The differential prenatal diagnosis of cystic hygromata and encephalocele by ultrasound examination

The difficulty in distinguishing an encephalocele from a cystic hygroma has recently been highlighted by five patients referred to our unit with an incorrect diagnosis of cystic hygroma. A review of the literature revealed four other cases of misdiagnosis. Based on review of 46 patients with one or other diagnosis, we have attempted to establish guidelines to aid diagnosis. We have always been able to identify the bony defect in the fetal vault in cases of encephaloceles. The pattern of the septa is usually characteristic in cystic hygroma.     

A comparative study of the orbicularis oculi muscle to the adductor pollicis muscle during vecuronium neuromuscular blockade

This study compared the orbicularis oculi muscle to the adductor pollicis muscle during vecuronium blockade. The orbicularis oculi muscle was found to be more resistant to and recovered from vecuronium neuromuscular blockade faster than the adductor pollicis muscle. Thus, caution should be utilized when assessing neuromuscular block with the orbicularis oculi muscle.     

Catheter intramural needle radiofrequency ablation creates deeper lesions than irrigated tip catheter ablation

Radiofrequency ablation of the left ventricle using an endocardially placed electrode is unable to reliably create transmural lesions even with active electrode cooling. To produce deeper radiofrequency lesions, the authors developed and tested a prototype intramural needle ablation catheter that had a distal 1.1-mm diameter straight needle that could be advanced 12 mm into the myocardium. Freshly excised hearts from eight male sheep were perfused and superfused with oxygenated ovine blood. Ablations were performed for 60 seconds with the prototype catheter and a conventional 5-mm irrigated tip ablation catheter at target temperatures of 90 degrees C and 50 degrees C, respectively. The ablation lesions were bisected and stained with blue tetrazolium to assess lesion geometry. The irrigated tip ablation catheter required significantly more power than the intramural needle ablation catheter (37.7 +/- 7.3 vs 6.4 +/- 2.1 W, P < 0.01). Intramural needle lesions were significantly deeper (12.5 +/- 3.0 mm vs 8.3 +/- 2.1 mm, P < 0.01) but less wide (3.9 +/- 1.1 mm vs 11.5 +/- 2.0 mm, P < 0.01) than irrigated tip lesions. There was a high incidence of crater formation (74%), popping (45%), and myocardial charring (29%) during irrigated tip ablation; these phenomena were not observed during intramural needle ablation. The intramural needle ablation catheter creates significantly deeper but narrower lesions without evidence of tissue boiling. This technology may be particularly useful for ablation of ventricular tachycardia originating from regions where tissue depth is increased, like the ventricular septum.     

Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8–23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition-sensitive agriculture programme

Inadequate diet quality is a cause of undernutrition among children 6–23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8–23 months. Data were collected from 45 mothers of children 8–23 months, who provided animal-source foods to their children (doers), and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severity and perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at home and the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn income and support gender-equitable household workloads and decision-making for optimal child feeding.