Search

Purpose: Our purpose was to evaluate the prognostic value of Vesical Imaging Reporting and Data System (VI-RADS) in bladder cancer (BCa) staging and predicting recurrence or progression., Methods: We retrospectively analyzed the prospectively collected data from 96 patients with bladder tumors who underwent VI-RADS-based multiparametric magnetic resonance imaging (mpMRI) before endourological treatment from April 2021 to December 2022. Diagnostic performance was evaluated by comparing mpMRI reports with final pathology, using logistic regression for muscle-invasive bladder cancer (MIBC) predictors. Follow-up until May 2023 included Kaplan-Meier and Cox regression analysis to assess VI-RADS predictive roles for recurrence-free survival (RFS) and progression-free survival (PFS)., Results: A total of 96 patients (19.8% women, 80.2% men; median age 68.0 years) were included, with 71% having primary tumors and 29% recurrent BCa. Multiparametric MRI exhibited high sensitivity (92%) and specificity (79%) in predicting MIBC, showing no significant differences between primary and recurrent cancers (AUC: 0.96 vs. 0.92, P = .565). VI-RADS emerged as a key predictor for MIBC in both univariate (OR: 40.3, P < .001) and multivariate (OR: 54.6, P < .001) analyses. Primary tumors with VI-RADS ≥ 3 demonstrated significantly shorter RFS (P = .02) and PFS (P = .04)., Conclusions: In conclusion, mpMRI with VI-RADS has a high diagnostic value in predicting MIBC in both primary and recurrent BCa. A VI-RADS threshold ≥ 3 is a strong predictor for MIBC, and in primary tumors predicts early recurrence and progression., (© 2024. The Author(s).)

Background: Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to evaluate the efficacy, safety, and feasibility of slow-pathway RFCA for AVNRT using a zero-fluoroscopy approach., Methods: Data were obtained from a prospective multicenter registry of catheter ablation from January 2012 to February 2018. Consecutive unselected patients with the final diagnosis of AVNRT were recruited. Electrophysiological and 3-dimensional (3D) electroanatomical mapping systems were used to create 3D maps and to navigate only 2 catheters from the femoral access. Acute procedural efficacy was evaluated using the isoproterenol and/or atropine test, with 15-min observation after ablation. Each case of recurrence or complication was consulted at an outpatient clinic during long-term follow-up., Results: Of the 1032 procedures, 1007 (97.5%) were completed without fluoroscopy. Conversion to fluoroscopy was required in 25 patients (2.5%), mainly due to an atypical location of the coronary sinus (n = 7) and catheter instability (n = 7). The mean radiation exposure time was 1.95 ± 1.3 min for these cases. The mean fluoroscopy time for the entire study cohort was 0.05 ± 0.4 min. The mean total procedure time was 44.8 ± 18.6 min. There were no significant in-hospital complications. The total success rate was 96.1% (n = 992), and the recurrence rate was 3.9% (n = 40)., Conclusion: Slow-pathway RFCA can be safely performed without fluoroscopy, with a minimal risk of complications and a high success rate., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ± 13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ± 16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ± 24.6 vs 49.1 ± 23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.

Background: Patients with pre-excitation without arrhythmic symptoms are diagnosed as Wolff-Parkinson-White (WPW) pattern., Aim: To evaluate the efficacy of radiofrequency ablation (RFA) in patients with a WPW pattern and reported dyspnoea., Methods: Five patients (four adults and one adolescent, all female, age 33 ± 15 years) with a WPW pattern were referred due to dyspnoea and exercise intolerance. None had a history of paroxysmal syncope, pre-syncope, dizziness or palpitation. Before and after RFA, additional tests were used to exclude organic diseases of the pulmonary vessels, heart and lung, as well as bronchial hyperreactivity and metabolic diseases. Cardiopulmonary exercise test (CPET), echocardiography, time of forced expiration, baseline dyspnoea index (BDI), and transition dyspnoea index (TDI) were included into an objective evaluation of breath pattern., Results: In all investigated patients, no arrhythmia was inducible during the electrophysiology study. The time of forced expiration increased immediately after RFA from 15.8 ± 2.9 to 29.2 ± 4.4 s (p < 0.001). The BDI score before RFA was 6.7 ± 1.9 and the TDI score after RFA showed a significant improvement: 8.0 ± 1.2 (p < 0.05). CPET revealed significant improvement in cardiopulmonary capacity after RFA in all cases: peak oxygen consumption [mL/kg/min]: 31.1 ± 7 vs. 42.6 ± 9.6 (p = 0.014); peak exercise minute ventilation [L/min]: 60.0 ± 19.9 vs. 82.0 ± 27 (p = 0.006); peak exercise tidal volume [L]: 1.56 ± 0.25 vs. 2.04 ± 0.24 (p = 0.002); ratio dead space/tidal volume at the end of exercise: 28 ± 2.6 vs. 25 ± 2.3 (p = 0.005)., Conclusions: Dyspnoea during sinus rhythm in women with pre-excitation may be considered to be an evaluation criterion before RFA.

