The Results of a New Distal Protection Method in Intervention for Chronic Total Occlusion of the Superficial Femoral Artery

Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method

Przezskórna ablacja opornego na farmakologiczne leczenie ustawicznego migotania komór w przebiegu ostrego incydentu wieńcowego

Mężczyznę w wieku 77 lat przyjęto do szpitala z powodu ostrego incydentu wieńcowego, ciężkiej niewydolności serca oraz nawracających epizodów migotania komór. Pojedyncze przedwczesne skurcze komorowe wywoływały częstoskurcz komorowy, który powtarzalnie przechodził w migotanie komór. W wyniku zastosowania ablacji tylno-przegrodowej części lewej komory, gdzie poprzednio rejestrowano podwójne potencjały pochodzące z włókien Purkinjego, wyeliminowano dodatkowe przedwczesne skurcze komorowe. Po zabiegu ustąpiły objawy „burzy elektrycznej” serca, a podczas wykonywanej po ablacji programowanej stymulacji komór nie wywołano żadnej tachyarytmii. Dodatkowe przedwczesne skurcze komorowe stały się mechanizmem wyzwalającym, a zarazem również substratem dla powstania częstoskurczu komorowego oraz migotania komór w przebiegu ostrego incydentu wieńcowego współistniejącego z niewydolnością serca. (Folia Cardiologica Excerpta 2006; 1: 492-496

Nonimmersive Virtual Reality Mirror Visual Feedback Therapy and Its Application for the Treatment of Complex Regional Pain Syndrome: An Open-Label Pilot Studyp me_819 622..629

Abstract Objective. Chronic pain conditions such as phantom limb pain and complex regional pain syndrome are difficult to treat, and traditional pharmacological treatment and invasive neural block are not always effective. Plasticity in the central nervous system occurs in these conditions and may be associated with pain. Mirror visual feedback therapy aims to restore normal cortical organization and is applied in the treatment of chronic pain conditions. However, not all patients benefit from this treatment. Virtual reality technology is increasingly attracting attention for medical application, including as an analgesic modality. An advanced mirror visual feedback system with virtual reality technology may have increased analgesic efficacy and benefit a wider patient population. In this preliminary work, we developed a virtual reality mirror visual feedback system and applied it to the treatment of complex regional pain syndrome. Design. A small open-label case series. Five patients with complex regional pain syndrome received virtual reality mirror visual feedback therapy once a week for five to eight sessions on an outpatient basis. Patients were monitored for continued medication use and pain intensity. Results. Four of the five patients showed >50% reduction in pain intensity. Two of these patients ended their visits to our pain clinic after five sessions. Conclusion. Our results indicate that virtual reality mirror visual feedback therapy is a promising alternative treatment for complex regional pain syndrome. Further studies are necessary before concluding that analgesia provided from virtual reality mirror visual feedback therapy is the result of reversing maladaptive changes in pain perception

MRI studies in two cases of hypertensive encephalopathy

Magnetic resonance imaging (MRI) findings were analyzed in two patients with hypertensive encephalopathy. MRI demonstrated focal cortical and subcortical lesions of hyperintense T 2 signal and hypointense Tl signal lesions with diffuse brain swelling. Focal lesions were hardly explained by involvements of major arterial supplies. There were no neurological focal signs suggesting dysfunctions in the abnormal areas of MRI. These MRI studies further support the hypothesis that hypertensive encephalopathy is induced by vasogenic edema during breakthrough of cerebral autoregulation. Prompt diagnosis and reduction of blood pressure are key points for improving the clinical condition. MRI better defines the cerebral involvements in detail and would help proper diagnosis and therapeutic decision

Chemical Composition of Ultra-High Energy Cosmic Rays Observed by AGASA

We have observed ultra-high energy cosmic rays above the Greisen-Zatsepin-Kuz\u27min cut-off energy by Akeno Giant Air Shower Array. Their chemical composition is a key discriminator of origin models. In the present work, we estimate the average composition by an analysis of muons in air showers with AIRES+QGSJET simulation. The data matches the prediction for light hadron primaries and no indication has been found for a gamma-ray dominance