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1.
World J Gastroenterol ; 27(23): 3413-3428, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34163121

RESUMO

BACKGROUND: Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs. AIM: To report an overview and updates on ablative techniques in pancreatic cancer. METHODS: Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the found papers were analysed for papers not indexed in the electronic databases. All titles and abstracts were analysed. RESULTS: We found 30 studies (14 studies for RFA, 3 for microwave therapy, 10 for IRE, and 3 for electrochemotherapy), comprising 1047 patients, which were analysed further. Two randomized trials were found for IRE. Percutaneous and laparotomy approaches were performed. In the assessed patients, the median maximal diameter of the lesions was in the range of 2.8 to 4.5 cm. All series included patients unfit for surgical treatment, but Martin et al assessed a subgroup of patients with borderline resectable tumours who underwent resection with margin attenuation with IRE. Most studies administered chemotherapy prior to ablative therapies. However, several studies suggest that the key determinant of improved survival is attributable to ablative treatment alone. Nevertheless, the authors suggested chemotherapy before local therapies for several reasons. This strategy may not only downstage a subgroup of patients to curative-intent surgery but also support to recognize patients with biologically unfavourable tumours who would likely not benefit from ablation treatments. Ablation therapies seem safe based on the 1047 patients assessed in this review. The mortality rate ranged from 1.8% to 2%. However, despite the low mortality, the reported rates of severe post procedural complications ranged from 0%-42%. Most reported complications have been self-limiting and manageable. Median overall survival varied between 6.0 and 33 mo. Regarding the technical success rate, assessed papers reported an estimated rate in the range of 85% to 100%. However, the authors reported early recurrence after treatment. A distinct consideration should be made on whether local treatments induce an immune response in the ablated area. Preclinical and clinical studies have shown that RFA is a promising mechanism for inducing antigen-presenting cell infiltration and enhancing the systemic antitumour T-cell immune response and tumour regression. CONCLUSION: In the management of patients with pancreatic cancer, the possibility of a multimodal approach should be considered, and conceptually, the combination of RFA with immunotherapy represents a novel angle of attack against this tumour.


Assuntos
Técnicas de Ablação , Ablação por Cateter , Neoplasias Pancreáticas , Ablação por Radiofrequência , Técnicas de Ablação/efeitos adversos , Ablação por Cateter/efeitos adversos , Eletroporação , Humanos , Pâncreas , Neoplasias Pancreáticas/cirurgia
2.
Methodist Debakey Cardiovasc J ; 17(1): 8-12, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104314

RESUMO

Catheter ablation is an established treatment strategy for ventricular arrhythmias. However, the presence of intramural substrate poses challenges with mapping and delivery of radiofrequency energy, limiting overall success of catheter ablation. Advances over the past decade have improved our understanding of intramural substrate and paved the way for innovative treatment approaches. Modifications in catheter ablation techniques and development of novel ablation technologies have led to improved clinical outcomes for patients with ventricular arrhythmias. In this review, we explore mapping techniques to identify intramural substrate and describe available radiofrequency energy delivery techniques that can improve overall success rates of catheter ablation.


Assuntos
Ablação por Cateter , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/diagnóstico por imagem , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
3.
Methodist Debakey Cardiovasc J ; 17(1): 13-18, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104315

RESUMO

Catheter ablation is an effective treatment method for ventricular arrhythmias (VAs). These arrhythmias can often be mapped and targeted with ablation from the left and right ventricular endocardium. However, in some situations the VA site of origin or substrate may be intramural or epicardial in nature. In these cases, the coronary venous system (CVS) provides an effective vantage point for mapping and ablation. This review highlights situations in which CVS mapping may be helpful and discusses techniques for CVS mapping and ablation.


Assuntos
Ablação por Cateter , Vasos Coronários/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Flebografia , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
4.
Methodist Debakey Cardiovasc J ; 17(1): 73-74, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104326

RESUMO

The column in this issue is supplied by Drs. Benjamin Lee, MD, and Usman Ansari, DO. Dr. Lee is an assistant professor of clinical medicine at the Houston Methodist Institute for Academic Medicine and Weill Cornell Medical College. After earning his medical degree at Harvard Medical School, Dr. Lee completed a residency in internal medicine and a nephrology fellowship at the University of California San Francisco (UCSF) while simultaneously obtaining a master of advanced study in clinical research from the UCSF departments of Epidemiology and Biostatistics. He maintains his clinical practice with the Houston Kidney Consultants. Dr. Ansari earned a Doctor of Osteopathy from Touro University College of Osteopathic Medicine in California and is completing his internal medicine residency at Houston Methodist.


