X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart.

The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.

Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature.

BACKGROUND: Accelerated idioventricular rhythm (AIVR) is a wide QRS complex dysrhythmia that, as far as pediatric population is concerned, occurs mostly in children with underlying systemic or heart disease. Its clinical course is thought to be typically benign in otherwise healthy children and treatment to be completely needless. Existing guidelines/recommendations are based entirely on cases that had low daily burden of AIVR, and those referring to treatment itself are very unspecific. Pharmacologic therapy has been mostly unsuccessful and catheter ablation as a way of treatment has been only sporadically reported. This article is a case report with a literature review that aims to practically separate the age groups into newborn and older children and to emphasize the different clinical outcomes of children with occasional and frequent AIVR. There are only a few cases so far describing undesirable outcomes of this condition, and most of these patients had high daily burden of AIVR. To be more specific, among 38 healthy children older than 1 year reported in total, 6 had undesirable outcomes, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy/heart failure. CASE PRESENTATION: An 11-year-old boy had been referred to our center for a workup of incidentally discovered wide-complex arrhythmia. He was asymptomatic, with no underlying cardiac or systemic diseases. Continuous heart rate monitoring detected AIVR during most time of monitoring. In 24-h Holter-ECG, wide QRS complexes accounted for 73%. With parental consent, we conducted an electrophysiological study accompanied by radiofrequent ablation of ectopic focus, which lead to an instantaneous sinus rhythm that continued during the entire follow-up. CONCLUSION: AIVR is a rare dysrhythmia in the pediatric population, typically considered benign. Nevertheless, more than a few cases evidence its harmful potential, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy. Gathering more knowledge and experience along with conducting further studies is essential for the enhancement of understanding this condition, and selecting potentially vulnerable patients as well as their treatment.

Antropological measurement of the calcaneus.

Transfer of the forces from the trunk to the lower extremities end on calcaneus which transports these forces to the pad, and that is why it is very important to research this bone. This study was done on 57 calcaneal bones of the osteological collection of the Department of Anatomy "Drago Perovic" Zagreb School of Medicine and Department of Anatomy Osijek School of Medicine. The intention was to notice the regularity of the relations between specific dimensions and bone mass and structure, which is of great importance for understanding interrelation between biomechanical parameters of calcaneus and development of involutive changes. In this study geometrical parameters of the calcaneus have been defined, so length of the whole bone and especially frontal and back part, width, height, weight of dry bone, volume, geometrical surface of lateral and longitudinal cross section have been measured on every anatomical specimen. --Mean value, standard deviation and standard error have been calculated for every measured parameter. Positive correlation between most of the parameters of the calcaneus and negative correlation between specific weight and surface of cross section have been found. Coefficient of variation is the highest for weight, and the smallest for width.

Recombinant activated factor VII controls chemotherapy-related hemorrhage in patients with solid intra-abdominal tumors: a report of three pediatric cases.

Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) is used predominantly for the treatment of bleeding in patients with hemophilia and inhibitors, and in patients with traumatic injury. There are also literature reports of its use in chemotherapy-related bleeding in leukemia patients and intra- or postoperative bleeding in patients with solid tumors. We describe three pediatric patients where rFVIIa was successfully used to manage bleeding following the failure of conventional hemostatic treatments during chemotherapy for intra-abdominal tumors (hepatoblastoma, rhabdomyosarcoma and non-classified malignant sarcoma). Recombinant FVIIa proved effective and maintained hemostasis in two of three cases, with no evidence for toxic or adverse events in any of the treated patients.

[Spontaneous closure of fistula between right coronary artery and right ventricle in an infant]. / Spontana okluzija fistule izmedu desne koronarne arterije i desne klijetke u dojenceta.

Here is presented a rare case of spontaneous closure of a fistula between the right coronary artery and the right ventricle in a female infant. At the age of 7 days continuous murmur intensity 3/6 was registered in the 3rd intercostal space along the right sternal border. Echocardiography indicated, with high probability, a coronary artery fistula. Definitive diagnosis was made at the age of 1 month with aortography. Radioscintiography and oximetric analysis revealed 47% of left-to-right shunting at level of fistula. Because of the size of the shunting a surgical correction had been planned, but in the mean-time the murmur had gone. At the age of 6 months control aortography showed spontaneous closure of the fistula, but with significant morphological changes in the right coronary artery (stenosis and aneurysms). The exact mechanism of spontaneous closure is unknown, as is the timing of therapeutic intervention. Control coronary angiography after 1 year showed the regression of pathological changes in the right coronary artery. Based on the literature and our own experiences we consider invasive therapy indicated in children with significant clinical symptoms. In cases were clinical symptoms are absent expectative state should be taken, because there is a chance of spontaneous closure of fistulas, even larger ones, as it is in our case.

Antropological measurement of the sacroiliac joint.

This study was done on 65 isolated pelvic bones, These cadavers belonged to adult people of mature and old age, and they had no pathological changes. These measurements were performed on osteological collection of Department of Anatomy Drago Perovic. Many geometrical parameters of facies auricularis were measured, which we considered important for further studies, simulations of joint's action, transfer calculations of the forces from spine to hip joint. We used paper, which partially adapted to the surface of facies auricularis, so the values are closer to real ones than projection values. The results have shown that the average surface of facies auricularis is 13.46 cm(2). There was no statistical significance found between left and right cadavers. For easier orientation we divided surface of facies auricularis into two parts: vertical and horizontal. Height of the vertical part was 3.99 cm, while the width was 2.05 cm. Height of horizontal part was 2.07 cm and the width 3.62 cm.