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Alhazmi S, Aljahdli B, Farsi R, Alharbi M, Algothmi K, Alburae N, Ganash M, Azhari S, Basingab F, Almuhammadi A, Alqosaibi A, Alkhatabi H, Elaimi A, Jan M, Aldhalaan H, Alyoubi R, Alrafiah A, Alrofaidi A. The correlation between copy number variation in Chromosome 14 and DNA methylation in Saudi autistic children. Eur Rev Med Pharmacol Sci 2022; 26:7866-7882. [PMID: 36394735 DOI: 10.26355/eurrev_202211_30138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that represents a range of aberrant behaviour symptoms such as repetitive behaviours and defects in social communication. The prevalence of ASD has been increasing worldwide and many studies have reported that both genetic and epigenetic factors play an important role in the etiology of this disorder. The aim of this study was to investigate the implementation of DNA methylation and Copy number variation (CNV) in the diagnosis of ASD. PATIENTS AND METHODS This study was carried out on 14 Saudi autistic children and four of their healthy siblings. Comparative genomic hybridization array was used to identify CNV in chromosome 14 and MethyLight qPCR was used to estimate levels of DNA methylation. RESULTS The results identified CNVs in six cytobands in chromosome 14 for 13 out of 14 autistic samples: 14q11.1-q11.2, 14q11.2, 14q12, 14q21.1, 14q32.2, and 14q32.33. However, some of these cytobands were also found in normal samples with different sizes. Interestingly, chromosomal abnormalities in 14q11.1-q11.2 was only found in ASD samples. The result also showed an increase in methylation ratio of ASD samples in those CNV regions compared with their siblings. CONCLUSIONS The findings suggest that CNV in 14q11.1-q11.2 might be a potential target in ASD diagnosis and further work is required to detect which biological pathways are affected.
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Affiliation(s)
- S Alhazmi
- Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
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2
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Prolic Kalinsek T, Sorli J, Jan M, Sinkovec M, Antolic B, Klemen L, Zizek D, Pernat A. Conventional fluorscopy-guided vs zero-fluorscopy catheter ablation of supraventricular tachycardias. Europace 2022. [DOI: 10.1093/europace/euac053.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Traditionally, X-ray fluoroscopy is used during catheter ablation procedures. The utilisation of ionising radiation carries non-negligible stochastic and deterministic risks to the health of both the patient and the professional staff. These effects are cumulative and behave in a linear no-threshold manner and, as such, are especially important in paediatric populations (1). The importance of reducing ionising radiation exposure has been recognised by the American College of Cardiology, which recommends the ALARA (as low as reasonably achievable) principle in all interventional laboratories (2). In recent years, advances in three-dimensional electroanatomical mapping systems and their utilisation have enabled the near-zero and zero-fluoroscopy approaches to be studied (3).
Purpose
The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy catheter ablation for supraventricular tachycardias (SVT).
Methods
584 consecutive patients referred to our institution for catheter ablation of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. Patient characteristics, procedural information, and follow-up data were compared.
Results
The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0 %; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators’ preferences.
Conclusion
The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.
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Affiliation(s)
- T Prolic Kalinsek
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
| | - J Sorli
- Medical Faculty of the University of Ljubljana, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
| | - M Sinkovec
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
| | - L Klemen
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
| | - A Pernat
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
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3
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Rauber M, Ivanovski M, Klemen L, Zupan Meznar A, Pernat A, Jan M, Zizek D, Antolic B. Conduction system pacing with AV node ablation versus catheter ablation for treatment of persistent atrial fibrillation in patients with heart failure with reduced ejection fraction. Europace 2022. [DOI: 10.1093/europace/euac053.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with persistent atrial fibrillation (PeAF) and heart failure with reduced ejection fraction (HFrEF) current guidelines recommend treatment of AF with catheter ablation (CA) (1). Recurrence of either AF or atrial flutter, often requiring additional procedures, are not uncommon, thus optimal long-term treatment of these patients is still unknown. Recently conduction system pacing (CSP), with more physiological ventricular activation, has made the ‘’pace and ablate’’ strategy an attractive alternative for the treatment of PeAF refractory to medical therapy (2).
Purpose
Long term data comparing CA with conduction system pacing and AV node ablation (CSP/AVNa) for treatment of patients with PeAF and HFrEF is lacking. Hence, we sought to compare clinical outcomes of both treatment modalities.
Methods
In a retrospective study consecutive patients under 75 years of age, with PeAF and left ventricular ejection fraction (LVEF) less than 50%, treated with CSP/AVNa from 2018 to 2021 in UMC Ljubljana were included. A control patient treated with CA for PeAF matched in age, sex and LVEF was assigned for each included CPS/AVNa patient. Both groups were compared for procedure-related characteristics, echocardiographic parameters, hospitalisations for heart failure and all-cause mortality.
Results
Among 771 patients referred for interventional treatment of AF, 23 patients treated with CSP/AVNa were included and compared with 23 CA matched controls. The general characteristics of both groups are summarised in Table 1. The mean follow-up was 20 ± 10 and 21 ± 8 months for CPS/AVNa and CA group, respectively (p=0.76). In CPS/AVNa group 83% received his bundle pacing and 17% left bundle branch area pacing. A selective CSP was achieved in 43% of CSP/AVNa patients. In addition to pulmonary vein isolation, additional ablation lines were performed in 35% of patients in the CA group. Significant improvement in LVEF was observed in both groups, 12% ± 11% (p<0.001) in CSP/AVNa and 21% ± 12% (p<0.001) in CA group. Hospitalisations for HF were rare during the follow-up, with 9% in CSP/AVNa and 4% in the CA ablation group (p=0.561). All-cause mortality was 9% in CSP/AVNa and 0% in CA group (p=0.153). However, major comorbidities were more common in the CSP/AVNa group than in the CA group, 3.4 ± 1.6 and 2.3 ± 1.5, respectively (p=0.017). Procedure-related characteristics are summarised in Table 1. In each group, 2 minor procedure-related adverse events were observed: 2 acute rises in pacing threshold post-AVNa in CSP/AVNa group and puncture site hematoma and transient pericardial effusion in CA group.
Conclusion
In patients with PeAF and HFrEF, CSP/AVNa treatment strategy seems to derive similar clinical outcomes compared to CA approach. Larger prospective randomised data are needed to further confirm these initial findings and determine optimal long-term treatment strategy for this group of patients.
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Affiliation(s)
- M Rauber
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Ivanovski
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - L Klemen
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - A Zupan Meznar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - A Pernat
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
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4
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Ivanovski M, Zupan Meznar A, Mrak M, Antolic B, Klemen L, Stublar J, Jan M, Pernat A, Zizek D. Biventricular versus conduction system pacing after atrioventricular node ablation in heart failure patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrioventricular node ablation (AVNA) with biventricular (BiV) pacing is an established treatment option for heart failure (HF) patients with drug refractory atrial fibrillation (AF) (1). However, compared to conduction system pacing (CSP) modalities, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), BiV pacing delivers non-physiological ventricular activation (2).
Purpose
To compare clinical outcomes of BiV pacing and both CSP modalities in HF patients with symptomatic AF who underwent AVNA.
Methods
Consecutive AF patients with LV ejection fraction (LVEF <50%) who received either BiV pacing or CSP in conjunction with AVNA between May 2015 and July 2021 were retrospectively analysed. Procedural characteristics, electrocardiographic, echocardiographic, and clinical parameters were assessed at baseline and 6 months after the procedure.
Results
Fifty-five patients (male 43.6%, age 71 years (IQR 10), LVEF 39% (IQR 14)) were included. Thirteen patients (23.6%) received BiV pacing, 30 patients (54.5%) HBP and 12 patients (21.8%) LBBP. All groups had similar baseline characteristics, acute success rate and adverse events. Post-procedural QRS duration was significantly shorter (p<0.01) in CSP (118 ms (IQR 28)) than in BiV pacing (172 ms (IQR 18)). While NYHA class improved in both HBP (p<0.01) and LBBP (p=0.01), it did not improve in BiV group (p=0.1) At follow-up, end systolic volume (ESVi) decreased in both HBP (48±20 to 32±12 mL/m2, p<0.01) and LBBP (62±22 to 52±22 mL/m2, p=0.02), but did not differ in BiV pacing group (51±12 to 53±14 mL/m2, p=0.6). Similarly, LVEF increased in HBP (form 39% (IQR 16) to 53% (IQR 14), p<0.01) and LBBP (from 41% (IQR 23) to 40% (IQR 25), p=0.04), but did not change in BiV group (from 38% (IQR 5) to 37% (IQR 6), p=0.9). Significantly lower (p<0.01) pacing thresholds were achieved in LBBP (0.75 V at 0.5 ms (IQR 0.3)) than in HBP group (1.0 V at 0.5 ms (IQR 1)). Two patients in HBP group were switched to right ventricular pacing due to rise in HBP threshold. In the remaining patients threshold remained stable during follow-up.
Conclusion
Conduction system pacing modalities showed superior symptomatic and echocardiographic improvement compared to BiV pacing after AVNA. While LBBP offered lower and more stable pacing parameters, there were no differences in clinical outcomes and echocardiographic remodelling when compared to HBP.
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Affiliation(s)
- M Ivanovski
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - A Zupan Meznar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Mrak
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - L Klemen
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - A Pernat
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
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5
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Zizek D, Topalovic M, Stublar J, Mrak M, Jan M, Weiss M. Conduction system pacing in paediatric patients: a single centre experience. Europace 2022. [DOI: 10.1093/europace/euac053.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Paediatric patients with conduction abnormalities are generally exposed to life-long dyssynchronous pacing from a very early age. Thus, preservation of cardiac function during chronic ventricular pacing is important. Conduction system pacing (CSP) with His bundle pacing (HBP) or left bundle branch pacing (LBBP) is an alternative method to standard right ventricular (RV) pacing that may preserve physiological ventricular activation and avoid potential pacing-induced cardiomyopathy (1). However, data on feasibility and safety of various CSP approaches in paediatric patients with or without congenital heart disease (CHD) is scarce and mainly relies on case studies (2-4).
Purpose
To assess feasibility and outcomes of different CSP techniques in paediatric patients.
Methods
Consecutive paediatric patients in whom CSP was attempted in our centre between November 2019 and December 2021 were analysed. Acute implant success rate, complications, fluoroscopy times, and CSP pacing parameters during follow-up were assessed.
To reduce radiation exposure, minimal fluoroscopy technique with three-dimensional (3D) electro-anatomical mapping (EAM) was also used in some cases. Geometry of right atrium and RV, along with mapping of His signal for HBP and potential LBBP sites in the RV septum were created using a decapolar catheter from the right femoral vein. Once relevant anatomy was obtained, HBP or LBBP was attempted using commercially available CSP tools. The pacing lead tip was visualised using the 3D EAM system. Transient fluoroscopy was used only for perpendicular placement of the sheath to the RV septum during LBBP, sheath removal, lead loop assessment to allow linear growth, and atrial lead placement.
Results
Six patients (100% female, age 9.3 ± 3.9 years, weight 41.8 ± 22.9 kg, baseline QRS 111.5 ± 6.3ms, CHD 50%, previous device 33%) with congenital complete AV block received CSP. One patient received HBP and 5 LBBP. The procedure was acutely successful in all patients (100%), pacing thresholds were low (0.56 ± 0.18V at 0.5ms) and there were no perioperative complications. During mean follow-up of 11.8 ± 7.8 months pacing parameters remained stable. However, significant rise of the pacing threshold (> 2.5V) was registered in the HBP patient, in whom lead revision was performed. Three-dimensional EAM was utilised in 3 patients (1 HBP, 2 LBBP). The use of minimal fluoroscopy technique with 3D EAM reduced fluoroscopy time (4.0, 3.2, 4.5 min vs. 9.5, 11.0, 8.0 min) without increasing procedural time (80, 70, 50 min vs. 110, 60, 75 min) compared to standard fluoroscopy technique.
Conclusion
Conduction system pacing is feasible and safe in paediatric patients with or without CHD. Additional utilisation of 3D EAM could reduce radiation exposure, without increasing procedural time. Future long-term studies should be considered to provide the ground for wider clinical adoption of CSP in paediatric population.
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Affiliation(s)
- D Zizek
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Topalovic
- University Medical Centre Ljubljana, Department of Paediatric Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Mrak
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - M Weiss
- University Medical Centre Ljubljana, Department of Cardiovascular Surgery, Ljubljana, Slovenia
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6
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Topalovic M, Prolic Kalinsek T, Zizek D, Kuhelj D, Lakic N, Mazic U, Jan M. Zero-fluoroscopy catheter ablation of supraventricular tachycardias in pediatric population. Europace 2022. [DOI: 10.1093/europace/euac053.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Catheter ablation (CA) of supraventricular tachycardias (SVTs) in pediatric patients is conventionally performed with the aid of X-ray fluoroscopy. Usage of the three-dimensional (3D) electro-anatomical mapping (EAM) system and the intracardiac echocardiography (ICE) enables zero-fluorscopy ablation, eliminating the harmful effects of the radiation (1-3).
Purpose
We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients.
Methods
In this retrospective study, we analyzed consecutive pediatric patients who underwent CA procedure due to SVT in our institution from April 2014 to October 2021. All procedures were performed completely without the use of fluoroscopy. A 3D EAM system and ICE were used as the principal modes of catheter visualisation. Left-sided procedures were done with ICE guided transseptal approach. Radiofrequency was the principal energy source, while cryoablation was used for arrhythmia substrates in the proximity of the conduction system.
Results
The study included 174 consecutive patients (69/174 (66%) female; 12.5 ± 3.9 years; 19.2 ± 3.6 kg/m2). Altogether 176 SVTs were diagnosed and treated. Atrio-ventricular nodal reentry tachycardia (AVNRT) was diagnosed in 45% of cases (80/176), atrio-ventricular reentry tachycardia (AVRT) in 47% (82/176), focal atrial tachycardia (AT) in 7% (13/176), typical atrial flutter (AFL) was treated in only one patient, while 2 patients had multiple arrhythmias (AVNRT and AVRT). In total, 202 procedures were performed. Radiofrequency ablation was performed in 76% (154/202), cryoablation in 20% (40/202) and both in 4% (8/202) of procedures. The acute procedural success rate was 96% (195/202). Procedural success rate was 99% (79/80) for AVNRT, 94% (77/82) for AVRT, 92% (12/13) for AT, and 100% (1/1) for AFL, respectively. There were no major complications in our study group. Follow-up was complete in 99% (172/174) of patients. During the follow-up period of a median of 316 days (181 - 747), 98% of patients were arrhythmia free. On average, 1.16 procedures per patient were performed with the long-term success rate of 99% (79/80), 98% (80/82), 100% (13/13) and 100% (1) for AVNRT, AVRT, AT, and AFL, respectively.
Conclusion
Zero-fluoroscopy CA of various types of SVTs in pediatric population is a feasible, effective, and safe treatment option.
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Affiliation(s)
- M Topalovic
- University Medical Centre Ljubljana, Pediatric clinic, Cardiology department, Ljubljana, Slovenia
| | - T Prolic Kalinsek
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Cardiology Department, Ljubljana, Slovenia
| | - D Kuhelj
- University Medical Centre Ljubljana, Institute of Radiology, Ljubljana, Slovenia
| | - N Lakic
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
| | - U Mazic
- University Medical Centre Ljubljana, Pediatric clinic, Cardiology department, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Cardiovascular Surgery Department, Ljubljana, Slovenia
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7
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Zeljkovic I, Brusich S, Scherr D, Velagic V, Traykov V, Pernat A, Anic A, Szavits Nossan J, Jan M, Bakotic Z, Pezo Nikolic B, Radeljic V, Bojko A, Benko I, Manola S, Pavlovic N. Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy. Clin Cardiol 2021; 44:1177-1182. [PMID: 34196416 PMCID: PMC8364723 DOI: 10.1002/clc.23681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. Methods We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi‐center, registry‐based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. Results Total of 873 patients were included (median age 61 years, IQR 53–66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). Conclusion There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban.
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Affiliation(s)
- Ivan Zeljkovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Daniel Scherr
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Vedran Velagic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Andrej Pernat
- Department of Cardiology, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Ante Anic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | | | - Matevz Jan
- Department of Cardiac Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Zoran Bakotic
- Department of Cardiology, General Hospital Zadar, Zadar, Croatia
| | - Borka Pezo Nikolic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vjekoslav Radeljic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Bojko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
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8
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Antolic B, Jan M, Vrbajnscak M, Zizek D, Kajdic N. Fluoroless ablation of atrial fibrillation using intracardiac ultrasound integrated with 3D electroanatomical mapping system. Europace 2021. [DOI: 10.1093/europace/euab116.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Intracardiac echocardiography (ICE) is gaining increasingly wider adoption in interventional electrophysiology (EP) and represents an all-round tool for ablation of atrial fibrillation (AF). The key upgrade to the usefulness of ICE is its integration into three-dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system).
Purpose
The aim of this single-centre retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF.
Methods
Patients with symptomatic paroxysmal or persistent AF referred for first pulmonary vein isolation (PVI) radiofrequency catheter ablation (RFCA) from September 2017 to August 2020 were included in the study. Those who underwent additional ablations for concomitant arrhythmias were excluded from statistical analysis. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping. PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI.
Results
A total of 56 patients underwent RFCA (35.7% females, median age 62.7 years, 53.6% paroxysmal AF). Acute PVI was achieved in all patients (100%). Adverse events were detected in two patients (3.6%). The median procedure duration was 110.5 min (IQR 100.0-133.8). First-pass isolation was achieved in 50/56 LPVs (89.3%) and in 44/56 RPVs (78.6%). In patients where first-pass isolation was no achieved, intravenous carina had to be ablated in 3/6 (50%) of LPVs and 9/12 (75%) of RPVs.