We describe a case of severe left ventricular (LV) heart failure caused by tachycardiomyopathy with concomitant presence of unsolved thrombus in left atrial appendage despite effective oral anticoagulant treatment. Successful ablation of atrial flutter and atrioventricular nodal reentry tachycardia entailed resolution of heart failure symptoms and normalisation of LV function.

Coronary artery fistulas are infrequent congenital malformations. We present the case of a patient with acute coronary syndrome and fistula between the proximal left anterior descending artery (LAD) and the pulmonary artery. The fistula was diagnosed during coronary angiography. Its presence and morphology was confirmed by a 64-slice computer tomography scan. The patient underwent a successful coronary artery bypass grafting procedure with surgical closure of the fistula.

Coronary fistula is a rare congenital heart disease. Usually it is diagnosed because of mild clinical event and sometimes detected by coronary angiography performed during acute phase of myocardial infarction. When the coronary fistula have an aneurysmatic form, it should be closed due to the risk of rupture and sudden death, especially when volumetric and pressure overload or coronary steal syndrome are present. The closure may be performed invasively or non-invasively; the latter method is prefered in asymptomatic patients.

We describe a case of a 67-year-old woman with incessant idiopathic ventricular tachycardia and tachycardia-induced cardiomyopathy who underwent a successful RF ablation of the arrhythmic focus located in the aorto-mitral continuity. The optimal approach and titration of RF energy was achieved by means of the intracardiac echocardiography. The regression of signs of heart failure has been also observed.

Few systematic trials have studied metastatic tumors to the heart and there are currently no guidelines for the treatment of heart metastases and its associated symptoms. This article presents the first known case of effective pharmacological treatment of heart failure due to metastases of renal cell carcinoma (RCC). Due to pressure caused by metastatic tissue on the left atrium and the decreased blood inflow to the left ventricle, the 61-year-old male patient suffered from dyspnea. Treatment with sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor, was initiated and led to a decrease in the mass of the metastasis infiltrating the left atrium. Arterial hypertension caused by sunitinib therapy was effectively controlled by the use of an angiotensin-converting-enzyme inhibitor. Therapy with sunitinib reduced the symptoms of exercise intolerance; the patient felt much better and was able to return to his family and resume professional activity. Further studies are required to confirm the utility of sunitinib therapy in patients with symptoms of heart failure due to heart metastases from RCC., (Copyright 2009 S. Karger AG, Basel.)

