INTRACARDIAC TUMOURS – EXPERIENCE WITH 12 CASES

Twelve cases of intracardiac tumours operated during the period 1975 to 1994 are presented. There were 8 males and 4 females in the age range of 18 years to 64 years. Tumours were located in the left atrium in 10 patients and in the right atrium in 2 patients. Standard cardiopulmonary techniques were followed. The right atrial tumours were approached through a right atrial incision while the left atrial tumours were approached through a bi-atrial trans-septal approach. One patient underwent a perineal urethrolithotomy for an impacted urethral calculus at the same sitting. Eleven of the tumour masses excised were myxomas confirmed on histopathology. The last patient, operated for synovial sarcoma of the left knee 2 years before, presented with a metastatic tumour mass in the left atrium. No deaths occurred in the series.KEY WORDS: Heart neoplasms, Heart surgery, Myxomas     

SILENT MYOCARDIAL ISCHEMIA IN HEMODIALYSIS PATIENTS — FACTOR FICTION?

Thirty eight patients underwent Holter ECG monitoring for a 48 hour period covering dialysis and intermediate period to detect incidence of myocardial ischemia manifesting as ST segment changes. Seventeen patients (44.7%) had 165 episodes of dynamic ST segment changes lasting from 1 to 177 minutes, with maximum ST depression of 4 mm. The mean age of patients was 45 ± 14 years and 14 (82.6%) of them were males. Ten (58.8%) patients had hypertension, and 5 (29.4%) patients each had diabetes mellitus and pre-existing coronary artery disease. Six (35.3%) patients with dynamic ST segment changes had ventricular ectopics ranging from isolated ventricular premature contractions to episodes of ventricular tachycardia. No significant hypotension or angina was documented during these episodes of ST segment deviation. We concluded that hemodialysis plays an important role in the genesis of the above ECG changes.KEY WORDS: Ischemic heart disease, Holter monitoring, Renal dialysis     

Construction of an ultrasound biopsy phantom

The technique for construction of an agar-based ultrasound biopsy phantom is described. Features include tissue equivalent reflectivity, long life and non-shadowing targets. The phantom is useful for learning the necesary co-ordination between needle and probe for ultrasound needle guidance. This skill should initially be practised in vitro, on a device such as this.     

Female fertility, obstetric and gynaecological history in coeliac disease: a case control study

Objectives : The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. Method : This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. Results : The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD± 0.9) compared to 2.5 (SD± 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD±0.9) compared to 0.7 in controls (SD±1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. Conclusions : Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.     

Co-bedding as a Comfort measure For Twins undergoing painful procedures (CComForT Trial)

Background  

Co-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), thus creating the opportunity for skin-to-skin contact and touch between the twins. In studies of mothers and their infants, maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates. It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact. The intent of this study is to compare the comfort effect of co-bedding (between twin infants who are co-bedding and those who are not) on infant pain response and physiologic stability during a tissue breaking procedure (heelstick).     

Insights into age- and sickle-cell-disease- interaction using principal components analysis

Background  

In the context of sickle cell anemia, peripheral blood indexes provide key information that is also potentially influenced by age. Therefore, it is necessary to understand the extent and nature of interactions between sickle cell anemia and age, especially in situations where there is a high prevalence of sickle cell anemia.