Assuntos
Ablação por Cateter , Hipertensão/cirurgia , Rim/irrigação sanguínea , Rim/inervação , Artéria Renal/inervação , Simpatectomia , Sistema Nervoso Simpático/cirurgia , Pressão Sanguínea , Ablação por Cateter/efeitos adversos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Simpatectomia/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(19): e25942, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106664

RESUMO

ABSTRACT: Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.


Assuntos
Ablação por Cateter/métodos , Fístula/cirurgia , Laringoscopia/métodos , Seio Piriforme/anormalidades , Seio Piriforme/cirurgia , Adolescente , Antibacterianos/administração & dosagem , Ablação por Cateter/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Laringoscopia/efeitos adversos , Tempo de Internação , Masculino , Recidiva , Estudos Retrospectivos
6.
Int J Hyperthermia ; 38(1): 976-984, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34167409

RESUMO

BACKGROUND: An intrathoracic goiter (ITG) is defined as a thyroid extension below the sternal notch. Compared to cervical goiters, surgery for ITG is more challenging, with a higher risk of an extracervical approach. Ultrasound (US)-guided radiofrequency ablation (RFA) is a minimally invasive treatment modality. The purpose of this study was to prospectively evaluate the safety and efficacy of RFA in patients with ITG. METHODS: From a total of 324 patients who underwent thyroid RFA at a single medical center, 15 patients (mean age 52.2 years; 73.3% female) with 16 ITGs were included and classified into three grades and three types using the cross-section imaging CT system. Clinical features and demographics, degree of extension, RFA details, goiter volume, and complications were analyzed. RESULTS: Mean pre- and post-RFA goiter volumes as measured by US were 106.62 ± 61.82 and 25.09 ± 14.22 mL respectively, with a volume reduction rate (VRR) of 75.5% (p < 0.001) at 6 months. The VRR as measured by CT/MRI was 57.0 ± 10.0% (p < 0.001) at 6 months. The intrathoracic length reduction rate at 6 months was 44.9 ± 39.2% (p = 0.001). In addition, 4 (25%) ITGs had total regression of the intrathoracic extension, with a downgrade from grade 1 to cervical goiter. Mean pre- and post-RFA symptom and cosmetic scores were 1.53 and 0.15 (p = 0.001), and 2.67 and 2.00 (p = 0.001), respectively. One patient had transient vocal cord palsy and another had perithyroidal and mediastinal hemorrhage. CONCLUSION: US-guided RFA is an effective treatment for ITG in terms of both cervical and intrathoracic reductions with an acceptable complication rate.


Assuntos
Ablação por Cateter , Bócio Subesternal , Ablação por Radiofrequência , Ablação por Cateter/efeitos adversos , Feminino , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
7.
Nutr Metab Cardiovasc Dis ; 31(6): 1798-1808, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-33985896

RESUMO

BACKGROUND AND AIMS: The nutritional risk of patients who undergo atrial fibrillation (AF) ablation varies. Its impact on the recurrence after ablation is unclear. We sought to evaluate the relationship between the nutritional risk and arrhythmia recurrence in patients who undergo AF ablation. METHODS AND RESULTS: We enrolled 538 patients (median 67 years, 69.9% male) who underwent their first AF ablation. Their nutritional risk was evaluated using the pre-procedural geriatric nutritional risk index (GNRI), and the patients were classified into two groups: No-nutritional risk (GNRI â‰§ 98) and Nutritional risk (GNRI < 98). The primary endpoint was a recurrence of an arrhythmia, and its relationship to the nutritional risk was evaluated. We used propensity-score matching to adjust for differences between patients with a GNRI-based nutritional risk and those without a nutritional risk. A nutritional risk was found in 10.6% of the patients, whereas the remaining 89.4% had no-nutritional risk. During a mean follow-up of 422 days, 91 patients experienced arrhythmia recurrences. The patients with a nutritional risk had a significantly higher arrhythmia recurrence rate both in the entire study cohort (Log-rank p = 0.001) and propensity-matched cohort (Log-rank p = 0.006). In a Cox proportional hazard analysis, the nutritional risk independently predicted arrhythmia recurrences in the entire study cohort (hazard ratio [HR]: 3.91, 95% confidence interval [CI]: 1.84-8.35, p < 0.001) and propensity-matched cohort (HR: 6.49, 95% CI: 1.42-29.8, p = 0.016). CONCLUSION: A pre-procedural malnutrition risk was significantly associated with increased arrhythmia recurrences in patients who underwent AF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Avaliação Geriátrica , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Desnutrição/complicações , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Eur J Radiol ; 140: 109635, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34024632

