Massive pulmonary haemorrhage in the newborn infant

Six cases of massive pulmonary haemorrhage in newborn infants are described. 2 term infants suffered severe birth asphyxia and massive pulmonary haemorrhage presented early (mean 5 hours); in 4 preterm infants massive pulmonary haemorrhage presented late (mean 4 days) while receiving assisted ventilation. All the infants were treated with positive pressure ventilation, vigorous correction of pH, anaemia, and hypovolaemia, and 4 survived the acute condition. We suggest that the early elective use of intermittnet positive pressure ventilation may be effective in controlling the pulmonary haemorrhage.     

Comparative evaluation of gustatory function between postmenopausal women and age‐matched men

Oral Diseases (2010) 16 , 469–475 Objective: The aim of the study was to compare the gustatory function between postmenopausal women and age‐matched men. Subjects and methods: During a period of 4 months, 30 postmenopausal women and 30 age‐matched men were prospectively evaluated for gustatory function. Each subject was given a symptoms questionnaire for self‐assessment of taste function. Then, whole mouth taste test was performed in which the quality identification and intensity ratings of taste solutions were measured. Results: Regarding correct quality identification, the results were statistically non‐significant (P > 0.05). As far as the intensity judgments are concerned, significant difference exists between postmenopausal women and age‐matched men. Intensity of taste perception for sucrose was significantly lower in postmenopausal women than intensity of taste perception for other tastes (P < 0.05). One of the noticeable findings is that 15 (50%) postmenopausal women reported a change in dietary habits; all expressed liking for sweeter food. Conclusion: Postmenopausal women appeared to have a reduced perception of sucrose, which can alter eating habits, such as intake of more sweet foods, whereas no significant difference is observed in taste perception of NaCl, citric acid and quinine hydrochloride between postmenopausal women and age‐matched men. Fifteen (50%) postmenopausal women stated fondness for sweet taste.     

The spectrum of injuries resulting from posterior abdominal stab wounds: a South African experience

Introduction

The spectrum of injury associated with anterior abdominal stab wounds (SWs) is well established. The literature on the spectrum of organ injury associated with SWs to the posterior abdomen, however, is limited.

Methods

We reviewed our experience of 105 consecutive patients who had established indications for laparotomy managed over a 4-year period in a high volume trauma service in South Africa.

Results

Of the 105 patients, 97 (92%) were male and the overall mean age was 24 years. Fifty-seven patients (54%) had immediate indications for laparotomy. The remaining 48 patients (46%) initially underwent active clinical observation and the indications for laparotomy became apparent during the observation period. Of the 105 laparotomies performed, 94 (90%) were positive and 11 (10%) were negative. Of the 94 positive laparotomies, 92 were therapeutic and 2 were non-therapeutic. A total of 176 organ injuries were identified: 50 (53%) of the 94 patients sustained a single organ injury while the remaining 44 (47%) sustained multiple organ injuries. The most commonly injured organs were the colon (n=63), spleen (n=21) and kidney (n=19).

Conclusions

The pattern of intra-abdominal injuries secondary to SWs to the posterior abdomen is different to that seen with the anterior abdomen. Colonic injury is most commonly encountered, followed by injuries to the spleen and kidney. Clinicians must remain vigilant because of the potential for occult injuries.     

Incidence of Perforation and Other Mechanical Complications During Dual Active Fixation

The intraoperative and early postoperative mechanical complications of a procedure combining an atrial screw-in lead and a ventricular screw-in lead insertion were prospectively evaluated. The procedure was performed in 119 consecutive patients (mean age 69 ± 8 years), at first implant in 100 patients and at reoperation in 19. Nine patients had previously undergone cardiac surgery and three underwent transvenous ventricular defibrillator implantation. The double sets of leads were introduced through 2 separate veins in 5 cases, through a single venous route in 114 cases, using a percutaneous approach in 75 cases and a venous cutdown in 49, and a guidewire procedure following the venotomy in 19. The screw was mannitol coated in 102 cases, exposed in 111, and extendable/retractable in 25. The fixation of the ventricular lead was performed at the apex in 108 cases, at the outflow tract in 11, and was followed by the fixation of the atrial lead at the appendage in 112 cases and at the lateral wall in 7 cases. The lead positioning and fixation were successful at first attempt in 103 cases and after repeated lead manipulation in 19 cases. The rotational torque could be transferred to the helix in all cases except in one patient who required a second vein puncture. Unintentional fixation in the ventricular chamber with subsequent failure to remove the lead occurred in one patient. Reoperation for lead dislodgment was required in two patients. In one patient, symptomatic pericarditis with pericardial effusion was observed 1 day after the procedure and resolved spontaneously. Dual active fixation is feasible with a low incidence of mechanical complications.     