Conclusions
Flouroless PVI using ICE/EAM automatic integration system is feasible, safe and acutely effective. We achieved high rate of first-pass isolation.
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Affiliation(s)
- B Antolic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre of Ljubljana, Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - M Vrbajnscak
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - N Kajdic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
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Jan M, Yazici M, Habjan S, Prolic Kalinsek T, Topalovic M, Zizek D, Stublar J, Rupar K, Lakic N. Analysis on the factors related to the acute success rate of fluoroless catheter ablation in patients with supraventricular tachycardias: a single-center experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In this retrospective study, we aimed to detect factors related to the acute success rate (ASR) of radiofrequency (RFA) and cryo-ablation (CRA) of SVTs guided by three-dimensional (3D) electroanatomical mapping (EAM) system completely without the use of fluoroscopy (FLR).
Methods and results
We analyzed 324 consecutive patients with SVTs [age was 30.65±20.71 (3.6–83.1) years, 147 patients <19 years old and 50.3% (163/224) patients were female]. There were 112 patients with accessory pathways (APs), 36 patients with atrial tachycardia (ATs), and 176 patients with atrioventricular nodal reentrant tachycardia (AVNRT). All procedures [(RFA (n=257), CRA (n=51), combined RFA and CRA (n=16)] were performed guided by the 3D EAM system completely without the use of FLR. Intracardiac echocardiography (ICE) was used as an imaging tool when transseptal approach was needed for treatment of left-sided arrhythmias. The acute success rate (ASR) was 90.4% (293/224). There were no procedural complications. After the first procedure, patients were divided into the “ablation success” group (group I, n=293) and the “ablation failure” group (group II, n=31). Two groups were similar in terms of age, BMI, gender distribution, and type of ablation procedure. In group II, number of ablation lesions was significantly higher than group I [respectively; 17.93±11.7 vs. 10.5±14.5; p=0.003]. Additionally, total ablation time (TAT) [respectively; 552.6±298.6 vs. 449.7±448.1; p=0.1] and total procedural time (TPT) [respectively; 116.3±54.2 vs. 94.5±82.0; p=0.05] were mildly higher. When compared to Group I, the number of patients with right-sided tachycardias was significantly higher in Group II.[67.74% (21/31 vs. 21.5% (63/293; p<0.001]. ASR was the highest for patients with AVNRT and lowest for patients with ATs [respectively; 95.4% (168/176) vs. 75.0% (27/36); p<0.001]. Binary logistic regression analysis (Nagelkerke R Square=0.201) showed that SVTs originating from the right side were an independent risk factor for procedural failure. Patients with right-sided SVTs faced an approximately 11-fold increased risk of failed ablation (OR=10.69, 95% CI 2.49–45.78, p=0.001). Type of arrhythmia, type of ablation procedure, the sex category, age, and BMI were not independent risk factors for failed ablation. A significant risk factor for recurrence could not be detected.
Conclusions
This study revealed that catheter ablation of SVTs completely without the use of fluoroscopy can be performed with high ASR and without procedural complications. Likewise, ASR of fluoroless ablation was the highest for patients with AVNRT and lowest for patients with AT. Moreover, right-sided SVTs were an independent risk factor for ablation failure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Jan
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - M Yazici
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - S Habjan
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - T Prolic Kalinsek
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - M Topalovic
- University Medical Centre of Ljubljana, Pediatric Cardiology, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre of Ljubljana, Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - K Rupar
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
| | - N Lakic
- University Medical Centre of Ljubljana, Cardiovascular Surgery, Ljubljana, Slovenia
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Ksela J, Racman M, Zbacnik R, Djordjevic A, Jan M. Pacemaker-generated stress fracture of the second rib: a case report. J Cardiothorac Surg 2020; 15:258. [PMID: 32938486 PMCID: PMC7493865 DOI: 10.1186/s13019-020-01303-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections. Case presentation A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography—computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life. Conclusions In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.
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Affiliation(s)
- Jus Ksela
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Mark Racman
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
| | - Rok Zbacnik
- Clinical Institute of Radiology, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
| | - Anze Djordjevic
- Department of Cardiac Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Matevz Jan
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia
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Prolic Kalinsek T, Pernat A, Sinkovec M, Jan M. Treatment of left-sided extension of AV node: A valuable integration of advance imaging modalities and cryoablation. Pacing Clin Electrophysiol 2020; 43:1605-1608. [PMID: 32681524 DOI: 10.1111/pace.14015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/20/2020] [Accepted: 07/12/2020] [Indexed: 12/01/2022]
Abstract
We present a case of successful cryoablation of the left extension of the atrioventricular (AV) node for treatment of a recurrent atrioventricular nodal reentry tachycardia without the use of fluoroscopy. Three-dimensional electroanatomic mapping system and intracardiac echocardiography were used to navigate catheters in the heart and position them according to anatomical landmarks. Due to the nature of cryoablation lesion formation, lesions were able to be applied safely in right atrium, as well as in left atrium, without damaging AV node or bundle of His.
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Affiliation(s)
- Tine Prolic Kalinsek
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Pernat
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matjaz Sinkovec
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matevz Jan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Zizek D, Antolic B, Zavrl-Dzananovic D, Klemen L, Jan M, Zupan Meznar A, Breskvar Kac UD, Stublar J, Zupan I, Sinkovec M. P508Biventricular pacing versus His bundle pacing after atrioventricular node ablation in heart failure patients with permanent atrial fibrillation and narrow QRS. Europace 2020. [DOI: 10.1093/europace/euaa162.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrioventricular (AV) node ablation with biventricular (BiV) pacemaker implantation is a feasible rate control strategy for symptomatic permanent atrial fibrillation (AF) with rapid ventricular response and tachycardia-induced heart failure (HF). However, certain controversy exists since BiV pacing delivers non-physiological ventricular resynchronization and does not return left ventricular (LV) activation times to those seen in individuals with intrinsically narrow QRS. Permanent His bundle pacing (HBP) is a physiological alternative to conventional and BiV pacing. By capturing the native conduction system, depolarization of the ventricles through the His-Purkinje system induces normal synchronous ventricular activation.
Purpose
The aim of the study was to compare short-term outcomes between BiV pacing and HBP after AV node ablation in HF patients with symptomatic permanent AF and narrow QRS.
Methods
A total of 25 consecutive HF patients with permanent AF and narrow QRS (≤110 ms) who underwent AV node ablation in conjunction with BiV pacing or HBP in our centre were enrolled. Post-implant QRS duration, echocardiographic data, and New York Heart Association (NYHA) functional class were assessed in short-term follow-up.
Results
Among 25 HF patients (aged 68 ± 7 years, 52% female, QRS 96 ± 9 ms, LVEF 37 ± 7%, NYHA II-IV), 13 received BiV pacing and 12 HBP. Implant and ablation procedures were acutely successful in both groups. In BiV group 1 patient had a LV lead dislodgement and 1 patient in the HBP group had an acute HB lead threshold increase after AV node ablation. In HBP group post-implant QRS duration was shorter compared to BiV (103 ± 15 ms vs. 177 ± 13 ms, p < 0.001). At a median follow-up of 6 months, patients treated with HBP had greater increase in LV ejection fraction compared to BiV (44 ± 10 vs. 37 ± 6, p = 0.045). A trend toward greater reduction of LV volumes (EDV 119 ± 54 ml vs. 153 ± 33 ml, p = 0.07; ESV 75 ± 34 ml vs. 97 ± 26 ml, p = 0.09) and improvement of NYHA class (2.1 ± 0.7 vs. 2.7 ± 0.8, p = 0.08) was also observed in HBP group compared to BiV group.
Conclusion
In rate control refractory HF patients with permanent AF and narrow QRS atrioventricular node ablation in conjunction with HBP demonstrated superior electrical resynchronization and greater increase in LV ejection fraction compared to BiV pacing. Larger prospective studies are warranted to address clinical outcomes between both pace and ablate strategies.
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Affiliation(s)
- D Zizek
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - D Zavrl-Dzananovic
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - L Klemen
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - A Zupan Meznar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - U D Breskvar Kac
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - I Zupan
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
| | - M Sinkovec
- University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
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Prolic Kalinsek T, Pernat A, Jan M, Sorli J, Vrbajnscak M, Sinkovec M, Antolic B, Klemen L. 233Conventional fluoroscopy guided vs zero-fluoroscopy catheter ablation of supraventricular tachycardias. Europace 2020. [DOI: 10.1093/europace/euaa162.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Introduction
Conventionally, catheter movement and placement during catheter ablation (CA) is guided by X-ray fluoroscopy. In recent years, an ‘as low as reasonably possible’ principle was established to minimize the ionizing radiation dose received by the patient and the operator. Zero-fluoroscopy approach is at the extreme end of the spectrum of this principle. With exclusion of X-ray fluoroscopy, three-dimensional electroanatomical mapping system and intracardiac echocardiography are used for catheter guidance during ablation procedures.
