A series of 25 patients with aggressive meningeal tumors was studied to determine the efficacy of various management options. The median age of the patients was 52 years, with a range of 13 to 73 years. A marked male preponderance (64%) was noted. Twenty of 25 patients experienced recurrence during a median follow-up time of 47 months. Survival and freedom from recurrence varied with histological diagnosis. Recurrence was noted sooner in patients who had received partial resections on first presentation of tumor than in those who had received total resections at first presentation. Survival time was also shorter for patients who underwent partial resections at first presentation than for patients who underwent total resections. Patients' prognoses did not improve as a result of either chemotherapy or radiotherapy. Of six patients with extracranial metastases, the median time to metastasis was 102 months, with a 5-year metastasis-free rate of 85%. The most common sites of metastasis in these six patients were lung and bone. In each tumor type, histological features used in diagnosis and radiological features studied from computerized tomography and magnetic resonance imaging were evaluated, compared, and discussed. Of eight patients studied with an in vivo bromodeoxyuridine (BUdR) labeling index (LI), seven showed an LI of 1% or more. The authors support the incorporation of the BUdR LI into the diagnostic process to provide a better estimate of the potential for tumor recurrence.
Background: Pulmonary vein isolation (PVI) has been shown to suppress atrial fibrillation (AF). We examined the effects of PVI on disorganization and dominant frequencies (DF) in patients with permanent AF. Methods and results: Twenty‐eight patients with permanent AF (>6 months) who failed ≥1 antiarrhythmic drugs (AAD) and ≥2 cardioversions (CV) with AF reversion <30 minutes after CV were included. PVI and isolation of DFs in pulmonary veins (PVs) was performed during AF. Fast Fourier transformations of atrial electrograms were performed. Disorganization index (DI) was defined as the percentage of time spent in type III AF during 1‐minute continuous recordings. The temporal stability and reproducibility of DIs from the same sites were verified over time prior to ablation. Highly disorganized AF activity concentrated in the posterior left atrium (PLA) including sites at the left atrial (PV‐LA) junction (55.7% of sites in PLA, 32.9% in septum, and 11.4% in other sites). DF and DI from the coronary sinus (CS) before and after PVI were analyzed. PVI reduced the DI (14.3 ± 25.0% before PVI vs 4.6 ± 8.6% after PVI; P < 0.02). There was significant reduction of DI in 26 of 28 patients. The DF remained unchanged (5.6 ± 1.3 Hz before PVI vs 5.9 ± 0.9 Hz after PVI; P = 0.31). After a follow‐up of 30 ± 11 months, 15 (54%) of patients are free of symptomatic AF, 3 (10%) in sinus rhythm on AAD, 5 (18%) with paroxysmal AF, 4 (14%) in chronic AF, and 1 (4%) with atypical flutter. Conclusions: In the vast majority of patients with chronic AF, PVI reduces AF disorganization without affecting the DF as measured in the CS.
Right atrial reentrant tachycardia resulting from lower loop reentry (LLR) around the inferior vena cava (IVC) has been described recently. However, all reported cases of LLR in the literature have negative flutter waves on the inferior surface ECG leads similar to that of counterclockwise typical atrial flutter around the tricuspid annulus (TA). Right atrial flutter with positive flutter waves in the inferior ECG leads has been assumed to rotate as a single reentrant activation wave front around the TA, and the role of LLR in those patients is not known.Twelve consecutive patients with flutter wave morphology on surface ECG consistent with clockwise atrial flutter were studied. The endocardial activation pattern recorded from conventional multipolar electrode catheters was characteristic of clockwise atrial flutter around the TA. Entrainment pacing in all 12 patients and 3D activation sequence mapping in 7 patients, however, revealed clockwise LLR involving the lower right atrium around the IVC in 7 patients, figure-of-8 double-loop reentry around both the IVC and TA in 4, and single reentrant loop around the TA in 1. Linear radiofrequency ablation in the isthmus between the TA and IVC (TI isthmus) terminated the tachycardia in all patients.Surface ECG flutter wave morphology and limited recording intracardiac sites proved insufficient to delineate the precise mechanism of the TI isthmus-dependent clockwise right atrial flutters. Most right atrial flutters with positive flutter wave on surface ECG may be supported by a reentrant circuit around the IVC or a figure-of-8 double-loop reentry involving both the IVC and TA.
A 70-year-old woman, told that her pacemaker lead was lying over her aorta, presented for a second opinion. Four years earlier, after a syncopal spell, she had undergone dual-chamber pacemaker placement. Transthoracic echocardiograms revealed that her ventricular pacemaker lead was in her left ventricle (LV). To determine the course of the ventricular lead, transesophageal echocardiography and computed tomographic angiography of the chest were performed (Fig. 1). The lead originated in the subclavian vein but then entered the left common carotid artery, approximately 3.3 cm from its ostium. The lead then coursed through the transverse aortic arch, proximal ascending aorta, and aortic valve, terminating in the distal lateral wall of the LV. The right atrial lead followed the usual venous course into the right atrium. After hearing the risks and benefits of surgically removing the lead from the left common carotid artery, the patient chose lifelong anticoagulation for stroke prophylaxis.Malposition of a ventricular lead in the LV occurs infrequently,1,2 and its prevalence has not been reported. Although the lead in our patient traversed the aortic valve, inadvertent crossing of the interatrial septum has been reported more often.3 Potential complications of lead malposition in the LV include systemic thromboembolism, perforation of the aortic or mitral valve leaflets, arterial thrombosis, and loss of capture.4 If malposition is diagnosed immediately after pacemaker implantation, lead removal may be considered.5 Otherwise, the lead should be left in place and lifelong anticoagulation prescribed to reduce the risk of systemic embolization.4
A 42-year-old woman with recurrent neurocardiogenic syncope underwent implantation of a dual-chamber pacemaker with active fixation leads; there were no apparent complications. Three weeks later, she reported having sharp pain in the left anterior chest wall. A chest radiograph and echocardiogram taken at that time revealed satisfactory lead placement and no evidence of pericardial effusion. Three months after implantation, the patient began to experience diaphragmatic pacing. Evaluation of the pacemaker revealed an absence of ventricular capture or sensing. Another chest radiograph revealed that the ventricular lead tip had changed position (Fig. 1). A computed tomographic scan showed the tip of the right ventricular pacemaker lead in the anterior aspect of the lower lobe of the left lung (Fig. 2). There was no pneumothorax or pericardial effusion, although focal thickening was noted where the lead traversed the pericardium. Repair was performed with the patient under general anesthesia and with use of transesophageal echocardiographic guidance. The helix at the end of the pacemaker lead was retracted, and the right ventricular lead was removed. A replacement lead was placed in the right ventricular apex without complications. A follow-up chest radiograph revealed a small left apical and a lateral pneumothorax, which later resolved. A follow-up echocardiogram showed no evidence of pericardial effusion.
