Global Neurosurgery: A Retrospective Cohort Study to Compare the Effectiveness of Two Training Methods in Resource-Poor Settings.

BACKGROUND AND OBJECTIVES: Many low- and middle-income countries are experiencing profound health care workforce shortages. Surgical subspecialists generally practice in large urban centers but are in high demand in rural areas. These subspecialists must be trained through sustainable programs to address this disparity. We quantitatively compared the relative effectiveness of 2 unique training models to advance neurosurgical skills in resource-poor settings where formally trained neurosurgeons are unavailable. METHODS: Neurosurgical procedure data were collected from 2 hospitals in Tanzania (Haydom Lutheran Hospital [HLH] and Bugando Medical Centre [BMC]), where 2 distinct training models ("Train Forward" and "Back-to-Back," respectively) were incorporated between 2005 and 2012. RESULTS: The most common procedures performed were ventriculoperitoneal shunt (BMC: 559, HLH: 72), spina bifida repair (BMC: 187, HLH: 54), craniotomy (BMC: 61, HLH: 19), bone elevation (BMC: 42, HLH: 32), and craniotomy and evacuation (BMC: 18, HLH: 34). The number of annual procedures at BMC increased from 148 in 2008 to 357 in 2012; at HLH, they increased from 18 in 2005 to 80 in 2010. Postoperative complications over time decreased or did not significantly change at both sites as the diversity of procedures increased. CONCLUSION: The Train Forward and Back-to-Back training models were associated with increased surgical volume and complexity without increased complications. However, only the Train Forward model resulted in local, autonomous training of surgical subspecialists after completion of the initial training period. Incorporating the Train Forward method into existing training programs in low- and middle-income countries may provide unique benefits over historic training practices.

ZAP-X Gyroscopic Radiosurgery System: A Preliminary Analysis of Clinical Applications within a Retrospective Case Series.

INTRODUCTION: The ZAP-X Gyroscopic Radiosurgery system (ZAP Surgical Systems, Inc., San Carlos, CA, USA) is a novel high-dose targeted stereotactic radiosurgery platform for outpatient use that includes self-shielding, X-ray image guidance, and the capacity to aim the radiation beam gyroscopically at an intracranial lesion using 5 independent degrees of freedom. The ZAP-X Gyroscopic Radiosurgery system accomplishes these actions while meeting widely accepted standards for dose gradient and accuracy. This retrospective study examined data of patients treated with gyroscopic radiosurgery (GRS) to document clinical outcomes. METHODS: Medical records of all outpatients treated with GRS over a 20-month period from January 2019 to August 2020 were searched to extract relevant details, including follow-up data until August 2021 (32-month study interval). Patients with <6 months of radiographical follow-up data were excluded unless death occurred. Data collection included pretreatment clinical history, pathological diagnosis, radiographical features, treatment parameters, and long-term clinical and radiographical follow-up. RESULTS: Sixty-eight patients received outpatient treatment with GRS during the 20-month treatment interval, with 59 patients remaining after exclusion for the minimum follow-up threshold, with a mean (standard deviation [SD]) fractionation of 1.85 (1.63). Eighty-two lesions were treated across a very heterogeneous patient population, including meningiomas (42.4%), metastases (39.0%), gliomas (6.8%), schwannomas (1.7%), and pituitary tumor (1.7%). Mean (SD) radiographical follow-up data (14.7 [6.60] months) were available for 56 patients. During that interval, 13 treated lesions in 13 patients (15.9%) demonstrated progression, 9 of which were stable during the initial posttreatment imaging surveillance period. Mean lesion volume was stable from pretreatment (2.54 cm3 [4.37 cm3]) to most recent follow-up (2.80 cm3 [8.20 cm3]) (t [79] = -0.310; p = 0.76). Minor adverse clinical events were noted in 3 (5.1%) of the 59 patients during the posttreatment phase that may have been related to the treatment. Ten (16.9%) patients died within the 32-month study interval. DISCUSSION/CONCLUSION: This preliminary assessment of the first series of patients treated with the Zap-X Gyroscopic Radiosurgery system documents its overall feasibility in clinical applications. Although the duration of follow-up was brief, GRS appeared to be both safe and effective. Additional analysis, with an ongoing prospective registry, is underway.

Treatment planning system and beam data validation for the ZAP-X: A novel self-shielded stereotactic radiosurgery system.

