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Objective To investigate the efficacy and safety of cool-tipped saline-irrigated catheter ablation of epicardial accesso-ry pathway in the patients after failure of conventional radiofrequency ablation .Methods 30 patients with epicardial accessory path-way after failuer of conventional radiofrequency ablation were included in this study ,among them ,25 cases of the left accessory pathway and 5 cases of the right accessory prathway used the cool-tipped catheter for conducting ablation through the endocardium (ventricular side or atrial side) or coronary sinus .Results All patients achieved success ,no intraoperative and postoperative related complications occurred .Conclusion The cool-tipped saline-irrigated catheter ablation of epicardial accessory pathway is effective and safe in the patients after failure of conventional radiofrequency ablation ,which may improve the success rate of epicardial acces-sory pathway ablation .
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms.</p><p><b>METHODS</b>Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA).</p><p><b>RESULTS</b>A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P < 0.001), revealing that 3D-CT angiograms correlated well with surgical findings. Compared with images obtained by routine catheter four-vessel angiography, MRA and DSA, 3D-CTA images depicted the relationship of aneurysms to parent vessels and other branches more clearly.</p><p><b>CONCLUSION</b>3D-CTA enables surgeons to understand the 3D structure of intracranial aneurysms and is very useful in planning the surgical treatment of cerebral aneurysms.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiography , Imaging, Three-Dimensional , Methods , Intracranial Aneurysm , Diagnostic Imaging , General Surgery , Tomography, X-Ray Computed , MethodsABSTRACT
OBJECTIVE: To investigate the influence of intra cranial pressure (ICP) and cerebral perfusion pressure (CPP) on neurological det erioration and outcome of severe traumatic brain injury (STBI). METHODS: A total of 245 patients with severe traumatic brain in jury were studied retrospectively with univariate and multivariate studies to ev aluate the contribution of ICP/CPP to neurological deterioration and outcome. RESULTS: The mortality rates rose from 16.2% in 142 patient s whose course of disease was smooth to 66.7% in 103 patients who suffered f rom neurological deterioration. Correspondingly, the favorable outcome fall from 54.2% in the patients without neurological deterioration to 18.3% in th ose with neurological deterioration. In the patients with clinical evidence of n eurological deterioration, the relative influence of the ICP and the CPP on outc ome was assessed. The most powerful predictors of neurological deterioration was the presence of intracranial hypertension (ICP>30 mm Hg, 1 mm Hg=0.133 kPa). The CPP also had a prognostic power on neurological deterioration when its level less than 60 mm Hg. CONCLUSIONS: It suggests that it's very important to lower the intracranial hypertension and keep the CPP not less than 60 mm Hg during the t reatment of STBI.