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  • 1
    Electronic Resource
    Electronic Resource
    Helical computed tomography diagnosis of gastrointestinal perforation in the elderly patient (2000)
    Springer
    Emergency radiology 7 (2000), S. 259-262 
    Details
    ISSN: 1438-1435
    Keywords: Key words Gastrointestinal tract, perforation – Pneumoperitoneum – Helical computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To determine the value of helical CT in a consecutive series of elderly patients referred with clinically suspected gastrointestinal perforation. Methods: Our series comprised 34 consecutive elderly patients (mean age: 68 years) presenting with acute abdominal symptoms potentially suggestive of gastrointestinal perforation. All the patients were prospectively subjected to abdominal computed tomography (CT). On helical CT, the presence of free air was considered diagnostic of gastrointestinal perforation. Other findings such as intraperitoneal free fluid, thickening of bowel wall, streaky density within the mesentery, “dirty fat” sign, and focal collection of extraluminal fecal matter (“dirty mass”) were considered indirect findings of perforation. Results: At surgery, the following sites of perforation were found: duodenum (38.2 %), stomach (29.4 %), ileum (8.8 %), sigmoid colon (8.8 %), rectum (5.8 %), and jejunum, appendix, and transverse colon (2.9 % of cases each). CT demonstrated the presence of free air in 94.1 % of cases; intraperitoneal free fluid was present in 76.4 % of patients and thickening of bowel wall in 50 %. Streaky density within the mesentery was found in one patient. Conclusion: CT is a reliable diagnostic method by which to assess gastrointestinal perforation, because it provides excellent contrast resolution to depict the presence of even small amounts of free air in the abdomen. This is particularly helpful where elderly patients are concerned.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00011837
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  • 2
    Electronic Resource
    Electronic Resource
    Gastrointestinal perforation: ultrasound diagnosis (2000)
    Springer
    Emergency radiology 7 (2000), S. 263-267 
    Details
    ISSN: 1438-1435
    Keywords: Key words Gastrointestinal tract, perforation – Pneumoperitoneum – Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To investigate the spectrum of US findings as encountered in a consecutive series of patients referred with clinically suspected gastrointestinal perforation. Methods: Seventy-two consecutive patients (mean age: 42.9 years) with clinically suspected gastrointestinal perforation were prospectively examined with abdominal ultrasound (US). The US examinations were all performed by a certified senior radiologist, who was blind to other imaging findings. Patients were screened for the presence of free intraperitoneal gas (characteristic comet-tail artifacts, ring-down artifacts, and the “shifting phenomenon” were our diagnostic indicators of pneumoperitoneum). Other signs potentially suggestive of gastrointestinal perforation were also looked for, including free intraperitoneal fluid, thickening of bowel walls, gallbladder walls, gastric walls, or duodenal walls, or local peritoneal inflammation. Patients with equivocal or inconclusive findings on US were submitted to abdominal computed tomography (CT) 10–15 min after US examinations. Results: Of the 72 patients prospectively examined by US, 63 (87.5 %) underwent subsequent emergent surgery within next 2 days. A gastrointestinal perforation was found in all the 63 patients referred for operative treatment: overall, 41 gastroduodenal and 22 intestinal perforations were found. On US, in the 41 patients with surgically proven gastroduodenal perforation, the most common finding was free intraperitoneal gas (28/41, 68.3 %). The 13/41 patients (31.7 %) without evidence of free gas on US underwent preoperative abdominal CT assessment, which allowed the correct diagnosis of gastroduodenal perforation in 12/13 cases. In the 22 patients with surgically proven intestinal perforation the most common finding detected on US was free intraperitoneal fluid (14/22, 63.6 %); sonographic evidence of free intraperitoneal gas was seen in only 8/22 patients (36.4 %). The 14/22 patients (63.6 %) without free gas on US underwent preoperative abdominal CT assessment, which allowed the diagnosis of intestinal perforation in 12/14 cases. Conclusion: US examinations allow very rapid screening of patients referred with clinically suspected gastrointestinal perforation and for triage of patients who are to undergo more invasive imaging tests.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00011838
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  • 3
    Electronic Resource
    Electronic Resource
    Haematological and Blood Chemical Values from Bothrops ammodytoides (Ophidia–Crotalidae) in Captivity (1999)
    Springer
    Comparative clinical pathology 9 (1999), S. 31-35 
    Details
    ISSN: 1433-2981
