The use of transtelephonic loop recorders for the assessment of symptoms and arrhythmia recurrence after radiofrequency catheter ablation.

Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patients often remain symptomatic after the procedure. We aimed to assess the arrhythmia recurrence after successful RFA in relation to patients' symptoms using transtelephonic loop recorders. Thirty-six consecutive patients (age 50 +/- 14 years, 17 males/19 females) were enrolled after successful RFA for atrioventricular (AV) nodal reentrant tachycardia (n = 21), AV reentrant tachycardia (n = 8), atrial tachycardia (n = 2), atrial fibrillation/flutter (n = 4), and ventricular tachycardia (n = 1). During 23 +/- 6 days of follow-up, 679 events were recorded, 246 of which were true arrhythmic events, mostly (56%) asymptomatic. The vast majority of these true arrhythmic events were due to trivial arrhythmias (extrasystoles or sinus tachycardia), equally distributed among symptomatic and asymptomatic episodes. Arrhythmia relapse was shown in four patients, who had a total of nine episodes, eight of which were symptomatic. No high degree AV block was detected. Overall, symptom recurrence had low sensitivity (44%) and high specificity (95%) for the detection of any arrhythmia, and high sensitivity (89%) but low specificity (58%) for the detection of relapse. In conclusion, transtelephonic monitoring was a useful tool for the assessment of symptoms after RFA and its use may be reserved for the most symptomatic patients to detect a relapse or to reassure them for the benign nature of their symptoms.

Abdominal metastases from lung cancer resulting in small bowel perforation: report of three cases.

Metastatic lung cancer to the small bowel is a rare occurrence. Acute complications such as perforation, hemorrhage and obstruction are even rarer. We present 3 cases of small bowel perforation from metastatic lung cancer. All 3 patients underwent emergency laparotomy. In 2 of them there was no obvious macroscopic appearance of metastatic disease either at the site of perforation or in any other area of the abdomen, whereas in the third patient there were hepatic metastases. The postoperative period was uneventful in all three cases. The longest survival was four months. Our cases bring the number of cases reported in the international literature to a total of 43.

Computer-based malignancy grading of astrocytomas employing a support vector machine classifier, the WHO grading system and the regular hematoxylin-eosin diagnostic staining procedure.

OBJECTIVE: To investigate and develop an automated technique for astrocytoma malignancy grading compatible with the clinical routine. STUDY DESIGN: One hundred forty biopsies of astrocytomas were collected from 2 hospitals. The degree of tumor malignancy was defined as low or high according to the World Health Organization grading system. From each biopsy, images were digitized and segmented to isolate nuclei from background tissue. Morphologic and textural nuclear features were quantified to encode tumor malignancy. Each case was represented by a 40-dimensional feature vector. An exhaustive search procedure in feature space was utilized to determine the best feature combination that resulted in the smallest classification error. Low and high grade tumors were discriminated using support vector machines (SVMs). To evaluate the system performance, all available data were split randomly into training and test sets. RESULTS: The best vector combination consisted of 3 textural and 2 morphologic features. Low and high grade cases were discriminated with an accuracy of 90.7% and 88.9%, respectively, using an SVM classifier with polynomial kernel of degree 2. CONCLUSION: The proposed methodology was based on standards that are common in daily clinical practice and might be used in parallel with conventional grading as a second-opinion tool to reduce subjectivity in the classification of astrocytomas.