Unlabelled: At present also radionuclide methods are used to diagnose pulmonary malignancies. One of them is solitary pulmonary nodule (SPN) scintigraphy using 99mTc-depreotide. 99mTc-depreotide is a somatostatin analogue with affinity to 3 out of 5 subtypes of somatostatin receptors., Aim of the Study: was to confirmed the usefulness of 99mTc-depreotide in detecting malignancy in SPN; finding lymph nodes metastases; and overlapping scintigraphic scans and CT in precise localizsation of malignancy and its lymph nodes metastases., Material and Methods: The group studied comprised 50 patients with radiologically diagnosed SPN. Forty patients had a high resolution CT scan done with a GE Light Speed equipment-device. The acquired CT scans were sent via LAN (Local Area Network) to an ARPACS server in the Department of Nuclear Medicine, and thence to a Hermes Nuclear Diagnostics workstation. CT examinations were followed by scintigraphy with 99mTc-depreotide., Results: In 32 patients 99mTc-depreotide was found to have accumulated excessively in SPN: in 23 cases malignancy was found, in the 9 remaining cases they were other abnormalities. In the 23 lung cancer patients, 99mTc-depreotide was found in 24 foci, including 18 in the mediastinum and axillary region. CT revealed affected lymph nodes only in 7 cases. The calculated sensitivity, specificity and accuracy in SPN were 89%, 60%, 82%, respectively. The tumour/background index in malignancies confirmed histologically was 2.58 +/- 0.89. Where lymph nodes metastases were suspected in the diagnosed malignancies, the lymph node/background index was 2.60 +/- 0.85. In 25 cases lesion localization was more accurate when scans were overlapped., Conclusions: 99mTc-depreotide based examination is a sensitive method in the evaluation of SPN malignancy. Overlapping SPECT and CT scans in diagnosing SPN enables both pathological and physiological changes to be localized precisely. This method seems particularly valuable in imaging lymph nodes where metastases are suspected, especially when CT scans revealed no abnormalities.

We present a case of a 19-year-old patient with incessant arrhythmias originating from the right upper pulmonary vein (RUPV) presenting as frequent premature beats, automatic rhythms mimicking sinus rhythm (SR) and pulmonary vein tachycardias. Morphology of P' wave resembled sinus P wave due to relatively short distance of the ectopic focus from the sinus node. Occasionally, when discharges from the focus were relatively slow (800-500 ms) and regular it was mimicking sinus rhythm. Activation preceding P' wave during arrhythmia was recorded in RUPV as well as in superior vena cava. In this paper we discuss our approach that allowed localising the arrhythmogenic focus in the RUPV. After isolation of the RUPV sinus rhythm was restored with tachycardia at a cycle length of 320 ms continuing in the isolated vein.

The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis.

We describe a case of a 34-year-old woman with atrial fibrillation induced by focal frequent tachycardias from superior vena cava and atypical atrioventricular nodal reentrant tachycardia. Selective isolation of SVC and slow pathway RF ablation cured all types of atrial arrhythmias. The slow pathway was localised in the postero-septal mitral anulus and ablated from the left atrium.

Introduction: Targeted treatment of atrial fibrillation (AF) involves circumferential isolation of all pulmonary veins (PV) or isolation of electrical connections within their ostia. Only in some cases are the real localisation and number of triggering foci, the anatomy of venous ostia as well as the form of AF (paroxysmal, persistent, chronic, primary or secondary) taken into consideration., Aim: To compare the results of selective electrical isolation (1-3 PV ostia or ablation of a single focus in other veins or atrium) versus isolation of all pulmonary veins., Methods: RF ablation was performed in eighty patients (51 men, 29 women) with symptomatic, drug-refractory AF. Fifty-nine patients had paroxysmal AF (PAF), 16 persistent (AFpers), and 5 chronic AF (AFchro). Selective ablation was carried out in those patients who had detectable AF triggers during sinus rhythm -- supraventricular extrasystolic beats (SVEB) of 1 to 3 morphologies (group I). Extended ablation -- isolation of all 4-5 PV -- was performed in patients with multiple SVEB morphologies and heterogeneous electrical connections within all PV (group II). Group I consisted of 60 patients (22 females) aged 46+/-14 years, whereas group II comprised 20 patients (7 females) aged 52+/-13 years. In 24 patients (18 from group I and 6 from group II) with concomitant typical atrial flutter, an ablation line in the cavo-tricuspid isthmus was also performed. Long-term results were assessed 17+/-15.6 (4-105) months after the procedure based on routine ECG, ambulatory 24-hour ECG monitoring, clinical evaluation and regular phone calls. In patients with PAF, left atrial diameter <4.2 cm and evidence of successful ablation, antiarrhythmic agents were withheld. In patients with AFpers and AFchro, antiarrhythmic drugs were discontinued 3 to 6 months after successful ablation., Results: Complete procedural success was achieved in 61 (76%) patients, and significant clinical improvement was observed in another 9 (11%) patients. Effective ablation significantly improved quality of life. In group I the procedure was entirely successful or a marked improvement was reported (single, transient palpitation episodes and/or atrial tachyarrhythmias lasting up to 30 seconds) in 54 (90%) patients. Among 48 (80%) patients with complete success, 25 (42%) did not receive any antiarrhythmic drugs during follow-up, 12 (20%) with arterial hypertension received beta-blockers, and 11 (18%) continued beta-blocker + class I antiarrhythmic drug. In another 6 (10%) patients a significant clinical improvement in arrhythmia control was observed. In Group II the procedure was fully effective or a significant improvement was observed in 16 (80%) patients. Among 13 (65%) patients with complete success, 5 (25%) did not require any antiarrhythmic drugs, 4 (20%) who had hypertension continued beta-blockers, and another 4 (20%) continued beta-blocker + I class antiarrhythmic drug. A significant clinical improvement of arrhythmia control was observed in another 3 (15%) patients., Conclusions: In patients with a limited number of triggering foci and limited AF substrate, selective ablation effectively eliminates AF with a low risk of complications. Detailed electrophysiological assessment (standard ECG, 12-lead Holter ECG monitoring and endocardial mapping) allows precise identification of this group of patients. In patients with chronic and persistent AF benefits occur with some delay which is associated with a delayed reversal of atrial remodelling.