Internal Cardioversion of Chronic Atrial Fibrillation

Chronic atrial fibrillation (AF), a common arrhythmia in clinical practice presents the danger of systemic embolization and an untoward effect on cardiac function. Furthermore, in occasional patients symptoms related to rapid ventricular response, resistant to bradycardiac agents, may lead to electrical ablation of the atrioventricular junction. A new technique of internal cardioversion of AF is described. It consists of delivering high energy shocks (200–400 joules) between the proximal electrode of a quadripolar catheter (cathode) and a backplate (anode). The catheter is positioned in the tricuspid valve area and pulled back just inferior to the site of the His bundle recording. This technique was performed in 24 patients. In all patients external cardioversion failed to restore sinus rhythm. All patients complained of symptoms despite antiarrhylhmic therapy. Sinus rhythm was restored by internal cardioversion in 20 of the 24 patients (83%). However, AF recurred in 7 of the 20 patients before hospital discharge. The only complication noted was transient atrioventricular block in 9 patients treated with prophylactic ventricular pacing. Of the 13 patients who were in sinus rhythm at the time of hospital discharge, 6 patients (46%) remained on stable sinus rhythm. Recurrence of atrial fibrillation was noted in the remaining 7 patients, in 4 within the first 4 months and in 3 patients 8, 9 and 18 months, respectively, after the procedure. A second attempt of internal cardioversion was performed in 3 and was successful in 2. With a follow-up ranging from 13 to 37 months (mean 25 months), 6 patients (49%) are in sinus rhythm. This study suggests that internal cardioversion may be useful in selected patients with chronic AF.     

Complete amino acid sequence of goose VLDV-neurophysin Traces of a putative gene conversion between promesotocin and provasotocin genes

Goose VLDV-neurophysin (mesotocin-associated neurophysin) has been purified from posterior pituitary glands through molecular sieving on Sephadex G-75 and high-pressure reverse-phase liquid chromatography on Nucleosil C-18 columns. Despite apparent molecular mass of unreduced VLDV-neurophysin measured by polyacrylamide gel electrophoresis with sodium dodecylsulfate appeared near 17kDa, this value fell to 11 kDa after reduction with mercaptoethanol, suggesting the existence of a homodimer. Complete amino acid sequence (93 residues) of goose VLDV-neurophysin has been determined. N- and C-terminal sequences of the protein have been established by Edman degradation (microsequencing) and use of carboxypeptidase Y, respectively. Peptides derived from oxidized or carboxamidomethylated neurophysin by trypsin or staphylococcal proteinase hydrolyses have been isolated by high-pressure liquid chromatography and microsequenced, allowing determination of the complete sequence. Comparison within the vertebrate VLDV-neurophysin lineage, namely goose VLDV-neurophysin to mammalian VLDV-neurophysins and to deduced toad VLDV-neurophysin, reveals a residue insertion between positions 66 and 67 in the nonmammalian VLDV-neurophysins. When goose MSEL-neurophysin (vasotocin-associated neurophysin) and goose VLDV-neurophysin are compared to their bovine counterparts, identical substitutions are found in positions 17 (Asn in both goose neurophysins instead of Gly in both ox neurophysins), 18 (Arg instead of Lys), 35 (Tyr instead of Phe), and 41 (Thr instead of Ala). Identity of the sequences 10-74 in both ox neurophysins has been explained by partial gene conversion between oxytocin and vasopressin genes, and identical substitutions in both goose neurophysins might reveal a similar gene conversion between mesotocin and vasopressin genes in birds.     

Is There Any Indication for an Intracardiac Defibrillator for the Treatment of Atrial Fibrillation?

ICD for Treatment of AF. The experience gained using intracardiac cardioverter defibrillators for the treatment of ventricular arrhythmias has prompted the development of an automatic atrial defibrillator capable of detecting and automatically terminating atrial fibrillation (AF). Experimental studies in sheep have shown that it is possible to terminate AF with energies ranging from < 1 to 7 joules [J], using biphasic shocks. The best electrode configuration using intracardiac catheters and/or a subcutaneous patch was two catheters, one in the right atrium and the other in the coronary sinus. Current studies in man focus on the answers to three questions. First, can the experimental results of atrial defibrillation derived from healthy anesthetized sheep without spontaneous AF be extrapolated to AF in man with areas of fibrosis within the atria and/or underlying heart disease in 80% of cases? Preliminary studies in man suggest that cardioversion of AF of short duration is feasible using a mean energy of 2 J. Second, are these energies well tolerated in an awake nonsedated patient? Energies < 1 J were well tolerated, but pain resulting from higher energies needs further investigation. Third, is low-energy atrial defibrillation safe, i.e., is there a risk of ventricular arrhythmias induced by an atrial shock? Experimental results in sheep have shown that the risk of R wave synchronized shock to induce ventricular arrhythmias was only present when the preceding RR interval was shorter than 300 msec. The risk of proarrhythmia in man is undergoing evaluation and must be sufficiently low (< 0.1) before sanctioning implantation of a stand-alone (without associated ventricular defibrillator) automatic atrial defibrillator. Preliminary data on 1212 shocks showed no proarrhythmia. There is definitely a significant group of patients with attacks of AF (Class IIIB or IIIC) that are resistant to antiar-rhythmic therapy. Another group of symptomatic patients may have infrequent attacks, or poorly tolerated (syncope or heart failure) or long-lasting attacks requiring medical intervention and/or hospitalization (Class IB, IIB), for whom an automatic atrial defibrillator may be a valuable option. The alternative therapies could be either catheter ablation of the AV node with implantation of a pacemaker or selective surgery. Most of the technical problems related to AF detection and reliable atrial defibrillation have been solved. However, clinical investigations are needed to evaluate the efficacy and safety of this new and exciting therapeutic modality.