Granulocyte transfusion vs. neutropenia — is there a chance to win this battle?

Bacterial and fungal infections remain a significant cause of morbidity and mortality in patients with prolonged severe neutropenia that results from the treatment of an underlying haematological malignancy. Granulocyte transfusions have been broadly used to prevent and/or treat life-threatening infections in these patients. The purpose of this review was to answer the question, “Are granulocyte transfusions effective in combating hazardous infections in haematology/oncology patients with neutropenia?”

Clinical application of intracardiac echocardiography in the ablation of atrial fibrillation

Background: The application of intracardiac echocardiography (ICE) in atrial fibrillation (AF) ablation may increase the success rate and decrease the complication rate of the procedure. We present our preliminary observations concerning the utility of ICE in AF ablation. Methods: In February and July 2004 we performed 6 radiofrequency (RF) ablations guided by ICE (EP Med Systems) in patients with atrial tachyarrhythmia. All patients had undergone at least three months of oral anticoagulation therapy before the procedure. For three days before ablation enoxaparin was administered. During each procedure the ICE catheter was placed in the right atrium. Transseptal puncture was guided by fluoroscopy and ICE imaging. After placement of the introducer in the left atrium a bolus of heparin (100 IU/kg) was administered followed by additional boluses (1000 IU/h). Electroanatomical isolation of the pulmonary vein ostia was performed with a 4 mm ablation catheter (RF energy was set at 50–55oC and 25–35 W). RF energy was titrated if microbubble formation was observed and delivery was immediately terminated when a brisk shower of bubbles was detected. Results: Transseptal puncture was performed at a typical location in all patients (atypical anatomy was not revealed by ICE). The microbubble effect was observed in all patients. In 1 patient the effect was observed despite a power reduction and the RF application had to be terminated. The following short (15-20 s) applications were performed with low RF energy. During the same procedure ICE imaging revealed 2 thrombi (2 and 5 mm) on the Lasso electrode. None of the patients experienced thromboembolic complications. Conclusions: Intracardiac echocardiography is a useful imaging method in RF ablation. Low RF-energy and standard anticoagulation treatment do not prevent the microbubble effect and the formation of small thrombi

Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Furtherstudies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted

The usefulness of an 18F-FDG-PET/MR examination in a patient with rectal and breast cancer. A case report

Recently, we have gained access to innovative radiological and metabolic examination methods. One of these methods is PET/MRI with fluorodeoxyglucose (18F-FDG) tracer. Performing this innovative examination in a 69-year-old woman with diagnosed rectal cancer brought additional benefits. The use of PET/MRI resulted in precise clinical staging, the detection of a synchronous early-stage right breast cancer, and in the optimisation of treatment of both cancers. To date, diagnostic guidelines concerning rectal and breast cancers do not recommend the use of functional imaging for routine imaging.Recently, we have gained access to innovative radiological and metabolic examination methods. One of these methods is PET/MRI with fluorodeoxyglucose (18F-FDG) tracer. Performing this innovative examination in a 69-year-old woman with diagnosed rectal cancer brought additional benefits. The use of PET/MRI resulted in precise clinical staging, the detection of a synchronous early-stage right breast cancer, and in the optimisation of treatment of both cancers. To date, diagnostic guidelines concerning rectal and breast cancers do not recommend the use of functional imaging for routine imaging

Systemic NK cell ablation attenuates intra‐abdominal adipose tissue macrophage infiltration in murine obesity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108606/1/oby20823.pd

Regulation of Lean Mass, Bone Mass, and Exercise Tolerance by the Central Melanocortin System

Signaling via the type 4-melanocortin receptor (MC4R) is an important determinant of body weight in mice and humans, where loss of function mutations lead to significant obesity. Humans with mutations in the MC4R experience an increase in lean mass. However, the simultaneous accrual of fat mass in such individuals may contribute to this effect via mechanical loading. We therefore examined the relationship of fat mass and lean mass in mice lacking the type-4 melanocortin receptor (MC4RKO). We demonstrate that MC4RKO mice display increased lean body mass. Further, this is not dependent on changes in adipose mass, as MC4RKO mice possess more lean body mass than diet-induced obese (DIO) wild type mice with equivalent fat mass. To examine potential sources of the increased lean mass in MC4RKO mice, bone mass and strength were examined in MC4RKO mice. Both parameters increase with age in MC4RKO mice, which likely contributes to increases in lean body mass. We functionally characterized the increased lean mass in MC4RKO mice by examining their capacity for treadmill running. MC4R deficiency results in a decrease in exercise performance. No changes in the ratio of oxidative to glycolytic fibers were seen, however MC4RKO mice demonstrate a significantly reduced heart rate, which may underlie their impaired exercise performance. The reduced exercise capacity we report in the MC4RKO mouse has potential clinical ramifications, as efforts to control body weight in humans with melanocortin deficiency may be ineffective due to poor tolerance for physical activity

