Although HIT is less frequently reported in newborns and children, paediatricians should be aware of HIT in childhood as a potential complication of heparin application. The widespread practice of flushing catheters with heparin should also be debated in view of the risk of triggering the primary immune-response of HIT. In 1999, treatment options for further parenteral anticoagulation of HIT patients are danaparoid sodium (a low-molecular weight heparinoid) and lepirudin (a direct thrombin inhibitor).
Sorafenib has been approved in the U.S.
and the European Union for patients with advanced renal
cell cancer (RCC). There is evidence that treatment with
sorafenib can achieve partial remissions in patients with
brain metastases of RCC. Case Report: We report of a patient
with leptomeningeal carcinomatosis of RCC, who
10 days after initiation of sorafenib therapy showed a noticeable
decrease in contrast enhancement of the tumor
in a magnetic resonance imaging (MRI) scan of the brain.
This partial response was verified by an MRI scan on day
74. Discussion: Results of a sub-evalution of a randomized
phase III trial show that sorafenib offers encouraging
activity in the treatment of patients with RCC and
brain metastases. Conclusion: This case shows that sorafenib
can achieve rapid tumor response in a patient
with leptomeningeal carcinomatosis of RCC. This partial
remission can persist for at least 10 weeks.
We have studied the group of 12 patients suffering from the Wolf-Parkinson-White (WP W ) syndrome. The noninvasive magnetocardiographic (MCG) mapping data were used to find a functional localization of accessory conduction pathway (AP) by using the current dipole source model in diflerent volume conductor models. The best reference interval for magnetic data baseline corrections as well as the onset of A P were determined automatically b y means of averaged standard deviation of magnetic recordings. The stability of MCG inverse solutions has been studied. For all cases the calculated A P spatial coordinates were compared to corresponding results obtained b y the invasive electrophysiological study (EPS).
IntroductionThe result of magnetocardiographic mapping is a spatio-temporal distribution of magnetic field in the vicinity of human chest. The aim of our work is the estimation of current sources which generate the measured magnetic field. This is a biomagnetic equivalence of a well known problem in bioelectric modeling where the electric current sources inside a volume conductor are estimated from potential measurements at the thorax surface. This is known as the inverse problem for which no mathematically unique solution exists. In order to localize electrical current sources one has to introduce some models and constraints.We have tried to localize the AP in the group of 12 patients suffering from the WPW syndrome. For these patients the AP occurs between the atria and ventricles and leads to a pre-excitation of ventricles and can cause heart arrhythmia which in turn can produce sudden cardiac death. We have used a moving current dipole as a model of current source. We have tested several volume conductor models like halfspace model, elliptic cylinder and three different realistic torso models. The catheter ablation was performed in all studied patients. Before the ablation the location of AP was determined by the invasive EPS. The spatial coordinates of the tip of ablation catheter obtained by the X-ray system have been used as a reference in the evaluation procedure of current source coordinates (the onset of the AP) calculated from the noninvasive magnetic measurements.
2.
MethodsIn order to find a successful solution to the inverse problem one has to solve first the forward problem for the chosen current source and volume conductor model, i.e. the mathematical relation between the source model and the corresponding magnetic field should be known in terms of finite number of parameters. The inverse problem is then solved by the parameter estimation procedure. Analytical solution for the magnetic field, generated by the current dipole, exists only for the simplest half-space model. For the volume conductor of an arbitrary shape the Boundary Element Method (BEM) has been used [l, 21. Details about our BEM approach and volume conductor models are described elsewhere [3].All MCG measurements were performed in the Berlin Magnetically Shielded Room [4] by means of 37-SQUID multichannel magnetometer system [5]. Up...
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