Citations

ABSTRACTBACKGROUND AND PURPOSERequests for after‐hours emergent spine MR imaging seem to be increasing. We sought to review the trend in after hours spine MRI utilization at our institution and to determine how these results impacted therapeutic intervention.METHODSFollowing Institutional Review Board approval, reports from 179 after hours spinal MRI's performed over the past 13 years were obtained and the relevant electronic medical records were reviewed.RESULTSEmergent after hours spine MRI utilization increased from 7 per year to 23 over 13 years. Fifty‐eight percent (104/179) had significant findings. Twenty‐nine percent (52/179) of all patients imaged underwent surgery to treat pathologies identified on MR. Surgery was performed in only 2% (4/179) of these patients within 3 hours and 6% (10/179) within 6 hours of MRI completion. Five percent (8/179) had findings that were treated with radiation therapy and in 78% of these it was performed within 6–12 hours. Of those in whom steroids or antibiotics were initiated, 41% and 50% were treated within 3 hours of MR scanning, respectively.DISCUSSIONClinical use of emergent after hours spine MRI is steadily increasing at our institution. While MR imaging often discerned significant pathologies, performing these emergent studies rarely resulted in immediate surgical or radiotherapeutic intervention.

BackgroundThis case‐series highlights strategies used for successful epicardial access in challenging cases.Percutaneous epicardial access has become a valuable tool for mapping and ablating arrhythmias. However, this technique can be especially difficult in certain circumstances and is frequently avoided.MethodsAll cases of epicardial access for ablation from our institution were reviewed searching for exceptionally difficult cases in patients with complex pericardial and thoracic anatomy. The successful strategies are characterized in this report.ResultsAmong 144 patients who underwent an epicardial ablation procedure between January 2004 and June 2013, four required unconventional approaches for epicardial access for ventricular tachycardia ablation. Two patients (one with previous cardiac surgery and one with prior pericardial effusion) had substantial fibrous pericardial adhesions with no virtual pericardial space and required adhesiolysis. One patient, status postpartial colectomy, underwent computed tomography‐guided intercostal epicardial access due to the presence of bowel throughout the subdiaphragmatic space in the upper abdomen. The fourth patient had partial congenital absence of the pericardium and underwent epicardial access through the creation of a subxiphoid window. All epicardial accesses were successful and performed without major complication.ConclusionsWith precise procedural planning and cardiac imaging, percutaneous epicardial access is feasible even in patients with significant anatomical challenges.

This single-centre, 12-week, double-blind, placebo-controlled trial assessed how the human glucagon-like-peptide 1 analogue liraglutide impacted endothelial function in adult patients (n = 49) with type 2 diabetes and no overt cardiovascular disease. Patients were randomized to liraglutide, placebo or glimepiride. At baseline and Week 12, venous occlusion plethysmography was used to measure forearm blood flow (FBF) in response to acetylcholine (ACh) and sodium nitroprusside (SNP) before and after l-N G -monomethyl arginine (L-NMMA) infusion. At Week 12, ACh-mediated FBF increased with liraglutide and decreased with placebo; however, the between-treatment difference was not significant ( p = 0.055). Inhibition of ACh-mediated FBF after L-NMMA infusion increased with liraglutide and decreased with placebo; this between-treatment difference was also not significant ( p = 0.149). No change in FBF was observed with SNP. Liraglutide did not significantly impact endothelium-dependent vasodilation after 12 weeks; however, additional investigations looking at the effect of liraglutide on endothelial function in alternative vasculature and during the postprandial period are warranted.