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BACKGROUND:In recent years left atrial approaches have become popular because of technical simplicity, reproducibility and minor surgical trauma compared to the standard maze procedure. We analysed mid-term results of intraoperative left radiofrequency ablation of atrial fibrillation.METHODS:From February 1998 to August 2002, 206 patients (mean age 59.1 +/- 10.2 years) scheduled for open-heart surgery underwent combined treatment of atrial fibrillation at our Institution. In 163 patients (79.1%) a standard left epicardial approach was performed while 43 patients (20.9%) needed a totally endocardial approach.RESULTS:All patients but 3 underwent mitral valve surgery (104 repair and 99 replacement). Hospital mortality was 1.9%. Actuarial freedom from atrial fibrillation was 78% at 2 years and 74% at 4 years. At 4 years survival was 94% and freedom from neurological events was 98%. All patients with stable sinus rhythm 3 months after surgery recovered biatrial contractility.CONCLUSIONS:Left radiofrequency ablation of atrial fibrillation is effective in restoring sinus rhythm and normal atrial function. Combined atrial fibrillation treatment should be considered in all patients undergoing open-heart surgery.

Background . The minor technical and time requirements with respect to the maze operation combined with a comparable efficacy has led to an increasing popularity of left atrial approaches to treat atrial fibrillation. We report our experience with a left atrial procedure based on extensive use of epicardial radiofrequency ablation in an effort to minimize cardiac arrest time. Methods . A total of 132 consecutive patients with atrial fibrillation (121 chronic, 11 paroxysmal) undergoing open heart surgery had combined intraoperative ablation. An original set of left atrial lesions was performed using a radiofrequency linear catheter. Most of the ablations were performed epicardially before aortic cross-clamping. Patients with contraindications to the epicardial approach had the whole lesion set performed endocardially. Results . The mean cardiac arrest time spent for open heart ablations was significantly shorter (5.2 ± 0.9 minutes with modern catheters) when the epicardial approach was used (107 of 132 patients, 81%). Hospital mortality was 0.8%. Freedom from atrial fibrillation was 77% 3 years after the operation. Of all the variables analyzed, only age at surgery and early postoperative arrhythmias increased the risk of recurrent atrial fibrillation. Overall 3-year survival was 94%. The 3-year actuarial freedom from stroke was 98%. No patient required implantation of a permanent pacemaker. Atrial contractility was recovered in all patients with stable sinus rhythm. Conclusions . Left atrial radiofrequency ablation allows recovery of sinus rhythm and atrial function in the great majority of patients with atrial fibrillation who undergo open heart surgery. The epicardial radiofrequency approach is a safe and effective means to cure atrial fibrillation with negligible technical and time requirements.

Made available in DSpace on 2021-07-14T10:30:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2004. Added 1 bitstream(s) on 2021-07-14T11:31:49Z : No. of bitstreams: 1 S1678-91992004000300008.pdf: 261878 bytes, checksum: 83233afd8a7c5a26056f5a4b0eb629b0 (MD5) Seventy-nine HIV-1 infected patients were studied in three groups: Group G1 - 11 patients with no antiretroviral therapy; G2 - 40 patients undergoing antiretroviral therapy, 33 with only two nucleoside reverse transcriptase inhibitors (NRTI), and seven with two NRTI and one protease inhibitor (PI), all with viral load (VL) equal or higher than 80 copies of plasma RNA/ml; Group G3 - 28 patients, 23 on highly active antiretroviral therapy (HAART), 18 with two NRTI and one PI, and five with two NRTI and one non-nucleoside reverse transcriptase inhibitor (NNRTI), the remaining five with combination of two NRTI. All G3 patients had undetectable viral load for at least the past six months. The control group (Gc) included 20 normal blood donors without clinical complaints or signs of disease and negative for anti-HIV-1/2 antibodies. Serum cytokine levels pg/ml (TNF-alpha, INF-gamma, IL-2, IL-4, and IL-10) were determined in all patients including controls. CD4+ T and CD8+ T lymphocyte counts were made in the 79 patients by flow cytometry; VL determination was by NASBA technology. Analysis of results showed that the number of CD4+ T and CD8+ T lymphocytes were higher in G2 than G1, while VL was 0.5 log lower. G3 patients had similar lymphocyte values to G2, however they were chosen for G3 because their VL was undetectable, different by 4.0 log to G2. These results show the effect of antiretroviral treatment in G2 and G3 patients with better performance in the latter. Statistical difference was seen between the three groups and controls for serum cytokine behavior: TNF-alpha [H=48.323; pGc]; INF-gamma[H=28.992; pGc]; IL-4[H=48.323; pGc]; IL-10[H=47.256; pGc. There was no statistical difference in IL-2 values between all groups (H=6.071; p>0.10; G1=G2=G3=Gc). In absolute values however, G3 showed slightly lower TNF-alpha, IL-4, and IL-10, and higher INF-gamma and IL-2, to G1 and G2. This suggests a better performance in G3 patients, especially in IL-2 behavior. For cytokine profile, the three groups showed mature Th0 subset. In G1 72.73% were mature Th0, and 27.27% Th2; G2, 72.50% mature Th0, and 27.50% Th2; and G3, 89.29% mature Th0, and 10.71% Th2. There was no statistical difference between groups (chi22=3.014; p>0.10; G1=G2=G3). Statistical difference was seen between G2 and G3 for antiretroviral regimes used (chi21=27.932; pG2); HAART with PI predominated in G3, suggesting that it was responsible for this better performance. Linear correlation between pairs of variables was made with patient groups only, excluding controls. This was made separately for G1 and G2, 51 patients with detectable VL, and G1, G2, and G3 also including those with undetectable VL. The results showed a strong positive correlation between TNF-alpha and IL-4; TNF-alpha and IL-10; INF-gamma and IL-2; IL-4 and IL-10; IL-2 and CD4+. Weak negative correlation was seen between IL-2 and VL. Considering all correlations together, we found that IL-2 had the most correlations - eleven - strong, weak, positive, and negative; it was the only one that correlated with CD4+ (positively) and LV (negatively). The number of correlations allowed us to evaluate qualitative aspects such as IL-2 correlated positively with INF-gamma and CD4+ and negatively with LV; this somehow expresses the compatible profile with subset Th1, which could signify a tendency towards immune response recovery. Determination of cytokine serum values, especially IL-2, could be useful in follow-up of HIV-1 infected patients under HAART together with CD4+ and VL count. Universidade Estadual Paulista, Botucatu School of Medicine Universidade Estadual Paulista, Botucatu School of Medicine

