Een worm in de navel?

Bij een massa, al dan niet met inflammatie, ter hoogte van de navel moet er gedacht worden aan een navelsteen. Deze benigne aandoening vergt enkel een niet-invasieve verwijdering van de versteende keratine en sebum, gevolgd door wondzorg

Septal flash : at the heart of cardiac dyssynchrony

Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number of patients do not respond adequately to CRT, echocardiographic dyssynchrony selection criteria have been proposed to improve CRT response, but these parameters eventually failed to provide superior selection of CRT candidates. In the last decade, an echo-dyssynchrony parameter called "septal flash" was been reported by several investigators and opinion leaders in the field of CRT. This parameter has a strong pathophysiological rationale and was shown to be a robust and predominant predictor of CRT response in recent observational and retrospective studies. We here provide a comprehensive and balanced overview of septa! flash and address several important aspects, questions and potential future implications of septal flash in cardiomyopathy and CRT. (C) 2019 The Authors. Published by Elsevier Inc

Progression of incomplete toward complete left bundle branch block : a clinical and electrocardiographic analysis

Background: Complete left bundle branch block (cLBBB) is associated with increased cardiovascular mortality and heart failure. On the contrary, the clinical relevance of incomplete left bundle branch block (iLBBB) is less known. This study investigated the profile and outcome of iLBBB patients and assessed the risk of progression to cLBBB. Methods: Patients diagnosed with iLBBB between July 2013 and April 2018 were retrospectively included. Subsequently, echo- and electrocardiographic examinations at time of iLBBB diagnosis and during follow-up, as well as progression to non-strict cLBBB and strict cLBBB, were evaluated. Results: The study enrolled 321 patients (33% female, age 74 +/- 11 years). During the follow-up of 21 (8;34) months, 33% of iLBBB patients evolved to non-strict cLBBB and 27% to strict cLBBB. iLBBB patients who evolved to non-strict or strict cLBBB were older, had more frequently reduced left ventricular ejection fraction, and had more often QRS notching/slurring in the lateral leads and inferior leads, compared to patients without progression to cLBBB. In multivariate analysis, only QRS notching/slurring in the lateral leads was independently associated with progression to non-strict cLBBB (odds ratio 4.64, p < .001) and strict cLBBB (odds ratio 9.6, p < .001). iLBBB patients with QRS notching/slurring had a progression rate to non-strict cLBBB of 52% and 49% to strict cLBBB. Conclusion: Among patients with iLBBB, up to one third of the patients progress to cLBBB within a period of 2 years. The presence of QRS notching/slurring in the lateral leads during iLBBB was the strongest predictor for progression toward cLBBB

Septal flash is a prevalent and early dyssynchrony marker in transcatheter aortic valve replacement-induced left bundle branch block

New-onset left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR) and provides an opportunity to study dyssynchrony immediately following acute LBBB. This study aims to (1) assess echocardiographic dyssynchrony in acute TAVR-induced LBBB (TAVR-LBBB), and (2) compare dyssynchrony parameters among different patient groups with LBBB. The study enrolled all TAVR-LBBB patients at Ghent University Hospital between 2013 and 2019. First, acute TAVR-LBBB dyssynchrony was assessed by: (1) septal flash (SF); (2) interventricular mechanical delay (IVMD; cut-off >= 40 ms) and (3) presence of 'classical dyssynchronous strain pattern' assessed with speckle tracking. Secondly, acute TAVR-LBBB patients with SF (LBBBTAVR+SF) were compared to randomly selected LBBB-SF patients with preserved (LBBBSF+PEF) and reduced ejection fraction (LBBBSF+REF). In TAVR-LBBB patients (n = 25), SF was detected in 72% of patients, whereas only 5% of TAVR-LBBB patients showed a classical dyssynchronous strain pattern. IVMD in these TAVR-LBBB patients was 39 ms. In 90% of LBBBTAVR+SF patients, SF was observed within 24 h after LBBB onset. Among LBBB-SF patients, a classical strain pattern was more prevalent in LBBBSF+REF patients compared to LBBBTAVR+SF patients (80% vs. 7%; p < 0.001). IVMD was significantly longer in LBBBSF+PEF patients (52 ms; p = 0.002) and LBBBSF+REF patients (57 ms; p = 0.009) compared to LBBBTAVR+SF patients (37 ms). SF is an early and prevalent marker of LV dyssynchrony in acute TAVR-LBBB, whereas strain-based measures and IVMD do not appear to capture dyssynchrony at this early stage. Our findings from the comparative analysis generate the hypothesis that progressive LBBB-induced LV remodeling may be required for a 'classical dyssynchrony strain pattern' or significant IVMD to occur in TAVR-LBBB patients

Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement : implications for prolonged heart rhythm monitoring

Background: Newonset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of newonset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR. Methods and results: This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12-lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 +/- 22.0 ms (p 24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p= 0.008). Conclusion: Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR. (c) 2020 Published by Elsevier Inc

Using privacy calculus theory to explore entrepreneurial directions in mobile location-based advertising: Identifying intrusiveness as the critical risk factor

Location-based advertising is an entrepreneurial and innovative means for advertisers to reach out through personalised messages sent directly to mobile phones using their geographic location. The mobile phone users’ willingness to disclose their location and other personal information is essential for the successful implementation of mobile location-based advertising (MLBA). Despite the potential enhancement of the user experience through such personalisation and the improved interaction with the marketer, there is an increasing tension between that personalisation and mobile users’ concerns about privacy. While the privacy calculus theory (PCT) suggests that consumers make privacy-based decisions by evaluating the benefits any information may bring against the risk of its disclosure, this study examines the specific risks and benefits that influence consumers’ acceptance of MLBA. A conceptual model is proposed based on the existing literature and a standardised survey was developed and targeted at individuals with known interests in the subject matter. From these requests, 252 valid responses were received and used to evaluate the key benefits and risks of MLBA from the users’ perspectives. While the results confirmed the importance of internet privacy concerns (IPC) as an important determinant, they also indicate that monetary rewards and intrusiveness have a notably stronger impact on acceptance intentions towards MLBA. Intrusiveness is the most important risk factor in determining mobile users’ intentions to accept MLBA and therefore establishing effective means of minimising the perceived intrusiveness of MLBA can be expected to have the greatest impact on achieving effective communications with mobile phone users