PURPOSE: To evaluate the treatment planning system (TPS) performance of the ZAP-X stereotactic radiosurgery (SRS) system through nondosimetric, dosimetric, and end-to-end (E2E) tests. METHODS: A comprehensive set of TPS commissioning and validation tests was developed using published guidelines. Nondosimetric validation tests included information transfer, computed tomography-magnetic resonance (CT-MR) image registration, structure/contouring, geometry, dose tools, and CT density. Dosimetric validation included comparisons between TPS and water tank/Solid Water measurements for various geometries and beam arrangements and end-to-end (E2E) tests. Patient-specific quality assurance was performed with an ion chamber in the Lucy phantom and with Gafchromic EBT3 film in the CyberKnife head phantom. RadCalc was used for independent verification of monitor units. Additional E2E tests were performed using the RPC Gamma Knife thermoluminescent dosimeter (TLD) phantom, MD Anderson SRS head phantom, and PseudoPatient gel phantom for independent absolute dose verification. RESULTS: CT-MR image registrations with known translational and rotational offsets were within tolerance (<0.5 × maximum voxel dimension). Slice thickness and distance accuracy were within 0.1 mm, and volume accuracy was within 0 to 0.11 cm3 . Treatment planning system volume measurement uncertainty was within 0.1 to 0.4 cm3 . Ion chamber point-dose measurements for a single beam in a water phantom agreed to TPS-calculated values within ±4% for collimator diameters 10 to 25 mm, and ±6% for 7.5 mm, for all measured depths (7, 50, 100, 150, and 200 mm). In homogeneous Solid Water, point-dose measurements agreed to within ±4% for cones sizes 7.5 to 25 mm. With 1-cm high/low density inserts, measurements were within ±4.2% for cone sizes 10 to 25 mm. Film-based E2E using 4/5-mm cones resulted in a gamma passing rate (%GP) of 99.8% (2%/1.5 mm). Point-dose measurements in a Lucy phantom with an ion chamber using 36 beams distributed along three noncoplanar arcs agreed to within ±4% for cone sizes 10 to 25 mm. The RPC Gamma Knife TLD phantom yielded passing results with a measured-to-expected TLD dose ratio of 1.02. The MD Anderson SRS head phantom yielded passing results, with 4% TLD agreement and %GP of 95%/93% (5%/3 mm) for coronal/sagittal film planes. The RTsafe gel phantom gave %GP of >95% (5%/2 mm) for all four targets. For our first 58 patients, film-based patient-specific quality assurance has resulted in an average %GP of 98.7% (range, 94-100%) at 2%/2 mm. CONCLUSIONS: Core ZAP-X features were found to be functional. On the basis of our results, point-dose and planar measurements were in agreement with TPS calculations using multiple phantoms and setup geometries, validating the ZAP-X TPS beam model for clinical use.

Rare Thyroid Transcription Factor 1-Positive Tumors of the Sellar Region: Barrow Neurological Institute Retrospective Case Series.

OBJECTIVE: Granular cell tumors (GCTs), pituicytomas, and spindle cell oncocytomas are rare, nonfunctioning pituitary tumors sharing positive staining of thyroid transcription factor 1. We present our series, the first single-institutional report with long-term surgical follow-up of all 3 tumor types. METHODS: Our institutional pathology database was queried for these 3 pathologic diagnoses. Clinical records were assessed for clinical presentation, preoperative and postoperative endocrine status, tumor location on imaging, surgical characteristics, pathology results, and tumor recurrence. RESULTS: Data were analyzed for 4 patients with GCTs, 4 with pituicytomas, and 3 with spindle cell oncocytomas. The most common symptoms at presentation were vision changes (64%), headache (55%), endocrine abnormalities (55%), and fatigue (46%). GCTs were the only subtype to present exclusively in the infundibulum and the only subtype in our series to be treated with a transcranial transsylvian approach to resection (n = 2). In our study, in contrast to other reports, estimated blood loss was less than 300 mL in all patients. Imaging confirmed gross total resection in all 11 cases with no known recurrences at a mean (standard deviation) follow-up of 4.7 (3.7) years. CONCLUSIONS: We present a single-institution series of rare thyroid transcription factor 1-staining posterior pituitary tumors of the sellar region. Key novel findings include gross total resection with no tumor recurrence at nearly 5 years of mean follow-up and no cases of excess or uncontrolled blood loss. Our findings reinforce the observation that GCTs present in the suprasellar space.

