Cardiac resynchronization therapy with biventricular pacing is an established therapy for heart failure patients with sinus rhythm, reduced left ventricular ejection fraction and electrical ...ventricular desynchronization. The aim of the study was to evaluate electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing before upgrading to cardiac resynchronization therapy. Heart failure patients with right ventricular pacing, DDD pacemaker, DDD defibrillator and 24.5 ± 4.9 % left ventricular ejection fraction were measured by surface ECG and transesophageal bipolar left ventricular ECG before upgrading to cardiac resynchronization therapy. Interventricular and intraventricular desynchronization in right ventricular pacemaker pacing were 228.2 ± 44.8ms QRS duration, 86.5 ± 32.8ms interventricular delay and 94.4 ± 23.8ms left ventricular delay. Cardiac resynchronization therapy was optimized by impedance cardiography. Transesophageal electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing may be additional useful ventricular desynchronization parameters to improve patient selection for upgrading right ventricular pacemaker pacing to cardiac resynchronization therapy.
Cardiac resynchronization therapy is an established therapy for heart failure patients. The aim of the study was to evaluate electrical left cardiac atrioventricular delay and interventricular ...desynchronization in sinus rhythm cardiac resynchronization therapy responder and non-responder. Cardiac electrical desynchronization were measured by surface ECG and focused transesophageal bipolar left atrial and left ventricular ECG before implantation of cardiac resynchronization therapy defibrillators. Preoperative electrical cardiac desynchronization was 195.7 ± 46.7 ms left cardiac atrioventricular delay and 74.8 ± 24.5 ms interventricular delay in cardiac resynchronization therapy responder. Cardiac resynchronization therapy responder New York Heart Association class improved during long term biventricular pacing. Transesophageal left cardiac atrioventricular delay and interventricular delay may be additional useful parameters to improve patient selection for cardiac resynchronization therapy.
To report the short to medium-term results of one-stage buccal mucosa ventral onlay in the treatment of recurrent urethral stricture disease.
Between April 1997 and July 2001, buccal mucosa was used ...as a ventral onlay graft in 38 patients with recurrent strictures of the bulbar (n = 30) and proximal penile urethra (n = 8). All patients had undergone at least 1 urethrotomy (range 1 to 10; mean 2.9) before reconstruction. Prospective follow-up included a simple questionnaire on patient satisfaction, uroflowmetry, and ultrasound estimation of postvoid residual urine volume and, in the case of recurrence, retrograde urethrography and cystoscopy.
The primary success rate at a mean follow-up of 22.8 months (range 8.7 to 40.7) was 80%. Stricture recurred in 7 patients, mostly within 12 months. A distinct residual irregularity at the former stricture site in the initial postoperative urethrogram was predictive of failed reconstruction. A second procedure was performed in 4 patients (1 urethrotomy and 3 re-buccal mucosa onlay grafts) with good results. Patient satisfaction was high in most instances. Three patients refused reoperation, preferring regular intermittent dilation.
When end-to-end anastomosis is impossible, onlay urethroplasty using buccal mucosa is a rather simple alternative with encouraging short to medium-term results in the proximal segments of the male urethra.
The purpose of this study was to evaluate termination of atrial flutter (AFL) by directed rapid transesophageal atrial pacing (TAP) with and without simultaneous transesophageal echocardiography ...(TEE) performed using a novel TEE tube electrode.
A total of 16 AFL patients (age 63+/-12 years; 13 males) with mean AFL cycle length of 224+/-24 ms (n=12) and mean ventricular cycle length of 448+/-47 ms (n=12) were analyzed using either an esophageal TO electrode (n=10) or a novel TEE tube electrode consisting of a tube with four hemispherical electrodes that is pulled over the echo probe (n=6). AFL could be terminated by directed rapid TAP using an esophageal TO electrode, leading to induction of atrial fibrillation (AF) (n=6), induction of AF and spontaneous conversion to sinus rhythm (SR) (n=3), and with conversion to SR (n=1). AFL could also be terminated by directed rapid TAP using the TEE tube electrode, with induction of AF (n=3) or induction of AF and spontaneous conversion to SR (n=3).
AFL can be terminated by directed rapid TAP with hemispherical electrodes with and without simultaneous TEE. TAP with the directed TEE tube electrode is a safe, simple, and useful method for terminating AFL.
Introduction: The purpose of this study was to evaluate termination of atrial flutter (AFL) by directed rapid transesophageal atrial pacing (TAP) with and without simultaneous transesophageal ...echocardiography (TEE) performed using a novel TEE tube electrode.