Obiettivo della presente ricerca è stato quello di interpretare la risposta al trattamento superovulatorio della manza di razza Piemontese in funzione del comportamento di alcuni ormoni interessanti il momento riproduttivo, cercando di individuare un 'modello' di profilo ormonale da utilizzare come mezzo di screening preventivo delle potenziali donatrici ai fini dell'ottimizzazione dell'efficienza della tecnica del trasferimento embrionale. Sono stati effettuati 2 cicli di superovulazione (5. e 6.): il 5. ha interessato 3 donatrici e 6 riceventi; il 6. 2 donatrici e 6 riceventi. Il protocollo sperimentale seguito prevedeva la somministrazione di 32 Unità di FSHp, cosí ripartite: 10, 12, 6 e 4 Unità rispettivamente nel 1., nel 2., nel 3. e nel 4. giorno della fase di superovulazione. A partire dal giorno precedente l'inizio del trattamento superovulatorio fino al giorno del flushing, da ogni donatrice sono stati prelevati campioni di sangue a cadenza giornaliera (ore 9) per il dosaggio, mediante metodo radioimmunologico (RIA), del progesterone, dell'estradiolo, dell'FSH (limitatamente al 6. ciclo) e dell'LH. Ai fini della determinazione del livello ematico di quest'ultimo ormone, a partire dalla 28. e fino alla 76. ora dopo il trattamento luteolitico (13. giorno), i prelievi di sangue sono stati effettuati ogni 3 ore. Mettendo in relazione i risultati relativi alla risposta ovarica con le indicazioni desumibili dal profilo ormonale, è stato evidenziato che: (a) le donatrici con un profilo ormonale considerabile 'normale' hanno fornito una sufficiente risposta ovarica alla stimolazione superovulatoria (b) lo squilibrio tra i tempi di increzione dei vari ormoni e la deviazione dal profilo ritenuto 'fisiologico' comportano, inevitabilmente, una risposta insoddisfacente (c) relativamente alla progesteronemia, contrariamente a quanto osservato per gli altri ormoni esaminati, in termini di risposta al trattamento superovulatorio, non sarebbe tanto importante che l'ormone raggiunga un livello ematico elevato, quanto che rispetti un andamento il piú possibile sovrapponibile a quello 'fisiologico' (d) in alcuni casi, la non perfetta sincronia fra il picco dell'LH e quello dell'estadiolo e/o il picco dell'LH eccessivamente basso sarebbero da ritenere la causa della compromissione dell'efficienza di raccolta degli embrioni, sebbene sia stata registrata un'adeguata reazione allo stimolo superovulatorio (e) la variabilità di risposta delle donatrici al trattamento di superovulazione risulta notevolmente elevata, sia entro che fra i cicli (f) il livello ematico del progesterone sarebbe correlato negativamente a quello dell'estradiolo e dell'LH, mentre esisterebbe una relazione positiva tra estradiolo e LH. Sulla base dei risultati ottenuti, non si è avuta conferma di alcune relazioni individuate da altri Autori nei bovini da latte e, in particolare, di quella tra tasso ematico di progesterone e numero di corpi lutei e di embrioni rispettivamente osservati e raccolti nel giorno del flushing.