Cost Transparency in Neurosurgery: A Single-Institution Analysis of Patient Out-of-Pocket Spending in 13 673 Consecutive Neurosurgery Cases.

BACKGROUND: Patient out-of-pocket (OOP) spending is an increasingly discussed topic; however, there is minimal data available on the patient financial burden of surgical procedures. OBJECTIVE: To analyze hospital and surgeon expected payment data and patient OOP spending in neurosurgery. METHODS: This is a retrospective cohort study of neurosurgical patients at a tertiary-referral center from 2013 to 2016. Expected payments, reflecting negotiated costs-of-care, as well as actual patient OOP payments for hospital care and surgeon professional fees were analyzed. A 4-tiered model of patient OOP cost sharing and a multivariate model of patient expected payments were created. RESULTS: A total of 13 673 consecutive neurosurgical cases were analyzed. Patient age, insurance type, case category, severity of illness, length of stay (LOS), and elective case status were significant predictors of increased expected payments (P < .05). Craniotomy ($53 397 ± 811) and posterior spinal fusion ($48 329 ± 864) were associated with the highest expected payments. In a model of patient OOP cost sharing, nearly all neurosurgical procedures exceeded yearly OOP maximums for Healthcare Marketplace plans. Mean patient payments for hospital care and surgeon professional fees were the highest for anterior/lateral spinal fusion cases for commercially insured patients ($1662 ± 165). Mean expected payments and mean patient payments for commercially insured patients increased significantly from 2013 to 2016 (P < .05). CONCLUSION: Expected payments and patient OOP spending for commercially insured patients significantly increased from 2013 to 2016, representing increased healthcare costs and patient cost sharing in an evolving healthcare environment. Patients and providers can consider this information prior to surgery to better anticipate the individual financial burden for neurosurgical care.

Structure and Reactions of

The exotic nucleus ^{11}Be has been extensively studied and much experimental information is available on the structure of this system. We treat, within the framework of renormalized nuclear field theory in both configuration and 3D space, the mixing of bound and continuum single-particle states through the coupling to collective vibrations of the ^{10}Be core. We also take care of the Pauli principle acting not only between the single valence particle explicitly considered and those participating in the collective states, but also between fermions involved in two-phonon virtual states dressing the single-particle motion. In this way, it is possible to simultaneously and quantitatively account for the energies of the 1/2^{+}, 1/2^{-} low-lying states, the centroid and line shape of the 5/2^{+} resonance and the one-nucleon stripping and pickup absolute differential cross sections involving ^{11}Be as either target or residual nucleus. Also for the dipole transition connecting the 1/2^{+} and 1/2^{-} parity inverted levels as well as the isotopic shift of the charge radius. Theory provides a unified and exhaustive nuclear structure and reaction characterization of the many-body effects which are at the basis of this paradigmatic one-neutron halo system.

Risk of intrauterine growth restriction among HIV-infected pregnant women: a cohort study.

The purpose of this investigation was to study the risk of intrauterine growth restriction in human immunodeficiency virus (HIV)-infected women and to describe the associated risk factors. A cohort study was performed among HIV-infected women who delivered in a single tertiary centre in Barcelona, Spain, from January 2006 to December 2011. Consecutive singleton pregnancies delivered beyond 22 weeks of pregnancy were included. Intrauterine growth restriction (IUGR) was defined as a birth weight below the 10th customised centile for gestational age and IUGR babies were compared to non-IUGR newborns. Intrauterine Doppler findings were described among IUGR foetuses. Baseline characteristics, HIV infection data and perinatal outcome were compared between groups. The results were adjusted for potential confounders. A total of 156 singleton pregnancies were included. IUGR occurred in 23.4 % of cases (38/156). In two-thirds of the cases detected before birth, Doppler abnormalities compatible with placental insufficiency were observed. IUGR pregnancies presented a worse perinatal outcome, mainly due to a higher risk of iatrogenic preterm delivery [adjusted odds ratio 6.9, 95 % confidence interval (CI) 1.4-33.5]. IUGR foetuses also had a higher risk of emergent Caesarean section and neonatal intensive care unit admission. No cases of intrauterine foetal death occurred. A high rate of IUGR was observed among HIV pregnancies, and it was associated with adverse perinatal outcomes, mainly iatrogenic preterm and very preterm birth due to placental insufficiency. Our results support that ultrasound detection and follow-up of IUGR foetuses should be part of routine antenatal care in this high-risk population to improve antenatal management.

Cooper pair transfer in nuclei.