Zastosowanie echokardiografii endokawitarnej podczas ablacji podłoża migotania przedsionków

Wstęp: Echokardiografia endokawitarna (ICE) stosowana podczas ablacji migotania przedsionków (AF) pozwala osiągnąć dużą skuteczność i mały odsetek powikłań. W niniejszej pracy zaprezentowano pierwsze doświadczenia autorów związane z zastosowaniem ICE podczas ablacji prądem o wysokiej częstotliwości (RF). Metody: W lutym i lipcu 2004 r. wykonano 6 zabiegów ablacji RF tachyarytmii przedsionkowych z zastosowaniem ICE (EP Med Systems). Sondę ICE umieszczano w prawym przedsionku. Nakłucie transseptalne wykonano pod kontrolą fluoroskopii oraz ICE. Po wprowadzeniu prowadnika do lewego przedsionka (LA) podawano pacjentom bolus heparyny (100 jm./kg mc.) + 1000 jm./h (wszystkich pacjentów uprzednio co najmniej 3 miesiące leczono acenokumarolem, a 3 dni przed zabiegiem podawano im enoksyparynę). Ablacje przeprowadzano metodą elektroanatomiczną, elektrodą 4 mm. Aplikacje wykonano proksymalnie do ujść żył płucnych z nominalnymi nastawami generatora RF: temperatura 50-55°C, moc 25-35 W. Po pojawieniu się spontanicznego kontrastu redukowano moc, a przy braku efektu przerywano aplikacje. Aplikacje przerywano również natychmiast po pojawieniu się intensywnego kontrastu (shower of bubbles). Wyniki: U wszystkich pacjentów nakłucie transseptalne wykonano w sposób typowy. Nie wykazano anatomii atypowej. Efekt spontanicznego kontrastu obserwowano podczas aplikacji u wszystkich badanych. U 1 pacjenta objaw ten występował mimo zmniejszenia energii aplikacji. Kolejne aplikacje trwały 15-20 s i wykonano je przy użyciu niskiej energii. U tego samego chorego zaobserwowano w trakcie ablacji 2 balotujące skrzepliny o długości 2 mm i 5 mm wytworzone na elektrodzie Lasso. U żadnego z pacjentów nie wystąpiły po zabiegu powikłania zakrzepowo-zatorowe. Wnioski: Echokardiografia endokawitarna jest metodą istotnie uzupełniającą dotychczas stosowane podczas ablacji techniki obrazowania. Nawet przy niskiej energii aplikacji i prawidłowym leczeniu przeciwzakrzepowym istnieje ryzyko powstania spontanicznego kontrastu i drobnych skrzeplin

Przydatność hybrydowego badania 18F-FDG-PET/MR u chorej na raka odbytnicy i piersi. Opis przypadku

W ostatnim czasie istnieje dostęp do innowacyjnych obrazowych badań radiologicznych i metabolicznych. Jedną z takich możliwości jest wykorzystanie hybrydy PET/MR z użyciem znacznika — fluorodeoksyglukozy (18F-FDG). Wykonanie tego badania w opisywanym przypadku 69-letniej chorej z rozpoznaniem raka odbytnicy przyniosło dodatkowe korzyści w postaci precyzyjnego określenia stadium zawansowania raka odbytnicy, wykrycia synchronicznego wczesnego raka piersi prawej oraz zoptymalizowania planu leczenia pacjentki z powodu obu tych nowotworów. Jak dotąd, wytyczne diagnostyki chorych na raka odbytnicy lub piersi nie zalecają stosowania badań metabolicznych w rutynowym postępowaniu

Developing Requirements for all the Oregon All-Payerall-Claims (APAC) Database

For our group project, we sought a database that was sizeable enough to necessitate advanced Data mining techniques while being common enough that the implications of the data and the business questions are clear to the audience. Specifically, two of our team members have past or current links to the healthcare industry and that field seemed appropriate. One of our team members, working as a Graduate Intern within the Data and Information Management Enhancement (DIME) Department at Kaiser Permanente (KP), arranged for an interview with Mr. Jeff Emch, MBI , a senior analyst at KP responsible for collecting and sending claims data to the State health agency, the Oregon Health Authority (OHA). He offered the perspective of both the preparer of this data as well as the recipient of this data, having considerable experience understanding the latter’s needs. During the interview, he role-played both the persona as a KP analyst and an OHA analyst- which helped us develop an all-round understanding of the project

The chance of the young literature

Tekst jest opisem początków Koła Młodych w Stowarzyszeniu Pisarzy Polskich w Krakowie. Autor opisuje dzieje tego krakowskiego środowiska młodoliterackiego od marca do września 1990 r.The text is a description of The Circle of Youn Writers at the Association of Polish Writers in Cracow. The author describes the history of this Cracow circle of young writers since March until September 1990