RESUMO

BACKGROUND: Postoperative major complications are potentially fatal to recurrent hepatocellular carcinoma (RHCC) patients. We aimed to construct a prediction model of major complications after RFA for RHCC patients. METHODS: We retrospectively reviewed the medical records of 407 RHCC patients who underwent RFA as second treatment. Patients were divided into two groups according to the date of RFA: training cohort (277 patients treated in 2010-2016) and validation cohort (130 patients treated in 2017-2019). 23 clinicopathological variables were recorded and analyzed. The logistic regression model was used to build a prediction model. RESULT: Major complications developed in 3.6 % of RHCC patients after RFA. In the multivariate analysis, tumor adjacent vessels (p = 0.004) and hepatitis C (p = 0.022) were associated with postoperative complications. The prediction model was described as follow: Risk score (major complication) = 5.180 + 3.391*tumor location+3.389*hepatic etiology, the Youden index was 0.642, the best cut-off value of the model was 8.57 (sensitivity, 78.57 %, specificity, 84.03 %). The area under the receiver operating characteristic curve of the predictive model was 0.85 (95 % CI, 0.82 to 0.88). The validation of the model demonstrated acceptable results, the sensitivity was 80.00 %, specificity was 98.40 %. CONCLUSIONS: This study developed a simple and reliable prediction model of postoperative major complications after RFA for RHCC patients.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/efeitos adversos , Humanos , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
9.
World J Gastroenterol ; 27(18): 2205-2218, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34025074

RESUMO

BACKGROUND: Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria. AIM: To evaluate short- and long-term outcome in elderly patients (> 70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA. METHODS: The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression. RESULTS: After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Disease-free survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo III-IV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (> 10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (> 1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (> 10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate. CONCLUSION: Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (> 70 years) with HCC in Milan criteria.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Doença Hepática Terminal , Neoplasias Hepáticas , Ablação por Radiofrequência , Idoso , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
J Int Med Res ; 49(5): 3000605211014375, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33983087

RESUMO

OBJECTIVE: The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. METHODS: This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. RESULTS: The median duration of PAF was 24 (3-60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191-3.004; hazard ratio=0.665, 95% confidence interval: 0.134-3.300, respectively). Kaplan-Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. CONCLUSIONS: FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência da Valva Mitral , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Veia Cava Superior/cirurgia
12.
Expert Rev Med Devices ; 18(5): 445-455, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33886427

RESUMO

INTRODUCTION: Advances in catheter design for minimally invasive surgery have brought about the incorporation of contact force (CF) sensors in catheters. Two main approaches to achieve CF sensing at the catheter end-effector consist of fiber optic or magnetic solutions. CF sensing feedback can be used to assist in ablation procedures, mapping cardiac regions, identifying tissue characteristics, and enhancing robotic catheter control. AREAS COVERED: This review covers the technological and clinical aspects of CFS in catheters. Contact force and force-time integral thresholds for ablation procedures, procedural complications, and electroanatomical mapping strategies are discussed. Future applications of improving catheter control, minimizing complications, and enhancing mapping techniques through CF are examined. EXPERT OPINION: Fiber optic CF catheters may be more desirable compared to magnetic modalities due to the lower cost, compactness, and higher accuracy. In ablation procedures, complications due to higher ablation duration, power, contact force, and force time can be reduced through practical experience and informed training for catheter operators. Future prospects consist of the incorporation of CF sensors with remote catheter systems to assist in catheter control. We propose that CF can also be used in machine learning decision-making algorithms to prevent complications or improve tissue characterization.


Assuntos
Cateteres Cardíacos/tendências , Fenômenos Mecânicos , Ablação por Cateter/efeitos adversos , Tecnologia de Fibra Óptica , Humanos , Magnetismo , Resultado do Tratamento
14.
Int J Cardiol ; 333: 110-116, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33647366

RESUMO

INTRODUCTION: Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation. PURPOSE: To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL. METHODS: We identified patients undergoing first-time CTIA during the period 2010-2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018. RESULTS: We identified 2409 consecutive patients. Median age was 66 (IQR 58-72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21). CONCLUSION: In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Acidente Vascular Cerebral , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
15.
J Card Surg ; 36(6): 2108-2112, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33522643

RESUMO

Left ventricular (LV) rupture after radiofrequency catheter ablation (RFCA) is a rare but life-threatening complication. We describe a case of LV rupture secondary to RFCA successfully treated with a transaortic, intraventricular patch exclusion surgical repair, assisted by transoesophageal echocardiography and epicardial ultrasound assessment. Patch exclusion technique can offer a physiological repair with better preservation of myocardial mechanical characteristics and possibly less damage to healthy myocardium and surrounding structures.


