The mean effective dose for MSCT coronary angiography was significantly higher than that for conventional angiography. As MSCT cardiac scanners become increasingly available, operators must be aware of the radiation dose and the factors that affect it.

During the last twenty years several investigations have been made into the circulation and metabolism of the human forearm muscles by taking blood samples from the deep branch of the median cubital vein, from which blood flows into the superficial veins above the elbow. Samples have been obtained by a catheter passed upstream into the deep veins of the forearm, or by puncture of the deep branch where it lies under the skin. In all studies neither the position of the tip of the catheter nor the source of the blood have been accurately determined.Bazett, Love, Newton, Eisenberg, Day & Forster (1948) suggest that hand effluent blood can enter the deep forearm veins. Other possible sources of blood in these veins include bone, muscle and skin. There are no major veins draining the skin passing through the deep fascia of the forearm and connecting with the deep veins, though the possibility must be considered that small functional communications may exist.The present observations were made to investigate the location of a catheter introduced through the deep branch of the median cubital vein and the source of the blood samples. The observations fall into three groups: 1, anatomical dissection of veins in the antecubital fossa; 2, measurement of the oxygen content of deep venous blood; and 3, the course taken by substances introduced into a superficial vein near the wrist. METHODSThe veins in the antecubital fossae of twenty-four arms were examined in the dissecting room. In sixteen out of the twenty-four arms, attempts were made to decide, from the anatomical appearance of the venous plexus, the source of the blood in the deep branch of the median cubital

We have evaluated oesophageal function in 34 diabetics and in 16 non-diabetic controls by a timed bolus transit method derived from dynamic oesophageal scintiscans (water transit time: WTT) and barium swallow. The diabetics were screened for autonomic neuropathy using standard cardiovascular responses and 10 patients were classified as abnormal. WTT was significantly prolonged in autonomic neuropaths compared with other diabetics (p less than 0.01) and controls (p less than 0.001). Abnormal peristalsis on barium swallow was seen more frequently in autonomic neuropaths (9/10) than in other diabetics (11/24, p less than 0.002). WTTs from all diabetic patients correlated with abnormal heart rate responses at rest (Rs = - 0.49, p less than 0.005), on deep inspiration (Rs = -0.48, p less than 0.005), and on standing (Rs = -0.39, p less than 0.025) but not with the Valsalva manoeuvre. A weaker correlation was found between the postural fall in blood pressure (Rs = 0.3, p less than 0.05). Diabetics with autonomic neuropathy frequently have asymptomatic oesophageal dysfunction which may result from a vagal neuropathy in view of its association with abnormalities of vagally mediated cardiovascular responses.

Background Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.

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