Noncontact endocardial mapping to guide ablation for hemodynamically unstable or nonsustained ventricular tachycardia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the feasibility and assess the validity of noncontact endocardial mapping to guide ablation of hemodynamically unstable or nonsustained ventricular tachycardia (VT).</p><p><b>METHODS</b>Noncontact mapping permitted individual-beat analysis of ventricular arrhythmias. Three-dimensional electroanatomical mapping allowed detailed reconstruction of a chamber geometry and activation sequence. Eighteen hemodynamically unstable or nonsustained VTs were induced (cycle length: 336 ms +/- 58 ms) in 17 patients and mapped by noncontact mapping using an EnSite 3000 system performed for the guidance of catheter ablation.</p><p><b>RESULTS</b>Three patients were mapped during premature ventricular complexes (PVCs) because sustained VT could not be induced. Analysis of the archived noncontact activation maps was performed to identify the exit site and/or the diastolic pathway of the VT reentry circuit. The endocardial exit sites 10 ms +/- 16 ms before QRS were defined in 9 right ventricular outflow tract (RVOT) and 5 ischemic VTs. The diastolic pathway was identified in 5 ischemic VTs. The earliest endocardial diastolic activity preceded the QRS onset by 60.1 ms +/- 42.6 ms. The earliest activation sites were identify in 3 patients with nonsustained VTs or PVCs. Radiofrequency current was applied around the exit site or to create a line of block across the diastolic pathway. Catheter ablation was performed in 17/18 (94%) VTs and 15/17 (88%) VTs was successfully ablated. Two (67%) of the three patients with non-sustained VTs were mapped and successfully ablated during PVCs. Catheter ablation was not performed in 1 patient (peri-Hisian VT) and was unsuccessful in 2 patients.</p><p><b>CONCLUSION</b>Noncontact endocardial mapping is able to be used to guide ablation of untolerated or nonsustained VTs.</p>

Total nasal reconstruction with expanded forehead flap

Total nasal reconstruction in stages with an expanded forehead flap is described. Reconstruction of the air passages were given due importance before embarking the total nasal reconstruction. Hence, in the first stage, the nasal air passages were reconstructed with local skin flaps and skin grafts, and a tissue expander was implanted in the forehead to generate adequate skin for the nasal reconstruction. In the second stage lining was reconstructed with local turn over flaps and external nasal skin by a paramedian forehead flap as a single unit from the expanded forehead after providing skeletal and cartilagenous support

Reconstructed complete sternal cleft. A Long term follow-up

A newborn baby with congenital complete sternal defect and partial hernation of the heart had successful reconstruction of the sternal defect with an iliac bone graft at the age of two months. Seven years follow up showed no complications. Clinically no abnormalities in the abdominal viscera and central nervous system were noted. The patient is followed up further for any late manifestations

Multiple primary skin cancers a case report

Basal Cell Carcinoma [BCC] is the most common of all skin cancers especially among the people of European race. In pigmented races it is associated with pre-disposing conditions such as naevus sebaceous, albinism or Xeroderma Pigmentosum. We are reporting a 64-year old gentleman of European origin working in Oman since 25 years who presented with multiple primary skin cancers on the scalp, face and upper trunk at different occasions

Cutaneous malignant melanoma with metastatic intracerebral space occupying lesion

A detailed case report of a patient with cutaneous malignant melanoma having a metastatic intracerebral space occupying lesion causing hemiplegia has been presented. A brief and relevant review of the subject has been summarized. It is our conclusion that [a] in the presence of slight pigmentation at the edge of any nodular or ulcerated lesion a diagnosis of malignant melanoma should be considered especially in sites where a predisposing mole may or can not have been noticed; [b] it is necessary to carry out thorough clinical, laboratory and radiological investigations to detect the presence of lymphatic or visceral [lung/liver/cerebral] metastasis, and [c] intracerebral metastatic lesions of malignant melanoma are uncommon and such lesions presenting as space occupying lesion in the brain are extremely rare