The second-order distorted wave Born approximation implementation of two-particle transfer direct reactions which includes simultaneous and successive transfer, properly corrected by non-orthogonality effects, is tested with the help of controlled nuclear structure and reaction inputs against data spanning the whole mass table, and showed to constitute a quantitative probe of nuclear pairing correlations.

Non-typhi Salmonella serovars found in Mexican zoo animals.

The aim of the present study was to determine the bacteriological prevalence of subclinical non-typhi Salmonella infections in zoo animals and to determine the most frequently isolated serovars of the bacteria. A total of 267 samples were analyzed, including fecal samples from zoo animals and rodents, insects (Musca domestica and Periplaneta americana) and samples of the zoo animal's food. Salmonella was detected in 11.6% of the samples analyzed. Characterization of the isolates was performed with serotyping and pulsed-field gel electrophoresis. The following serovars were isolated: S. San Diego, S. Oranienburg, S. Weltevreden, S. Braenderup, S. Derby, S. 6,7, H:en x:- and S. 3,10, H:r:-. The isolates showed seven pulsed-field gel electrophoresis patterns with a Jaccard coefficient≥0.75 indicating a possible common origin. The prevalence of asymptomatic infections caused by Salmonella spp. in zoo animals was high. These findings demonstrate the diversity of Salmonella serovars in several captive wild animal species.

Calculation of the transition from pairing vibrational to pairing rotational regimes between magic nuclei ¹°°Sn and ¹³²Sn via two-nucleon transfer reactions.

Absolute values of two-particle transfer cross sections along the Sn-isotopic chain are calculated. They agree with measurements within errors and without free parameters. Within this scenario, the predictions concerning the absolute value of the two-particle transfer cross sections associated with the excitation of the pairing vibrational spectrum expected around the recently discovered closed shell nucleus(50)(132)Sn(82) and the very exotic nucleus (50)(100)Sn(50) can be considered quantitative, opening new perspectives in the study of pairing in nuclei.

Neuropatía periférica como forma de presentación de poliangeítis microscópica / Peripheral neuropathy as a first sign of microscopic polyangiitis

No disponible

Evidence for phonon mediated pairing interaction in the halo of the nucleus ¹¹Li.

With the help of a unified nuclear-structure-direct-reaction theory we analyze the reaction ¹H(¹¹Li,9Li)³H. The two halo neutrons are correlated through the bare and the induced (medium polarization) pairing interaction. By considering all dominant reaction channels leading to the population of the 1/2⁻ (2.69 MeV) first excited state of 9Li, namely, multistep transfer (successive, simultaneous, and nonorthogonality), breakup, and inelastic channels, it is possible to show that the experiment provides direct evidence of phonon mediated pairing.

Hematomas cerebrales espontáneos múltiples. Descripción de una serie y revisión de la bibliografía / Multiple spontaneous cerebral haemorrahges. Descriptión of a series and review of the literature

Resumen. Introducción. La aparición simultánea de hemorragias cerebrales en diferentes territorios arteriales ocurre en el 2-3% de los accidentes cerebrovasculares. Diversos factores de riesgo se han asociado con la presentación de múltiples hemorragias cerebrales, pero ninguno ha sido confirmado. Presentamos los síntomas clínicos, las manifestaciones radiológicas y la evolución clínica de siete casos admitidos en nuestro centro durante los últimos nueve años, así como los distintos factores etiológicos. Pacientes y métodos. Se revisaron retrospectivamente los pacientes con un episodio de accidente cerebrovascular agudo ingresados en nuestro servicio durante el período comprendido entre enero de 1998 y febrero de 2007. Se excluyó a los pacientes con historia de traumatismo cerebral o infartos hemorrágicos. Se analizaron la edad, los factores de riesgo, la presentación clínica, el número y localización de los hematomas y su evolución. Resultados. Presentamos 7 casos (5 hombres y 2 mujeres). La edad media fue de 78 años. Las manifestaciones clínicas más frecuentes fueron la disminución del nivel de conciencia y la pérdida de fuerza. El total de hematomas fue de 20, de los cuales 19 (95%) eran supratentoriales, y 15 (75%), lobares. En un paciente la hemorragia se extendió al sistema ventricular. Tres pacientes (43%) tuvieron historia de hipertensión, un caso se asoció con la toma de anticoagulación oral (14%) y otro con discrasias sanguíneas (14%). Tres pacientes fallecieron (43%). Conclusión. Nuestra serie de pacientes con múltiples hemorragias cerebrales, respecto a los síntomas, los hallazgos radiológicos y la evolución es similar a otras previamente descritas, pero nuestros pacientes son mayores. La avanzada edad y la localización de los hematomas sugieren que la angiopatía amiloidea puede ser un importante factor de riesgo para presentar hemorragias cerebrales múltiples (AU)

