Limited fluoroscopy catheter ablation of accessory pathways in children.

BACKGROUND: Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. METHODS: Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). RESULTS: The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications. CONCLUSIONS: A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.

Welcomed triplets following gestation with retained intrauterine device.

Multiple gestations with concurrent intrauterine devices (IUDs) are rare events. We handled the case of a woman who discovered she was pregnant with triplets after the 12th week of gestation. Upon the mother's request the IUD was removed immediately and the pregnancy led a normal course until the planned caeserean delivery of three baby girls. This is the first report of triplet births after an early sharing occupancy of the narrow uterine cavity with an IUD. Such a gestation upon discovery should not automatically be presumed undesirable. Especially when faith issues are predominant such cases may end with satisfied parents as demonstrated in this case.

Modified sleeve method treatment of ingrown toenail.

BACKGROUND: Ingrown toenail is a common problem that causes inconvenience, pain, and limitation of daily function. Current conventional treatment methods are not satisfactory and have a high recurrence rate. OBJECTIVE: To evaluate a modification of an existing, although uncommonly used, method for treating ingrown toenail. METHODS: Patients with ingrown toenail were treated under local anesthesia by insertion of a flexible narrow plastic tube under the toenail along its lateral border. Tube fixation was performed with silk or nylon 2-0 sutures passed through the toenail. Granulomatous and inflamed tissue was removed by electrocautery or local excision. RESULTS: Twenty-eight procedures were performed in 25 patients. In 20 procedures (71.4%), no recurrences were recorded; the other 8 procedures (28.6%), were symptomatic. CONCLUSION: This method for the treatment of ingrown toenail was found to be simple and efficient, with a relatively low recurrence rate. Therefore we currently advocate this procedure as the treatment of choice.