Multidetector Computed Tomography Assessment of Anatomical Ventricular Tachycardia Isthmuses in Repaired Tetralogy of Fallot.

BACKGROUND: Tetralogy of Fallot (TOF) is associated with risk for sustained monomorphic ventricular tachycardia (VT). Preemptive electrophysiology study before transcatheter pulmonary valve placement is increasing, but the value of MDCT for anatomical VT isthmus assessment is unknown. OBJECTIVES: The purpose of this study was to determine the impact of multidetector computed tomography (MDCT) in the evaluation of sustained monomorphic VT for repaired TOF. METHODS: Consecutive pre-transcatheter pulmonary valve MDCT studies were identified, and anatomical isthmus dimensions were measured. For a subset of patients with preemptive electrophysiology study, MDCT features were compared with electroanatomical maps. RESULTS: A total of 61 repaired TOFs with MDCT were identified (mean 35 ± 14 years, 58% men) with MDCT electroanatomical map pairs in 35 (57%). Calcification corresponding to patch material was present in 46 (75%) and was used to measure anatomical VT isthmuses. MDCT wall thickness correlated positively with number of ablation lesions and varied with functional isthmus properties (blocked isthmus 2.6 mm [Q1, Q3: 2.1, 4.0 mm], slow conduction 4.8 mm [Q1, Q3: 3.3, 6.0 mm], and normal conduction 5.6 mm [Q1, Q3: 3.9, 8.3 mm]; P < 0.001). A large conal branch was present in 6 (10%) and a major coronary anomaly was discovered in 3 (5%). Median ablation lesion distance was closer to the right vs the left coronary artery (10 mm vs 15 mm; P = 0.01) with lesion-to-coronary distance <5 mm in 3 patients. CONCLUSIONS: MDCT identifies anatomical structures relevant to catheter ablation for repaired TOF. Wall thickness at commonly targeted anatomical VT isthmuses is associated with functional isthmus properties and increased thermal energy delivery.

Exposure and effects assessment of resident mink (Mustela vison) exposed to polychlorinated dibenzofurans and other dioxin-like compounds in the Tittabawassee River basin, Midland, Michigan, USA.

Historically, sediments and floodplain soils of the Tittabawassee River (TR; MI, USA) have been contaminated with polychlorinated dibenzofurans (PCDFs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated biphenyls (PCBs). Median concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TEQs) based on 2006 World Health Organization tetrachlorodibenzo-p-dioxin toxic equivalency factors (TEFs) in the diet of mink (Mustela vison) ranged from 6.8 x 10(-1) ng TEQ/kg wet weight upstream of the primary source of PCDF to 3.1 x 10(1) ng TEQ/kg wet weight downstream. Estimates of toxicity reference values (TRVs) derived from laboratory studies with individual PCDDs/PCDFs and PCB congeners or mixtures of those congeners, as well as application of TEFs, were compared to site-specific measures of mink exposure. Hazard quotients based on exposures expressed as concentrations of TEQs in the 95th percentile of the mink diet or liver and the no-observable-adverse-effect TRVs were determined to be 1.7 and 8.6, respectively. The resident mink survey, however, including number of mink present, morphological measures, sex ratios, population age structure, and gross and histological tissue examination, indicated no observable adverse effects. This resulted for multiple reasons: First, the exposure estimate was conservative, and second, the predominantly PCDF congener mixture present in the TR appeared to be less potent than predicted from TEQs based on dose-response comparisons. Given this, there appears to be great uncertainty in comparing the measured concentrations of TEQs at this site to TRVs derived from different congeners or congener mixtures. Based on the lack of negative outcomes for any measurement endpoints examined, including jaw lesions, a sentinel indicator of possible adverse effects, and direct measures of effects on individual mink and their population, it was concluded that current concentrations of PCDDs/PCDFs were not causing adverse effects on resident mink of the TR.

Nondestructive scat sampling in assessment of mink (Mustela vison) exposed to polychlorinated dibenzofurans (PCDFs).

The mink (Mustela vison) is often utilized as a sentinel species for ecological assessments at sites where contaminants of concern include dioxins and dioxin-like compounds. Utilizing mink scat as a nondestructive tool to determine internal exposure to dioxin-like compounds may allow for rapid, accurate estimates of exposure without the need to capture mink or their prey. To determine the relationships between concentrations of polychlorinated dibenzofurans (PCDFs) in tissues (liver and adipose) and those in scat, mink were fed PCDFs in scat during a controlled laboratory study for 180 days. Mink were fed a control diet, diets with three doses of 2,3,4,7,8-pentachlorodibenzofuran (2,3,4,7,8-PeCDF) or 2,3,7,8-tetrachlorodibenzofuran (2,3,7,8-TCDF), and a diet with an environmentally relevant mixture of the two congeners. Concentrations of PCDFs in liver and adipose were measured after 0, 90, and 180 days of exposure. Concentrations of the two PCDF congeners in mink scat were determined after 2, 23, 45, 90, and 180 days of exposure. Concentrations of both PCDF congeners in scat were significantly correlated with those in liver and adipose tissue (r(2) = 0.94-0.97, p < 0.01). This indicates that measurements of concentrations of both PCDFs in scat can be used to predict concentrations of PCDFs in liver and adipose. Assimilation and elimination characteristics of 2,3,4,7,8-PeCDF or 2,3,7,8,-TCDF and a mixture of the two congeners by mink could be predicted from concentrations of these congeners in scat. Overall, concentrations of PCDFs in mink scat can be used as a rapid and inexpensive nondestructive method to predict concentrations of PCDFs in mink when certain assumptions are met.

Treatment of pediatric suppurative mastoiditis: is peripherally inserted central catheter (PICC) antibiotic therapy necessary?

OBJECTIVE: A review of the treatment of pediatric acute mastoiditis requiring surgical intervention managed with and without PICC therapy postoperatively. STUDY DESIGN AND SETTING: Retrospective study of 42 cases from 1989 to 2004 treated at a regional children's hospital. RESULTS: Sixteen patients received postoperative PICC therapy and 26 received a course of oral antibiotics. The PICC group received on average 12.12 days of intravenous antibiotics compared to only 3.53 days for the non-PICC group (P < 0.001). No differences were observed between the two groups in treatment outcomes. One patient from each group required rehospitalization. One minor complication was experienced in a patient in the PICC group. There were no surgical complications. The total cost for outpatient PICC therapy increased treatment costs by approximately $1500 to $2500. CONCLUSIONS: Oral antibiotic therapy is sufficient after surgical intervention for acute pediatric suppurative mastoiditis without intracranial complications and does not result in adverse treatment outcome. SIGNIFICANCE: Use of PICC therapy after surgical intervention for mastoiditis should be limited. EBM RATING: B-3b.