Purpose
The aim of our study was to assess and compare procedural parameters and clinical outcomes of conventional X-ray fluoroscopy guided and zero-fluoroscopy CA for treatment of supraventricular tachycardias.
Methods
Retrospective analysis included CA procedure between April 2014 and May 2019. Five hundred and thirteen (513) patients were selected for analysis; they had confirmed diagnosis of atrioventricular nodal reentry tachycardia (AVNRT) or atrioventricular reentry tachycardia (AVRT). Patients were divided into two groups based on the use of fluoroscopy (conventional approach group - CG; zero-fluoroscopy group - ZF). Procedural data and clinical outcomes were analyzed. Two groups were compared using chi-squared test or Mann-Whithney U test when appropriate.
Results
There were 249 patients (44.2% males) in CG group, and 260 patients (47.5% males) in ZF group. ZF group included 113 (43.5%) pediatric patients. The groups differed in mean age (53.4 ± 16.4 years vs 30.0 ± 19.8 years (CG vs ZF), p < 0.001), postprocedural use of antiarrhythmic agents or beta blockers (55.3% vs 17.0% (CG vs ZF), p < 0.001) and type of arrhythmia (72.3% vs 60.6% AVNRT (CG vs ZF), p = 0.003).
In CG group, all procedures were performed using radiofrequency (RF) energy, whereas in ZF group, cryoablation was used in 18.3% of procedures at the discretion of the operator. Mean procedural duration was longer in CG group (100.1 ± 48.8 vs 90.4 ± 83.0 minutes, p < 0.001). The mean fluroscopy time was 13.6 ± 9.3 minutes and mean dose area product was 554.1 ± 713.6 mGycm2 in the CG group. Acute success rate was higher in CG group (95.7 vs 90.7%, p = 0.027). However, the arrhythmia-free survival rate after 13.8 ± 11.0 months of follow-up was lower in the CG group (90.9 vs 96.5%, p = 0.009). Mean number of procedures per patient was 1.04 in the CG group and 1.14 in the ZF group (p < 0.001). There were no severe complications.
Conclusions
Zero-fluoroscopy CA of supraventricular tachycardias is associated with lower procedural success rate, but higher long-term arrhythmia-free survival rate when compared to conventional fluoroscopy guided procedures. It is possible, that these differences are stemming from somewhat different patient populations in both groups.
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Affiliation(s)
- T Prolic Kalinsek
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - A Pernat
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - J Sorli
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - M Vrbajnscak
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - M Sinkovec
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - L Klemen
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
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Prolic Kalinsek T, Zizek D, Stublar J, Kuhelj D, Jan M. 1325Zero-fluoroscopy cryoablation for treatment of atrioventricular nodal reentry tachycardia in adult and pediatric patients. Europace 2020. [DOI: 10.1093/europace/euaa162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Introduction
Cryoablation is considered a safe but somewhat less effective alternative to radiofrequency ablation (RF) for treatment of atrioventricular nodal reentry tachycardia (AVNRT). Additionally, it is traditionally performed with the aid of X-ray fluoroscopy as the principal imaging method causing radiation exposure, which is especially undesired in the pediatric population.
Purpose
The aim of our study was to assess feasibility, safety and success rate of nonfluoroscopic cryoablation for treatment of AVNRT.
Methods
Forty-eight consecutive patients with a diagnosed AVNRT (aged 40 ± 22 years, 29 (60%) female, 19 (40%) male) were included in the study. Among the study population, 14 (29%) were pediatric patients aged 11.5 ± 4.1 years. Cryoablation was used at the discretion of the operator. Only three dimensional electroanatomic mapping system and intracardiac electrograms were used to guide catheter movement and positioning. X-ray fluoroscopy was not used. The initial approach in all procedures was cryomapping in the region of the slow pathway during ongoing AVNRT, with a switch to cryoablation when termination of tachycardia within 20 seconds of reaching -30°C was achieved. When cryomapping was not possible due to catheter instability, cryoablation was used during ongoing AVNRT for up to 10 seconds at -70°C or lower. When AVNRT was not readily inducible, termination of slow pathway conduction was targeted with cryomapping during programmed stimulation with atrial extrastimuli. Procedural endpoint was noninducibility of AVNRT. Recorded residual slow pathway conduction was not considered a failure.
Results
Mean procedural duration was 79 ± 34 minutes. On average, 4 ± 2 cryoablations, with a 240 seconds of cryoablation time per each application. Cryoablation was used as a first choice in 45 (45/48, 93.7%) patients. In the remaining 3 patients (3/48, 6.3%) RF ablation failed as the first choice due to transient AV conduction disturbance and cryoablation had to be used to reach the endpoint. Cryoablation was unsuccessful only in 3 cases (6.6%) where RF ablation was needed to achieve procedural endpoint. Targeting termination of AVNRT during cryomapping or cryoablation was possible in 25 patients (25/48, 52%). In 14 patients AVNRT was not inducible and termination of the slow pathway conduction was targeted instead. In 9 patients inadvertent catheter tip contact mechanically terminated AVNRT or slow pathway conduction; site of mechanical termination was then targeted with cryoablation. After mean follow-up of 349 ± 201 days 47 patients were free of recurrence (47/48, 98%). There were no procedural complications.
Conclusions
In our study population with adult and pediatric patients, zero-fluoroscopy cryoablation of AVNRT proved feasible, safe and resulted in high success rates. Cryomapping or cryoablation for AVNRT termination was possible in approximately half of the procedures.
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Affiliation(s)
- T Prolic Kalinsek
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - D Kuhelj
- University Medical Centre Ljubljana, Clinical Institute of Radiology, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
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Zupan Meznar A, Zizek D, Breskvar Kac UD, Writzl K, Jan M, Toplisek J, Baraga M, Sinkovec M. P497Arrhythmic burden in patients with filamin C (FLNC) truncating variant associated cardiomyopathy. Europace 2020. [DOI: 10.1093/europace/euaa162.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Truncating variants in FLNC gene are associated with an overlapping phenotype of arrhythmogenic and dilated cardiomyopathy. There are reports of high arrhythmia propensity with sudden cardiac death (SCD) often being the first symptom of the disease. It has been suggested that the current European guidelines primary prevention (PP) recommendation about implantable cardioverter-defibrillator (ICD) implantation might not be applicable in these patients and that earlier intervention should be considered.
Purpose
We sought to investigate the arrhythmic burden in FLNC truncation carriers in our centre.
Methods
Adult FLNC truncation carriers diagnosed in our centre between the years 2018 and 2019 were included in the study. We retrospectively analysed clinical data, and ICD follow-up reports in the cohort. Patients implanted with an ICD were divided in 3 groups: group A (secondary prevention ICD implantation), group B (PP indication according to the current guidelines – left ventricular ejection fraction (LVEF) below 35%) and group C (early PP– FLNC truncation carrier, LVEF < 50% and late gadolinium enhancement on cardiac magnetic resonance). We report the number of patients experiencing SCD and the number of appropriate and inappropriate ICD therapies per group.
Results
Twenty-four adult patients from 3 different families with three distinct FLNC truncating variants were identified. Ten (42%) were male; the average age was 45 ± 14 years. There were 3 (13%) SCDs in one family (2 male and one female, 29-42 years old) and two (8%) aborted SCDs in the remaining two families (one male and one female, 66 and 51 years old). Altogether eleven (46%) patients were implanted with an ICD. There were three patients in group A (2 aborted SCDs and 1 sustained ventricular tachycardia (VT)), two patients in group B and six patients in group C. Average ICD follow-up times were 42, 48 and 6 months for groups A, B and C, respectively. Eight appropriate ICD therapies occurred in 3 patients (27%). In group A, there were four sustained VT episodes successfully converted with an anti-tachycardia pacing (ATP) in two patients (67%); the average time to first therapy was 33 months. In group B, there was one appropriate shock for ventricular fibrillation (VF), and three sustained VT episodes in one patient (50%), time to first therapy was 60 months. After six months follow-up, there were no appropriate therapies registered in group C. Two patients (18%) experienced inappropriate shocks due to sinus tachycardia, one in group A and one in group C.
Conclusion
One-fifth of FLNC truncation carriers in our cohort experienced SCD. When patients received an ICD according to the current guidelines, majority experienced appropriate ICD therapy. Further clinical studies with longer follow-up will be needed to define appropriate risk stratification and optimal timing for prophylactic ICD intervention in these patients.
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Affiliation(s)
- A Zupan Meznar
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - D Zizek
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | | | - K Writzl
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - J Toplisek
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - M Baraga
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - M Sinkovec
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
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Prolic Kalinsek T, Gersak B, Jan M. P1425Complication rate and incidence of esophageal injury after minimally invasive convergent procedure for treatment of atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Introduction
Convergent procedure is a minimally invasive surgical approach for treatment of atrial fibrillation (AF) combining epicardial and endocardial radiofrequency (RF) ablation. However, there is conflicting data regarding the rate of major complications after convergent treatment of AF. Apart from common complications the esophageal injury incidence after convergent procedure is not well documented.
