IMAGES IN CARDIOLOGY: LEFT VENTRICULAR FREE WALL RUPTURE

Left ventricular free wall rupture is thought to account for approximately 15% of deaths following acute myocardial infarction (MI). We present a case of left ventricular free wall rupture in a 64-year-old man following a lateral MI. The diagnosis was made with 2D and colour flow Doppler echocardiography. Unfortunately the patient died before emergency surgery, could be performed.     

Headaches and stress in schoolchildren: an epidemiological study

Headache parameters, personality variables and stress factors were assessed in a sample of about 2,300 school pupils between 10 and 17 years of age in Amsterdam. More than 15% of the subjects reported headaches occurring weekly. Fear of failure and school problems, but not achievement motivation, had significant positive correlations with headache complaints after correction for differences in sex and age. Menarche and social class had little bearing in relation to the headache variables. From all reported causes of headache, stress was mentioned most frequently in both elementary and secondary schools.     

A prospective, randomized, double-blind study for the evaluation of assisted hatching in patients with advanced maternal age

The objective of this study was to determine if assisted hatching improved the rates of implantation, clinical pregnancy and ongoing pregnancy for in-vitro fertilization (IVF) patients aged > or =36 years. On the day of oocyte aspiration, consenting patients were randomized according to whether all embryos underwent the hatching procedure (hatched; n = 41) or all embryos remained unhatched (controls; n = 48). Patients in both groups were treated with methylprednisolone and doxycycline starting on the day of oocyte retrieval and continuing for 4 days. The hatching procedure was performed approximately 55 h after insemination on all potential embryos for transfer and employed the release of acidified acid Tyrode's medium against the zona pellucida to create an opening approximately 20 microm in diameter. No significant differences were noted in the mean age, number of oocytes aspirated and number of embryos transferred between the hatched and control groups. In addition, no significant differences were observed in the rates of implantation (11.1 versus 11.3%), clinical pregnancy (39.0 versus 41.7%) and ongoing pregnancy (29.3 versus 35.4%) between the hatched and control groups respectively. These results suggest that assisted hatching may have no significant impact on IVF success rates in the patient population studied.      

Toxic Shock Syndrome in a neonate?

Toxic Shock Syndrome is an acute multisystemic disease, characterized by high fever, hypotension and involvment of the skin and mucous membrane, associated with multisystem dysfunction. It is a rare condition in the paediatric population. We describe a newborn child with asphyxia and meconium aspiration, who developed a temperature of ≥38.9°C, severe hypotension and rash with desquamation, associated with evidence of coagulopathy and renal and muscular dysfunction. Strict CDC criteria of toxic shock syndrome were fulfilled in our patient, with all major criteria verified. These criteria have never been validated in neonates, but in this case some symptoms favour a diagnosis of toxic shock syndrome since they are not associated with birth asphyxia, viral intrauterine infection or other disease. We believe a probable intrapartum transmission occurred through ingestion or aspiration of contaminated amniotic fluid. The patient described in this report is, to our knowledge, one of the youngest described to fulfil all of the strict CDC criteria for Toxic Shock Syndrome.