Summary. Introduction. The simultaneous occurrence of intracerebral haemorraghes in different arterial territories is an clinical event that develops in 2% to 3% of hemorrhagic strokes. Multiple risk factors have been associated with multiple intracerebral haemorraghes, but none of them are clearly defined. We reported clinical features, radiological findings, and outcome of 7 patients admitted to our department during last nine years and the diverse etiologic factors are discussed. Patients and methods.We retrospectively reviewed all patients with acute stroke admitted to our department during the period January 1998-February 2007. Patients with a history of traumatic brain injury or suspected hemorrhagic infarctions were excluded. We collected data concerning age, risk factors, clinical features, number and location of haematomas and outcome. Results. We studied 7 patients (5 males and 2 females) Mean age was 78. The most common clinical manifestations were decreased alertness and weakness. Total number of haematomas was 20, 19 (95%) supratentorial and 15 (75%) in lobar area. One patient haemorrhage extended into the ventricular system. Three patients (43%) had hipertensive history, and in only one case was associated with oral anticoagulant (14%) and one blood dyscrasia (14%). Three patients died (43%). Conclusion. In our series of patients with multiple intracerebral haemorraghes, clinical and radiological findings and outcome were comparable to others previously described, but our patients were older. The advanced age and lobar localization suggest amyloid angiopathy is an important risk factor to multiple intracerebral haemorraghes (AU)

[Multiple spontaneous cerebral haemorrhages. Description of a series and review of the literature]. / Hematomas cerebrales espontáneos múltiples. Descripción de una serie y revisión de la bibliografía.

INTRODUCTION: The simultaneous occurrence of intracerebral haemorraghes in different arterial territories is an clinical event that develops in 2% to 3% of hemorrhagic strokes. Multiple risk factors have been associated with multiple intracerebral haemorraghes, but none of them are clearly defined. We reported clinical features, radiological findings, and outcome of 7 patients admitted to our department during last nine years and the diverse etiologic factors are discussed. PATIENTS AND METHODS: We retrospectively reviewed all patients with acute stroke admitted to our department during the period January 1998-February 2007. Patients with a history of traumatic brain injury or suspected hemorrhagic infarctions were excluded. We collected data concerning age, risk factors, clinical features, number and location of haematomas and outcome. RESULTS: We studied 7 patients (5 males and 2 females) Mean age was 78. The most common clinical manifestations were decreased alertness and weakness. Total number of haematomas was 20, 19 (95%) supratentorial and 15 (75%) in lobar area. One patient haemorrhage extended into the ventricular system. Three patients (43%) had hipertensive history, and in only one case was associated with oral anticoagulant (14%) and one blood dyscrasia (14%). Three patients died (43%). CONCLUSION: In our series of patients with multiple intracerebral haemorraghes, clinical and radiological findings and outcome were comparable to others previously described, but our patients were older. The advanced age and lobar localization suggest amyloid angiopathy is an important risk factor to multiple intracerebral haemorraghes.

Esófago de barret / Barrett's esophagus

El esófago de Barrett (EB) es una entidad clínico-patológica caracterizada por la substitución del epitelio esofágico normal por otro de tipo gástrico; esto ocurre como consecuencia del reflujo crónico y compromete una porción más o menos extensa del extremo inferior del esófago. El interés de su conocimiento radica en la posibilidad cierta de ser asiento de displasias de diverso grado, hasta el adenocarcinoma.El EB carece de síntomas específicos y su diagnóstico queda sujeto a las complicaciones del reflujo gastroesofágico (RGE); el control endoscópico de los pacientes portadores de RGE complementado con biopsias dirigidas constituye una propuesta consensuada para evitar el desarrollo del cáncer.En este trabajo de revisión bibliográfica, los autores realizan una investigación de los avances en el conocimiento de la afección, centrándose en la patogenia, clasificación, diagnóstico, tratamiento y seguimiento.

Partitioning and interfacial tracers for differentiating NAPL entrapment configuration: column-scale investigation.

