How an innovative catheter with temperature control and very high-power, short-duration ablation changed our approach to the treatment of persistent atrial fibrillation.

Ablation targets of persistent atrial fibrillation remain poorly understood nowadays: due to structural alterations of the left atrium, isolation of the pulmonary veins alone has proved ineffective. New ablation targets such as the posterior wall, coronary sinus, and left atrial appendage were then sought. A new catheter (QDOT Micro™) has recently been released, which has the potential to increase the safety and efficacy of the procedure: it is connected to a new radiofrequency generator that allows for temperature-controlled ablation by reducing power and increasing irrigation with the increase in tissue temperature and allows to deliver power up to 90 W for few seconds (very high-power short-duration).

Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: A dual-center experience.

Introduction: The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. We conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT).

Methods: We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n = 14) or recurrent VT (n = 7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n = 9).

Estro-progestin and progestogen intake: What's the impact on hysteroscopic imaging?

Background: In current literature there is no report aimed to evaluate the effects of exogenous steroids on hysteroscopic imaging.

Objectives: To evaluate the hysteroscopic features of endometrium in women undergoing female hormones administration.

Materials And Methods: We reviewed video-records of hysteroscopies carried-out in women taking estro-progestins (EP), progestogen (P) and Hormonal Replacement Therapy (HRT).

Seizure outcome after extratemporal epilepsy surgery in childhood.

Aim: The aim of the study was to describe seizure outcome following surgery for focal extratemporal epilepsy and identify factors associated with prolonged postsurgical freedom from seizures.

Method: In this retrospective cohort study, children with drug-resistant focal extratemporal epilepsy were treated surgically and followed up in a single tertiary care centre between 1997 and 2008.

Results: Eighty children were identified for inclusion in the study (42 males, 38 females; median age 9y 1mo, range 3mo-18y 7mo).

Psychopathology in children before and after surgery for extratemporal lobe epilepsy.

Aim: To establish the rates and types of psychiatric disorder in children before and after surgery for extratemporal epilepsy. Relationships between psychiatric morbidity and demographic/clinical variables were examined.

Method: A retrospective case note review of 71 children undergoing extratemporal focal resection for drug resistant epilepsy in a specialist epilepsy surgery programme between 1997 and 2008.

Cognitive outcome after extratemporal epilepsy surgery in childhood.

Purpose: The present study aims to describe the cognitive profile of children with medically refractory extratemporal epilepsies who undergo focal surgery and to identify determinants for preoperative and postoperative cognitive level.

Methods: This is a retrospective cohort study. Children who underwent operations between 1997 and 2008 with a focal lesion in frontal, parietal, or occipital cortices and with a presurgical or postsurgical cognitive evaluation, were eligible for the study.

VNS in drug resistant epilepsy: preliminary report on a small group of patients.

Background: In 1997 Vagus Nerve Stimulation (VNS) received approval from the US Food and Drug Administration (FDA) as an adjunctive therapy in the treatment of medically intractable partial epilepsy in people aged 12 years and older who are ineligible for resective epilepsy surgery. Although the exact mechanisms of action are unknown, the use of VNS with children has increased, including those younger than 12 years of age, or those with generalized epilepsy.

Methods: We describe the outcome for the first group of nine patients, aged 8-28 years, who had pharmaco-resistant epilepsy and were treated with VNS.

Unusual diagnosis in a child suffering from juvenile Alexander disease: clinical and imaging report.

Alexander disease is a rare, sporadic leukoencephalopathy characterized by white-matter abnormalities with frontal predominance and, as a rule, clinically associated with megalencephaly, seizures, spasticity, and psychomotor deterioration. We describe a boy who was diagnosed as affected by anorexia nervosa because of his refusal to eat, progressive weight loss, and psychologic disturbances. The observation of a hyperintense lesion on T(2)-weighed magnetic resonance images (MRIs) was initially explained as a pontine and extrapontine myelinolysis related to malnutrition.

Clinical features of benign infantile convulsions: familial and sporadic cases.

The authors describe the so-called benign convulsions of infancy and confirm the existence of benign nonfamilial infantile convulsions during the first 2 years of life and their benign course. The authors evaluated 58 patients: 17 subjects had a family history of benign epilepsy, and 41 did not. No clinical differences were observed between the two groups.

Accuracy of hysteroscopic diagnosis of endometrial hyperplasia: a retrospective study of 323 patients.

Study Objective: To evaluate the diagnostic accuracy of hysteroscopic view in endometrial hyperplasia.

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: Public hospital in northern Italy.

Outpatient hysteroscopic polypectomy in 237 patients: feasibility of a one-stop "see-and-treat" procedure.

Study Objective: To evaluate the feasibility of a "see-and-treat" office polyp resection, using a 5-mm sheathed operative hysteroscope.

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: Public hospital.

Hysteroscopically targeted biopsies compared with blind samplings in endometrial assessment of menopausal women taking tamoxifen for breast cancer.

Study Objective: To determine the validity of tissue sampling accomplished by hysteroscopically targeted or blind biopsies in the assessment of endometrial morbidity associated with tamoxifen treatment.

Design: Retrospective, unrandomized study (Canadian Task Force classification II-2).

Setting: Public hospital.

Saline infusion sonography and office hysteroscopy to assess endometrial morbidity associated with tamoxifen intake.

Objective: The objective of this study was to compare office feasibility, patient acceptance, and diagnostic accuracy of hysteroscopy (HYS) and saline infusion sonography (SIS) in breast cancer patients taking tamoxifen.

Methods: Sixty-six asymptomatic postmenopausal women on tamoxifen for breast cancer underwent SIS, followed by outpatient HYS with endometrial biopsy. In all women an endometrial stripe over 4 mm was previously measured by transvaginal ultrasonography (TU).

Hysteroscopic assessment of menopausal breast-cancer patients taking tamoxifen; there is a bias from the mode of endometrial sampling in estimating endometrial morbidity?

The aim of this study is to evaluate the accuracy of hysteroscopy in detecting tamoxifen-associated endometrial morbidity. Ninety-eight menopausal breast cancer patients taking tamoxifen underwent hysteroscopy because of an endometrial thickness above 4mm measured by Transvaginal Ultrasonography. Thirty-one women recorded uterine bleeding while 67 were asymptomatic.

Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women.

Study Objective: To estimate the accuracy of hysteroscopy in predicting endometrial histopathology.

Design: Retrospective analysis (Canadian Task Force classification II-2).

Setting: Public hospital.

[The possibility of using sulprostone during laparoscopic myomectomy in uterine fibromyomatosis. Preliminary studies].

The authors considered sulprostone effects, PGE2 synthetic derivative, on the hematic loss during laparomyomectomy. This drug is been used by intravenous way during the operation in 84 patients affected with uterine myomatosis. The effectiveness and tolerance of the drug is thus evident in the reduction of the hematic intraoperative loss.

[Ultrasonographic monitoring of the endometrium in post-menopausal women asymptomatic or undergoing hormone replacement therapy].

This study evaluated the reliability of ultrasonography in the post-menopausal period for the screening of endometrium pathology in women who are non-symptomatic or undergoing hormone replacement therapy. A total of 152 women were examined, 76 were non-symptomatic and 76 were undergoing estro-progestational therapy. As in previous studies on the subject, we took 0.