary glands and the nose and paranasal sinuses in the minor salivary glands. The local control rate was 71.1% at 5 years and 44.3% at 8 years. Late-occurring distant metastases did not allow a plateau in survival curves, even after 8 years. Our study also revealed that surgery combined with postoperative radiotherapy could yield better local control.

Spectrofluorimetric determination of iron(III) with 2-pyridinecarbaldhyde-5-nitro-pyridylhydrazone in the presence of hexadecyltrimethylammonium bromide surfactant.

2-pyridinecarbaldehyde-5-nitro-pyridylhydrazone (2PC-5NPH) was synthesized and its application in the spectrofluorimetric determination of Fe(III) ions in the presence of surfactants was examined. An emission peak of 2PC-5NPH, which increased remarkably by the addition of Fe(III), occurs at 420 nm upon excitation at 300 nm, and allows for the sensitive, selective determination of the ferric ion in the 0.20-1.45 mug ml(-1) range. The detection limit is 0.028 mug ml(-1) in the presence of hexadecyltrimethylammonium bromide (CTMAB).

Spectrophotometric determination of trace amounts of cobalt with 2-hydroxybenzaldehyde-5-nitro-pyridylhydrazone in presence of surfactant after separation with Amberlite IRC-718 resin.

2-Hydroxybenzaldehyde-5-nitro-pyridylhydrazone (2HB-5NPH) was synthesized and its application in the spectrophotometric determination of metal ions was studied in the presence of surfactants. A separation procedure, using a short column filled with Amberlite IRC 718, is proposed for the spectrophotometric determination of traces of cobalt. The influence of several ions, as interference, was discussed. The procedure was applied to determination of cobalt in mixture sample with satisfactory results (>/=recovery 96%; relative error

Postembryonic development of leucokinin-like immunoreactive neurons in the moth Spodoptera litura.

Antiserum to leucokinin I, a neuropeptide originally isolated from the cockroach Leucophaea maderae, was used for immunocytochemical labeling of neurons in the brain and ventral ganglia of the moth Spodoptera litura during postembryonic development. In the ventral ganglia, leucokinin-like immunoreactivity begins to occur in the abdominal ganglion A3 to A7 of first instar larva. One to two weakly labeled pairs of bilateral LK-LI cell bodies are located in the subesophageal ganglion of fourth to sixth instar larvae and in the abdominal ganglia A1 to A7 of second to sixth instar larvae. The abdominal ganglion A1 of fourth to sixth instar larvae and A8 of sixth instar larva each contain one weakly labeled pair of median LK-LI cell bodies. Two strongly labeled pairs of bilateral LK-LI neurons are found in A3 to A7 of third to sixth instar larvae. Abdominal ganglia A1 to A8 of prepupa, pupa and adult contain one to three weakly labeled pairs of bilateral LK-LI neurons. Two strongly labeled pairs of bilateral LK-LI neurons in each of the abdominal ganglia of larva, prepupa, pupa and adult send axons to the neuropil, and then each axon bifurcates into two axonal branches. Theses axonal branches from two bundles. From each of the two pairs of neurons an axon exits through the posterior ventral nerve (N2) which runs to the transverse nerve of the next posterior segment. In larval brains, 2-16 pairs of bilateral LK-LI cell bodies can be found together with LK-LI processes in the central neuropil. The larval brains show large changes in the number of LK-LI neurons throughout postembryonic development. The number of LK-LI cell bodies are reduced in number from sixth instar larval brain. Therefore, prepupal, pupal and adult brains contain a smaller number of LK-LI cell bodies. Two pairs of LK-LI median neurosecretory cells located immediately beside the pars intercerebralis in larval brains increase to three pairs in the 7-day-old pupal brain. In the adult, however, LK-LI median neurosecretory cells decrease to one pair.

Transection and occlusion of lateral semicircular canal in guinea pigs.

Audiologic and histopathologic examinations were made after occlusion of the lateral semicircular canal in eight guinea pigs. The lateral semicircular canal was drilled out, and then the canal lumens were plugged with muscle pieces. After a serial recording of auditory brain stem responses for 2 months, histologic specimens of the temporal bones were prepared in the lateral semicircular canal plane. One animal developed profound hearing loss due to suppurative labyrinthitis. The other seven animals showed no significant threshold elevation during this period. Histopathologic examination revealed that the bone defect on the lateral canal was replaced with newly formed bone; the perilymphatic and endolymphatic spaces maintained their compartmentalization; and the membranous endolymphatic canal healed to form complete blind ducts. These findings suggest that proper management of the injured semicircular canal is important for maintenance of postoperative hearing.

Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy.

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.

Spinal cord injury caused by a stab wound--a case report.

The authors present a case of incomplete spinal cord injury (Brown Sequard syndrome) after a stab wound. A direct history and examination revealed that the patient was stabbed in the back while fighting with his friends. He immediately lost motor and sensory function in the lower extremities and collapsed to the ground. The patient was given primary closure after wound toilet and was treated with antibiotics. With rehabilitation he became ambulatory with a cane and long leg brace two months after the stabbing.

Comparison of sympathetic skin response and digital infrared thermographic imaging in peripheral neuropathy.

It is well known that the SSR (sympathetic skin response) is to evaluate the function of sudomotor activity and Digital infrared thermal imaging (DITI) is to evaluate the function of vasomotor activity of the sympathetic nerve. To assess the sympathetic nerve impairment in the patients with peripheral neuropathy, the SSRs and DITIs were tested in 35 cases. Twenty-four (68.6%) patients were abnormal on SSR test and twenty-nine (82.9%) patients were abnormal on DITI test. In the relationship between DITI and SSR, 19 (54.3%) cases were abnormal and 1 case was normal finding in both of these two tests. And the remaining 25 (42.9%) patients were abnormal on only either one of both tests. Frequency of abnormal SSR and DITI findings were correlated with severity of axonal involvement in peripheral nerve lesion. The results of this study revealed DITI to be more sensitive test in assessing sympathetic dysfunction in peripheral neuropathy than the SSR. However DITI has very limited values in the patients with symmetrically involved peripheral neuropathy because thermal asymmetry is considered as abnormal on DITI. Therefore, in assessing the function of sympathetic nerve in peripheral neuropathy, combined tests of SSR and DITI are useful.