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"Leading authorities on percutaneous tumor ablation come together in this volume to provide a complete overview of everything physicians and other health professionals need to know to successfully implement and administer an image-guided ablation service. After an introduction to the protocols and attendant physics of ablation technology, concise organ-based chapters focus on a wide range of both straightforward and atypical cases to teach readers how to handle the unique clinical and technical challenges associated with percutaneous tumor ablation in different areas of the body. Succinct, step-by-step descriptions complement high-resolution images throughout to illustrate the nuances of each procedure. This must-have clinical reference will develop the technical and clinical tumor ablation skills of every fellow and practicing physician in interventional radiology, oncology, and surgical oncology."

"Achalasia is defined as a motor disorder of I he esophageal smooth muscle in which the lower esophageal sphincter does not relax properly with swallowing and the normal peristalsis of the esophageal body is replaced by abnormal contractions. The definite etiology is unknown. The incident is infrequent. The diagnosis of achalasia was established by clinical, radiological investigation, and manometric data. The management of achalasia consists of conservative treatment, dilation and surgical treatment. Esophageal dilation is the technique used to stretch open the blocked portion of the esophagus. Balloon dilation is a form of definite treatment beside myotomy or Heller's operation. We hereby report a case managed by balloon dilation catheter after failure by means of conservative treatment."

"Tujuan penelitian ini untuk melihat karakteristik elektrofisiologi dan hasil ablasi frekuensi radio (AFR) pada flutter atrium (FLA) yang belum tersedia hingga saat ini di Indonesia. Tiga buah kateter elektroda multipolar dimasukkan perkutan ke dalam jantung lalu ditempatkan di sinus koronarius (SK), berkas His dan mengitari anulus trikuspid. Kateter ablasi 8 mm digunakan untuk AFR linier cavotrikuspid isthmus (CTI) pada FLA tipikal dan kebalikan tipikal. Blok bidireksional ditentukan atas dasar pemanjangan waktu konduksi dinding lateral bawah ke ostium SK dan sebaliknya lebih dari 90 mdet, dan/atau dengan cara pemacuan diferensial. Terdapat 27 subyek dengan 30 FLA terdokumentasi yang terdiri dari 19 tipikal, 5 tipikal terbalik dan 6 atipikal. Hanya 9 pasien yang tidak mempunyai penyakit jantung struktural. Rerata panjang siklus takikardia (PST) adalah 261,79 ± 42,84, 226,5 ± 41,23, dan 195,4 ± 9,19 mdet masing-masing untuk FLA tipikal, kebalikan tipikal dan atipikal (p = 0,016). Konduksi CTI menempati 60% dari PST atau rerata 153,0 ± 67,37 mdet. Aktivasi SK terbagi menjadi 3 jenis yaitu proksimal ke distal, distal ke proksimal dan fusi. AFR pada FLA tipikal dan tipikal terbalik sukses sebanyak 96 % dengan tingkat kekambuhan 4,5 % pada rerata masa pengamatan 13 ± 8 bulan. Pada populasi penelitian ini jenis FLA terbanyak adalah FLA tipikal. Kebanyakan subyek menderita penyakit jantung struktural. AFR sangat efektif menyembuhkan FLA tipikal dan kebalikan tipikal. (Med J Indones 2007; 16:151-8)

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This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which has not been established in Indonesia. Three multipolar catheters were inserted percutaneously and positioned into coronary sinus (CS), His bundle area and around tricuspid annulus. Eight mm ablation catheter was used to make linear ablation at CTI of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. Thirty AFL from 27 patients comprised of 19 typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8 ± 42.84, 226.5 ± 41.23, and 195.4 ± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 ± 67.37 msec. CS activation distributed to three categories which comprised of proximal to distal, distal to proximal and fusion activation. Only nine of 27 patients had no structural heart disease. RFA of symptomatic typical and reverse typical AFL demonstrated 96% success and 4.5 % recurrence rate during 13 ± 8 months follow up. Typical AFL is the predominant type of AFL in our population. The majority of AFL cases suffered from structural heart disease. RFA was highly effective to cure typical and reverse typical AFL. (Med J Indones 2007; 16:151-8)"

"ASBTRACTPurpose: Very few studies have investigated the efficacy of ganglionated plexus ablation during the conventional maze procedure. In this study, we sought to evaluate its additive effect in reducing recurrent atrial fibrillation after concomitant maze surgery.Methods: A retrospective study was conducted of 79 patients who underwent Cox maze IV concomitantly with open-heart surgery with (GP group) or without (Maze group) ganglionated plexus mapping. All active ganglionated plexuses were ablated. The two groups were compared and their follow-up data were analyzed.Results: Active ganglionated plexuses were found in 81% of patients who underwent ganglionated plexus mapping. The rates of freedom from atrial fibrillation at 1 year in the GP and Maze groups were 77 and 75%, respectively. The cumulative freedom from atrial fibrillation at follow-up (27.7 ± 17.3 months) was comparable in the two groups (p = 0.427). A multivariate analysis revealed that persistent atrial fibrillation for more than 90 months was an independent predictor of recurrent atrial fibrillation.Conclusion: Ganglionated plexus ablation with Cox maze IV did not reduce the incidence of recurrent atrial fibrillation in comparison to Maze alone."

"A 31-year-old patient came to visit the outpatient clinic at the hospital for his routine twice-weekly hemodialyis (HD) session. During HD, the patient suddenly developed a fever with shivering. At that time, a diagnosis of catheter-related blood stream infection (CR-BSI) was developed, HD catheter or the catheter double lumen (CDL) was uninstalled and the patient was hospitalized. Results of culture withdrawn through the tip of catheter lumen and peripheral blood revealed identical microorganism, i.e. the Enterobacter cloacae. Diagnosis of CR-BSI in the present case was made based on the 2009 Infectious Disease Society of America (IDSA) criteria. In general, prevention measures for CR-BSI should be taken into account including education for patient, awareness of the health care providers who install the CDL, implementation of procedure for appropriate skin aseptic technique and best practice for HD catheter care, particularly on the exit site of the CDL to prevent the development of CR-BSI.

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Seorang pasien pria usia 31 tahun, datang berobat jalan ke rumah sakit untuk hemodialisis (HD) rutin 2 kali dalam seminggu. Saat dilakukan tindakan HD mendadak pasien demam dan menggigil, saat itu ditegakkan diagnosis catheter-related blood stream infection (CR-BSI), dilakukan pencabutan catheter double lumen (CDL) dan pasien kemudian dirawat. Hasil kultur tip CDL dan kultur darah perifer didapatkan kuman yang sama yaitu Enterobacter cloacae. Diagnosis CR-BSI pada kasus ini ditegakkan berdasarkan kriteria Infectious Disease Society of America (IDSA) tahun 2009. Secara keseluruhan harus diperhatikan langkah pencegahan CR-BSI berupa edukasi pasien dan petugas yang memasang CDL, penerapan prosedur tindakan aseptik kulit yang benar serta perawatan exit site CDL, untuk mencegah terjadinya CR-BSI."