Purpose
Our aim was to assess major complication occurrence after convergent procedure with additional emphasis on the incidence of esophageal injury.
Methods
One hundred forty-seven consecutive patients (113 male, mean age 59 ± 9 years, BMI 29 ± 5 kg/m2) with persistent (122, 83%) and paroxysmal (25, 17%) AF were treated with convergent procedure that included epicardial RF ablation with coagulation devices (12 lesions, each for 90 s, with 30 W power), combined with endocardial RF catheter ablation for pulmonary vein isolation. The approach for epicardial ablation was diaphragmatic pericardial window through subxiphoid incision. Infusion of cooled saline into the pericardial space during epicardial ablations and monitoring of esophageal temperature with temperature probe were additional precautions to avoid esophageal overheating. All patients had endoscopy of the esophagus at least 2 days after the procedure to assess for presence of esophageal injury. Adverse events resulting in additional intervention or causing long-term disability were defined as major complication.
Results
During short-term follow-up (minimum of 5 months) major complication rate was 6.1%. Three patients had cardiac tamponade, 4 had abdominal bleeding, 1 had ischemic stroke and 1 had arterial pseudoaneurysm. Esophageal mucosal lesions were observed in 11 patients (7.5%) that did not result in major complication. All lesions were followed with additional endoscopies and resolved without any intervention.
Conclusions
Complication rate after minimally invasive convergent procedure for treatment of AF in our patient cohort is low. Prevention of esophageal overheating resulted in absence of major esophageal injury.
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Affiliation(s)
- T Prolic Kalinsek
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - B Gersak
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
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Zizek D, Antolic B, Kajdic N, Zorz N, Breskvar U, Zupan Meznar A, Jan M. P1411 Ultrasound-guided transseptal access in catheter ablation of left-sided tachyarrhythmias - single centre experience. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transseptal puncture (TSP) for catheter ablation (CA) of left-sided tachycardias is traditionally performed with the aid of fluoroscopy. Compared to fluoroscopy, intracardiac echocardiography (ICE) can provide better orientation and imaging of soft tissue structures that are relevant to TSP.
Objective
Our aim was to evaluate feasibility and safety of ICE-guided TSP in CA treatment of left-sided tachyarrhythmias.
Methods
Consecutive fluoroless CA procedures with combined use of three-dimensional electroanatomic mapping system and ICE requiring TSP were evaluated in 357 patients (269 male, mean age 54 ± 18 years) referred to our hospital from July 2014 to November 2018. Among CA treated left-sided tachyarrhythmias 55 patients had accessory pathway, 16 had focal atrial tachycardia, 276 had atrial fibrillation or atypical atrial flutter and 10 had ventricular tachycardia. Success of transseptal access and complications related to TSP were analyzed. Adverse event requiring additional intervention was defined as major complication.
Results
Double TSPs were performed in 253 patients and single in 104 patients. Additional ablation procedures were needed in 26 patients and the rest had a single CA procedure. Altogether, 661 TSPs (274 double and 111 single) were attempted and 659 were successful (99.7%). Both TSPs failed due to severely thickened interatrial septum after previous cardiac surgery. In 14 patients (21 TSPs, 3.2%) a cardiac implantable electronic device (CEID) was present. ICE provided excellent lead visualisation and no lead dislodgements were recorded. Additional radiofrequency energy application to the transseptal needle was used for 3 challenging TSPs. Minor complications (pericardial effusions managed conservatively) occurred after 7 double TSP procedures (12/661, 1.8%). Major complication with pericardial tamponade (requiring pericardiocentesis) occurred during one double TSP (2/661, 0.3%). No TSP-related embolic complications were observed.
Conclusion
ICE-guided TSP in CA of left-sided tachyarrhythmias is safe with excellent success rates. In addition, ICE could provide additional reassurance in difficult cases and in patients with CEIDs.
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Affiliation(s)
- D Zizek
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Kajdic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Zorz
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - U Breskvar
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Zupan Meznar
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre Ljubljana, Ljubljana, Slovenia
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Prolic Kalinsek T, Zizek D, Kuhelj D, Antolic B, Stublar J, Jan M. 1205Zero-fluoroscopy catheter ablation of right- and left-sided supraventricular tachycardias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Catheter ablation (CA) of supraventricular tachycardias (SVTs) is traditionally performed with the aid of fluoroscopy. However, ionizing radiation is associated with potentially harmful deterministic and stochastic effects to the patient and operator. Many methods have been suggested to reduce the radiation exposure, one of the methods, which completely eliminates ionizing radiation exposure, is zero-fluoroscopy catheter ablation.
Purpose
Our aim was to assess feasibility, success rate and safety of zero-fluoroscopy CA for treatment of various right and left-sided SVTs with the use of three-dimensional (3D) electroanatomical mapping system (EAM) and intracardiac echocardiography (ICE).
Methods
Consecutive 274 patients (140 male, mean age 33.5±21.8 years) with documented SVTs underwent CA in our center from April 2014 to May 2018. All procedures were performed with the 3D EAM without any use of fluoroscopic guidance. ICE was used as primary visual modality when left-sided approach was required. The procedural endpoint for atrioventricular nodal reentrant tachycardia (AVNRT) was nodal rhythm during radiofrequency (RF) energy delivery and non-inducibility. The procedural endpoint for focal atrial tachycardia (AT) was termination and non-inducibility. The procedural endpoint for accessory pathway (AP) mediated tachycardia was absence of bidirectional conduction over the AP. The procedural endpoint for typical atrial flutter (AFL) was bidirectional block over the cavo-tricuspid isthmus.
Results
One hundred thirty two patients had AVNRT, 79 had AP mediated tachycardia (47 left-sided, 25 septal and 7 right-sided), 31 patients had AT (8 left-sided), 32 patients had AFL. Cryo-ablation was used in 14 (14/132, 10.6%) patients with AVNRT and 5 patients with septal AP (5/25, 20%), RF was used in the rest. The procedural endpoint was achieved in all procedures (100%). During the mean follow-up of 343±253 days the recurrence rate for AVNRT, AP mediated tachycardia, focal AT, AFL was 7.5%, 16.4%, 32.3% and 9.4%, respectively. No procedural complications were observed.
Conclusions
Zero-fluoroscopy CA of right and left-sided SVTs with the use of the 3DEAM and ICE is feasible, safe and results in promising long-term success rates after single CA procedure.
Acknowledgement/Funding
None
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Affiliation(s)
| | - D Zizek
- University Medical Centre of Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - D Kuhelj
- University Medical Centre of Ljubljana, Clinical Department of Radiology, Ljubljana, Slovenia
| | - B Antolic
- University Medical Centre of Ljubljana, Clinical Department of Cardiology, Ljubljana, Slovenia
| | - J Stublar
- University Medical Centre of Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
| | - M Jan
- University Medical Centre of Ljubljana, Clinical Department of Cardiovascular Surgery, Ljubljana, Slovenia
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Krajnc M, Jan M, Azman Juvan K, Klokocovnik T. Intuity™ aortic valve thrombosis. Wien Klin Wochenschr 2018; 130:735-737. [PMID: 30112585 DOI: 10.1007/s00508-018-1380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Martina Krajnc
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000, Ljubljana, Slovenia.
| | - Matevz Jan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000, Ljubljana, Slovenia
| | - Katja Azman Juvan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000, Ljubljana, Slovenia
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Jan M, Zizek D, Antolic B, Klemen L, Rihtarsic Z, Prolic Kalinsek T, Mazic U, Kuhelj D. P494Zero-fluoroscopy radiofrequency and cryo-ablation of accessory pathway mediated tachycardias in the pediatric population. Europace 2017. [DOI: 10.1093/ehjci/eux141.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jan M, Peichl P, Zizek D, Mijovski G, Mazic U, Klemen L. P493Successful catheter ablation of ventricular ectopy in a young patient with implanted melody valve. Europace 2017. [DOI: 10.1093/ehjci/eux141.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jan M, Zizek D, Antolic B, Mazic U, Kuhelj D, Prolic Kalinsek T, Jug D. 595Fluoroless transseptal puncture for catheter ablation of left-sided tachycardias in pediatric population. Europace 2017. [DOI: 10.1093/ehjci/eux144.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jan M, Antolic B, Prolic Kalinsek T. 1216Zero-fluoroscopy catheter ablation for treatment of atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baloch AH, Khosa AN, Bangulzai N, Sadia H, Ahmed M, Khan F, Jan M, Tareen M, Kakar MH, Shuja J, Naseeb HK, Ahmad J. The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan. Indian J Cancer 2017; 53:363-365. [PMID: 28244458 DOI: 10.4103/0019-509x.200672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5%-15% of all the breast cancer cases. The present study was performed on 171 breast cancer patients from Balochistan registered in CENAR (Center for Nuclear Medicine and Radiotherapy), Quetta. MATERIALS AND METHODS Written consent was obtained from the patients. The history of the disease was taken from the patients, and the patients' enrollment files were retrieved. RESULTS Of the 171 patients, 5 (2.96%) were diagnosed with ILC with tumor Grade II, and stage of the cancer reported was Grade III in all the 5 patients affected with ILC. CONCLUSION ILC is the second most common type of breast cancer diagnosed with comparatively lower grade but almost reported infiltrating.
