Hybrid convergent procedure with proactive oesophageal cooling for the treatment of long-standing persistent atrial fibrillation: a case series.

Background: The hybrid convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal oesophageal temperature (LET) monitoring, oesophageal injury is still possible. A dedicated device for proactive oesophageal cooling has recently been cleared by the Food and Drug Administration to reduce the likelihood of ablation-related oesophageal injury resulting from radiofrequency cardiac ablation procedures. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of hybrid convergent procedures. Case summary: Five patients with long-standing persistent AF underwent hybrid convergent ablations with the use of proactive oesophageal cooling as means of oesophageal protection. All cases were completed successfully with no adverse effects. Most notably, cases were shorter when compared to cases using LET monitoring, likely due to lack of pauses for overheating of the oesophagus that would otherwise be required to prevent damage to the oesophagus. Discussion: This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of five hybrid convergent procedures. Use of cooling enabled uninhibited deployment of lesions without the need to pause energy delivery due to elevated temperatures in the oesophagus, providing a feasible alternative to LET monitoring.

Itchy scalp with scale.

The patient had a history of treatment for head lice, but a dermatoscopic exam revealed that lice weren't to blame for his itchy scalp.

Facial swelling in an adolescent.

Clinical findings, as well as the patient's age and sex, pointed to the diagnosis.

Incomplete superficial palmar arch and bilateral persistent median artery.

INTRODUCTION: The superficial palmar arch (SPA) is a major source of blood supply to much of the hand and is conventionally formed by the anastomosis of the ulnar artery with the superficial branch of the radial artery. The SPA has been classified into complete or incomplete based on the presence or absence of anastomosis between the arteries contributing to the formation of this palmar arch. CASE REPORT: Reported here is a unilateral presentation of incomplete superficial palmar arch. The ulnar artery (UA) gave off one proper palmar digital artery, which supplied the ulnar side of the little finger, and two common palmar digital arteries, which supplied the little, ring, and the middle finger. The superficial palmar branch of the radial artery gave off a proper palmar digital artery to the thumb, and two common palmar digital arteries, which supplied the thumb, index, and middle fingers. Apart from the presence of the incomplete SPA, persistent median arteries were also observed bilaterally in this cadaver. DISCUSSION: The prevalence of incomplete SPA has been reported to vary between 3.6-54.76%. To the best of our knowledge, this is the first case report describing an incomplete palmar arch and bilateral persistent median artery in a cadaver. CONCLUSION: Patients should be screened for the presence of complete or incomplete SPA before harvesting the radial artery either for myocardial revascularization or for radial artery forearm flap to prevent ischemic complications in the hand.

Is It "In" to Wear Scrubs Out?

OBJECTIVE: This study aimed to identify differences in perceptions between healthcare and non-healthcare personnel when it comes to wearing scrubs in non-healthcare settings. METHODS: An anonymous survey with 11 closed-ended questions sent via e-mail to healthcare students and employees at The University of Texas Health San Antonio and non-healthcare students and employees at The University of Texas at San Antonio. The answers were scored from 1 to 5 for each question, with a total score ranging from 11-55. Total scores were analyzed and compared between the two groups using a sample t test. RESULTS: 2730 people responded to the survey. The mean healthcare-related group responses scored 33.96 ± 7.65, while the non-healthcare group scored 34.47 ± 8.08, (p=0.096). CONCLUSIONS: In this study, we found no significant difference in attitudes about wearing scrubs in public between healthcare and non-healthcare; it appears that both groups are concerned about wearing scrubs in public. Both groups agree with the value of wearing scrubs in the clinical settings only. Healthcare professionals in this study did not endorse the need to change out of scrubs after work, while non-healthcare subjects believed changing one's scrubs before leaving a clinical setting was proper. The authors believe healthcare institutions should emphasize wearing scrubs only in professional circumstances, make a distinction between uniform and surgical scrubs, provide clean surgical scrubs to their employees, and designate locker rooms to encourage staff to change before the end of the work period.