Evaluation of subthreshold stimulation the predicting the site of successful radiofrequency ablation in supra-ventmcular tachycardia

This study is aimed to determine the incidence of terminating the supra-ventricular tachycardia [SVT, [AVNRT and AVRT]] by Subthreshold stimulation [STS] and to evaluate the ultrarapid STS in predicting the site of successful radiofrequency ablation in these arrhythmias. Thirty patients were selected during routine EPS; for this study; fifteen have had AVNRT and fifteen have had AVRT, [patients with other arrhythnhias were excluded]. All patients were well prepared for EPS and subjected to the following: Pacing protocol: in all cases pacing of the RV was followed to avoid early atrial stimulation that would potentially throw the patients into AF 1- Ventricular stimulation protocol: to initiate orthodromic tachycardia and localization the site; and to detect the site of earliest retrograde atrial activation. 2- Atrial stimulation protocol: to initiate antidromic wide QRS tachycardia and discover presence or absence of AH jump suggesting dual AVNodal pathway. Subthreshold stimulation [STS] method. Once patient developed AVNRT or AVRT we put ablation catheter near to expect site of ablation either slow pathway in case of AVNRT or accessory pathway in case of AVRT. We started pacing from ablation catheter aiming to terminate the re-entry circuit by STS and not to capture the whole myocardium. STS by threshold ranging between 2-5 mA and cycle length [CL] shorter than that of tachycardia by 50 msec., then decreasing CL every step by 50 msec., until reach CL 200 msec., for aduration of 3-5 sec. continuous pacing each step. If AVNRT or AVRT was terminated in certain site we started ablation in this site and if AVNRT lead to slow Junctional rhythm or AVRT terminated tachycardia with or without VA dissociation this would be considered. a positive result. If AVNRT or AVRT was not terminated in certain site we started ablation in this site and if slow functional rhythm in AVNRT or termination of AVRT with or without AV dissociation in AVRT this would be considered negative result. If AVNRT or AVRT did not terminated by STS as well as by ablation we tried STS and ablation in another site and so on. We achieved [53%] positive results in cases of AVRT and negative results in [47%] of cases; while in AVRT the positive results was [66%] of cases and the negative results was [34%] of cases. STS-guided mapping is a novel tool for the detection of target sites of slow pathway [SP] and accessory pathway [AP] ablation in patients with reproducible inducible and sustained AVNRT and AVRT. This technique helps to reduce the number of RFC pulses required for SF and AP ablation without an increase of fluoroscopy time or procedure duration

Different modalities of management of lower uretric calculi

Eighty two patients with lower third ureteric calculi were categorised into 3 group; 27 patients were treated conservatively according to specific radiological parameter; 34 patients were subjected to ureteroscopic manipulation, while 30 patients, underwent open surgery. Comparing the results, the success rates were 70%; 82%; and 100% respectively. We concluded that, ureteroscopy is an alternative modality for lower ureteric stones, it has a low, complication rate provided that, the patients are carefully selected; availability of different ureteroscopic armamentarium, and progress in the surgeon learning curve

Efficacy of chlorhexidine as a bladder irrigant in minimizing lower urinary tract infection after endoscopic procedures

This study involved 180 patients admitted for transurethral endoscopic manipulations either diagnostic or therapeutic. All patients entered the study have sterile urine as proved by bacterial counting in mid-stream urine samples below 10[5]/ml. Patients were divided into two groups; 90 patients for each. Treatment group, those receiving intravesical instillation of 100 ml. of 0.05% Chlorhexidine digluconate in sterile water that was retained in the bladder for 10 minutes before recommending free-drainage, twice daily postoperatively as long as the catheter in place. Control group; those were receiving normal saline for intravesical irrigation. In patients with catheter remaining less than two days; infection was found in catheter specimen and mid-stream urine after catheter removal in 19.35% and 12% respectively in comparison with the control group 27.6% and 40%. While those patients with catheter remaining more than two days; infection was found in catheter specimens and mid-steam urine after catheter removal in 22% and 5.2%]. Respectively in comparison with the control group [27.9% and 22.7] We conclude that chlorhexidine is effective in minimizing post operative bacteriuria especially in those patients keeping the catheter for less than two days. No local or systemic complications has been reported

When chronic prostatitis is to be considered?

We studied 50 patients with lower urinary symptoms, sexual symptoms and/or bacteruria. Their age ranged between 25-50 years. All patients were subjected to: full history taking, clinical and laboratory investigation including urine analysis and culture and sensetivity; prostatic smear analysis and culture; prostatic needle biopsy and culture. All specimens were grown on aerobic cultures and blood agar plates. The most common presentations of our cases were sexual troubles as weak erection [40%] and lower urinary symptoms as burning micturation [18%]. Significant bacteriuria was found in only 20% of patients and E.coli was the most common isolated organism. Infected prostatic secretion with pus cells over 100/H P.F. was found in most cases [45%]. Prostatic secretion, semen and prostatic needle biopsy cultures revealed bacteriological growth in 76%, 67%, and 72% respectively. Regarding cost benefit and invasion, prostatic biopsy was of significant value in diagnosis of chronic prostatitis

Efficacy of an enzyme immunoassay for detection of gonorrhea in males and females

An enzyme immunoassay for detecting gonococcal antigen [Gonozyme -GC- EIA] was evaluated in this study in diagnosis of both male and female urogenital specimens and copared to the conventional methods i.e. Gram-Stained smears, and culture. For male specimens, specificity and both positive and negative predictive values [p.v.] all exceeded 92% and up to 100%. With female patients the values were slightly lower but still of high specificity [89.2%] and negative p.v. [87%]. Gram staining showed much lower sensitivity especially in the endocervical specimens [55.5% compared to 88.8% of GC-EIA], however, it had 100% +ve p.v. In both populations. In conclusion GG-EIA is useful as a rapid, specific and sensitive diagnostic tool of gonorrhoea