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  • 1
    ISSN: 1600-0536
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  Background: Even with rapid diagnosis and effective medical treatment mortality in type B aortic dissection with evidence of extraaortic leakage of blood remains high. Considering a mortality rate of 29% to 50% associated with emergency surgical repair, the concept of endovascular stent-graft placement may become a life-saving option in impending or evolving rupture by endovascular sealing of the entry tear and subsequent abortion of leakage. Methods: The concept was tested by comparing short-term and 1-year outcomes of 11 patients after emergency endovascular stent-graft placement with historic-matched control patients subjected to conventional therapy. All patients had acute type B dissection complicated by loss of blood into periaortic spaces. Results: Emergency stent-graft placement was successful without periprocedural morbidity, aborted leakage, and ensured reconstruction of the dissected aorta; at a mean follow-up of 15 ± 6 months no death had occurred in the stent-graft group whereas four patients had died with conventional treatment (p 〈 0.05). Conclusion: With appropriate logistics and expertise, type B aortic dissection with leakage and evolving rupture may benefit from nonsurgical reconstruction of the dissected segment by endovascular stent grafts.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1550-7408
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology
    Notes: Up to half of the biomass in the rumen can be represented by ciliates, which play an important role in the digestion processes of their hosts. In the literature, very little information can be found on determination of the diversity of complex rumen ciliate communities. The identification of these fast moving protists is mainly based on live observations and comparisons of their highly variable cell morphologies. It makes accurate identification and quantification of rumen ciliates very difficult if not impossible. The development of fluorescence in situ hybridization (FISH), established as a technique to identify prokaryotes and eukaryotes using ribosomal RNA-targeted fluorescently labeled oligonucleotide probes, is a promising approach to identify and investigate rumen ciliates. The present study, part of CIMES (ciliates as monitors for environmental safety), a project sponsored by the European Commission, shows the problems of applying FISH on rumen ciliates and how to solve them. Tests resulted in a new protocol, which recommends para-formaldehyde and formaldehyde at 1–2% final concentration to preserve the ciliates before applying FISH. Furthermore, seven new oligonucleotide probes could be developed and successfully be tested to identify different rumen ciliate taxa of the order Entodiniomorphida (class Litostomatea) by applying FISH. It is also shown, how FISH together with confocal laser scanning microscopy can improve analyses of ciliate cell morphologies. Thanks to Peter Pristas, Peter Javorsky, Ralf Einspanier, Susanne Ulbrich (providing rumen samples), Seung Yeo Moon-van der Staay, Georg van der Staay (providing unpublished 18S-rDNA sequences), the European Commission (financial support, project QLK3-CT-2002-02151).
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Catheter ablation has become a well-established therapy for isthmus-dependent right atrial flutter (AFL). Recently, mapping and ablation of AFL have been performed using sophisticated three-dimensional mapping systems, such as electroanatomic and noncontact mapping systems. The LocaLisa system enables nonfluoroscopic navigation of intracardiac electrode catheters based on impedance changes related to catheter movements in transthoracic current fields. The aim of this randomized prospective study was to compare the efficacy of the LocaLisa system with the conventional mapping/ablation approach for radiofrequency ablation of AFL. Methods and Results: Fifty consecutive patients with AFL (39 men and 11 women; age 65 ± 10 years) were studied. The patients were randomly assigned to undergo radiofrequency ablation guided by a conventional fluoroscopy-based approach (24 patients) or by the LocaLisa system (26 patients). Ablation success rate and documentation of bidirectional isthmus block were 100% in both groups. Compared with fluoroscopy-guided approaches, LocaLisa-guided procedures demonstrated a reduction in total fluoroscopy time from 15.9 ± 10.6 minutes to 7.5 ± 6.5 minutes (P 〈 0.005). Total fluoroscopy dosage was reduced from 21.0 ± 19.8 to 8.7 ± 9.5 Gycm2 (P 〈 0.05). Fluoroscopy time required for ablation was significantly shortened in the LocaLisa group (2.6 ± 2.6 min) compared with the conventional approach group (11 ± 10 min, P 〈 0.0005). In 9 (35%) of 26 patients, the ablation could be performed with a fluoroscopy time ≤1 minute. There were no significant differences with regard to the number of radiofrequency applications, fluoroscopy time needed for diagnostic reasons, total procedure time, or other ablation data. Conclusion: Compared with the conventional approach, the LocaLisa system significantly reduces the fluoroscopy times needed for ablation of typical AFL. (J Cardiovasc Electrophysiol, Vol. 14, pp. 587-590, June 2003)
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Percutaneous transcatheter closure has been proposed as an alternative to surgical closure or long-term anticoagulation in patients with presumed paradoxical embolism and patent foramen ovale (PFO). We report our mid-term results of 55 consecutive symptomatic patients (mean age: 47 years, range: 20–79) who underwent percutaneous transcatheter closure of PFO after at least one event of cerebral ischemia; 16 (29%) patients had at least one transient ischemic attack and 39 (71%) patients at least one embolic stroke. Multiple embolic events had occurred in 6 (11%) patients. Percutaneous transcatheter closure was technically successful in all 55 patients (100%). For the majority of patients, an Amplatzer PFO occluder measuring 25 mm in diameter (n = 49) or an Amplatzer PFO occluder measuring 35 mm in diameter (n = 6) was used. Complete occlusion by color Doppler and transesophageal contrast echocardiography investigation was achieved in 96% at follow-up 3-6 months after implantation; only 2 patients had a trivial residual shunt at follow-up. Mean fluoroscopy time was 6.7 minutes (range: 1.7–47.1), and in-hospital follow-up was uneventful except for 1 patient who developed a cardiac tamponade requiring uneventful and successful needle pericardiocentesis. At a mean follow-up of 19 months (range: 3–32) no recurrent embolic neurological events was observed. Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism and aneurysmatic or nonaneurysmatic PFO. Percutaneous closure is associated with a high success rate, low incidence of hospital complications, and freedom of cerebral ischemia events.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The cutting balloon is a new device for coronary angioplasty, that, by the combination of incision and dilatation of the plaque, is believed to be promising for treatment of in-stent restenosis. The purpose of the study was to evaluate the safety and efficacy of CBA. We reviewed the immediate and 6-month follow-up angiographic and clinical outcome of 147 patients (109 men and 38 women) with a mean age of 67.3 ± 10 undergoing this procedure at eight interventional centers in Austria. The target lesions treated with CBA were in-stent restenosis in 61% of patients, stenosis after balloon angioplasty in 8% of patients, and native lesions in 33% of patients. Sixty-five percent of the patients included had multivessel disease. Lesion type was A in 18% of patients, B1 in 31% of patients, B2 in 39% of patients, and C in 12% of patients. The degree of stenosis was 87%± 9%, the length of the target lesion treated with CBA was 8.8 ± 5.1 mm . Target vessel was left circumflex artery in 22 cases, right coronary artery in 36 cases, and left anterior descending artery in 89 cases. The overall procedural success rate was 90.5%. “Stand-alone” CBA was performed in 63% of patients, the procedure was combined with coronary stenting in 16% of patients, and with balloon angioplasty in 21% of patients. Coronary complications occurred in eight cases (5.4%) with coronary dissection in seven (total dissection rate of 4.7%) and urgent bypass surgery in one case (0.7%). No further complications such as death, occlusion, or perforation of coronary arteries, embolization, or thrombosis were observed. Six-month clinical follow-up revealed q-wave myocardial infarction in 2.7% of patients, aortocoronary bypass surgery in 8.5% of patients, and repeated percutaneous coronary intervention in 17% of patients (11.5% with stenting). Six-month angiographic follow-up of patients with recurrent angina showed target lesion restenosis (〉50% diameter stenosis) in 14% of patients, late lumen loss with ≤50% diameter stenosis in 6% of patients and progression of “other than target” lesions with 〉50% diameter stenosis in 14% of patients. This series demonstrates the safety and feasibility of cutting balloon angioplasty in patients with complex coronary artery disease and in-stent restenosis. (J Interven Cardiol 2003;16:15–21)
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK; Malden, USA : Blackwell Science Inc
    Public health nursing 21 (2004), S. 0 
    ISSN: 1525-1446