Assuntos
Ablação por Cateter , Ablação por Cateter/efeitos adversos , Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Resultado do Tratamento
16.
Nefrología (Madrid) ; 41(1): 41-44, ene.-feb. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-199571

RESUMO

La presencia de una pieza de metal en el extremo de los catéteres autoposicionantes provoca dudas e incertidumbres a la hora de realizar una resonancia magnética (RM) a pacientes que portan este tipo de catéter. Simulamos un peritoneo con un catéter lastrado para comprobar el comportamiento del catéter durante la realización de una resonancia en equipos 1,5 T y 3 T. Y revisamos los casos en los que se realizaron RM en pacientes con este tipo de catéter. En la simulación, la punta del catéter peritoneal autoposicionante provoca un artefacto de susceptibilidad magnética que dificulta la visión de zonas cercanas, pero se comporta como dispositivo seguro para la RM. Se realizaron 14 RM en pacientes con catéteres autoposicionantes, ninguna en la zona abdominal. No hubo complicaciones en los pacientes ni en la técnica tras la realización de RM


The fact that self-locating catheters have a piece of metal at the tip leads to doubt and uncertainty around performing magnetic resonance imaging (MRI) in patients with this type of catheter. We simulated a peritoneum with a weighted catheter to ascertain how the catheter behaved during MRI scans in 1.5 T and 3 T machines. We also reviewed cases in which MRI had been performed in patients with this type of catheter. In the simulation, the tip of the self-locating peritoneal catheter caused a magnetic susceptibility artefact that made it difficult to see nearby areas, but it proved to be a safe device for MRI. 14 MRI scans were performed in patients with self-locating catheters, none in the abdominal area. There were no complications in the patients or the technique after performing MRI


Assuntos
Cateteres de Demora/efeitos adversos , Cavidade Peritoneal/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Simulação de Doença/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Espectroscopia de Ressonância Magnética
17.
J Med Vasc ; 46(1): 3-8, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546819

RESUMO

BACKGROUND: Endovenous treatment of lower limb varicose veins is progressively replacing conventional surgery. The authors are investigating radiofrequency (RFA) results in terms of vein occlusion, complications, patient's satisfaction and quality of life in a single centre. METHODS AND MATERIALS: A retrospective analysis of medical charts with a prospective follow-up was performed on data about patients undergoing RFA for insufficiency of great saphenous vein (GSV). RESULTS: A total number of 135 patients (164 limbs) (63% n 85 female; 37% n 50 male; mean age of 53.9 years, range 24-85 years; mean VCSS score (Venous Clinical Severity Score) 6, range 4-22) were included. Complete obliteration of GSV was obtained in 98.2% of the cases. No device- or procedure-related adverse events occurred. No deep venous thromboses, pulmonary embolism, phlebitis, major bleeding, paraesthesia nor skin burn were detected. Patients returned to normal activities in a mean of 8 days (range 5-10). One-month postoperatively, the mean quality of life scores 6 (range 5-9) and mean satisfaction score was 6 (range 4-8) in a scale from 0 to 8. At a median follow-up of 11 months (range 2-18), mean VCSS was 3.9 (range 2-8). CONCLUSIONS: Radiofrequency guarantees good functional outcomes and low rate of complications. It is associated with high satisfaction rate and quality of life score.


Assuntos
Ablação por Cateter , Qualidade de Vida , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Medicine (Baltimore) ; 100(6): e24595, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578560

