Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.

• MeSH
• dávka záření MeSH
• elektrofyziologické techniky kardiologické MeSH
• fluoroskopie metody   MeSH
• katetrizační ablace * MeSH
• lidé MeSH
• radiační expozice * škodlivé účinky   MeSH
• srdeční arytmie terapie   MeSH
• srdeční elektrofyziologie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Cadmium-Zinc-Telluride (CZT) technology allows use of low activities of radiopharmaceuticals. The aim was to verify the values of left ventricular volume parameters, obtained via ultra-low-dose thallium Single Photon Emission Computed Tomography (SPECT) using a CZT camera. METHODS AND RESULTS: Forty-five patients referred for an assessment of myocardial perfusion or viability imaging were examined using CZT-SPECT and 1.5 T magnetic resonance (MRI) scanner. The ultra-low-dose protocol with 0.5 Mbq 201-Tl per kg of body weight was used. The values of end-systolic (ESV) and end-diastolic volumes (EDV), left ventricular ejection fraction (EF) and myocardial mass (MM) were assessed using both techniques. A very good correlation was found between the EF, ESV, and EDV values assessed with CZT-SPECT and cardiac magnetic resonance MRI; the Pearson coefficients were 0.86, 0.95, and 0.91, respectively. A moderate correlation was found for myocardial mass, r = 0.57. Compared to MRI, SPECT systematically overestimated ESV and MM, while it underestimates the EF, with P ≤ .001 in all cases. There was no difference in EDV estimation. CONCLUSIONS: Left ventricular volumes and ejection fraction assessed via ultra-low-dose CZT-SPECT showed very good correlation with the values obtained by MRI. A moderate correlation was found for myocardial mass.

• MeSH
• funkce levé komory srdeční * MeSH
• jednofotonová emisní výpočetní tomografie * metody   MeSH
• kadmium MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• radioizotopy thallia MeSH
• telur MeSH
• tepový objem MeSH
• zinek MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30-7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.

• MeSH
• časové faktory MeSH
• dávka záření * MeSH
• design vybavení MeSH
• gama kamery * MeSH
• ischemická choroba srdeční diagnostické zobrazování   mortalita   patofyziologie   terapie   MeSH
• jednofotonová emisní výpočetní tomografie škodlivé účinky   přístrojové vybavení   metody   MeSH
• kadmium * MeSH
• koronární cirkulace * MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• progrese nemoci MeSH
• puriny aplikace a dávkování   MeSH
• pyrazoly aplikace a dávkování   MeSH
• radiační expozice škodlivé účinky   prevence a kontrola   MeSH
• radiofarmaka aplikace a dávkování   škodlivé účinky   MeSH
• radioizotopy thallia aplikace a dávkování   škodlivé účinky   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• telur * MeSH
• vazodilatancia aplikace a dávkování   MeSH
• zátěžový test MeSH
• zinek * MeSH
• zobrazování myokardiální perfuze škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

High efficiency cadmium-zinc-telluride (CZT) cameras provide an opportunity to lower the injected activities of radiopharmaceuticals for single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). The limits for reducing activities of thallium have not been determined, particularly in obese patients. After an injection of 0.7 megabecquerel (MBq) of thallium/kg, we collected an average 1.5 million counts for the 10-min acquisition in a pilot cohort of ten patients. After extrapolation, we reduced the administered activity to 0.5 MBq/kg to obtain the expected 1 million counts. We studied the image quality in 124 patients (86 men, 43 obese with body mass index over 30 kg/m(2)) referred for MPI. The quality of images was assessed by a number of recorded counts and visually by a four-grade scale (one-poor quality, four-excellent quality). In non-obese and obese patients, the average number of recorded counts was 1.1 vs. 1.07 million counts for the 10-min stress acquisition, 1.04 vs. 1.06 million counts for the 13-min rest acquisition, and the average quality score was 3.97 vs. 3.90, respectively (p = NS).The mean administered activity was 39.2 ± 7 MBq for non-obese and 48.7 ± 6 for obese patients (p < 0.0001), and the calculated effective dose was 4.0 ± 0.7 and 4.9 ± 0.6 mSv respectively (p < 0.0001). The ultra-low-dose thallium stress-redistribution protocol, including post-stress prone imaging, provides good quality of images with a low radiation burden, even in obese patients.

• MeSH
• dávka záření * MeSH
• gama kamery * MeSH
• index tělesné hmotnosti MeSH
• jednofotonová emisní výpočetní tomografie přístrojové vybavení   metody   MeSH
• kadmium aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci srdce komplikace   diagnostické zobrazování   patofyziologie   MeSH
• obezita komplikace   diagnóza   MeSH
• pilotní projekty MeSH
• polohování pacienta * MeSH
• prediktivní hodnota testů MeSH
• pronační poloha * MeSH
• radiofarmaka aplikace a dávkování   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• telur aplikace a dávkování   MeSH
• zinek aplikace a dávkování   MeSH
• zobrazování myokardiální perfuze přístrojové vybavení   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: Management of refractory chronic lymphocytic leukemia (CLL) represents a major challenge because of the poor prognosis and limited treatment options. While corticosteroids have been used to treat CLL since 1940s, their benefit has never been conclusively proved. Recently, several groups reported use of high-dose corticosteroids (methylprednisolone or dexamethasone) either alone or combined with chemotherapy and/or monoclonal antibodies in relapsed/refractory CLL. AREAS COVERED: While efficacy of high-dose corticosteroids is excellent including responses in patients with bulky lymphadenopathy or those considered ultra high-risk CLL because of deletion and/or mutation of p53 gene, the duration of response is still unsatisfactory. Combination with monoclonal antibodies seems to improve therapeutic efficacy but no randomized trials have been conducted. For the purpose of this review, a search for terms, high-dose corticosteroids/methylprednisolone/dexamethasone, and chronic lymphocytic leukemia has been performed in PubMed and database of abstracts from American Society of Hematology Meetings. EXPERT OPINION: High-dose corticosteroids appear to play an important role in the management of highly pretreated relapsed/refractory CLL including patients with massive lymphadenopathy. Myelosuppression is usually limited but infectious toxicity, including increased risk of invasive fungal infections, represents the most dreaded side effects. This therapeutic approach should be further tested within large prospective trials, to optimize efficacy and safety.

• MeSH
• chemorezistence MeSH
• chronická lymfatická leukemie farmakoterapie   genetika   MeSH
• geny p53 genetika   MeSH
• glukokortikoidy aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• mutace MeSH
• protokoly protinádorové kombinované chemoterapie aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH