Inadvertent pacemaker lead dislodgement.

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for aortic valve stenosis in patients with a high risk for conventional surgical valve replacement. A well-known complication is the development of conduction abnormalities. In the case of a new third-degree atrioventricular block, the complication can be life-threatening and permanent pacing is needed. Often these patients have a venous sheath placed in the jugular vein for the perioperative period. We report a case of inadvertent dislodgement of a permanent pacemaker lead after removal of a preoperatively placed venous sheath in a TAVI patient.

How to prevent inadvertent emergency anticoagulation in acute type A aortic dissection: when in doubt, don't.

Inadvertent emergency anticoagulation in patients with acute type A aortic dissection (ATAAD) has been sparsely reported. There are case reports bringing this potential critical incident to attention, however, little is known about the number of undetected and unreported cases. We approach this issue based on a case report of inadvertent emergency anticoagulation in ATAAD and attempt to shed light on aspects that may have contributed to the critical incident: The challenge of distinguishing an ATAAD from an acute coronary syndrome (ACS) and the potential underestimation of incidents of ATAAD. We also discuss errors and biases in medical decision making, and provide suggestions that may help raise awareness of how ATAAD can be mimicking ACS in clinical practice.

Chemical contaminants in fish species from rivers in the North of Luxembourg: Potential impact on the Eurasian otter (Lutra lutra).

Contamination levels of PCBs, and of the heavy metals cadmium (Cd), lead (Pb) and mercury (Hg) were analyzed in four fish species from seven rivers in the North of Luxembourg. During August and September 2007, 85 samples of fish were collected belonging to four species: the stone loach (Barbatula barbatula, n=12 pools), the chub (Squalius cephalus, n=36), the barbel (Barbus barbus, n=23) and eel (Anguilla anguilla, n=14). The concentration of seven indicator PCBs ( summation operator(7)PCBs) reached a mean of 39ngg(-1) and varied between 4.0 and 346.2ngg(-1) (wet wt) depending on the site and species. Fish collected at Wallendorf on the Our River and sites on the Wiltz and the Clerve rivers showed the highest concentrations for PCBs. In comparison with 1994, PCB levels in fish decreased strongly during the last decade in these rivers. Lead was detected at low levels (0-181.4ngg(-1) wet wt). Mercury concentrations ranged between 10.3 and 534.5ngg(-1) (wet wt) exceeding maximum tolerable levels for human consumption of 500ngg(-1) in two fish out of 85. Chubs and eels from the Sûre River were the most contaminated by mercury. Cadmium levels varied between 4.0 and 103.9ngg(-1) (wet wt). In addition to mercury in fish, cadmium was the most problematic pollutant on the Our, the Wiltz, the Clerve and the Troine Rivers, because values found in 20% of fish exceeded the threshold of about 10-50ngg(-1) (wet wt) recommended for human health. The total PCB level predicted to accumulate in livers from otter potentially feeding on these fish based on a previously published mathematical model is 37.7microgg(-1) (lipid wt), which is between a proposed "safe level" and a "critical level" for otters. Rivers in the North of Luxembourg are thus to some extent polluted, and the establishment of otter populations could be affected by current levels of contamination.

Type-I but not type-II interferon receptor knockout mice are susceptible to biliary atresia.

The etiology of biliary atresia (BA) is not yet understood, but recent studies have shown inflammation with an up-regulated interferon (IFN) activity in the intra- and extrahepatic bile ducts of patients with BA. These findings support an inflammatory/infectious cause of BA as mimicked in our infective murine model. To study the role of the IFN receptors in our model, we used mice with inactivated INF-alpha/beta receptor A129, with inactivated IFN-gamma receptor G129, or inactivation of both interferon receptors AG129 as well as the wild type controls W129. Mice were infected with rotavirus within 48h of birth and 7 d postpartum. The incidence of BA in each group was determined during a 3 wk period. In the second week the virus load was measured. BA incidence was 76% in A129 and 67% in AG129 animals, whereas in the G129 group only 33% of the pups developed BA. The wild type presented with a BA-incidence of 15%, while 7 d old mice failed to develop BA. There was no significant difference in the virus load of the livers between the groups independent of clinical symptoms. In conclusion, inactivation of type I INF-receptor significantly increases the incidence of BA following postpartal rotavirus infection. This effect is independent of the presence of type II-INF-receptors. Thus, in our model a type I IFN-linked deregulation of the innate immune system appears to be crucial for the induction of biliary atresia.

Computerized three-dimensional study of a rotavirus model of biliary atresia: comparison with human biliary atresia.

Biliary atresia is a panbiliary disease causing obstructive jaundice in neonates and infants. The clinical spectrum can be broadly categorized into the fetal and perinatal types. A consistent animal model that accurately mimics the whole clinical spectrum of biliary atresia is not yet available. However, rotavirus infection of neonatal mice has been shown to produce atresia in the biliary system. This study investigates the three-dimensional computerized morphology of the murine neonatal model comparing with age-matched control mice. Newborn Balb/c mice were injected intraperitoneally with rhesus rotavirus within 24-48 h after birth. Control mice received 0.9% NaCl. Pups with symptoms of cholestasis were sacrificed from the 5th to the 15th postinjection day, as were age-matched controls. Their hepatobiliary tissues were prepared for three-dimensional computerized image reconstruction. Rotavirus infection caused obliteration of the intrahepatic bile ducts and single to multiple atresias in the extrahepatic bile duct. At 15 days postinjection, intrahepatic ductal proliferation appeared, and the three-dimensional appearances of the intrahepatic biliary structures were similar to the human disease. Cystic duct and gallbladder dilatation was frequently seen in this model, and this feature distinguishes it from the human disease in which the gallbladder is almost always atretic. This rotavirus murine model demonstrates many of the features of human perinatal biliary atresia, and can be used as an investigative tool to further study the pathogenesis of biliary atresia.