Materials and methods, and Results: A total of 16 AFL patients (age 63±12 years; 13 males) with mean AFL cycle length of 224±24 ms (n=12) and mean ventricular cycle length of 448±47 ms (n=12) were analyzed using either an esophageal TO electrode (n=10) or a novel TEE tube electrode consisting of a tube with four hemispherical electrodes that is pulled over the echo probe (n=6). AFL could be terminated by directed rapid TAP using an esophageal TO electrode, leading to induction of atrial fibrillation (AF) (n=6), induction of AF and spontaneous conversion to sinus rhythm (SR) (n=3), and with conversion to SR (n=1). AFL could also be terminated by directed rapid TAP using the TEE tube electrode, with induction of AF (n=3) or induction of AF and spontaneous conversion to SR (n=3).
Conclusion: AFL can be terminated by directed rapid TAP with hemispherical electrodes with and without simultaneous TEE. TAP with the directed TEE tube electrode is a safe, simple, and useful method for terminating AFL.
Einleitung: Die Terminierung von Vorhofflattern (AFL) mit gerichteter hochfrequenter transösophagealer Vorhofstimulation (TAP) wurde mit und ohne simultane transösophageale Echokardiographie (TEE) mit einer neuen TEE-Schlauchelektrode evaluiert.
Material und Methode und Ergebnisse: 16 AFL Patienten (Alter 63±12 Jahre; 13 Männer) mit einer mittleren AFL-Periodendauer von 224±24 ms (n=12) und einer mittleren ventrikulären Periodendauer von 448±47 ms (n=12) wurden mittels Ösophaguselektrode „TO” (n=10) oder neuer „TEE-Schlauchelektrode”, die aus einem Schlauch mit 4 halbkugelförmigen Elektroden besteht und über die Echokardiographiesonde gezogen wird (n=6), analysiert. AFL konnte mit gerichteter hochfrequenter TAP und TO-Elektrode durch Induktion von Vorhofflimmern (AF) (n=6), Induktion von AF mit spontaner Konversion in den Sinusrhythmus (SR) (n=3) und Konversion in den SR (n=1) terminiert werden. AFL konnte mit gerichteter hochfrequenter TAP und TEE-Schlauchelektrode durch Induktion von AF (n=3) und Induktion von AF mit spontaner Konversion in den SR (n=3) terminiert werden.
Schlussfolgerung: AFL kann durch gerichtete hochfrequente TAP mit halbkugelförmigen Elektroden mit und ohne simultane TEE terminiert werden. TAP mit der gerichteten TEE-Schlauchelektrode ist eine sichere, einfache und praktikable Methode zur Terminierung von AFL.
We report on a 17-year-old white woman with multiple bilateral renal angiomyolipomas (AMLs) in the absence of tuberous sclerosis. Multiple hyperdense lesions were detected in both kidneys by ...sonography. A computed tomography (CT) scan confirmed mainly fatty tissue. Sparing as much functional tissue as possible, eight AMLs of the right kidney were resected. The largest removed tumour measured 7 x 4 x 2.4 cm. Renal function was completely preserved. An AML is a benign, generally unilateral renal tumour. Treatment is necessary in cases of flank pain, spontaneous bleeding, obstruction by tumour growth and tumours exceeding 4 cm in diameter. Patients who present are often symptomatic due to pain, retroperitoneal bleeding or haematuria. An AML occurs either sporadically or in association with tuberous sclerosis. Bilateral or unilateral multiple AMLs are rare.
Water scarcity severely impairs food security and economic prosperity in many countries today. Expected future population changes will, in many countries as well as globally, increase the pressure on ...available water resources. On the supply side, renewable water resources will be affected by projected changes in precipitation patterns, temperature, and other climate variables. Here we use a large ensemble of global hydrological models (GHMs) forced by five global climate models and the latest greenhouse-gas concentration scenarios (Representative Concentration Pathways) to synthesize the current knowledge about climate change impacts on water resources. We show that climate change is likely to exacerbate regional and global water scarcity considerably. In particular, the ensemble average projects that a global warming of 2 °C above present (approximately 2.7 °C above preindustrial) will confront an additional approximate 15% of the global population with a severe decrease in water resources and will increase the number of people living under absolute water scarcity (<500 m3 per capita per year) by another 40% (according to some models, more than 100%) compared with the effect of population growth alone. For some indicators of moderate impacts, the steepest increase is seen between the present day and 2 °C, whereas indicators of very severe impacts increase unabated beyond 2 °C. At the same time, the study highlights large uncertainties associated with these estimates, with both global climate models and GHMs contributing to the spread. GHM uncertainty is particularly dominant in many regions affected by declining water resources, suggesting a high potential for improved water resource projections through hydrological model development.
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