CT-fluoroscopic-guided left atrial ablation is feasible and allows appropriate catheter manipulation in the left atrium.

Acute pancreatitis following renal transplantation is an unusual complication that carries a high mortality. Over the last 10 yr, five of 185 patients at our center developed acute pancreatitis. All had live related donors and were on conventional triple drug immunosuppression. Pancreatitis was classified according to the computed tomography scan based on Atlanta Classification. All five patients who developed acute pancreatitis had evidence of symptomatic or serologically active viral infection (chicken pox in two, cytomegalovirus infection in two, hepatitis E virus in one) and no patient without viral infection developed pancreatitis. Overall, 45 patients developed symptomatic or serologically active viral infection. There was a significant association between viral infection and pancreatitis (chi-square test, p < 0.001). Three patients with severe acute pancreatitis died while both patients with mild pancreatitis survived. An active search for viral infections should be made in all patients with acute pancreatitis. Specific antiviral measures may help reduce the mortality of acute pancreatitis in these patients. Consideration must be given to varicella immunization in patients with renal failure.

Purpose: To validate a novel, real-time, steady-state free precession (SSFP), single-breathhold technique for the assessment of left ventricular (LV) and right ventricular (RV) function in heart failure patients. Materials and Methods:A total of 20 heart failure patients (mean age 59 Ϯ 17 years) underwent scanning with our new, real-time, spiral SSFP sequence in which each cardiac phase was acquired in 118 msec at a resolution of 1.8 ϫ 1.8 mm. Each cardiac slice (1-cm thick) was automatically advanced based on a cardiac trigger, allowing complete coverage of the heart in a single breathhold. The patients also underwent LV and RV assessment with the gold standard: multiple breathhold, cardiac-gated, segmented k-space strategy. LV and RV end-systolic volume (ESV) and enddiastolic volume (EDV) and LV mass were compared between the two imaging techniques. Results:The new real-time strategy was highly concordant with the gold standard technique in the assessment of LVEDV (r ϭ 0.98), LVESV (r ϭ 0.98), RVESV (r ϭ 0.86), RVEDV (r ϭ 0.91), LVMASS (r ϭ 0.95), RVEF (r ϭ 0.70), and LVEF (r ϭ 0.94). The mean bias (95% confidence interval [CI]) for each parameter is LVEDV: 10.6 cc (cm 3 ) (3.8 -17.4 cc), LVESV: -0.8 cc (-5.3 to 3.7 cc), RVEDV: 3.7 cc (-5.6 to 13.2 cc), RVESV: -3.1 cc (-11.1 to 4.9 cc), LVMASS: 26 g (12.4 -39.8 g), RVEF: -2.9% (1.3 to -7.2 %), LVEF: 1.9% (5 to -1.1%). In addition, data acquisition was only nine Ϯ two seconds with the real-time strategy vs. 312 Ϯ 41 seconds for the standard technique. Conclusion:In patients with heart failure, real-time, spiral SSFP allows rapid and accurate assessment of RV and LV function in a single-breath hold. Using the same strategy, increased temporal resolution will allow real-time assessment of cardiac wall motion during stress studies.

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Hepatitis B (HB) virus infection is a major health problem in dialysis dependent end stage renal failure (ESRF) patients. The sero-conversion rate after recombinant HB vaccine in ESRF patients is poor. Adjuvants like Granulocyte Macrophage-Colony Stimulating Factor (GM-CSF) have been found to improve response rate to vaccines. This study was conducted to evaluate the efficacy of GM-CSF as an adjuvant to HB vaccine in ESRF patients who were non-responders to the usual three double dose vaccinations (primary non-responders). Fifty consecutive HBsAg negative and anti-HBs negative ESRF patients on hemodialysis over thirty months were prospectively included (Jan. 96-June 98). All received 40 microg of recombinant HB vaccine at 0, 1, 2 month interval. Anti-HBs titres were subsequently tested after four weeks of the third dose. There were 19 (38%) primary non-responders (antiHBs negative). Twelve (Group I) of primary non-responders were given an additional dose of HB vaccine with 300 microg (5-6 microg/kg) of GM-CSF (Leucomax) and the remaining seven (Group II) received only an additional dose of HB vaccine. Anti-HBs was determined by Abbott's ELISA kit, and titre above 10 mIU/mL was considered as protective. In Group I, sero-protective titres were obtained in 11 out of 12 (91.6%) patients, whereas in Group II none of the patients achieved sero-protection (p < 0.001). The sero-conversion rate improved from initial 62% (31/50) to overall 84% (42/150) after the use of GM-CSF. There were no adverse events noted with the use of GM-CSF. At one year, 24 out of 32 (75%) who were sero-protected earlier continued to remain sero-protected. This study indicates that GM-CSF is a potent HB vaccine adjuvant for sero-conversion in primary non-responders.

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During 12+/- 9.8 months follow-up, 67% of the patients with peri-infarct ischemia and 13% of the patients without peri-infarct ischemia had cardiovascular events (p = 0.03). CONCLUSION. In severe ICM patients, the presence of peri-infarct ischemia was associated with a higher incidence of cardiovascular events.