Impedance cardiographic monitoring during pericardiocentesis: comparison with echocardiography

OBJECTIVE: Thoracic impedance cardiography (TIC) is a noninvasive method which has proved to be useful in monitoring the haemodynamic status of the patients. In this study, we evaluated the TIC findings in patients with pericardial effusion and cardiac tamponade. METHODS AND RESULTS: The study consisted of patients with pericardial effusion with (group A) or without (group B) cardiac tamponade (CT). The stroke volume, cardiac output and ejection fraction was measured by both echocardiography and TIC. The measurements were done at baseline in both groups and following pericardiocentesis in group A. The variables were compared by linear regression analysis, paired sample's t test and chi-square test. The study included 32 patients. Group A consisted of 16 patients and group B of 14 patients. Two patients were excluded from comparisons because of insufficient quality of the echocardiographic examination. There were no significant differences between group A and B with regard to demographic features. Both echocardiographic and TIC measurements at baseline revealed decreased cardiac output, EDV and SV in group A and EF was not different. Linear regression analysis revealed that echocardiography and TIC were in significant correlation with regard to cardiac output, enddiastolic volume, stroke volume (p < 0.01) but not ejection fraction (p = 0.8910). The correlation was also present after pericardiocentesis. CONCLUSIONS: TIC can be safely used in patients with pericardial effusion. It provides suggestive data for the diagnosis of CT and can be used as a means of monitoring the results of the pericardiocentesis.     

Prostatic adenocarcinoma metastasis in the thyroid gland

Metastasis from prostate to thyroid gland is very uncommon. Here we report a 77-year-old man who was admitted to the hospital because of a nodular goiter. A fine-needle aspiration biopsy of the nodule showed metastatic prostatic adenocarcinoma. This is the second case of a metastatic prostate carcinoma to the thyroid gland.     

Prevalence of Beijing genotype Mycobacterium tuberculosis strains in Istanbul.

To determine the prevalence of Beijing genotype Mycobacterium tuberculosis in Istanbul, 4069 strains were subjected to DNA fingerprinting. This is the first study to reveal the presence of the Beijing genotype in Istanbul. The prevalence rate was estimated as 1.13%, and it was shown that these strains were carried over from countries of the former Soviet Union. The study also showed that the prevalence of the Beijing genotype among at least rifampicin (RMP) resistant strains was significantly higher (2.7%) than among RMP-susceptible strains (0.9%).     

Safety and efficacy of radiofrequency energy catheter ablation of atrial fibrillation in patients with pacemakers and implantable cardiac defibrillators

BACKGROUND: Catheter ablation has significantly transformed the clinical management of atrial fibrillation (AF). The safety and efficacy of this procedure are not well understood in patients with pacemakers and defibrillators. OBJECTIVES: The purpose of this study was to study the impact of radiofrequency catheter ablation of AF in patients with pacemakers and implantable cardiac defibrillators. METHODS: We studied 86 patients with pacemakers and defibrillators (group I) and a similar number of age- and gender-matched controls (group II) who underwent AF ablation between 1999 and 2004. Clinical and procedural variables were compared between the two groups. In group I, various generator and lead parameters were compared before and after the procedure. Resurgence of clinical AF after 2 months was considered recurrence. RESULTS: Both groups were similar with regard to age, gender, body mass index, and type of AF. Group I had a higher incidence of diabetes (17% vs 6%, P = .03), coronary artery disease (25% vs 13%, P = .05), less prolonged AF (31 +/- 21 vs 45 +/- 30 months, P <.001), lower left ventricular ejection fraction (49 +/- 13% vs 52 +/- 9%, P = .03), and left ventricular end-diastolic dimensions (4.97 +/- 0.81 vs 4.72 +/- 0.67, P = .03). No changes in the sensing and pacing thresholds, impedance of atrial and ventricular leads, or defibrillator coil impedance after AF ablation were observed in group I. Atrial lead dislodgment was seen in two patients. Transient abnormal but "expected" pulse generator behavior was seen in 25% of patients without permanent malfunction. Stroke (1% vs 1%, P = 1.000), pulmonary vein stenosis (2% vs 1%, P = .77), and AF recurrence rates at 12 months were similar between groups I and II, respectively (19% vs 21%, P = .73). CONCLUSION: AF ablation is safe and efficacious in patients with pacemakers and defibrillators.     

Importance of ablating all potential right atrial flutter circuits in postcardiac surgery patients

OBJECTIVES: In patients with atrial flutter (AFL) and postoperative right atrial incisional scars, we sought to assess if the use of additional ablative lesions that targeted all potential re-entrant circuits, regardless of the presenting type of flutter, would prevent long-term recurrence. BACKGROUND: Patients with AFL and incisional scars have a complex atrial substrate that may promote multiple mechanisms of intra-atrial re-entry. METHODS: Twenty-nine patients with single right atrial incisional scars undergoing ablation for scar-dependent (n = 15) and cavotricuspid isthmus (CTI)-dependent (n = 14) flutter were studied. RESULTS: In the scar-dependent group, 9 of 15 (60%) patients had inducible or spontaneous CTI-dependent flutter immediately after ablation. In the group with CTI flutter, 7 of 14 (50%) patients had scar-related flutter immediately after ablation. If a second type of flutter was found during the initial ablation, a second ablation was performed either along the isthmus (scar-dependent group) or from the scar to another anatomic boundary (isthmus-dependent group). Patients were followed for 24 +/- 5 months and 18 +/- 6 months in the scar- and CTI-dependent groups, respectively. In the scar-dependent group, five of six (83%) who underwent only a single flutter line had recurrence at 3 +/- 1 months. In the isthmus-dependent group, three of seven (42%) patients who had only one flutter line performed had recurrence at 5 +/- 3 months. There was no flutter recurrence in patients who initially received two different flutter lines or in patients who subsequently underwent a second flutter line at follow-up. CONCLUSIONS: In patients with postoperative right atrial incisional scar and flutter, multiple ablation lines that target both scar-related and classic isthmuses appear necessary to prevent long-term recurrence.     

Assessment the long-term effects of septoplasty surgery on olfactory function

Objectives: This research aimed to evaluate pre-operatively and post-operatively the olfactory function of patients who had undergone surgery in our clinic for chronic nasal blockage via the Connecticut Chemosensory Clinical Research Center (CCCRC) smell test.

Method: Thirty-seven patients (24 females, 13 males) were enrolled in this study. All had undergone surgery in our clinic due to chronic nasal blockage (not for smell dysfunction), having been diagnosed with septal deviation in conjunction with concha bullosa and/or inferior turbinate hypertrophy. This is a prospective study without a control group. The mean age was 33.74?±?8.98 (range =19–54). All of the operations were performed under general anesthesia. CCCRC smell tests were performed on every patient before the operation and at post-operative 1st week, 6th week, 6th month, and 1st year.

Results: In this study, we found that septoplasty, in conjunction with middle concha surgery and/or inferior concha radiofrequency, did not affect the olfactory function negatively.

Conclusion: Although nasal surgery has the potential to affect the smell function negatively, it was found that olfactory function was not affected after the surgery during a considerably long follow-up period. Moreover, an improvement in smell function was detected at post-operative 6th month and 1st year.