Atrial flutter: management

ESC CardioMed ◽  
2018 ◽  
pp. 2211-2217
Author(s):  
Tilman Maurer ◽  
Christine Lemes ◽  
Karl-Heinz Kuck
Keyword(s):  
Atrial Flutter ◽  
Structural Heart Disease ◽  
Term Treatment ◽  
Non Invasive ◽  
Surface Ecg ◽  
Long Term Treatment ◽  
The Common ◽  
The Right ◽  
Electrocardiogram Ecg

Atrial flutter (AFL) is the most common macroreentry tachycardia in patients with and without structural heart disease. In the majority of cases, the arrhythmia is associated with a pre-existing comorbidity such as heart failure or lung disease. AFL refers to an electrocardiogram (ECG) pattern of a regular tachycardia with an atrial rate of more than 240 beats per minute and a lack of an isoelectric baseline between deflections. The most frequent form is termed ‘common’ or ‘typical’ if biphasic waves are present in the inferior leads, resembling a ‘saw-tooth’ pattern. Common AFL is diagnosed in 90% of cases and its mechanism is a macroreentry within the right atrium involving the cavotricuspid isthmus. ‘Atypical’ AFL refers to any ECG flutter morphology different from the common type. While the surface ECG provides a widely available and non-invasive diagnostic tool, a definite diagnosis of the underlying tachycardia mechanism can only be established by invasive electrophysiological testing. Acute management of AFL includes measures for rate control by pharmacological treatment or rhythm control by antiarrhythmic drugs or electrical cardioversion. For long-term treatment, catheter ablation offers a safe, effective, and curative approach for common flutter and is also a treatment option for atypical AFL. Anticoagulation should be initiated according to risk stratification based on the CHA2DS2-VASc score to prevent thromboembolic complications. This chapter provides a detailed overview on the pathophysiology and electrocardiographic characteristics of AFL and discusses the clinical management of the arrhythmia.

scholarly journals A rare case of bilateral obstructive megaureter with a giant uretal ureterocele on the left

2020 ◽  
Vol 24 (3) ◽  
pp. 205-209
Author(s):  
G. N. Rumyantseva ◽  
V. N. Kartashev ◽  
Marina V. Dolinina ◽  
I. B. Osipov ◽  
A. I. Osipov ◽  
...  
Keyword(s):  
Left Kidney ◽  
Boarding School ◽  
Term Treatment ◽  
Ectopic Ureterocele ◽  
Surgical Department ◽  
Long Term Treatment ◽  
Obstructive Megaureter ◽  
The Right ◽  
Medical University

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

scholarly journals Extensive skull base osteomyelitis, devastating complication of otitis externa: A case report and review of the literature

2021 ◽  
Vol 2 (3) ◽  
pp. 1-7
Author(s):  
Khadija El Bouhmadi ◽  
◽  
Myriam Loudghiri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Skull Base ◽  
Otitis Externa ◽  
Delayed Diagnosis ◽  
Petrous Bone ◽  
Term Treatment ◽  
Skull Base Osteomyelitis ◽  
Long Term Treatment ◽  
Orbital Wall ◽  
The Right

Skull base osteomyelitis (SBO), also referred to as malignant otitis externa (MOE) in its typical form, is usually a complication of otitis externa and severe uncommon and life-threatening condition requiring early diagnosis and long-term treatment in order to avoid its neurologic sequelae. We report the case of 69 years old female with a history of uncontrolled type 2 diabetes, who presented refractory and chronic right-sided purulent otorrhea with temporal headaches for 6 months, treated with no improvement by multiple attempts of ambulatory empiric therapy. After the appearance of grade III facial palsy and painful swelling in the right periorbital and zygomatic areas, the patient consulted in our department where a CT scan showed massive cortical and trabecular destruction of the right petrous bone and the mastoid extended to the lateral orbital wall, the zygomatic arch and the greater sphenoid wing realising extensive osteomyelitis of the skull base and the lateral face. The treatment was started immediately based on intravenous broad-spectrum antibiotics. Despite aggressive long-term treatment, the patient passed away, underlying the increased SBO morbidity and mortality secondary to delayed diagnosis.