    Keywords: Key words:Biochemical values – Blood –Bothrops ammodytoides– Captivity – Haematology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: In order to establish reference haematological and blood chemistry parameters, blood samples were obtained from 50 healthy specimens of Bothrops ammodytoides kept in captivity. The haematological parameters determined were: red blood cell count (RBC); total leucocyte (WBC) and differential leucocyte cell count; thrombocyte count; haematocrit (PCV); haemoglobin concentration; mean corpuscular volume (MCV); mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). Blood chemistry parameters measured were: total protein; albumin; globulins; glucose; urea; uric acid; triglycerides; cholesterol; calcium; phosphorus; magnesium; sodium; potassium and chloride concentrations and the activities of aspartate amino transferase (AST) and alanine amino transferase (ALT). Compared to the values published for other ophidian species, RBC count, PCV and WBC count in Bothrops ammodytoides are lower than in most of the crotalids. Total protein and glucose concentrations are lower, whereas uric acid concentration, AST and ALT levels are higher than the values reported for other species.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010004
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  • 4
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    Iatrogenic atrial septal defects following atrial fibrillation transcatheter ablation: a relevant entity? (2014)
    Oxford University Press
    In: Europace
    Details
    Publication Date: 2014-10-26
    Description: Aims The previous literature has suggested that the iatrogenic atrial septal defects (IASDs) may follow left atrial (LA) access by transseptal (TS) puncture, especially in the case of a single TS for more than one catheter. The aim of the present study is to describe the prevalence of patent foramen ovale (PFO) and IASDs in a cohort of atrial fibrillation (AF) patients undergoing redo catheter ablation (CA) procedures in a high-volume centre accessing LA by a standardized single TS puncture. Methods and results Patients ( n = 197) who underwent at least one redo AFCA, between 2004 and 2012, were retrospectively enroled. Transoesophageal echocardiography was performed before each procedure during which LA was accessed via a PFO, if present, or by single TS for both the mapping and ablation catheters. At baseline, PFO was detected in 43 (21.8%) patients. Clinical and echocardiographic parameters recorded did not differ within patients presenting with or without PFO. Left atrium was accessed via PFO in 39 (90.7% of those with PFO) patients during the first procedure. New-onset IASD occurred in 11 (5.6%) patients following the first procedure and in 1 (2.2%) patient following the second procedure. The clinical and echocardiographic parameters did not differ within the patients irrespective of whether IASD was reported or not. No TS-related complications occurred. Conclusion In the present cohort, LA access by PFO or single TS for both the mapping and ablation catheters lead to a small risk of asymptomatic IASD, not increased by redo procedures, confirming that it represents a safe approach. No clinical and/or echocardiographic parameters seemed to predict IASD occurrence.
    Print ISSN: 1099-5129
    Electronic ISSN: 1532-2092
    Topics: Medicine
    Published by Oxford University Press
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  • 5
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    Incidence of cerebral thromboembolic events during long-term follow-up in patients treated with transcatheter ablation for atrial fibrillation (2014)
    Oxford University Press
    In: Europace
    Details
    Publication Date: 2014-06-26
    Description: Aims Net clinical benefit of long-term oral anticoagulation therapy (OAT) continuation after successful atrial fibrillation (AF) ablation is still controversial. To evaluate long-term thromboembolic (TE) and haemorrhagic events incidence according to OAT strategy used after AF transcatheter ablation. Methods and results Three months after AF ablation, OAT was discontinued in patients with CHADS 2 ≤ 1 if no recurrences were documented, while OAT was maintained in patients with CHADS 2 ≥ 2 regardless of AF recurrences. CHA 2 DS 2 VASc and HAS-BLED scores have been retrospectively evaluated. Seven hundred and sixty-six patients were followed for a median of 60.5 months. Six (6/267 = 2.2%) and five (5/499 = 1%) TE events occurred in the ON and the OFF-OAT patients, respectively ( P = 0.145), all in concomitance with the AF recurrence. CHADS 2 and CHA 2 DS 2 VASc ≥ 2 were associated with high TE incidence ( P = 0.047 and P = 0.020). Among patients with a CHADS 2 score of 0 or 1, a CHA 2 DS 2 VASc score ≥ 2 was predictive of TE events ( P = 0.014). Overall, the incidence of the TE events in patients with CHA 2 DS 2 VASc ≥ 2 was 0.6 per 100 patient-years whereas seven haemorrhagic events occurred, all of them in the ON-OAT patients (7/267 = 2.6%). Conclusion Patients with AF undergoing transcatheter ablation have a lower incidence of TE events as compared with the general AF population, regardless of OAT maintenance. The unpredictable risk of AF recurrence, mandate the routine use of the CHADS 2 , CHA 2 DS 2 VASc, and HAS-BLED scores to guide clinical decision regarding OAT management in this peculiar setting of patients. The potential protective role of rhythm control strategy in the TE events needs to be confirmed by future large randomized trials.