Background: The MSCT calcium scoring allows to identify patients with increased coronary event risk or at early stages of coronary artery disease (CAD)., Aim: The aim of the study was to find the correlation of calcium score with various clinical features and degree of coronary stenosis., Methods: 40 consecutive patients (10 women) with angiographically proven coronary artery disease were assessed for coronary calcium score by means of MSCT not later than 48 hours after the angiography. The acquisition parameters were as follows: 3.2 mm slice thickness, 1.6 mm increment, pitch 1.25, 120 kV, 200 mAs, rotation time of 500 ms, supine patients during single breath-hold. The calcium score was semiautomatically calculated taking into account the size and density higher than 130 Hounsfield units. The clinical features such as the presence of hypertension, diabetes, dyslipidaemia, obesity (body mass index), smoking, CCS angina score, previous myocardial infarction, CAD duration, degree of stenosis and diffused disease were also analysed by means of Spearman's test., Results: The calcium score in the left anterior descending artery (LAD) 271 + 598 showed good correlation with the degree of stenosis in the LAD 69 +/- 37 (r = 0.591, p<0.0001) and angina score (median 2, p<0.001). It was also correlated as well as calcium score in the LMA 55 +/- 147 with the CAD duration of 9 +/- 9 years and diabetes (p<0.01). The CS in the RCA 102 +/- 362 was associated with the diabetes, dyslipidaemia and obesity with the p<0.03. The score in the LCX 282 +/- 797 was correlated with the degree of stenosis in every artery (p<0.001 for the LCX = 56 +/- 39). The total calcium score 675 +/- 1462 was associated with the angina score, CAD duration (p<0.001), diffused disease and the stenosis in the LAD and LCX (p<0.0001)., Conclusion: The total and the LAD coronary calcium score may be associated with the severity of symptoms, degree of stenosis in the LAD and disease extent. The calcium deposits in the RCA may be more frequent in patients with metabolic disorders.

On the basis of case of 78 years old female patient being on chronic hemodialysis we present the usefulness of spiral computed tomography in the diagnosis of pseudoaneurysm complicating arterio-venous fistula for hemodialysis as well as usefulness of endovascular stent for closing such pseudoaneurysm.