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Affiliation(s)
- A H Baloch
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
| | - A N Khosa
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
| | - N Bangulzai
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
| | - H Sadia
- Department of Biotechnology, Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - M Ahmed
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - F Khan
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - M Jan
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
| | - M Tareen
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - M H Kakar
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Balochistan, Pakistan
| | - J Shuja
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - H K Naseeb
- Center for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - J Ahmad
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
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Young C, Hicks M, Ermolova N, Nakano H, Jan M, Younesi S, Nelson S, Miceli C, Pyle A, Spencer M. Development of a CRISPR/Cas9-mediated gene editing platform to restore the reading frame for 60% of Duchenne muscular dystrophy patients. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sigward JM, Desbois B, Jan M, Jehel L, Lamy S. Évaluation des séances d’acupuncture dans la prise en charge des patients toxicomanes au CHU de Martinique à l’aide des échelles visuelles analogiques. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ObjectifsL’acupuncture est une technique de plus en plus utilisée dans la prise en charge des patients consommateurs de substances. Notre étude permet d’évaluer les bienfaits subjectifs de l’acupuncture chez ces patients en utilisant les échelles visuelles analogiques (EVA) avant et après les séances.MéthodesCes évaluations ont été proposées à l’ensemble des patients venus faire une séance d’acupuncture (auriculothérapie ou corps entier) durant les mois de juillet 2012 et mai 2013. Ils ont côté sur une échelle entre 0 et 10 leur fatigue, bien-être, stress/anxiété, détente, douleur physique avant et après les séances.RésultatsCent quatre vingt-quatre fiches anonymes avant/après ont été analysées. Cinquante sujets ont participé. Au niveau déclaratif : 24,5 % d’abstinents, 22,2 % en sevrage, 40,2 % consomment régulièrement une ou plusieurs substances (42 % alcool, 58 % de tabac, 20 % de crack, 38 % de cannabis). Les bienfaits ressentis sont multiples dans les jours qui suivent une séance : 64 % ont un meilleur sommeil, 48 % moins anxieux, 54 % disent avoir moins envie de consommer, 16 % remarquent une meilleure gestion de leurs émotions. L’ensemble des patients ont rapporté une diminution de leurs anxiété/stress (p = 0,0001), sensation de fatigue (p = 0,001) et douleur physique (p = 0,0001). Ils signalent également une amélioration de leur détente (p = 0,001) et de leur bien-être (p = 0,001). Nous avons également observé que les effets de l’acupuncture semblent être supérieurs chez les patients consommateurs par rapport aux patients qui déclarent être abstinents et que les bienfaits étaient supérieurs avec l’acupuncture corps entier versus auriculothérapie.ConclusionDans notre population, les séances d’acupunctures semblent améliorer les ressentis des patients dans plusieurs domaines. L’étude se poursuit afin de mieux étudier non seulement les biais liés à la relaxation et aux croyances magico-religieuses mais aussi en étudiant différents paramètres objectifs comme la diminution de la consommation.
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Geršak B, Zembala MO, Müller D, Folliguet T, Jan M, Kowalski O, Erler S, Bars C, Robic B, Filipiak K, Wimmer-Greinecker G. European experience of the convergent atrial fibrillation procedure: Multicenter outcomes in consecutive patients. J Thorac Cardiovasc Surg 2014; 147:1411-6. [DOI: 10.1016/j.jtcvs.2013.06.057] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/10/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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Evans M, Vacher E, Lamy S, Seridi H, Jan M, Debien C, Sigward JM, Jehel L. [First stage in identifying traumatic profil inpatients hospitalised in psychiatry in Martinique]. Sante Ment Que 2014; 39:253-269. [PMID: 25590554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The population hospitalised in psychiatry seems more exposed to traumatic events than the French general population, with particularly more sexual aggressions. The aim of this study is to describe the population hospitalised in psychiatry and more precisely the traumatic history of these patients, their comorbidities (mental diseases and addictions), and socio economical level. This descriptive, cross sectional and retrospective study took place in the Crisis Center in the University Hospital in Martinique (French West Indies), from February to July 2013. A socio-demographic information, the Mini International Neuropsychiatric Interview 5.0, the Trauma History Questionnaire and the Impact Events Scale-Revised were realised with 49 of the 143 patients admitted during this period (34.3%). In this population, we found a mean of 6.5 (standart-deviation=4.2) different types of traumatic event, with 38.8% patients reporting a natural disaster, and 38.8% declaring at least one sexual aggression. In the 25 patients suffering from post-traumatic stress disorder, 66.7% underwent a sexual aggression, significatively during childhood (before 10 years old, P=0.01), and during adolescence (between 10 to 18 years old, P=0.01). These results underline the importance of a systematic screening of the traumatic profile: the characteristics of the traumatic events and its clinical impact.
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Affiliation(s)
- M Evans
- Centre Hospitalier Universitaire de Martinique
| | - E Vacher
- Centre Hospitalier Universitaire de Martinique
| | - S Lamy
- Centre Hospitalier Universitaire de Martinique
| | - H Seridi
- Centre Hospitalier Universitaire de Martinique
| | - M Jan
- Centre d'Investigation Clinique, Rouen
| | - C Debien
- Centre Hospitalier Universitaire de Martinique; Centre d'Investigation Clinique, Rouen
| | - J-M Sigward
- Centre Hospitalier Universitaire de Martinique
| | - L Jehel
- Centre Hospitalier Universitaire de Martinique; INSERM 669, Université-Paris-Sud et Université Paris-Descartes; Université des Antilles et de la Guyane, UAG; Laboratoire d'éthique médicale et médecine légale, Paris
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Desbois B, Lacoste J, Jan M, Jehel L, Lamy S. Évaluation des bienfaits de l’acupuncture dans la prise en charge des sujets dépendants aux substances à l’aide des Échelles Visuelles Analogiques. Eur Psychiatry 2013. [DOI: 10.1016/j.eurpsy.2013.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectifsL’acupuncture est de plus en plus utilisée en addictologie [1,2]. Au CHU de Martinique, les patients présentant des addictions aux substances en bénéficient depuis une quinzaine d’années. Notre étude permet d’évaluer les bienfaits subjectifs de l’acupuncture chez ces patients en utilisant les Échelles Visuelles Analogiques avant et après les séances.MéthodesCes évaluations ont été proposées à l’ensemble des patients venus faire des séances d’acupuncture durant le mois de juillet 2012. Les patients ont côté sur une échelle entre 0 et 10 leurs fatigue, bien-être, stress/anxiété, détente, douleur physique avant et après les séances.RésultatsCent six fiches anonymes avant/après ont été analysées. Trente-cinq patients déclarent être abstinents, 53 déclarent être consommateurs réguliers d’une ou plusieurs substances (42 % alcool, 58 % tabac, 20 % crack, 38 % cannabis) et 18 sont données manquantes. L’ensemble des patients ont rapporté une diminution de leurs anxiété/stress (p = 0,0001), sensation de fatigue (p = 0,001) et douleur physique (p = 0,0001). Ils signalent également une amélioration de leur détente (p = 0,001) et de leur bien-être (p = 0,001).
ConclusionDans notre population, les séances d’acupuncture semblent améliorer les ressentis des patients dans plusieurs domaines. Il sera intéressant de poursuivre cette étude en étudiant non seulement les biais liés à la relaxation et aux croyances magico-religieuses mais aussi en étudiant différents paramètres objectifs comme la diminution de la consommation et le cardio feedback.
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Breil R, Kurtz B, Bories MC, Vallet C, Jan M, Eltchaninoff H. Usefulness and reliability of POCKET ultrasound in assessing cardiac function in patients hospitalized for heart failure in a cardiology department. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C, Viennet G, Bonneville JF, Assaker R, Auger C, Brue T, Cornelius A, Dufour H, Jouanneau E, François P, Galland F, Mougel F, Chapuis F, Villeneuve L, Maurage CA, Figarella-Branger D, Raverot G, Barlier A, Bernier M, Bonnet F, Borson-Chazot F, Brassier G, Caulet-Maugendre S, Chabre O, Chanson P, Cottier JF, Delemer B, Delgrange E, Di Tommaso L, Eimer S, Gaillard S, Jan M, Girard JJ, Lapras V, Loiseau H, Passagia JG, Patey M, Penfornis A, Poirier JY, Perrin G, Tabarin A. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 2013; 126:123-35. [PMID: 23400299 DOI: 10.1007/s00401-013-1084-y] [Citation(s) in RCA: 308] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/07/2013] [Accepted: 01/17/2013] [Indexed: 01/03/2023]
Abstract
Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.
