Assessing the potential for human exposure and resultant health risk from applying dioxin-contaminated papermill sludge to agricultural and silvicultural lands in Central Wisconsin is a complex issue. This is an intricate problem with many facets to consider. Among the exposure and risk assumption issues discussed are application of dioxin and furan equivalency factors; acceptable daily intake levels; cancer risk levels; and exposure scenarios including food, air, dermal, and soil ingestion. The range of regulatory options run from banning any application of dioxin-contaminated sludge to establishing acceptable or tolerable contamination limits. A preliminary assessment of potential human exposure scenarios found a many thousand-fold range of risk.

Air Pollutants↗

PubMedDate not supplied

Sport fish consumption and body burden levels of chlorinated hydrocarbons: a study of Wisconsin anglers.

Sport-caught fish consumption is the major source of polychlorinated biphenyls (PCBs) exposure for the general population. To assess this and 2,2'-bis-(p-chlorophenyl)-1,1-dichloroethylene (DDE) exposure, we surveyed 801 Wisconsin anglers for fishing and consumption habits and comprehension of and compliance with the Wisconsin fish consumption health advisory. The mean annual number of sport-caught fish meals was 18. Seventy-two percent of anglers were familiar with the health advisory and 57% had changed their fishing or fish consumption habits as a result of the advisory. The mean PCB serum congener sum level for 192 anglers was 2.2 micrograms/l (range = nondetectable to 27.1 micrograms/l); mean DDE was 6.3 micrograms/l (range = nondetectable to 40.0 micrograms/l). Statistically significant positive Spearman correlations were observed between sport-caught fish meals and PCB and DDE sera levels (R = .21 and .14, respectively) and between kilograms of fish caught and PCB sera levels (R = .25). These results demonstrate that anglers may provide a population for assessment of PCBs and DDE associated morbidity and mortality.

Adult↗

PubMedDate not supplied

Survival outcomes of patients with giant cell myocarditis bridged by ventricular assist devices.

Giant cell myocarditis is a highly lethal disorder characterized by rapidly progressive congestive heart failure. The aim of this study was to describe the clinical course of patients with giant cell myocarditis who received a ventricular assist device. Patients with giant cell myocarditis were identified from the Multicenter Giant cell Myocarditis Registry. Bridging to cardiac transplantation in the giant cell myocarditis patients who received a ventricular assist device was compared with bridging in the general population of heart failure patients, as reported in the literature. Median posttransplantation survival for patients with giant cell myocarditis who received and did not receive ventricular assist devices was calculated by the Kaplan-Meier method and compared with use of the log-rank test. Nine patients with giant cell myocarditis who received ventricular assist devices were identified. Seven patients survived to transplantation, four were alive 30 days posttransplantation, and two survived to 1 year. The rate of successful bridging to transplantation in seven of nine patients (78%) is similar to that reported for other ventricular assist device recipients. Posttransplantation survival of 57% (4 of 7) at 30 days and 29% (2 of 7) at 1 year was significantly lower compared with 93% 1-year survival of the 30 patients with giant cell myocarditis who did not receive ventricular assist devices before transplantation (p<0.001). Ventricular assist devices can be an effective bridge to transplantation for patients with heart failure caused by giant cell myocarditis. Although their posttransplantation survival was poor in our series, a few patients had long-term survival.

Adolescent↗

PubMedDate not supplied

Increased incidence of chronotropic incompetence in older donor hearts.

BACKGROUND: Previous Registry studies have reported that heart transplantation with older donor hearts is associated with a more than twofold increase in early mortality. METHODS: An analysis of 77 consecutive patients undergoing heart transplantations at our institution between June 1988 and July 1994 was performed to assess the effect of donor age on mortality and morbidity. Recipients were grouped into those receiving hearts from younger donors (aged < 40 years, n = 60) and those receiving hearts from older donors (aged > 40 years, n = 17). RESULTS: There were two deaths within the first 30 days in the younger donor group and no deaths in the other group. One-year survival rate was 95% and 100% for the "younger" and "older" groups, respectively. The mean recipient age of the younger donor group was lower (46 +/- 14 years) compared with the older donor group (57 +/- 7 years). Morbidity was compared between the two groups; the length of hospital stay (22.6 +/- 15.8 days versus 21.3 +/- 9.4 days), the graft ejection fraction at 1 week (64% +/- 5% versus 62% +/- 7%), and the mean number of rejection episodes within the first 3 months (0.79 versus 0.65) were not statistically different between the two groups. However, the incidence of chronotropic incompetence requiring permanent pacemaker implantation was significantly greater in the group who received older donor hearts (41.2% versus 10.3%, p < 0.05), independent of the ischemic time. CONCLUSIONS: This study shows that older donor hearts may be used safely in selected patients with excellent outcome, although there is an increased incidence of chronotropic incompetence requiring implantation of permanent pacemakers.

Adolescent↗

PubMedDate not supplied

Methylergonovine-induced diffuse coronary spasm in a patient with exercise-induced coronary spasm after heart transplantation.

Coronary artery spasm is a rarely reported condition after heart transplantation. We report a case of exercise-induced coronary artery spasm in a patient 1-year after orthotopic heart transplantation. Serial quantitative coronary angiography showed significant diffuse loss of luminal diameter. Provocative testing with intracoronary acetylcholine and intravenous methylergonovine maleate was performed in an effort to document efficacy of the antispasm regimen. Infusion of acetylcholine into the left anterior descending coronary artery resulted in transient closure of the vessel. Diffuse spasm resulting in hypotension and ventricular fibrillation occurred with intravenous methylergonovine maleate administration. Because of the risk of provoking diffuse spasm, intravenous administration of methylergonovine maleate should be avoided in the posttransplantation setting. Review of the literature suggests that coronary artery spasm after transplantation is often associated with severe transplant coronary artery disease and may be associated with a poor prognosis. Coronary artery spasm may be a more common cause of syncope and death after transplantation than it is currently thought to be.

Acetylcholine↗