The Common Side Effects of Long Term Treatment with Clozapine and Their Impact: a Sri Lankan Experience

2015 ◽  
Vol 30 ◽  
pp. 1586
Author(s):  
S.W. Kotalawala ◽  
K.P.M. Dalpatadu ◽  
C.U. Suraweera ◽  
K.G.C.L. Kapugama ◽  
H.G.V.W. Wijesiri ◽  
...  
Keyword(s):  
Side Effects ◽  
Term Treatment ◽  
Sri Lankan ◽  
Long Term Treatment ◽  
The Common

Long-term clinical use of mirabegron in patients with overactive bladder syndrome

2020 ◽  
Vol 13 (4) ◽  
pp. 460-464
Author(s):  
Tomasz Wiatr ◽  
Piotr Chłosta
Keyword(s):  
Overactive Bladder ◽  
Term Treatment ◽  
Overactive Bladder Syndrome ◽  
Invasive Treatment ◽  
Treatment Development ◽  
Non Invasive ◽  
Antimuscarinic Drugs ◽  
Adrenoceptor Agonist ◽  
Long Term Treatment

Overactive bladder syndrome (OAB) is defined by the International Continence Society (ICS) as urinary urgency with increased daytime frequency and nocturia in the absence of proven infection or any other pathology, usually with or without urgency incontinence. Pharmacotherapy with antimuscarinic drugs is highly effective, but more than 60% of patients discontinue the treatment. Development of mirabegron, a β3-adrenoceptor agonist (β3-AR), has become an expected pharmacotherapy option for the non-invasive treatment of overactive bladder. The available studies show that long-term treatment with 50 mg mirabegron in patients with OAB is associated with reducing the severity of symptoms. Data from clinical trials show that mirabegron provides efficacy similar to antimuscarinic drugs, but with a better tolerance profile.

Aluminium Bone Deposits in Normal Renal Function Patients after Long-Term Treatment by Plasma Exchange

1989 ◽  
Vol 12 (10) ◽  
pp. 664-667 ◽  
Author(s):  
C. Mousson ◽  
S.A. Charhon ◽  
M. Ammar ◽  
M. Accominotti ◽  
G. Rifle
Keyword(s):  
Renal Function ◽  
Bone Formation ◽  
Plasma Exchange ◽  
Normal Renal Function ◽  
Bone Biopsy ◽  
Term Treatment ◽  
Normal Range ◽  
Non Invasive ◽  
Long Term Treatment

The accumulation of aluminium (AI) can cause AI bone deposits, osteomalacia and encephalopathy. As albumin solutions used as replacement fluid in plasma exchange (PE) are contaminated with AI, we studied AI overload in two symptomless patients with normal renal function, treated by long-term plasma exchange (PE). Total AI loading was calculated at 1750 μmol in patient 1 (178 PE sessions) and 2100 μmol in patient 2 (153 PE sessions). Bone biopsy showed AI deposits and low bone formation without osteomalacia in patient 1 and only osteoporosis in patient 2. Plasma AI levels were useless in detecting early AI overload, because the remained in the normal range, even after PE in both patients. Bone biopsy was the best means of recognizing AI intoxication, but cannot be recommended for frequent evaluations. However, the desferrioxamine mobilization test can be proposed as a repetitive non-invasive investigation method.

Fulgazepam: A Fulgimide-Based Potentiator of GABAA Receptors

2019 ◽  
Author(s):  
Karin Rustler ◽  
Galyna Maleeva ◽  
Alexandre M. J. Gomila ◽  
Pau Gorostiza ◽  
Piotr Bregestovski ◽  
...  
Keyword(s):  
Protein Function ◽  
Biological Evaluation ◽  
Term Treatment ◽  
Allosteric Modulators ◽  
Design Synthesis ◽  
Non Invasive ◽  
Long Term Treatment ◽  
Benzodiazepine Derivatives ◽  
Synthesis And Biological Evaluation

The <i>γ</i>-aminobutyric acid gated chloride channel represents the major mediator of inhibitory neurotransmission in the mammalian central nervous system and its dysfunction is related to severe diseases like epilepsy and depression, which can be relieved by the application of allosteric modulators. However, the drugs’ potential side-effects limit their application for long-term treatment. Applying light as external stimulus to modify the pharmacophore’s activity, as emerged in the field of photopharmacology, provides a non-invasive tool with high spatial and temporal resolution for the modulation of protein function. Herein, we report the design, synthesis, and biological evaluation of photochromic fulgimide-based benzodiazepine derivatives as light-controllable potentiators of GABA<sub>A</sub> receptors (GABA<sub>A</sub>Rs). A photocontrolled potentiator of GABA<sub>A</sub>Rs (Fulgazepam) has been identified that does not display agonist or antagonist activity and allows manipulating zebrafish larvae swimming.