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Kurtz B, Breil R, Bories MC, Vallet C, Jan M, Eltchaninoff H. Usefulness and reliability of pocket ultrasound in assessing cardiac function in patients hospitalized for heart failure in a cardiology department. Arch Cardiovasc Dis 2013. [DOI: 10.1016/j.acvd.2013.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zizek D, Cvijic M, Tasic J, Jan M, Frljak S, Zupan I. Effect of cardiac resynchronization therapy on beat-to-beat T-wave amplitude variability. Europace 2012; 14:1646-52. [DOI: 10.1093/europace/eus055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Paulova L, Jan M, Melzoch K, Klein J, Meyer H, Kovar K. Effect of carbon-substrates on biomass growth and recombinant protein formation in continuous cultures of Pichia pastoris Mut+ strain. N Biotechnol 2009. [DOI: 10.1016/j.nbt.2009.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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N’Dri O, François P, Ismail M, Jan M. Les méningiomes intracrâniens traumato-induits : étude de trois observations et revue de la littérature. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bouetel V, Lescanne E, François P, Jan M, Morinière S, Robier A. [Evolution of facial nerve prognosis in vestibular schwannoma surgery by translabyrinthine approach]. Rev Laryngol Otol Rhinol (Bord) 2008; 129:27-33. [PMID: 18777766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES OF THE STUDY To evaluate our results on the postoperative facial function, its pre and preoperative predictive factors, and the application of the surgical technique to lesions of decreasing size. PATIENTS AND METHODS A series of 248 patients operated of an unilateral vestibular schwannoma has been reviewed. We have compared the results gathered over two periods corresponding to the evolution of our surgical technique since 1998. RESULTS Immediate and 1 year postoperative facial function is significantly better among patients operated after 1998 (satisfactory in 75 and 88% respectively). This trend marked by the improvement of the results since 1998 has to be discussed according to other predictive factors. One of predictive factor is the decrease of the size of the lesion during the same period. The other factors are the hearing level, deafness duration, trigeminal nerve involved, vestibular status and ABR desynchronization. CONCLUSION The positive predictive factors are usually correlated with the size of the tumour This implies the necessity of an early diagnosis of the schwannomas. The second predictive factor of the facial function is the use of a soft surgical technique.
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Affiliation(s)
- V Bouetel
- CHRU Bretonneau, Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, 37044 Tours cedex, France.
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Legeais M, Cottier J, Yapo P, Couchot M, Pefoubou Y, Jan M, Herbreteau D. Diagnostic et prise en charge thérapeutique d’une fistule durale à drainage veineux péri médullaire par injection d’Onyx. ACTA ACUST UNITED AC 2007; 88:1893-5. [DOI: 10.1016/s0221-0363(07)78368-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Francois P, Ben Ismail M, Jan M, Velut S. Abord sous-temporal trans-pétreux ou trans-tentoriel des cavernomes pontiques. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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N'dri Oka D, Aesch B, Jan M. [Acute non-traumatic extensive subdural spinal hematoma]. Neurochirurgie 2007; 53:292-5. [PMID: 17602712 DOI: 10.1016/j.neuchi.2007.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 03/26/2007] [Indexed: 10/19/2022]
Abstract
Acute spinal subdural hematoma is a somewhat rare pathology. Its severity comes from the constitution of an acute spinal cord compression. In many cases MRI is useful for the differential diagnosis with the epidural hematoma. A 79-year-old patient was referred for emergency neurosurgery for acute spinal cord compression. The vascular risk in this patient was significant: hypertension, oral anticoagulants. Clinically, acute non-traumatic subdural spinal hematoma was suspected. The spinal cord MRI was in favor of the diagnosis which was confirmed intraoperatively. The surgical procedure revealed an extensive hematoma which infiltrated the spinal cord. The diagnosis of nontraumatic subdural spinal hematoma may be difficult in some cases and correctly established only during the surgical procedure. In comparison with reports in the literature, we discuss the underlying mechanisms of this hematoma. Spinal subdural haematoma must be considered in patients taking anticoagulant therapy or with a coagulation disorder who present signs of acute spinal cord compression. MRI sagittal T1 and T2-weighted images are adequate and reliable for diagnosis of spinal subdural hematoma. Prompt surgical evacuation of this hematoma is crucial.
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Affiliation(s)
- D N'dri Oka
- Service de neurochirurgie, hôpital Bretonneau, 2 bis, boulevard Tonnellé, 37044 Tours cedex, France.
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Jan M, Dufour H, Brue T, Jaquet P. Prolactinoma surgery. Annales d'Endocrinologie 2007; 68:118-9. [PMID: 17512893 DOI: 10.1016/j.ando.2007.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/20/2007] [Accepted: 03/19/2007] [Indexed: 10/22/2022]
Abstract
Surgery is generally used as second-line treatment in prolactinomas. For microprolactinomas, it may be indicated in cases of resistance or intolerance to dopamine agonists or where patients prefer definitive cure to lifelong drug treatment. In highly trained hands, selective adenomectomy results in normalization of prolactin levels in 75-90% of cases with little morbidity and no mortality. However, subsequent relapse is possible in up to 20% of cases. In macroprolactinoma, a definitive cure is unlikely due to the frequency of invasive tumor extension. A transsphenoidal or, less frequently, a transfrontal surgical approach is necessary in patients resistant to or intolerant of medical treatment, and also in rare cases such as pituitary apoplexy or cerebrospinal fluid rhinorrhea.
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Affiliation(s)
- M Jan
- Department of Neurosurgery, Bretonneau Regional University Teaching Hospital, 2 Bd Tonnellé, 37044 Tours cedex, France
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Abstract
We have shown that A1 adenosine receptors (A1ARs) are cytoprotective against renal tubular necrosis and apoptosis both in vivo and in vitro. To study the role of A1AR numbers on renal epithelial cell survival, we stably overexpressed the human A1 receptor in a porcine renal tubule cell line and utilized primary cultures of proximal tubules obtained from A1AR knockout mice. Receptor-overexpressing cells were protected against peroxide-induced necrosis and tumor necrosis factor-alpha/cycloheximide-induced apoptosis. Conversely, cultured proximal tubule cells from receptor knockout mice showed more necrotic and apoptotic cell loss than corresponding cells from wild-type mice. Overexpression of the receptor resulted in a significantly higher baseline expression of both total and phosphorylated heat-shock protein (HSP)27; the latter due to A1 receptor enhancement of p38 and AP2 mitogen-activated protein kinase activities. The resistance to cell death in the porcine cells was reversed by selective A1 receptor antagonism and by a selective inhibitor of HSP synthesis. Receptor activation in wild-type mice in vivo led to increased total and phosphorylated HSP27, whereas receptor knockout mice showed decreased baseline and adenosine-mediated HSP phosphorylation. These studies show that endogenous A1AR activation produces cytoprotective effects in renal proximal tubules by modulating HSP27 signaling pathways.
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Affiliation(s)
- H T Lee
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York 10032-3784, USA.
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François P, Ben Ismail M, Lioret E, Jan M. Ostéosynthèse crânienne utilisant le matériel Bioplate® et Biomesh® : expérience tourangelle entre 2001 et 2005. Neurochirurgie 2006. [DOI: 10.1016/s0028-3770(06)71340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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François P, Ben Ismail M, N’Dri D, Prunier Aesch C, Jan M. Hypotension intracrânienne spontanée : à propos de 6 cas. Neurochirurgie 2005. [DOI: 10.1016/s0028-3770(05)83582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ozsancak C, Auzou P, Jan M, Defebvre L, Derambure P, Destee A. The place of perceptual analysis of dysarthria in the differential diagnosis of corticobasal degeneration and Parkinson's disease. J Neurol 2005; 253:92-7. [PMID: 16096817 DOI: 10.1007/s00415-005-0932-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 04/24/2005] [Accepted: 05/03/2005] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize the dysarthria in patients with corticobasal degeneration (CBD) and determine if analysis of speech in isolation helps to distinguish CBD patients from patients with Parkinson's disease (PD). METHODS 60 subjects were assessed by means of perceptual analysis of speech: 15 patients with CBD, 15 patients with PD and 30 control subjects. A detailed profile was furnished with the help of 33 perceptual items. A global perceptual approach was used to classify patients by judges blind to the medical diagnosis. Rating scales were adapted to quantify the degree of spasticity and hypokinesia in the speech of each patient. RESULTS Dysarthria was frequent in CBD even though it remained mild for a long period of time. Group analysis revealed the importance of temporal errors of speech control in CBD patients while voice disturbances were most frequent in PD patients. However, attempts to classify patients according to global perceptual analysis remained below a reasonable level of clinical acceptability. Finally, even though the widespread neuropathological changes suggest that deviant speech dimensions of several types of dysarthria might be found in CBD, evidence for a mixed dysarthria with presence of spastic elements could not be established. CONCLUSION The findings support the view that even though perceptual analysis is mandatory in the management of dysarthric patients, it does not help in the clinical differential diagnosis of CBD.
