Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach.

BACKGROUND: The superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target site. METHODS: Of the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively analyzed. RESULTS: All patients who had undergone the STA had incisional AFL rotated in a long loop within the right atrium (RA) and cavo-tricuspid isthmus (CTI)-dependent AFL. The linear lesions were created in the CTI, the superior RA vestibule, and between the RA-free wall incision or the septal incision and the inferior vena cava. Procedural success was achieved with dual linear lesions in the CTI and superior RA vestibule. Two of seven patients had AFL recurrence during a mean observation period of 22.5 ± 16.7 months. The circuits of recurrent AFL were CTI-dependent AFL and perimitral AFL, respectively. No AFL recurrence was noted with reconduction of the superior RA vestibular lesion. CONCLUSION: Dual linear lesions in the CTI and superior RA vestibule are an effective treatment option for RA macroreentrant AFL after the STA.

A novel approach to typical atrioventricular nodal reentrant tachycardia with high-resolution mapping using the CARTO 3 cardiac mapping system.

BACKGROUND: We hypothesized that high-resolution activation mapping during sinus rhythm (SR) in Koch's triangle (KT) can be used to describe the most delayed atrial potential around the atrioventricular node and evaluated whether ablation targeting of this potential is safe and effective for the treatment of patients with typical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS: We conducted a prospective, non-randomized, observational study using high-resolution activation mapping from the sinus node to KT with a PENTARAY or OCTARAY catheter using the CARTO 3 cardiac mapping system (Biosense Webster) during SR in 62 consecutive patients (22 men; age [mean ± standard deviation] = 55 ± 14 years) treated for typical AVNRT at our institution from August 2021 to March 2023. RESULTS: In all cases, the most delayed atrial potential was observed near the His potential within KT. Ablation targeting of this potential helped successfully treat each case of AVNRT, with a junctional rhythm observed at the ablation site. Initial ablation was deemed successful in 55/62 patients (89%); in the remaining seven patients, lesion expansion resolved AVNRT. One procedural complication occurred, namely, a transient atrioventricular block lasting 45 s. One patient experienced a transient tachycardic episode by the 1-month follow-up, but no further episodes were noted up to the 1-year follow-up. CONCLUSION: Activation mapping at KT during SR with the high-resolution CARTO system clearly revealed the most delayed atrial potential near the His potential within KT. Targeting this potential was a safe and effective treatment method for patients with typical AVNRT in our study.

Comparison of lengths of hospital stay after surgery and mortality in elderly hip fracture patients between Japan and the United States - the relationship between the lengths of hospital stay after surgery and mortality.

PURPOSE: To examine whether the length of stay (LOS) after hip fracture surgery was related to mortality after discharge by comparing between hospitals in Japan and the United States (US). METHOD: This is a retrospective observational study of three hospitals in Japan and two in the Pacific Northwest in the US. The median follow-up day was 276 days after surgery. The participants were 65 years or older who had experienced hip fracture and were admitted to one of the study hospitals for surgery. RESULTS: The median LOS after surgery was 34 days in Japan and 5 days in the US. The survival rate was 89.5% in Japan and 77.2% in the US among patients who could be followed-up. In the Cox regression, every 10 day increase in the LOS after surgery was associated with a 26% reduction in the risk of mortality (Hazard ratio = 0.744, p = 0.014) after adjusting for LOS before surgery, patients' basic characteristics, number of complications and country. CONCLUSIONS: Shorter lengths of stay after surgery did not predict better survival across the two countries. Larger longitudinal or randomized studies that determine the effects of LOS after surgery on mortality are necessary.

Comparison of outcomes and costs after hip fracture surgery in three hospitals that have different care systems in Japan.

Hip fracture is a medical and socioeconomic problem among the 65 years and older population in Japan. Length of hospital stay in Japan is much longer than other developed countries, and the Japanese government has tried to reduce length of stay in order to reduce medical expenditures. The objective of this study was to compare outcomes and costs of health care services for patients with hip fracture surgery among three hospitals with different care systems in Japan. Medical records of patients who were 65 years or older, who had hip fracture surgery within the past 2.5 years were reviewed. A questionnaire was sent to patients and/or their family members to ask patients' health outcomes and approximate costs of care after discharge. Initial hospitalization costs, costs of subsequent transitional care hospital, elders' care services and family's salary loss were estimated and compared among the three hospitals after adjusting for patients' characteristics and treatments. The response rate of the questionnaire was 70% (n=149/211). Patients' outcomes (mortality and ambulatory ability) after discharge were comparable. Hospitals that had shorter lengths of stay reduced costs to themselves, but did not reduce overall costs including care after discharge; however, costs were even higher because patients stayed in subsequent hospitals longer and/or used more elders' care services. Reducing the length of stay in the initial acute care hospitals could be just a method of cost-shifting to subsequent care services and is unlikely to bring an overall cost-savings to the Japanese health care system.

[A case of nail candidiasis with severe deformities treated with oral fluconazole].

We report a case of nail candidiasis with severe deformities. The patient was a 71-year-old woman who initially consulted our department on April 5, 2006. She had diabetes, chronic rheumatoid arthritis and multiple liver metastasis of unknown origin. She had taken prednisolone for treatment of chronic rheumatoid arthritis for a long period. The initial examination demonstrated deformation of 1/3 of the inner part of the nail plate in both the third and fourth fingers, with apparent hyperkeratosis under the deformed nail plates. KOH-prepared direct microscopy revealed the presence of numerous spores and pseudohyphae. Numerous fungal elements were detected by Grocott staining and PAS staining. Candida albicans was isolated and identified by cultivation on the ATG agar and PCR-RFLP. Fluconazole (100 mg/day) was administered from April 8, 2006. After 14 weeks of treatment her clinical findings had improved, however she died of multiple organ failure on July 25, 2006.

[Comparative study between culture and PCR-RFLP analysis on identification of the causative agent of Tinea Unguium].

BACKGROUND: To identify the pathogenic fungi of dermatophytosis, restriction fragment length polymorphism (RFLP) analysis of PCR amplified ribosomal DNA including internal transcribed spacers (ITS) has been established in Japan. Our purpose was to evaluate the usability of PCR-RFLP analysis to identify the causative agent of tinea unguium directly from a nail sample. METHOD: Samples of tinea unguium from 100 nails were collected and cultured on Sabouraud's glucose agar and observed for 2 months. DNA was extracted from these samples, and the PCR product was digested with restriction enzymes Mva I and Hinf I. Weight of the samples was determined. RESULT: Sensitivity of PCR-RFLP analysis (73%) was higher than that of culture (20%) showing that PCR is more advantageous for identification of the causative agent of tinea unguium. Sensitivity of PCR-RFLP did not depend on weight of the nail sample.

[Evaluation of the efficacy of miconazole nitrate shampoo for prevention against T. tonsurans infection].

UNLABELLED: We report the efficacy of miconazole nitrate shampoo (Furfur Shampoo) to prevent T. tonsurans infection. METHOD: Experimental models were made from stratum corneum of healthy human heel or guinea pig skin. Before and/or after T. tonsurans was applied, samples were washed with miconazole nitrate shampoo, then inoculated on a Sabouraud culture plate. RESULT: Though miconazole nitrate shampoo did not eliminate T. tonsurans on the sample completely, the time required to develop the colony (9.9 days) was obviously extended (7.7 days by control). DISCUSSION: We concluded that miconazole nitrate shampoo is a useful method of preventing T. tonsurans infection, and should be used every day (before/after the chance to infect).