RESUMO

ABSTRACT: Gastroesophageal reflux (GER) in radiofrequency catheter ablation (RFCA) occurs due to vagal plexus damage during pulmonary vein isolation. We hypothesized that the frequency of GER in the oropharynx will be less compared to other areas (low-esophagus, mid-esophagus). We confirmed the frequency of GER before and after RFCA in 3 areas.We studied 30 patients who were scheduled for RFCA under general anesthesia. Anesthesia was performed using supraglottic devices (SGD) with a suction port. Two esophageal temperature probes capable of suction and measuring temperature were inserted through the suction port. The pH of the 3 areas was measured before and after the RFCA at 3 areas (mid-esophagus, low-esophagus, and oropharynx).GER was observed in 13 of 30 patients (43%). In one patient, it was observed in the oropharynx, in 4 patients it was observed in the mid-esophagus, and in 13 patients, it was observed in the low-esophagus. For patients with GER at the oropharynx and mid-esophagus, it was also observed at the low-esophagus. The difference in the pH before and after the RFCA was not significant at the oropharynx and mid-esophagus (P = .726 and P = .424, respectively), but it was significantly different at the low-esophagus (P < .001). The total ablation time was longer in the GER group compared to the non-GER group (P = .021).GER after RFCA occurred in 43% of patients, only 1 patient in the oropharynx. And aspiration pneumonia after SGD extubation did not occur. Therefore, the use of SGDs in RFCA does not completely eliminate the possibility of aspiration, so care should be taken.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Refluxo Gastroesofágico/etiologia , Idoso , Anestesia Geral , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , República da Coreia/epidemiologia
19.
Nutr Metab Cardiovasc Dis ; 31(3): 834-840, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33549446

RESUMO

BACKGROUND AND AIMS: Both malnutrition and atrial fibrillation (AF) are the major health problems in modern society. Only a few studies focused on the relationship between malnutrition and recurrence of atrial arrhythmias post AF ablation (AF recurrence), which used body mass index (BMI) as nutrition assessment tool. However, BMI can't credibly reflect body composition and has limitation in patients with water-sodium retention. In this study, we used controlling nutritional status score (CONUT score) and geriatric nutritional risk index (GNRI) to identify the malnutrition patients and explored the effect of malnutrition on AF recurrence. METHODS AND RESULTS: This retrospective study included 246 patients who underwent AF ablation. During a median 11-month follow-up, 77 patients (31.3%) experienced AF recurrence. The recurrence group had higher CONUT score (2.3 ± 1.5 vs. 0.9 ± 1.0, P < 0.001) and lower GNRI (99.9 ± 7.6 vs. 103.9 ± 5.6, P < 0.001). After balancing the traditional risk factors, both CONUT score (OR: 2.614, 95%CI: 1.831-3.731, P < 0.001) and GNRI (OR: 0.884, 95%CI: 0.828-0.944, P < 0.001) were the independent predictors for AF recurrence. Pre-ablation CONUT score ≥1 and GNRI≥95.66 are indicative of AF recurrence. Adding CONUT score or GNRI to the base prediction model for AF recurrence significantly improved the discrimination and calibration. However, adding BMI to the base prediction model did not improve the model performance. CONCLUSIONS: CONUT score and GNRI are ideal tools to evaluate the nutrition status of AF patients. Undernourished patients are more likely to suffer from AF recurrence. Improving nutrition status may be a potential target for reducing the postoperative recurrence rate.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Avaliação Geriátrica , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Trials ; 22(1): 35, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413569

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia, which is closely related to cardiovascular morbidity and mortality. Although acupuncture is used in the treatment of AF, the evidence is insufficient. The objective of this pilot trial is to evaluate the feasibility, preliminary efficacy, and safety of acupuncture in reducing AF burden for persistent AF after catheter ablation (CA). METHODS AND DESIGN: This will be a multi-center, 3-arm, pilot randomized controlled trial in China. Sixty patients in total will be randomly assigned to the specific acupoints group, the non-specific acupoints group, or the non-acupoints group in a 1:1:1 ratio. The whole study period is 6 months, including a 3-month treatment period and a 3-month follow-up period. All patients will receive 18 sessions of acupuncture over 12 weeks after CA and appropriate post-ablation routine treatment. The primary outcome is AF burden at 6 months after CA measured by electrocardiography patch that can carry out a 7-day continuous ambulatory electrocardiographic monitoring. The secondary outcomes include AF burden at 3 months after CA, recurrence of AF, quality of life, etc. The adverse events will also be recorded. DISCUSSION: This pilot study will contribute to evaluating the feasibility, preliminary efficacy, and safety of acupuncture in reducing AF burden for persistent AF after CA. The results will be used for the sample size calculation of a subsequent large-scale trial. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000030576 . Registered on 7 March 2020.


Assuntos
Terapia por Acupuntura , Fibrilação Atrial , Ablação por Cateter , Terapia por Acupuntura/efeitos adversos , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , China , Humanos , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia , Projetos Piloto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Resultado do Tratamento
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