Baritosis

Pneumatosis intestinalis is defined as the presence of gas in the bowel wall. The combination of the two risks, pre-existing connective tissue diseases and barium contrast examination, may trigger pneumatosis intestinalis, albeit at a low incidence. Clinicians should be aware of the condition for proper differential diagnosis.

The most feared complication of pulmonary vein isolation (PVI) is an atrioesophageal fistula (AEF). While rare (0.1-0.25%), primary surgical closure (as opposed to esophageal stenting) is associated with lower mortality. Pericardioesophageal fistula (PEF) may present prior to fistulization into the atrium. Unfortunately, data on the optimal management of PEFs is lacking.

71 year old male with AF presented with chest pain 3 weeks after radiofrequency PVI. CTA chest and echocardiogram showed pneumopericardium. Barium esophagram showed extravasation from esophagus into the pericardium without connection to the left atrium. Sternotomy with mediastinal exploration exposed the pericardial defect, over which a CorMatrix patch was placed. The fistula was then stented endoscopically with endosuture fixation. Post-stent esophagram did not show barium leak and the patient was discharged home. One week later, the patient returned with enterococcal and candida bacteremia and an acute right parietal/occipital lobe infarct. Barium esophagram showed contrast extravasation into the pericardium. The patient rapidly succumbed to his illness and died. Autopsy revealed pericardial abscess posterior to the LA in communication with the esophagus. Extension to the LA was not seen.

While the surgical treatment of AEF is relatively well established, there is no consensus in the management of PEF. While prior small series have suggested PEF may be managed with esophageal stenting, our case illustrates the limitations of this approach. This article is protected by copyright. All rights reserved.

In this paper, we have performed determination of the concentration of twenty elements in seven human organs (spleen, liver, kidney, muscle, heart, lungs, and brain) using two-jet plasma atomic emission spectrometry. The method allows multielemental analysis of solid samples without wet acid digestion. Before analysis, all human organs were first dried, ground to powders, and carbonized. The relative content of elements in each of the seven organs was very different depending on the donor. The average content of twenty elements in various organs varied in the following ranges (μg/g of dry weight): Ag (<0.02-0.2), Al (2.1-263), B (<0.5-2.5), Ca (323-1650), Cd (<0.1-114), Co (<0.2-1.0), Cr (<0.5-4.0), Cu (4.2-47), Fe (156-2900), Mg (603-1305), Mn (0.47-8.5), Mo (<0.2-4.9), Ni (<0.3-3.1), Pb (<0.3-1.9), Si (31.6-2390), Sn (<0.3-3.2), Sr (0.2-1.0), Ti (<2-31, mainly in lungs), and Zn (120-292). The concentration range of Ba in organs of five donors was <0.2-6.9 and 2.0-5600 for one donor with pneumoconiosis (baritosis). The maximum element contents were found, respectively, in the following organs: Al, B, Cr, Ni, Si, Sn, Sr, Ti (lungs), Fe (lungs and spleen), Mn (liver and kidney), Ag and Mo (liver), Ca (lungs and kidney), Cu (brain), Cd (kidney), Pb (brain), and Zn (liver, kidney, and muscle). The minimal content of elements was observed, respectively, in the following organs: Ag (all organs except liver), Ba (spleen, muscles, and brain), Ca and Mg (liver), Si (liver, muscle, and brain), Cd and Sr (heart and brain), Al, Cu, Fe, and Mn (muscle), and Zn (spleen and brain). The analysis of possible biological role and reasons for the increased content of some elements in the organs analyzed was carried out.