Fig. 1 A chest radiograph shows 2 pacemaker leads. One lead terminates as expected in the right atrium, while the 2nd lead projects beyond the right ventricular wall.
Fig. 2 Multiplanar reconstruction of a chest computed tomographic scan in an oblique axial projection shows the distal pacemaker lead passing through the anteroinferior aspect of the right ventricular wall, with the tip in the anterior aspect of the lower ...
Abstract NOTE: The first page of text has been automatically extracted and included below in lieu of an abstract Civil Engineering Education at the University of Florida and the Middle East Technical University, Turkey Abstract Civil engineering is a discipline that amalgamates art and science to create and refine infrastruc- ture work, provides solutions according to the needs of modern civilization, and protects the environment. The dynamics of the current global marketplace suggests that civil engineers are among the best-positioned professionals to be able to utilize the cutting edge technology. Civil engineers find numerous opportunities in industry, be it through consulting practices, research or development. However, for civil engineering to maintain its importance in a global business setting, it is imperative that institutions’ curricula be regularly revised to meet the world’s perpetual evolving social and environmental needs. Both the civil engineering programs leading to a bachelor’s of science degree are four-year programs. The College of Engineering at the University of Florida has 11 academic departments, while the College of Engineering at the Middle East Technical University has 14. Civil engineering is one of the departments in the College of Engineering at both universities. However, the required credits required between the programs are quite varied. The curriculum leading to the Bachelor of Science in Civil Engineering degree at the University of Florida consists of 131 credits, while that of the Middle East Technical University consists of a minimum of 152 credits. The University of Florida allows for 52 general education credits while the Middle East Technical University provides for 39. In terms of core engineering credits, the University of Florida requires 79 engineering-based credits, while the Middle East Technical University requires 85. This paper compares and analyzes the current civil engineering undergraduate curriculum at the Middle East Technical University with that of the University of Florida’s. The results of this study indicate that both curricula meet the educational requirements of both the United States and that of the Republic of Turkey. Introduction The Middle East Technical University (METU) is located in Ankara, the capital city of Turkey. METU was founded in 1956 under the name of Middle East High Technology Institute to help contribute to the development of Turkey and Middle East countries by graduating skilled workforces in the fields of natural and social sciences. There are currently 47 undergraduate programs divided into five faculties, namely the Faculty of Architecture, Faculty of Engineering, Faculty of Economic and Administrative Sciences, Faculty of Arts and Sciences, and the Faculty of Education. There are 152 graduate programs in graduate schools of natural sciences, social sciences, informatics, applied mathematics and marine sciences. The official language utilized by instructors at METU is English. The civil engineering undergraduate program at METU was founded between 1957 and 1958 during the establishment of the Faculty of Engineering.
In patients with ST-segment elevation myocardial infarction, visualization of a large thrombus burden in the culprit artery may portend a suboptimal outcome. On the other hand, visualization of coronary collaterals to the culprit territory is thought to be reassuring: a source of additional arterial blood to myocardium affected by infarction. The article by Vural et al unexpectedly correlates these 2 angiographic findings.1 They found a high thrombus burden in 92.7% of patients with well-developed coronary collateral circulation and only 68.7% of patients with insufficient coronary collateral circulation. As the authors correctly point out, their findings suggest that interventional cardiologists should consider using well-developed coronary collaterals as a clue to the presence of a greater-than-expected thrombus burden; they will then be prepared to provide pharmacologic or mechanical bail-out procedures with wire crossing. Although limited by the small sample size and the subjective nature of its angiographic analysis, this paper is a thought-provoking platform for further study on the relationship between coronary collaterals and thrombus burden.
Left atrial pressure indicates the left ventricular filling pressure in patients who have systolic or diastolic left ventricular dysfunction or valvular heart disease. The use of indirect surrogate methods to determine left atrial pressure has been essential in the modern evaluation and treatment of cardiovascular disease because of the difficulty and inherent risks associated with direct methods (typically the transseptal approach). One method that has been widely used to determine left atrial pressure indirectly is Swan-Ganz catheterization, in which a balloon-flotation technique is applied to measure pulmonary capillary wedge pressure; however, this approach has been associated with several limitations and potential risks. Measuring left ventricular end-diastolic pressure has also been widely used as a simple means to estimate filling pressures but remains a surrogate for the gold standard of directly measuring left atrial pressure. We describe a simple, low-risk method to directly measure left atrial pressure that involves the use of standard coronary catheterization techniques during a transradial procedure.
