Performance of the minimalistic hybrid approach algorithm versus other conventional algorithms in the percutaneous treatment of chronic total occlusions.

BACKGROUND: The "Minimalistic Hybrid Approach" (MHA) has been proposed to reduce the invasiveness of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS: This study aims to assess whether MHA may also reduce the utilization of PCI resources (devices, radiations, and contrast) by comparing it with other conventional algorithms. METHODS: We aimed to assess the impact of MHA on device, radiation, and contrast usage during CTO-PCI analyzing data from the Belgian Working Group on CTO (BWG-CTO) registry. Patients were divided, depending on the algorithm used, into two groups: Conventional versus Minimalistic. Primary objectives were procedure performance measures such as device usage (microcatheters and guidewires), radiological parameters, and contrast use. At 1-year follow-up, patients were evaluated for target vessel failure (TVF), defined as a composite of cardiac death, new myocardial infarction, and target vessel revascularization. RESULTS: Overall, we analyzed 821 CTO-PCIs (Conventional n = 650, Minimalistic n = 171). The Minimalistic group demonstrated higher complexity of CTO lesions. After adjusting for propensity score, the Minimalistic group had a significantly lower number of microcatheters used (1.49 ± 0.85 vs. 1.24 ± 0.64, p = 0.026), while the number of guidewires was comparable (4.80 ± 3.29 vs. 4.35 ± 2.94, p = 0.30). Both groups had similar rates of success and procedural complications, as well as comparable procedural and fluoroscopic times and contrast volume used. At the 1-year follow-up, both groups showed comparable rates of TVF (hazard ratio: 0.57; 95% confidence interval: 0.24-1.34, p = 0.195). CONCLUSION: The MHA may slightly reduce the number of dedicated devices used during CTO-PCI, without adversely affecting the procedural success or long-term outcome.

[Rare combination injury of traumatic spondylolisthesis of the lumbosacral junction and Malgaigne's C3 fracture of the pelvis : Lessons learned]. / Seltene Kombinationsverletzung einer traumatischen Spondylolisthese des lumbosakralen Übergangs und C3-Beckenfraktur (Malgaigne-Verletzung) : "Lessons learned".

This article reports on the case of a rare combination injury of a C3 pelvic ring fracture (Malgaigne's fracture) and simultaneous unstable traumatic spondylolisthesis (Meyerding grade 2) of the lumbosacral spine. The patient had pronounced neurological deficits of the lower extremities and tearing of the thecal sac. The selected primary and secondary surgical treatment algorithm of the polytraumatized patient as well as the course are described and critically discussed on the basis of the sparsely available literature.

Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity.

BACKGROUND: Conventional stainings (including H&E and special stains like Giemsa) are the most widely applied histopathologic detection methods of Helicobacter pylori (HP). MATERIALS AND METHODS: We aimed to compare the diagnostic performance of Giemsa staining with immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) on a monocentric cohort of 2896 gastric biopsies and relate results to histologic alterations in order to find such histopathologic subgroups in which these methods underperform. All cases were categorized regarding presence or absence of chronic gastritis, inflammatory activity, and mucosal structural alterations. RESULTS: Giemsa revealed 687 cases (23.7%), IHC 795 cases (27.5%), and FISH 788 cases (27.2%) as being HP positive. Giemsa showed significantly lower overall sensitivity (83.3%) compared to IHC (98.8%) and FISH (98.0%). Moreover, the sensitivity of Giemsa dramatically dropped to 33.6% in the nonactive cases. We found that sensitivity of Giemsa strongly depends on HP density and, accordingly, on the presence of activity. Structural alterations (intestinal metaplasia, atrophy, etc.) had only no or weak effect on sensitivity of the three stainings. Both IHC and FISH proved to be equally reliable HP detecting techniques whose diagnostic performance is minimally influenced by mucosal inflammatory and structural alterations contrary to conventional stainings. CONCLUSIONS: We highly recommend immunohistochemistry for clinically susceptible, nonactive chronic gastritis cases, if the conventional stain-based HP detection is negative. Moreover, we recommend to use IHC more widely as basic HP stain. Helicobacter pylori FISH technique is primarily recommended to determine bacterial clarithromycin resistance. Furthermore, it is another accurate diagnostic tool for HP.

Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study).

BACKGROUND: AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum. METHODS: AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up. RESULTS: Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively. CONCLUSIONS: IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.

[Hungarian Society for Sleep Medicine guideline for detecting drivers with obstructive sleep apnea syndrome]. / A Magyar Alvásdiagnosztikai és Terápiás Társaság módszertani ajánlása a közúti jármuvezetok egészségi alkalmasságának vizsgálatához az obstruktív alvási apnoe szindróma vonatkozásában.

Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control.

Utilidad de un esquema sencillo para el diagnóstico de arritmias cardíacas / Usefulness of simple scheme for the diagnosis of cardiac arrhythmias

Objetivo: Determinar si un algoritmo diseñado en nuestra Sección de Electrofisiología facilita el diagnóstico electrocardiográfico de las taquiarritmias. Métodos: Treinta y dos sujetos: médicos residentes del primer año de postgrado de cardiología, médico sinternos y estudiantes del último año de medicina recibieron un curso de electrocardiografía. Luego se les repartieron 100 ECG de pacientes con taquiarritmias y se dividieron al azar en dos grupos. El grupo A emitió su diagnóstico sin el uso del algoritmo, y el Grupo B analizó los ECG con auxilio del algoritmo. Los diagnósticos fueron comparados contra el emitido por un electrofisiólogo. Resultados: El diagnóstico del grupo A tuvo una concordancia de 41% con el diagnóstico formulado por electrofisiólogo. El grupo B tuvo una concordancia del 64% (p = 0.0000013). Entre los dos grupos no hubo diferencias en cuanto al tipo o número de ECG no respondidos. Conclusiones: Este árbol de decisiones incrementa la certeza del diagnóstico en manos menos experimentadas, lo cual, a su vez, podría redundar en una mejoría de las medidas terapéuticas aplicadas a las arritmias.

Objective: To determine whether an algorythm designed at our Electrophysiology Unit could facilitate the electrocardiographic diagnosis of tachyarrhythmias. Methods: Twenty two first-year cardiology residents, general practitioners and last-year medical students attended an electro-physiology course. One hundred ECG of tachyarrhythmic patients were distributed to the participants who were then randomly divided into 2 groups. Group A analyzed the ECG with the help of the algorythm, whereas Group B analyzed them without it. Results were compared to those obtained by an electrophysiologist. Results: Group A diagnosis coincided with that of the electrophysiologist in 41% of the cases. In Group B the concordance reached 64% (p = 0.0000013). There was no between-group difference regarding the type and number of uninterpreted ECG. Conclusions: The decision tree increases diagnostic accuracy in less expert hands. This could in turn entail an improvement in the therapeutic measures applied to the study of arrhythmias.