Three-dimensional computed tomography overlay for pulmonary vein antrum isolation: Follow-up and clinical outcomes.

BACKGROUND: To facilitate the creation of circumferential lines in pulmonary vein (PV) antrum isolation, three-dimensional (3D) navigation systems are used widely. Alternatively, 3D reconstructions of the left atrium (LA) can be superimposed directly on fluoroscopy to guide ablation catheters and to mark ablation sites. METHODS: In 71 atrial fibrillation patients circumferential PV ablation was performed. 3D reconstructions of the LA were derived from contrast cardiac-computed tomography and circumferential PV isolation was performed. In subsequent ablation procedures, veins were re-isolated, and defragmentation or linear lesions were performed if necessary. RESULTS: Adequate 3D reconstructions were formed and registered to fluoroscopy in all patients. All veins, except 2 in one single patient, could be isolated, resulting in freedom of AF in 45 patients (63 %). In 19 patients a second procedure was performed, in which 2.7 ± 1.1 PV per patient were re-isolated; in 3 patients a third procedure was performed. After follow-up of 15 ± 8 months, 51 (91 %) of patients with paroxysmal and 10 (67 %) with persistent AF were free of AF. CONCLUSIONS: The results of 3D overlay for circumferential PV isolation are good, although the reconduction rate and need for subsequent ablations remains high, and the outcomes of this technique appear to be equivalent to other mapping techniques.

Evaluation of a real-time hybrid three-dimensional echo and X-ray imaging system for guidance of cardiac catheterisation procedures.

Minimally invasive cardiac surgery is made possible by image guidance technology. X-ray fluoroscopy provides high contrast images of catheters and devices, whereas 3D ultrasound is better for visualising cardiac anatomy. We present a system in which the two modalities are combined, with a trans-esophageal echo volume registered to and overlaid on an X-ray projection image in real-time. We evaluate the accuracy of the system in terms of both temporal synchronisation errors and overlay registration errors. The temporal synchronisation error was found to be 10% of the typical cardiac cycle length. In 11 clinical data sets, we found an average alignment error of 2.9 mm. We conclude that the accuracy result is very encouraging and sufficient for guiding many types of cardiac interventions. The combined information is clinically useful for placing the echo image in a familiar coordinate system and for more easily identifying catheters in the echo volume.

Juvenile sex-only and sex-plus offenders: an exploratory study on criminal profiles.

In this study, research was done on the criminal profiles of a large group of juvenile sex-only and sex-plus (sex and other offenses) delinquents (N = 4,430) in the Netherlands. Use was made of information from police records. Results show that sex-plus offenders start their careers earlier, that more of these offenders are of non-Dutch origin, that they commit more crimes, and will partly continue their criminal career after their adolescence. Juvenile sex-only offenders rarely go on committing crimes. In sex-plus offenders, sexual crimes play only a minor role in their total crime repertory. As time goes by, their criminal career will develop into the direction of property crimes. Finally, the implications and limitations of this study will be discussed.

Anti-GQ1b antibodies and evoked acetylcholine release at mouse motor endplates.

Miller Fisher syndrome (MFS) is clinically characterized by ataxia, areflexia, and ophthalmoplegia, and is associated with serum anti-GQ1b-ganglioside antibodies. We have previously shown that anti-GQ1b antibodies induce complement-dependent, alpha-latrotoxin-like effects at mouse neuromuscular junctions (NMJs) in vitro. This effect comprises a massive increase in spontaneous quantal acetylcholine (ACh) release, accompanied by block of evoked release and muscle paralysis. This mechanism may contribute to the motor features of MFS. Whether the block of evoked ACh release is a primary effect of anti-GQ1b antibodies or occurs secondary to massive complement-dependent spontaneous release is unknown. Using conventional micro-electrode methods, we measured in detail ACh release evoked with low- and high-rate nerve stimulation, and studied the effect on it of a purified MFS IgG and a mouse monoclonal anti-GQ1b IgM (without added complement). We found that evoked transmitter release was unaffected. Control experiments proved binding of anti-GQ1b antibody at the NMJ. We conclude that the block of nerve-evoked ACh release at the NMJ is not a primary effect of anti-GQ1b antibodies, but is dependent on antibody-mediated complement activation. It remains to be determined whether the block of nerve-evoked ACh release is the consequence of massive spontaneous ACh release or occurs as a concomitant event.

Monoclonal antibodies raised against Guillain-Barré syndrome-associated Campylobacter jejuni lipopolysaccharides react with neuronal gangliosides and paralyze muscle-nerve preparations.

Guillain-Barré syndrome and its variant, Miller-Fisher syndrome, are acute, postinfectious, autoimmune neuropathies that frequently follow Campylobacter jejuni enteritis. The pathogenesis is believed to involve molecular mimicry between sialylated epitopes on C. jejuni LPSs and neural gangliosides. More than 90% of Miller-Fisher syndrome cases have serum anti-GQ1b and anti-GT1a ganglioside antibodies that may also react with other disialylated gangliosides including GD3 and GD1b. Structural studies on LPS from neuropathy-associated C. jejuni strains have revealed GT1a-like and GD3-like core oligosaccharides. To determine whether this structural mimicry results in pathogenic autoantibodies, we immunized mice with GT1a/GD3-like C. jejuni LPS and then cloned mAb's that reacted with both the immunizing LPS and GQ1b/GT1a/GD3 gangliosides. Immunohistology demonstrated antibody binding to ganglioside-rich sites including motor nerve terminals. In ex vivo electrophysiological studies of nerve terminal function, application of antibodies either ex vivo or in vivo via passive immunization induced massive quantal release of acetylcholine, followed by neurotransmission block. This effect was complement-dependent and associated with extensive deposits of IgM and C3c at nerve terminals. These data provide strong support for the molecular mimicry hypothesis as a mechanism for the induction of cross-reactive pathogenic anti-ganglioside/LPS antibodies in postinfectious neuropathies.

[Osseous desmoid fibroma of the mandible. An unusual case in a 15-month-old infant]. / Fibrome desmoïde osseux du maxillaire inférieur. Cas exceptionnel d'un enfant de quinze mois

The authors present a rare case, unique in the literature, of an osseous desmoid fibroma in which the histological diagnosis was made at the age of fifteen months. The signs were of a slight swelling with complete trismus of the mandible. After excision of the tumour, with a resultant defect in the superior ramus of the mandible, the trismus disappeared spontaneously after two weeks.