ABSTRACT
BACKGROUND: Cryoablation is increasingly utilized in children because of its safety profile. Recently, larger catheter tips have been more widely used to improve long-term success rates. The aim of this study was to assess the safety and efficacy of 8-mm-tip catheters for cryoablation of right-sided accessory pathways (APs) in children. METHODS: Electrophysiological procedures were performed using the EnSite™ system (St. Jude Medical Inc., St. Paul, MN, USA). RESULTS: Between July 2010 and July 2014, 54 patients (mean age: 13.1 ± 3.7 years) underwent cryoablation using an 8-mm-tip catheter. In 18 of 54 (33%) patients where an 8-mm-tip catheter was the first-choice catheter, the success rate was 18 of 18 (100%). There was a history of previous failed attempts or recurrence with radiofrequency ablation and/or 6-mm-tip cryoablation in 36 of 54 (67%) patients. The success rate in these patients was 24 of 36 (67%). No fluoroscopy was used in 34 of 54 procedures. The recurrence rate was six of 42 (14%) during a mean follow-up period of 32 ± 15 months. In one patient, transient atrioventricular block occurred. CONCLUSIONS: Cryoablation with an 8-mm-tip catheter for right-sided APs in children who weigh over 40 kg appears to be safe and acutely effective in cases where conventional ablation methods fail and also as a first choice for ablation procedure. However, the recurrence rate still seems to be high.
Subject(s)
Accessory Atrioventricular Bundle/epidemiology , Accessory Atrioventricular Bundle/surgery , Cardiac Catheters/statistics & numerical data , Cryosurgery/instrumentation , Cryosurgery/statistics & numerical data , Postoperative Complications/epidemiology , Accessory Atrioventricular Bundle/diagnosis , Adolescent , Causality , Equipment Design , Equipment Failure Analysis , Female , Humans , Male , Postoperative Complications/prevention & control , Retrospective Studies , Risk Assessment , Risk Factors , Treatment Outcome , Turkey/epidemiologyABSTRACT
Macrolides have antiinflammatory effects that are potentially useful in cystic fibrosis (CF). In this placebo-controlled, randomized, double-blind crossover study, 18 CF patients were randomized to receive either clarithromycin (CM) (Group 1) or placebo (Group 2) for three months. After 15 days, the treatments were crossed over. Bronchoalveolar lavage (BAL) was obtained in the beginning and at the end of each treatment period. There was no significant difference in median cell counts and median cytokine levels at baseline, after CM use and after placebo use between the two groups. In Group 2, the median neutrophil elastase (NE) level decreased with CM. Patients had less acute pulmonary exacerbations and median clinical score decreased with CM in both groups. Median z-scores for weight increased with CM in Group 2. We could not demonstrate a fall in proinflammatory cytokines in BAL; however, some improvement in clinical status could be shown with three-month CM.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Clarithromycin/therapeutic use , Cystic Fibrosis/drug therapy , Adolescent , Biomarkers/analysis , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid/cytology , Bronchoalveolar Lavage Fluid/immunology , Child , Child, Preschool , Cross-Over Studies , Cystic Fibrosis/immunology , Disease Progression , Double-Blind Method , Female , Health Status , Humans , Interleukin-8/analysis , Leukocyte Elastase/analysis , Male , Treatment Outcome , Tumor Necrosis Factor-alpha/analysisABSTRACT
Diffuse panbronchiolitis (DPB) is a chronic, potentially life-threatening lower respiratory tract disease that is particularly common in Japanese people. If left untreated, it progresses to bronchiectasis, respiratory failure, and death. Lack of familiarity with DPB in the non-Far East may result in a failure to correctly diagnose and treat this disorder. We describe a child with DPB. We suggest that DPB is a sinopulmonary disease that is not exclusive to the Asian population and to adults. Its clinical and radiological features should be better known by pediatric pulmonary physicians.