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  The purpose of this descriptive study was to describe the characteristics and relationship of organizational structure and job satisfaction in public health nursing. A significant relationship was found between organizational structure variables and job satisfaction for public health nurses employed in down state Illinois local health departments. The findings of this study suggest that work environments in which supervisors and subordinates consult together concerning job tasks and decisions, and in which individuals are involved with peers in decision making and task definition, are positively related to job satisfaction. This information will assist nurse administrators in development of work structures that support participative decision making and enhance job satisfaction, critical to retaining and attracting a well-qualified public health nurse workforce.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 56-year-old patient with paroxysmal atrial fibrillation who developed a transient 2:1 block between the left atrium and right inferior pulmonary vein during a single application of radiofrequency current was described. The production of transient and complete atriovenous block by a single application of radiofrequency current demonstrates that a single connection between the pulmonary veins muscle and the left atrium may exist. (PACE 2004; 27[Pt. I]:829–830)
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  • 9
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims: Two different ablation procedures are performed to cure patients of atrial fibrillation (AF): (1) the electrophysiological pulmonary vein (PV) isolation, and (2) the anatomical circumferential ablation of all four PV ostia. The aim of this study was to determine the effects of circumferential radiofrequency lesions around the ostia on PV activation. Methods and Results: In 34 patients with drug refractory paroxysmal (N = 22) or persistent (N = 12) AF a 31-mm basket catheter (BC) was introduced transseptally in the PVs. After creating a circumferential ablation line around the PV ostia using a nonfluoroscopic 3D-navigation system, electrical isolation was achieved in 46% of the PVs, and prolongation of conduction time (+39 ± 34 ms) was observed in 30%. PVs with persistent conduction (54%) were isolated by ablating the remaining conduction pathways using the BC. At 12 months follow-up, 62% of the patients were in stable sinus rhythm without antiarrhythmic drug therapy. Six patients had developed left atrial flutter. Conclusions: Anatomically guided, circumferential lesions around the PV ostia resulted in isolation in only 46% of the veins. At 12 months, 62% of the patients were free of AF without antiarrrhythmic drug treatment, however, 6 patients (18%) developed left atrial flutter.
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  • 10
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Characterization of AF with Noncontact Mapping. Introduction: Information on the spatiotemporal organization of atrial activity at the onset of atrial fibrillation (AF) is limited. Methods and Results: The study consisted of 26 consecutive patients (22 men and 4 women; mean age 56 ± 9 years) with AF in whom the left atrium (LA) was mapped using a noncontact mapping system. At the onset of AF, the AF cycle lengths and wavefronts were analyzed at the site of origin of the triggering atrial premature complex (APC) and five predefined sites within the LA (superior, anterior, posterior, lateral, and septal walls). If repetitive activity was observed at the site of origin of APCs, triggered AF episodes were considered as focally driven. APCs that induced AF had shorter coupling intervals than APCs that did not induce AF (300 ± 41 msec vs 392 ± 64 msec, P 〈 0.001). Immediately after AF onset, repetitive firing was crucial for maintenance of arrhythmia in 52 (80%) of 65 AF episodes. In 13 AF onset episodes (20%), AF was maintained by other mechanisms. The number of LA wavefronts after AF onset was lower in focally driven AF episodes compared with episodes in which no focally driven activity was observed (1.9 ± 0.6 v. 2.3 ± 2.3 wavefronts, P 〈 0.05). After the onset of AF, the posterior wall of the LA showed the earliest disorganized activity (after 5.2 ± 3.1 cycles). Conclusion: In the majority of AF episodes (80%), repetitive firing from the triggering foci may play an important role in maintaining AF immediately after arrhythmia onset. In 20% of the episodes, AF at early stages seems to be maintained by other mechanisms. The capability of APCs to induce AF depends on the coupling interval and the focus localization. The posterior wall of the LA shows the earliest disorganization of wavefronts at the onset of AF. (J Cardiovasc Electrophysiol, Vol. 14, pp. 176-181, February 2003)
    Type of Medium: Electronic Resource
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