Research on the use of partitioning and interfacial tracers has led to the development of techniques for estimating subsurface NAPL amount and NAPL-water interfacial area. Although these techniques have been utilized with some success at field sites, current application is limited largely to NAPL at residual saturation, such as for the case of post-remediation settings where mobile NAPL has been removed through product recovery. The goal of this study was to fundamentally evaluate partitioning and interfacial tracer behavior in controlled column-scale test cells for a range of entrapment configurations varying in NAPL saturation, with the results serving as a determinant of technique efficacy (and design protocol) for use with complexly distributed NAPLs, possibly at high saturation, in heterogeneous aquifers. Representative end members of the range of entrapment configurations observed under conditions of natural heterogeneity (an occurrence with residual NAPL saturation [discontinuous blobs] and an occurrence with high NAPL saturation [continuous free-phase LNAPL lens]) were evaluated. Study results indicated accurate prediction (using measured tracer retardation and equilibrium-based computational techniques) of NAPL amount and NAPL-water interfacial area for the case of residual NAPL saturation. For the high-saturation LNAPL lens, results indicated that NAPL-water interfacial area, but not NAPL amount (underpredicted by 35%), can be reasonably determined using conventional computation techniques. Underprediction of NAPL amount lead to an erroneous prediction of NAPL distribution, as indicated by the NAPL morphology index. In light of these results, careful consideration should be given to technique design and critical assumptions before applying equilibrium-based partitioning tracer methodology to settings where NAPLs are complexly entrapped, such as in naturally heterogeneous subsurface formations.

[Influence of the intravenous nitroglycerin dose on the appearance of drug tolerance]. / Influencia de la dosis de nitroglicerina intravenosa en la aparición de tolerancia farmacológica.

BACKGROUND: There are few studies on the influence of different doses of intravenous nitroglycerin (NTG) on the appearance of drug tolerance. METHODS: A controlled clinical trial was performed in 40 patients admitted to an ICU with the diagnosis of acute myocardial infarction (AMI). The patients were divided into two groups: group A with a continuous perfusion of NTG at 2 mg/h, and group B with 4 mg/h. At 30 minutes of the infusion, NTG was exchanged for a placebo in half of the patients of each group (subgroups A1 and B1) with the remaining patients continuing with NTG for 24 h (A2 and B2). The hemodynamic variables studied were central venous pressure (CVP), pulmonary capillary pressure (PCP), mean pulmonary artery pressure (PAP) and mean blood pressure (BP). RESULTS: The patients in group A showed a decrease in the hemodynamic effects in all the variables studied. At 24 h of infusion no differences were observed with respect to the previous NTG values for CVP and PCP, with significant differences being maintained for PAP and BP. In group B the hemodynamic effect was maintained for all the variables during the 24 hours studied. CONCLUSIONS: In patients with acute myocardial infarction, the dosis of nitroglycerin administered was found to have a determined influence in the appearance of drug tolerance with this fact being more evident on evaluation of the effect of nitroglycerin on the venous system.

Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency.

OBJECTIVE: Evaluation of efficacy of intravenous flecainide to revert supraventricular arrhythmias to sinus rhythm in patients with respiratory insufficiency. DESIGN: Comparative randomized prospective trial. SETTING: ICU in a University Hospital. PATIENTS: 30 patients with acute respiratory insufficiency or acute exacerbation of chronic respiratory insufficiency and supraventricular arrhythmias. Intravenous flecainide was administered to 15 patients (Group A) (2 mg/kg for 10 min and continuous perfusion of 1.5 mg/kg for 1 h). Intravenous verapamil was administered to 15 patients (Group B) (0.15 mg/kg for 5 min and continuous perfusion of 0.005 mg/kg/min for 1 h). MEASUREMENTS AND RESULTS: The categories of patients' arrhythmias were: Group A-atrial fibrillation (AF) in 5 cases, atrial flutter (AFl) in 2, multifocal atrial tachycardia (MAT) in 4 and other supraventricular tachycardia (SVT) in 4. Group B-AF in 6 cases, AFL in 2, MAT in 2 and SVT in 5 cases. Flecainide reverted arrhythmias to sinus rhythm in 12 out of 15 cases (80%); of these 12, 11 reverted with the initial bolus. Verapamil reverted 5 out of 12 cases (33.3%, p < 0.01). No significant secondary adverse effects were detected. CONCLUSION: Intravenous flecainide is an effective antiarrhythmic drug to treat acute supraventricular arrhythmias in patients with respiratory insufficiency.