Medical ethical moral and legal aspects of Jehovah´s Witnesses operations.

OBJECTIVE: To point out principles of blood sparing surgery. Medical ethical moral and legal aspects of operations on Jehovahs Witnesses. DESIGN: Retrospective clinical study. Review of articles. SETTING: Dept. of Gynecology and Obstetrics, University Hospital, Olomouc; Dept. of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlín. MATERIALS AND METHODS: 72 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases since 2007-2017. All patiens were operated according to the rules of blood sparing surgery. RESULTS: There were no excesive blood loss at any of the operations. The estimated blood loss was between 10 to 550 ml. CONCLUSIONS: The main principles of blood sparing surgery should be applied not only for Jehovahs Witnesses but for all patients. Even if the blood transfusion is the last resort for excessive blood loss during complicated operations it always carries some health risks. There are also the economical aspects. Blood transfusions should be therefore used only at very rare occasions. Jehovahs Witnesses refuse blood transfusions at all even if it is the only life saving resort. Our legislation deal with this problem but there are also moral and ethical aspects. The attitude of gynecological surgeons how to solve this problem differ a great deal.

The impact of ECG synchronization during acquisition of left­atrium computed tomography model on radiation dose and arrhythmia recurrence rate after catheter ablation of atrial fibrillation - a prospective, randomized study.

BACKGROUND: The impact of ECG gating during computed tomography (CT) acquisition of left atrium (LA) model on radiation dose, image quality and ablation event-free survival rate after catheter ablation (CA) of atrial fibrillation (AF) is not well defined. METHODS: Sixty-two patients with paroxysmal atrial fibrillation were randomized for two types of LA CT (with vs without ECG gating) before CA. Pulmonary veins isolation was performed in all patients. Patients were followed for 12 months after CA. RESULTS: There was no difference between the groups in CA length (131.61±32.57 vs 119.84±33.18 min; p=0.108), CA fluoroscopy time (4.48±2.19 vs 3.89±1.83 min; p=0.251), CA fluoroscopy dose (3.99±2.79 vs 3.91 vs2.91 Gy*cm2; p=0.735), visual data quality (1.77±0.88 vs 2.0±0.63; p=0.102) and registration error (2.42±0.72 vs 2.43±0.46 mm; p=0.612). We found a significant difference in CT Dose index (89.55±5.99 vs 19.19±4.33 mGy; p<0.0001) and Dose Length product (1438.87±147.75 vs 328.21±73.83 mGy*cm; p<0.0001). Twelve months after CA, 25 of 31 patients in the gated group and 24 of 31 patients in the non-gated group were free of AF (80.65 vs 77.42 %; p=0.838). CONCLUSION: ECG gating of computed tomography of LA before AF ablation burdens patients with a four times higher radiation dose while improving neither the quality of CT model or fusion of CT with the electroanatomic map. As a result, it has no significant impact on arrhythmia recurrence rate after ablation (Tab. 3, Fig. 3, Ref. 25).