Scope and efficacy of complex radiofrequency ablation.

Radiofrequency ablation is an effective treatment for various tachycardias. In some patients undergoing radiofrequency ablation, there are additional complexities. Of 254 consecutive patients (161 males, 93 females, aged 38 +/- 15 years) who underwent radiofrequency ablation, two groups were identified. Patients with structural heart disease, multiple accessory pathways, multifocal idiopathic ventricular tachycardia, parahisian accessory pathways, and multiple mechanisms of tachycardia were considered as complex radiofrequency ablation (Group I) and the remaining as non-complex radiofrequency ablation (Group II). There were 23 patients in Group I. The overall success rate was not different in the two groups: 20/23 (87%) vs 208/231 (90%) in groups I and II, respectively. The procedure and fluoroscopy time (212 +/- 91 min vs 136 +/- 45 min; p = 0.0001; and 55 +/- 31 min vs 31 +/- 21 min; p = 0.001, respectively) were significantly longer in Group I. There was a higher recurrence rate in Group I (6/20, 30% vs 20/208, 9.6%; p = 0.02); repeat radiofrequency ablation was successfully performed in four patients with recurrence in Group I. Complications were rare in both the groups. There was no mortality. Thus radiofrequency ablation in complex situations was effective, though more demanding than non-complex radiofrequency ablation and associated with higher recurrence.

Obstructive total anomalous pulmonary venous drainage.

Obstructive total anomalous pulmonary venous drainage (TAPVD) has a florid presentation in the neonatal period from the resulting pulmonary edema. A complete anatomical and functional diagnosis is usually possible by transthoracic color Doppler echocardiography, and cardiac catheterization with its attendant risks can usually be avoided in the sick neonate. Currently balloon atrial septostomy has a limited role in palliation of these neonates. Corrective surgery on urgent basis has gratifying results and prevents progression of pulmonary vascular occlusive disease. Pulmonary hypertensive crisis in the early post-operative course needs to be avoided and treated vigorously if it were to develop. Late post-operative course can be complicated by anastomotic obstruction or progressive narrowing of the individual pulmonary veins. Although the former can be dealt successfully by re-operation, surgical treatment of the latter is not satisfactory. Balloon dilatation of the obstructed pulmonary venous pathways, native and post-operative, has been reported with equivocal results. Infant heart-lung transplant is a viable option in patients with diffusely narrow pulmonary veins or complex TAPVDs.

Is haemorrhagic myocardial infarction more common with streptokinase?

Autopsy reports and clinical data of 226 consecutive myocardial infarction deaths in whom postmortem studies could be carried out during the period 1980 to 1996 were analyzed retrospectively for the presence of haemorrhagic myocardial infarction (HMI). Of 53 autopsies done from 1980 to 1986 [prior to use of streptokinase (SK) therapy in our institution] none of the specimens showed haemorrhagic infarction. Of 173 autopsies done from 1987 to 1996 (intravenous SK therapy was utilised in this period), 20 specimens showed haemorrhagic infarctions. Sixteen of these 20 patients had received SK, while 66 of the remaining 153 non-haemorrhagic myocardial infarction patients received SK (statistically significant association of SK with HMI, p < 0.005). Acute mechanical complications [ventricular septal rupture (n = 10), papillary muscle rupture (n = 2), cardiac free wall rupture (n = 7)] were seen in 19 cases. Of these, 16 were HMIs and 14 of these patients had received streptokinase. These observations suggest a strong association of HMI with SK therapy and with acute mechanical complications.

Total and segmental colonic transit time in non ulcer dyspepsia.

BACKGROUND: Patients with non ulcer dyspepsia (NUD) often have associated lower alimentary tract symptoms which are labelled as due to the irritable bowel syndrome. AIMS: To asymptomatic colonic dysmotility is present in patients with NUD. METHODS: We studied total and segmental colonic transit times in 25 patients with NUD (14 men age range 20-70 yr), and 25 matched normal controls (13 men; 18-50 yr), using the multiple-marker, single-film technique. Twenty markers each were administered at 0, 9 and 18 h and an abdominal film taken at 27 h. RESULTS: Total colonic transit time was shorter (median 9 h) in patients with NUD as compared to controls (median 15.8 h) p = 0.0018, with similar segmental motility pattern as in controls. There was no significant difference between the symptom subgroups of NUD. CONCLUSIONS: Patients with NUD often have altered colonic transit even in the absence of symptoms. NUD may therefore be only a subset of diffuse gastrointestinal dysmotility with predominant proximal alimentary tract symptoms, whereas the term irritable bowel syndrome is used when lower tract symptoms predominate.