scholarly journals The Role of Advanced Imaging in Gout Management

2022 ◽  
Vol 12 ◽  
Author(s):  
Shuangshuang Li ◽  
Guanhua Xu ◽  
Junyu Liang ◽  
Liyan Wan ◽  
Heng Cao ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Term Treatment ◽  
Advanced Imaging ◽  
Non Invasive ◽  
Long Term Treatment ◽  
High Prevalence ◽  
Magnetic Resonance Imaging Mri ◽  
Urate Crystals

Gout is a common form of inflammatory arthritis where urate crystals deposit in joints and surrounding tissues. With the high prevalence of gout, the standardized and effective treatment of gout is very important, but the long-term treatment effect of gout is not satisfied because of the poor adherence in patients to the medicines. Recently, advanced imaging modalities, including ultrasonography (US), dual-energy computed tomography (DECT), and magnetic resonance imaging (MRI), attracted more and more attention for their role on gout as intuitive and non-invasive tools for early gout diagnosis and evaluation of therapeutic effect. This review summarized the role of US, DECT, and MRI in the management of gout from four perspectives: hyperuricemia, gout attacks, chronic gout, and gout complications described the scoring systems currently used to quantify disease severity and discussed the challenges and limitations of using these imaging tools to assess response to the gout treatment.

scholarly journals Fulgazepam: A Fulgimide-Based Potentiator of GABAA Receptors

2019 ◽  
Author(s):  
Karin Rustler ◽  
Galyna Maleeva ◽  
Alexandre M. J. Gomila ◽  
Pau Gorostiza ◽  
Piotr Bregestovski ◽  
...  
Keyword(s):  
Protein Function ◽  
Biological Evaluation ◽  
Term Treatment ◽  
Allosteric Modulators ◽  
Design Synthesis ◽  
Non Invasive ◽  
Long Term Treatment ◽  
Benzodiazepine Derivatives ◽  
Synthesis And Biological Evaluation

The <i>γ</i>-aminobutyric acid gated chloride channel represents the major mediator of inhibitory neurotransmission in the mammalian central nervous system and its dysfunction is related to severe diseases like epilepsy and depression, which can be relieved by the application of allosteric modulators. However, the drugs’ potential side-effects limit their application for long-term treatment. Applying light as external stimulus to modify the pharmacophore’s activity, as emerged in the field of photopharmacology, provides a non-invasive tool with high spatial and temporal resolution for the modulation of protein function. Herein, we report the design, synthesis, and biological evaluation of photochromic fulgimide-based benzodiazepine derivatives as light-controllable potentiators of GABA<sub>A</sub> receptors (GABA<sub>A</sub>Rs). A photocontrolled potentiator of GABA<sub>A</sub>Rs (Fulgazepam) has been identified that does not display agonist or antagonist activity and allows manipulating zebrafish larvae swimming.

scholarly journals A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis

2019 ◽  
Vol 22 (1) ◽  
pp. 18-23
Author(s):  
Kira E. Zotkina ◽  
Olga M. Lesnyak ◽  
Aleksandr Yu. Kochish ◽  
Ivan V. Sushkov
Keyword(s):  
Postmenopausal Osteoporosis ◽  
Femur Fracture ◽  
Term Treatment ◽  
Atypical Femur Fracture ◽  
First Line Therapy ◽  
Oral Bisphosphonate ◽  
Long Term Treatment ◽  
Rare Side Effect ◽  
The Right

Bisphosphonates is a first-line therapy for treatment of osteoporosis. In the last decade, the number of atypical femur fracture (AFF) cases during long-term treatment with bisphosphonates has increased. The aim of this article was to analyze the literature data on this problem, to define the diagnostic criteria of AFF and to present the case of AFF in the patient who received treatment with alendronate for 3.5 years. A 78-year-old woman, receiving oral bisphosphonate for severe postmenopausal osteoporosis for 3.5 years, suddenly started feeling pain in her right thigh while walking. Three months later, she had got a fracture in middle third of the right femur after falling from her standing height. According to instrumental diagnostics, this fracture had all criteria of AFF. Blocking intramedullary osteosynthesis with shafts was performed. A retrospective analysis of soft tissue magnetic resonance imaging in the area of right thigh, done before the fracture, showed the presence of undiagnosed incomplete right femur fracture in the middle third, which subsequently led to a complete fracture. Presented clinical case demonstrates the complexity of AFF diagnostics. The purpose of the publication is to draw attention of medical specialists to the issue of this rare side effect of bisphosphonate treatment.

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