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Affiliation(s)
- Canan Ozsancak
- Service de Neurologie, Centre Hospitalier de Boulogne sur Mer, 62200 Boulogne sur Mer, France.
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Delgrange E, Sassolas G, Perrin G, Jan M, Trouillas J. Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochir (Wien) 2005; 147:751-7; discussion 757-8. [PMID: 15971099 DOI: 10.1007/s00701-005-0498-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prolactinomas usually exhibit a benign course and can be safely and effectively managed by dopamine agonists (DA). However, some are locally invasive and may show resistance to DA therapy, and the management of such cases remains controversial. The aim of the present study was to determine whether histological features and markers of cell proliferation correlated to the clinical behaviour of prolactinomas and with DA resistance. METHOD This retrospective study included 74 cases (36 men and 38 women) who had monohormonal prolactinomas removed by transsphenoidal surgery. The prolactinomas were categorized on the basis of tumour size (48 macroadenomas), invasion of the cavernous sinus (n = 31), and resistance to bromocriptine (BRC) therapy (n = 14). Group 1 consisted of non-invasive microprolactinomas (n = 24), group 2 of non-invasive macroprolactinomas (n = 19), group 3 of invasive non-BRC-resistant tumours (n = 19), and group 4 of invasive BRC-resistant tumours (n = 12). The later group included one case of carcinoma with bone and lung metastases. Seven additional parameters were studied, these being age, sex, basal prolactin (PRL) levels, the Ki-67 and PCNA labelling indices (LI), mitotic count, and cellular atypia. FINDINGS Age and preoperative PRL levels did not correlate to the histological parameters studied. Tumour size and invasion were related to cellular atypia and the Ki-67 LI. BRC-resistant tumours were more frequently invasive (12/14) than BRC-responsive tumours (11/30; p = 0.002) and were more frequent in men than in women (33 versus 5%; p = 0.003). BRC-resistant tumours had a higher Ki-67 LI and mitotic count (4.2+/-2.0% and 4+/-1, respectively) than other tumours (0.7+/-0.2% and 1+/-0, respectively; p<0.05). The strongest correlations with tumoural staging were seen with male sex and high mitotic activity. Six out of the 12 invasive BRC-resistant macroprolactinomas, including the PRL secreting carcinoma, exhibited histological features of aggressiveness (a mitotic count >/=3 [i.e. in the fourth quartile] and/or a high Ki-67 LI and cellular atypia). CONCLUSIONS In this surgical retrospective series, histological signs of aggressiveness are present in 50% of invasive and BRC-resistant prolactinomas, which are more frequent in men than in women. This fits with the behaviour of BRC-resistant prolactinomas, which can continue to grow despite DA treatment. These findings justify the long-term follow up of these tumours, and the use of surgery and/or radiotherapy if there is concern about the control of tumour growth.
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Affiliation(s)
- E Delgrange
- Department of Internal Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Louvain, Belgium.
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Mihalescu-Maingot M, Bergemer-Fouquet A, Velut S, Jan M. Le neurocytome central — à propos d’une série consécutive de 10 cas. Neurochirurgie 2004. [DOI: 10.1016/s0028-3770(04)98405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Francois P, N’Dri D, Jan M. Les adénomes corticotropes silencieux : à propos d’une série de 7 patients. Neurochirurgie 2004. [DOI: 10.1016/s0028-3770(04)98372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Denier C, Goutagny S, Labauge P, Krivosic V, Arnoult M, Cousin A, Benabid AL, Comoy J, Frerebeau P, Gilbert B, Houtteville JP, Jan M, Lapierre F, Loiseau H, Menei P, Mercier P, Moreau JJ, Nivelon-Chevallier A, Parker F, Redondo AM, Scarabin JM, Tremoulet M, Zerah M, Maciazek J, Tournier-Lasserve E. Mutations within the MGC4607 gene cause cerebral cavernous malformations. Am J Hum Genet 2004; 74:326-37. [PMID: 14740320 PMCID: PMC1181930 DOI: 10.1086/381718] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 11/25/2003] [Indexed: 11/04/2022] Open
Abstract
Cerebral cavernous malformations (CCM) are hamartomatous vascular malformations characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. They cause seizures and focal neurological deficits due to cerebral hemorrhages. CCM loci have already been assigned to chromosomes 7q (CCM1), 7p (CCM2), and 3q (CCM3) and have been identified in 40%, 20%, and 40%, respectively, of families with CCM. Loss-of-function mutations have been identified in CCM1/KRIT1, the sole CCM gene identified to date. We report here the identification of MGC4607 as the CCM2 gene. We first reduced the size of the CCM2 interval from 22 cM to 7.5 cM by genetic linkage analysis. We then hypothesized that large deletions might be involved in the disorder, as already reported in other hamartomatous conditions, such as tuberous sclerosis or neurofibromatosis. We performed a high-density microsatellite genotyping of this 7.5-cM interval to search for putative null alleles in 30 unrelated families, and we identified, in 2 unrelated families, null alleles that were the result of deletions within a 350-kb interval flanked by markers D7S478 and D7S621. Additional microsatellite and single-nucleotide polymorphism genotyping showed that these two distinct deletions overlapped and that both of the two deleted the first exon of MGC4607, a known gene of unknown function. In both families, one of the two MGC4607 transcripts was not detected. We then identified eight additional point mutations within MGC4607 in eight of the remaining families. One of them led to the alteration of the initiation codon and five of them to a premature termination codon, including one nonsense, one frameshift, and three splice-site mutations. All these mutations cosegregated with the disease in the families and were not observed in 192 control chromosomes. MGC4607 is so far unrelated to any known gene family. Its implication in CCMs strongly suggests that it is a new player in vascular morphogenesis.
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Affiliation(s)
- C. Denier
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - S. Goutagny
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - P. Labauge
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - V. Krivosic
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - M Arnoult
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - A. Cousin
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - A. L. Benabid
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - J. Comoy
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - P. Frerebeau
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - B. Gilbert
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - J. P. Houtteville
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - M. Jan
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - F. Lapierre
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - H. Loiseau
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - P. Menei
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - P. Mercier
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - J. J. Moreau
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - A. Nivelon-Chevallier
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - F. Parker
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - A. M. Redondo
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - J. M. Scarabin
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - M. Tremoulet
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - M. Zerah
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - J. Maciazek
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
| | - E. Tournier-Lasserve
- INSERM E365, Faculté de Médecine Lariboisière,Laboratoire de Cytogénétique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, and Service de Neurochirurgie, CHU de Necker-Enfants Malades, Paris; Service de Neurologie, CHU Montpellier Nîmes, Nîmes, France; Service de Neurochirurgie, CHU de Grenoble, Grenoble, France; Service de Neurochirurgie, CHU de Kremlin-Bicêtre, Kremlin-Bicêtre, France; Service de Neurochirurgie CHU de Montpellier, Montpellier, France; Génétique, CHU de Limoges, and Service de Neurochirurgie, CHU de Limoges, Limoges, France; Service de Neurochirurgie, CHU de Caen, Caen, France; Service de Neurochirurgie, CHU de Tours, Tours; Service de Neurochirurgie, CHU de Poitiers, Poitiers, France; Service de Neurochirurgie, CHU de Toulouse, Toulouse; Service de Neurochirurgie, CHU de Angers, Angers, France; Génétique, CHU de Dijon, Dijon; Service de Neurochirurgie, Hôpital Beaujon, Clichy, France; and Service de Neurochirurgie, CHU de Rennes, Rennes, France
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49
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Jaquet P, Cortet-Rudelli C, Sassolas G, Morange-Ramos I, Chanson P, Brue T, Andrieu JM, Beckers A, Bertherat J, Borson-Chazot F, Brassier G, Caron P, Cogne M, Cottier JP, Delemer B, Dufour H, Enjalbert A, Figarella-Branger D, Gaillard R, Gueydan M, Jan M, Kuhn JM, Raingeard I, Regis J, Roger P, Rohmer V, Sadoul JL, Saveanu A, Tabarin A, Travers N, Trouillas J. [Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry]. Ann Endocrinol (Paris) 2003; 64:434-41. [PMID: 15067248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
UNLABELLED From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05). RESULTS 46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.
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Affiliation(s)
- Ph Jaquet
- Service d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille
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50
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Praline J, Cottier JP, Aesch B, Herbreteau D, Jan M. [Image-guided epidural blood patch as effective treatment of intracranial hypotension. A case report]. Neurochirurgie 2003; 49:51-4. [PMID: 12736582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
We report the case of a patient with postural headache. A CT scan revealed bilateral subdural hygroma. Brain MRI showed diffuse pachymeningeal enhancement. A diagnosis of intracranial hypotension was therefore made. Thoracic cerebrospinal fluid leak was proved by radionuclide cisternography and contrast myelography. Conservative medical treatment was ineffective. Two thoracic epidural blood patches with radiographic control were made. We think the blood patch is the most important element for success.
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Affiliation(s)
- J Praline
- Service de Neurologie, CHU Bretonneau, 37044 Tours Cedex.
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