Unlabelled: The aim of the study was to compare the utility of multidetector computed tomography (MDCT) in assessment of arterio-venous fistula (AVF) for hemodialysis (HD) in comparison with the "golden standard" which is digital subtraction angiography (DSA)., Material and Methods: The group consisted of 14 pts (9 males and 5 females, mean age 56.8 years +/- 14.3) on HD for 5 to 104 months, clinically suspected for failure of AVF. In all 14 subjects we performed MDCT and DSA of the arterio-venous fistula (AVF). MDCT exams were conducted on a 16 slice LightSpeed16 GE scanner, and on a Marconi Dual MX 8000. We assessed AVF from subclavian artery to the right atrium of the heart. DSA examinations were performed on GE Advantx LCA by Seldinger method. MDCT images were analysed on GE Advantage Workstation 4.1 with different reconstruction techniques: MPR (multiplanar reformation), MIP (maximum intensity projection), VE (virtual endoscopy), VR (volume rendering) and advanced vessel analysis for quantitative assessment of the vasculature., Results: MDCT showed 31 pathologies of AVF in 13 patients. Only one patient did not have any significant abnormalities. DSA was normal in 5 pts and demonstrated 14 pathologies in further 9 patients. MDCTproved to be more useful than DSA in diagnosis of the following abnormalities: thrombosis, intramural calcifications and thickness of AVF wall (respectively MDCT/DSA--8/1; 2/1; 6/0)., Conclusion: In summary, MDCT is more useful diagnostic method than DSA in assessment of AVF morphology. Its high sensitivity and specificity makes this method especially useful in assessment of complicated AVF.

On the basis of two cases of haemodialysed patients we present the usefulness of spiral computed tomography in the diagnosis of pseudoaneurysm as a complication of arteriovenous fistula for haemodialysis.

This review is devoted to imaging techniques of kidney and renal vasculature including evaluation of renal artery stenosis, parenchymal renal diseases, living-related renal donor candidates and preoperative evaluation of abnormal renal masses for nephron sparing surgery. Special interest is paid to the advantages of spiral CT in naphrology and transplantology.

Failure of arteriovenous fistula (AVFf) still remains the "Achilles'heel" of chronic haemodialysis (HD) programme. Therefore, early, potentially non-invasive diagnosis and prompt surgical correction of AVFf are needed. For these purposes spiral computed tomographic angiography (SCTA) was used for evaluation of clinically suspected AVFf in 19 patients (10M/9F, aged 58.6 +/- 14.6 years, on HD for 34.4 +/- 29.3 months). SCTA was performed using Marconi MX8000 scanner covering whole AVF. After intravenous administration to the peripheral vein of the other leg of 100 ml of non-ionic lomeron 350 contrast (3 ml/s), axial CT images were obtained helically covering whole surface of AVF. Time delay was measured by Trigger function. Maximum Intensity Projections (MIP), 4D-Angio and virtual endoscopy (VE) techniques were used for reconstruction. MIP images demonstrated contrast-enhanced vascular structures and other high-density tissues (calcifications). VE enabled non-invasive simulation of endoscopic procedures and interactive intravascular navigation. Total number of 24 SCTA were performed. We found normal patency of AVF in 5 patients. In the remaining 14 subjects, the following abnormalities were found: stenosis of AVF at the site of anastomosis or in distal segment of efferent vein in 6 SCTA examinations, dilatation in 7 SCTA, acute or chronic thrombosis of AVF in 9 SCTA procedures including total occlusion of AVF in 2 cases. In 2 cases pseudoaneurysms of AVF were found. In 7 SCTA examinations more than one reason of AVFf was found. Photographs of every AVF complication are presented. We noted only one complication of SCTA-rupture of venous vessel on the opposite arm during contrast injection. There were no hypersensitivity reactions to the contrast.

Fourteen different plasmids hybridizing to Aspergillus nidulans 5S rRNA were isolated from a gene bank obtained after cloning Sau3A partial digests of A. nidulans DNA in a yeast--Escherichia coli vector, pBB29. The restriction maps of these plasmids were determined. The size of the cloned fragments was 2.7-9.5 kb, 12 of the plasmids were found to code for single 5S rRNA genes and 2 coded for 2 genes. No similarity of the sequences surrounding the 5S rRNA genes was found by restriction mapping.

Several different 5S rRNA genes from Aspergillus nidulans cloned in an Escherichia coli--Saccharomyces cerevisiae shuttle vector were introduced into S. cerevisiae cells by transformation. The A. nidulans 5S rRNA genes were not transcribed in S. cerevisiae.