Fetal constrictive pericardial defect with pulmonary capillary hemangiomatosis

Pericardial defect is a rare anomaly that has a variable presentation. Prompt recognition and early surgical intervention are associated with a favorable outcome. The authors present an unusual case of unexpected fetal demise in a 31-week-gestational-age girl who had a large pericardial defect forming a constrictive ring around both ventricular chambers. The defect coexisted with pulmonary capillary hemangiomatosis, an association that has not been reported in cases of pericardial defect. J Pediatr Surg 37:1512-1514.     

Teaching epidemiology inside and outside the classroom

There is no single ideal way of teaching epidemiology. Teaching can take place in different situations, and its techniques and content may differ. A good teaching programme is one that is geared to its students' needs, capacity, interests and preferences, and exploits available teaching situations and techniques to provide learning opportunities that will achieve the educational objectives. This paper reviews some features of the teaching of epidemiology inside and outside the classroom. It starts with a discussion of the main factors that affect the choice of methods and then deals in turn with conventional classroom methods, laboratory teaching (problem-solving and other exercises), self-instruction, problem-oriented projects, and distance learning. Separate consideration is then given to teaching in the hospital and in the field (with special attention to teaching in a community health center).     

Breast lesions detected on MR imaging: features and positive predictive value

OBJECTIVE: The purpose of this study was to analyze features of breast lesions detected on MR imaging that had subsequent biopsy and to determine the positive predictive value (PPV) of these features. MATERIALS AND METHODS: Retrospective review was performed of 100 consecutive solitary MR imaging-detected breast lesions that had MR imaging-guided needle localization and surgical excision. We described lesions, using terms found in a proposed breast MR imaging lexicon. Histologic findings were reviewed. RESULTS: Carcinoma was identified in 25 lesions (25%), including ductal carcinoma in situ (DCIS) in 13 (52%) and infiltrating carcinoma in 12 (48%). Carcinoma was found in 15 (25%) of 60 masses versus 10 (25%) of 40 nonmass lesions; most malignant masses (73%) were infiltrating carcinoma, whereas most malignant nonmass lesions (90%) were DCIS. The features with the highest PPV were spiculated margin (80% carcinoma), rim enhancement (40% carcinoma), and irregular shape (32% carcinoma) for mass lesions and segmental (67% carcinoma) or clumped linear and ductal enhancement (31% carcinoma) for nonmass lesions. Visually assessed kinetic patterns were not significant predictors of carcinoma, but washout was present in 70% of infiltrating carcinomas versus 9% of DCIS lesions (p < 0.01). Carcinoma was present in 17 (19%) of 88 lesions classified as suspicious versus eight (67%) of 12 lesions classified as highly suggestive of malignancy (p = 0.001). CONCLUSION: Among MR imaging-detected breast lesions referred for biopsy, carcinoma was found in 25%, of which half were DCIS. Features with the highest PPV were spiculated margin, rim enhancement, and irregular shape for mass lesions and segmental or clumped linear and ductal enhancement for nonmass lesions. Final assessment categories were significant predictors of carcinoma.     

Patients' views of the burden of asthma: a qualitative study

OBJECTIVES: To explore the burden of asthma on the lives of people presenting to hospital emergency departments for asthma treatment. DESIGN: A qualitative study. Consenting individuals with asthma who presented to emergency departments were interviewed in-depth, and interviews were taped, transcribed and thematically analysed. Questionnaire data on medication use, respiratory health and asthma knowledge were also collected. Asthma severity was determined from the medical records. SETTING: A tertiary teaching hospital and a suburban hospital during March and April 2000, and a rural hospital during July and August 2000. PARTICIPANTS: Sixty-two participants (19 male and 43 female), aged 18-70 years. RESULTS: The burden of asthma was broad, affecting social life, personal relationships, employment and finances. The cost of asthma medication was an issue for nearly two-thirds of participants. Individuals performed their own "cost-benefit analysis" for medication use, weighing up expense, perceived side effects and potential benefits. As a consequence, several participants chose to alter their medication dose, or not to take prescribed medications. For some participants, asthma directly contributed to diminished employment opportunities. CONCLUSIONS: To achieve a therapeutic partnership, doctors need to be aware of the substantial social, personal and financial burden of asthma for their patients. They should also recognise that patients' perceptions of treatment cost may compromise treatment adherence.     

Effect of pneumoperitoneal pressure on tumor dissemination and tumor recurrence at port-site and midline incisions

Over the past several years numerous cases of port site tumor recurrence after laparoscopic resection of a cancerous tissue have been reported. Possible mechanisms for tumor seeding include tumor removal, contaminated instruments, pneumoperitoneum, and aerosolization of tumor cells. This experiment examined the relationship among trocar contamination, aerosolization, and tumor recurrence with increasing pneumoperitoneal pressure using a hamster model. Increased pneumoperitoneal pressure significantly increased both instrument contamination and tumor recurrence at midline and port site incisions. Interestingly, increasing pneumoperitoneal pressure had no significant effect on the number of aerosolized tumor cells. The results reaffirm that the use of a reduced pneumoperitoneum or gasless laparoscopy may significantly lower port site tumor recurrence.     

Aspergillus endocarditis in chronic granulomatous disease

We report the first case, to our knowledge, of Aspergillus endocarditis in chronic granulomatous disease in a patient who also had an atrial septal defect. A diagnosis was made on culture of the organism from the mass despite extensive prior investigation. The presence of distinctive skin lesions as a diagnostic clue of fungaemia is highlighted. Possible advances in diagnosis by detection of fungal cell wall components and in prophylaxis by use of itraconazole are referred to. We conclude that fungal endocarditis should be considered in this condition, especially in the presence of a structural heart defect.