Magnetic resonance angiography virtual endoscopy in the assessment of pulmonary veins before radiofrequency ablation procedures for atrial fibrillation.

Magnetic resonance angiography (MRA) is a safe and non-invasive imaging method that can readily depict the pulmonary veins (PV), whose imaging has acquired momentum with the advent of new techniques for radiofrequency ablation of atrial fibrillation (AF). We evaluated whether virtual endoscopy from 3D MRA images (MRA-VE) is feasible in studying the morphology of PV. Fifty patients with AF underwent pre-ablative MRA (1.5 T). Images were acquired with axial T-2 weighted and 3D-SPGR sequences after intravenous administration of Gd-DTPA and automatic triggering. Postprocessing was performed by an experienced radiologist with maximum intensity projection (MIP) and virtual endoscopy software (Navigator, GEMS). The venoatrial junction was visualized with MRA-VE in 49 of 50 patients (98.0%). Twenty-seven patients (55.1%) had two ostia on both sides, 13 patients (26.5%) had two ostia on the right and a single common ostium on the left, 5 patients (10.2%) had accessory PV and 4 patients (8.2%) had both an accessory right PV and a single common ostium on the left. Flythrough navigation showed the number and spatial disposition of second-order PV branches in 48 out of 49 patients (98.0%). MRA-VE is an excellent tool for at-a-glance visualization of ostia morphology, navigation of second-generation PV branches and easy endoluminal assessment of left atrial structures in pre-ablative imaging.

Should stimulation therapy for congestive heart failure be combined with defibrillation backup?

Biventricular pacing has been proposed to resynchronize ventricular contraction in patients with congestive heart failure (CHF) and interventricular conduction delay. However, the sudden death rate is still high despite the improvement in cardiac performance. Devices combining biventricular pacing with implantable cardioverter defibrillator (ICD) backup are now under clinical investigation to demonstrate whether they can decrease sudden death. From the first implant of an ICD with biventricular transvenous pacing on August 1998 to April 2000, 96 patients underwent such implants: 67 (70%) received pacemakers alone and 29 (30%), who had class I ICD indications, received combined pacemaker/ICD systems. During a mean follow-up of 283 +/- 170 days, 13 (14%) patients died: 5 of 29 (17%) in the ICD group and 8 of 67 (12%) in the pacemaker group. A total of 15 patients (52%) had ICD shocks and 6 patients (21%) had 113 episodes of ventricular tachyarrhythmias, of which 96 (85%) were converted to sinus rhythm with antitachypacing. The echocardiograms showed a narrowing of the delay between the onset of right and left ventricular outflow from 40 +/- 37 msec to 17 +/- 16 msec (p = 0.03) and a reduction of the mitral regurgitation area from 7 +/- 3.8 cm2 to 5 +/- 4 cm2 (p = 0.04) at 3 months. Functional class improved from 2.8 +/- 0.7 to 1.6 +/- 0.5 (p <0.001) 3 months after implant. Thus, ischemic patients with reduced left ventricular ejection fraction and ventricular tachyarrhythmias seem good candidates for biventricular pacing with ICD backup. The sudden death risk for those with idiopathic dilated cardiomyopathy, however, is difficult to stratify, and the choice of ICD backup has to be considered on the basis of patient safety, as well as of costs.

[Syndrome 49,XXXXY,9qh+. Case report]. / La sindrome 49,XXXXY,9 qh +. Descrizione di un caso.

The case of a patient with 49, XXXXY, 9qh + syndrome is described. Father's karyotype is 46,XY,9qh+,9(qh +,inv(pllh12)).

[Detoxification from opiates through hospitalization: the long-term results. A longitudinal study of 104 admissions in 1982-1986]. / Disassuefazione da oppiacei mediante ospedalizzazione: risultati a distanza. Studio longitudinale riguardante 104 soggetti ricoverati negli anni 1982-1986.

One hundred and four drug addicts admitted to hospital during the period 1982-1986 were studied in order to evaluate whether detoxification from opiates in a protected environment had positive long-term results, namely a definitive rejection of the world of drugs. A follow-up of this population was carried out at the start of the current year and approximately 20% were found to be drug-free. Accumulated experience leads to the conclusion that hospitalisation may have a positive long-term outcome if a subject with proven motivation to "give up" is carefully selected, and if the subject is then inserted in a broader social health project.

[Changes induced by carbamazepine in the action of ADH (antidiuretic hormone) in neurologic patients]. / Modificazioni indotte dalla carbamazepina sull'azione dell'ADH (ormone antidiuretico) in pazienti neurologici.

We report the result of a study performed in 27 patients taking carbamazepine because of epilepsy or neuralgia, in order to point out subclinical water abnormal retention. We tested serum sodium and potassium levels, plasma and urine osmolarity, free water clearance. The carbamazepine serum level is also reported. We didn't find abnormal values. So in our experience there is not any complication concerning water retention during oral carbamazepine treatment.