Background/Aim: High-dose chemotherapy (HDCT) and stem cell transplantation (SCT) have been established as the standard of care in patients with relapsed germ cell tumours (GCTs). We evaluated the safety, efficacy and tolerability of HDCT/ SCT in patients with relapsed GCTs. Patients and Methods: Twenty-eight patients with relapsed GCTs, treated with HDCT, were included in this study. The conditioning regime was carboplatin, etoposide, cyclophosphamide and paclitaxel. Clinical, radiological imaging and tumour markers determined treatment outcomes. Results: Median age was 35 years (range=21-57 years) with 26 males and 2 females. Median time to first relapse was 6 months. Median time to progression after 2 nd line chemotherapy was 17.3 months. Fourteen patients hadMedian survival was 62 months and 16 patients (57%) are in clinical follow-up with surveillance. Conclusion: In relapsed GCT patients, median survival may exceed 5 years post-HDCT and SCT.

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Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.

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Introduction Catheter ablation for supraventricular tachycardia (SVT) in patients with congenital heart disease (CHD) is an important therapeutic option. Complex atrial substrate in this cohort makes atrial flutter (AFl) a common occurrence. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric Cavotricuspid Isthmus CTI line ablation in case of non-inducibility of arrhythmia will lead to good outcomes. Long-term outcomes of empiric versus entrained CTI ablation in CHD patients with right-sided supraventricular arrhythmias were examined. Methods and results 51 right-sided atrial flutter ablations in 49 patients from 2007-2015 were included. Data was analysed retrospectively. Medical records were reviewed and patients were contacted for follow-up. All patients with left sided arrhythmias were excluded. The mean age of the whole cohort was 43 years and 50% of the patients were men. Underlying aetiology included ASD (33.3%), VSD (19.6%), Fallot's tetralogy (15.6%), Ebstein's anomaly (3.9%), Fontan surgery (10%) and Mustard repair (17.6%). There was no significant difference in the right atrial sizes between the two groups. AFl was entrained in 34 patients whereas it was noninducible/non-sustained in 17 patients. The latter had an empiric CTI line ablation. Of those in the entrained group, 3% had other atrial arrhythmias induced in addition to typical AFl. 51% of procedures were performed without a general anaesthetic. There were no procedural complications. There was no significant difference in the mean procedure and fluoroscopy times between the two groups (Empiric vs Entrain CTI; 176.5 vs 163.8 and 41.5 vs 30.5 min). After a mean follow-up of 21 months, arrhythmia-free survival was 71% versus 85% (p-value 0.21) in the empiric and entrained CTI ablation groups. Conclusion Long-term outcomes after empiric and entrained CTI line ablation for AFl in patients with CHD are comparable. This is a safe and effective treatment option. In the case of non-inducibility of atrial flutter, an empiric CTI line ablation should be performed in this cohort.