Phased RF ablation in persistent atrial fibrillation.

Background: Persistent and long-standing persistent atrial fibrillation (AF) often requires extensive and/or repeat radiofrequency (RF) ablation procedures.

Objective: The Tailored Treatment of Persistent Atrial Fibrillation (TTOP-AF) study assessed the effectiveness and safety of the phased RF system in a randomized controlled comparison of medical therapy against phased RF ablation for the management of persistent and long-standing persistent AF.

Methods: Patients who had failed at least 1 antiarrhythmic drug (AAD) were randomized (2:1) to ablation management (AM) or medical management (MM).

Multivariate analysis of prognostic factors for survival following doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma.

Purpose: To identify prognostic factors for survival in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization with doxorubicin-eluting beads (DEBs).

Materials And Methods: In a retrospective, single-center analysis, tumor- and patient-related factors were recorded for univariate and multivariate analyses via Kaplan-Meier and Cox regression. Infiltrative HCC phenotype and portal vein invasion (PVI) were correlated, and patients with either or both were classified as having radiographically advanced (RAdv) HCC.

Humeral head resurfacing for glenohumeral arthritis associated with dysplasia.

Humeral head resurfacing is indicated for the treatment of glenohumeral arthrosis in a variety of well-described situations, including humeral shaft abnormalities and obstructing hardware. This report of 2 cases emphasizes the benefit of this stemless device in situations in which dislocation of the humeral head and access to the humeral canal is not possible. In these 2 patients with developmental dysplasia and secondary glenohumeral arthrosis, humeral head resurfacing arthroplasty resulted in successful improvement of severe preoperative pain.

The Goldilocks mastectomy.

Objective: To reconstruct a breast mound from cutaneous mastectomy flap tissue alone, obviating the need for additional flap or implant techniques.

Summary Background Data: With growing numbers of obese and elderly women facing breast cancer, options outside of simple mastectomy without reconstruction and formal breast reconstruction using complex autologous flap harvesting techniques or artificial implants need to be explored.

Methods: Patients who declined traditional methods of breast reconstruction were offered standard skin sparing mastectomy with closure utilizing a standard Wise pattern.

William Henry Welch (1850-1934): the road to Johns Hopkins.

William Henry Welch's selection in 1884 as the first faculty member of the new medical school at Johns Hopkins created the invigorating atmosphere that generated the revolutionary changes in medical training and laboratory medicine that transformed medicine in America. Dr. Welch's family traditions, his New England upbringing, Yale education, and German university experience prepared a unique individual to lead American medicine into the 20th century.

Fondaparinux (Arixtra(R)), a safe alternative for the treatment of patients with heparin-induced thrombocytopenia?

Unlabelled: Fondaparinux, a pentasaccharide which selectively binds to antithrombin III, has negligible to no cross-reactivity with heparin-induced thrombocytopenia (HIT) antibodies in in vitro studies. The lack of cross-reactivity suggests a potential role in the management of HIT, and indeed, there are several such case reports and small studies. These published data have used both the prophylactic and weight-based treatment doses.

Guideline for minimizing radiation exposure during acquisition of coronary artery calcium scans with the use of multidetector computed tomography: a report by the Society for Atherosclerosis Imaging and Prevention Tomographic Imaging and Prevention Councils in collaboration with the Society of Cardiovascular Computed Tomography.

Coronary artery calcium (CAC) scanning is an important tool for risk stratification in intermediate-risk, asymptomatic subjects without previous coronary disease. However, the clinical benefit of improved risk prediction needs to be balanced against the risk of the use of ionizing radiation. Although there is increasing emphasis on the need to obtain CAC scans at low-radiation exposure to the patient, very few practical documents exist to aid laboratories and health care professionals on how to obtain such low-radiation scans.

Acute liver injury with severe coagulopathy in marasmus caused by a somatic delusional disorder.

Marasmus is a severe form of protein-calorie malnutrition characterized by the depletion of fat stores, muscle wasting, and the lack of edema. In developed countries, marasmus is often the result of anorexia nervosa. Abnormal transaminases with liver synthetic dysfunction have rarely been reported with anorexia nervosa.

Lacrimal gland choristoma in a preterm infant, presenting with spontaneous hyphema and increased intraocular pressure.

We report a case of intraocular lacrimal gland choristoma presenting very early in a preterm infant with hyphema, a mass lesion and raised intraocular pressure. Enucleation of the involved eye, which is the treatment in most cases, was performed and prosthesis was fitted successfully. An interesting additional finding in our patient was a choroidal defect, not reported to date with other cases in the literature.

Health insurance status of US living kidney donors.

Background And Objectives: Ensuring follow-up of living kidney donors (LKDs) is essential to long-term preventive care. We sought information on health insurance status of US LKDs, with particular attention to age, gender, and ethnicity.

Design, Setting, Participants, & Measurements: The United Network for Organ Sharing/Organ Procurement Transplantation Network database was queried for associations among age at donation, race, gender, and health insurance status.

Bilateral Acanthamoeba keratitis in Synergeyes contact lens wear: clinical and confocal microscopy findings.

Objective: To report three cases of bilateral Acanthamoeba keratitis in association with Synergeyes hybrid contact lens wear.

Methods: Retrospective case series of six eyes of three patients that developed Acanthamoeba keratitis with Synergeyes hybrid contact lens wear.

Results: Acanthamoeba keratitis was diagnosed in six eyes with a previous misdiagnosis of Herpes simplex keratitis in two patients and a misdiagnosis of corneal graft rejection in the third patient.

Fulminant Wilson's disease requiring liver transplantation in one monozygotic twin despite identical genetic mutation.

Acute decompensated Wilson's disease (WD) that presents as fulminant hepatic failure carries significant mortality without hepatic replacement. The abnormal gene implicated in WD, ATP7B, has been mapped to chromosome 13, and leads to decreased passage of copper from hepatocytes to bile. Excess copper accumulation exceeds hepatocyte storage capacity resulting in intracellular necrosis, apoptosis and cell death in various organs of the body.

A novel percutaneous mechanical biventricular bridge to recovery in severe cardiac allograft rejection.

We describe the case of a 36-year-old man with acute cardiac transplant rejection bridged to recovery using simultaneous Impella 2.5 and TandemHeart percutaneous support devices. The patient underwent orthotopic cardiac transplantation 2 years earlier, and presented to our hospital with allograft failure 7 days after non-compliance with tacrolimus.

Concurrent acanthamoeba and Fusarium keratitis with silicone hydrogel contact lens use.

Purpose: To report a case of simultaneous Acanthamoeba and Fusarium keratitis associated with no-rub multipurpose contact lens solution and silicone hydrogel contact lens use.

Method: Observational case report.

Results: A 39-year-old woman was referred for worsening of a presumed bacterial corneal ulcer in the setting of silicone hydrogellens wear with occasional overnight wear, no-rub multipurpose contact lens solution use, and combined topical antibiotic/corticosteroid treatment.