    Print ISSN: 1099-5129
    Electronic ISSN: 1532-2092
    Topics: Medicine
    Published by Oxford University Press
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  • 6
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    Selective Vulnerability of Cortical Border Zone to Microembolic Infarct [Clinical Sciences] (2015)
    American Heart Association (AHA)
    In: Stroke
    Details
    Publication Date: 2015-06-23
    Description: Background and Purpose— Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation. Methods— Seventy-eight of 927 consecutive patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance. SCI were identified and marked, and their coordinates were transformed from native space into the International Consortium for Brain Mapping/Montreal Neurological Institute space. We then computed the voxel-wise probability distribution map of the SCI using the activation likelihood estimation approach. Results— SCI were more commonly found in the cortex. In supratentorial regions, SCI selectively involved cortical border zone between anterior, middle, and posterior cerebral arteries; in infratentorial regions, distal territory of posteroinferior cerebellar artery. Possible explanations include selective embolization, linked to the vascular anatomy of pial arteries supplying those territories, reduced clearance of emboli in a relatively hypoperfused zone, or a combination of both. This particular distribution of lesions has been reported in both animal models and in patients with microemboli of different sources. Conclusions— A selective vulnerability of cortical border zone to microemboli occurring during atrial fibrillation transcatheter ablation was observed. We hypothesize that such selectivity may apply to microemboli of different sources.
    Keywords: Embolic stroke, Computerized tomography and Magnetic Resonance Imaging
    Print ISSN: 0039-2499
    Electronic ISSN: 1524-4628
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 7
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    Very long-term results of electroanatomic-guided radiofrequency ablation of atrial arrhythmias in patients with surgically corrected atrial septal defect (2014)
    Oxford University Press
    In: Europace
    Details
    Publication Date: 2014-11-24
    Description: Aims Atrial tachycardias are common after repair of atrial septal defect (ASD). Although ablation has shown promising results in the short and mid-term follow-up, little data regarding the very long-term success exist. Our aim was to assess very long-term follow-up in patients who have undergone electroanatomic-guided radiofrequency (RF) ablation of late-onset atrial arrhythmias after ASD surgery. Methods and results Forty-six consecutive patients with surgically repaired ASD were referred for atrial tachycardia ablation. Electrophysiological (EP) study and ablation procedure with the aid of an electroanatomic mapping (EAM) system were performed. Mean age was 49 ± 13 years (females 61%). The presenting arrhythmias were typical atrial flutter (48%), atypical atrial flutter (35%), and atrial tachycardia (17%). In 41% of patients, atrial fibrillation was also present. The EP study showed a right atrial macroreentrant circuit in all the patients. In 12 of 46 (26%), the circuit was localized in the cavo-tricuspid isthmus, whereas in the remaining 34 patients (74%) was atriotomy-dependent. Acute success was 100%. Clinical arrhythmia recurred in 24% of the patients. Nine patients underwent a second and two a third ablation procedure, reaching an overall efficacy of 87% (40 of 46) at a mean follow-up of 7.3 ± 3.8 years since the last procedure. With antiarrhythmic drugs the success rate increased to 96% (44 of 46). No complications occurred. Conclusion In patients with surgically corrected ASD, EAM-guided RF ablation of late-onset macroreentrant atrial arrhythmias demonstrated a high success rate in a very long-term follow-up. Therefore, RF ablation could be considered early in the management of late-onset macroreentrant atrial tachycardias.
    Print ISSN: 1099-5129
    Electronic ISSN: 1532-2092
    Topics: Medicine
    Published by Oxford University Press
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  • 8
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    Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow up? (2018)
    Oxford University Press
    In: Europace
    Details
    Publication Date: 2018-03-06
    Description: Aims Atrial fibrillation (AF) transcatheter ablation is a safe and effective procedure. However, outcome over 10 years of follow-up has never been reported. The aim of this study is to assess outcome, describe predictors of recurrences, and report on quality of life (QoL) the decade after an AF ablation. Methods and results Patients referred for AF ablation in a single high volume centre from June 2004 to June 2006 were enrolled and followed in a prospective fashion by yearly clinical assessment and Holter monitoring. Among 255 patients (42.7% paroxysmal AF, 77% males, after a follow-up of 125 ± 7 months), 132 (52%) were arrhythmia-free including (58, 32% after a single procedure) while 27 (10%) progressed to permanent AF. At multivariate analysis, a greater left atrium antero-posterior diameter (HR 1.05 95% CI 1.02–1.09, P  = 0.02) related to arrhythmic recurrences, while no increase in blood pressure (HR 0.06 95% CI 0.02–0.20, P  = 0.01), BMI (HR 0.06 95% CI 0.02–0.09, P  〈 0.001), and fasting glucose (HR 0.58 95% CI 0.36–0.92, P  = 0.02) during follow-up were protective for arrhythmic recurrences. Overall QoL improved significantly, significantly related to the absence of recurrences, arrhythmic burden reduction and blood pressure, and BMI control ( P  〈 0.001). Conclusion The outcome of AF ablation over more than 10 years is characterized by a low incidence of progression towards permanent AF. Greater LA anteroposterior diameter related to arrhythmic recurrences, while blood pressure, BMI, and fasting blood glucose control emerged as predictors of sinus rhythm maintenance. Eventually, QoL improved significantly over the follow-up.
    Print ISSN: 1099-5129
    Electronic ISSN: 1532-2092
    Topics: Medicine
    Published by Oxford University Press
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