A new technique of impression making for an obturator in cleft lip and palate patient

Cleft lip and palate is a birth defect occurring in the orofacial region. One of the immediate problems to be addressed in a newborn with this defect would be to aid in suckling and swallowing. Here we present a case of a 5-day-old infant with unilateral cleft lip and palate for whom feeding obturator was made by using a simplified impression technique to facilitate feeding.     

Tuberculosis affecting the oesophagus

Three Asian patients presenting with dysphagia were shown to have oesophageal involvement secondary to adjacent tuberculous mediastinal lymph nodes. The findings included fistula between the oesophagus and the tracheobronchial tree and extrinsic compression of the oesophagus. These cases reflect the increasing incidence of mediastinal lymphadenopathy in adult tuberculosis, especially in our immigrant community.     

Effect of recorded maternal voice on child’s cooperation during cardiac catheterization – A randomized controlled trial

Objective

To assess the effect of recorded maternal voice on child’s cooperation during cardiac catheterization.

Design

Randomized placebo controlled trial.

Setting

Cardiac catheterization laboratory at a tertiary care hospital.

Participants

90 children with congenital heart disease scheduled for cardiac catheterization between July 2014 and Dec 2014 randomized to maternal voice group and control group.

Intervention

During cardiac catheterization, children in maternal voice group listened to a 3-min audio-recording of their mother’s voice, played in loop, using head-phones. Children in the other group wore headphones without auditory stimuli.

Main outcome measures

Child’s cooperation during cardiac catheterization as assessed by Child Emotional Manifestation Scale.

Results

Children in the maternal voice group showed lower mean (SD) distress scores [13.2 (4.6) vs. 16 (5.6), P=0.01]. The requirement of sedative agents during the procedure was not different (P=0.09).

Conclusion

Allowing children to listen to recorded voice of their mother is an effective strategy to improve cooperation during cardiac catheterization.

     

Ultrasound evidence of gas in the fissure for ligamentum teres: a sign of perforated duodenal ulcer

We present a case of confined duodenal ulcer perforation diagnosed on ultrasound. Locules of gas were visible in the fissure for ligamentum teres along with a small amount of free fluid in Morrison's pouch and thickening of the gall bladder wall. To our knowledge, "free" intraperitoneal gas confined to the fissure for ligamentum teres has not previously been reported as an ultrasound finding in perforated duodenal ulcer.     

Gestational effects on host inflammatory response in normal and pre-eclamptic pregnancies

Objective

Pre-eclampsia (PET) remains a leading cause of maternal and neonatal morbidity and mortality. Although its pathophysiology involves an underlying inflammatory dysfunction, it is unclear how this may be affected by increasing gestational age, particularly in relation to the time of onset of disease. Murine studies have indicated that a progressive increase in serum inflammatory profile is a physiological feature of normal gestation. The present study aimed to investigate this phenomenon in women in relation to normal and pre-eclamptic pregnancies.

Study design

Control and PET groups (each n = 20) were divided into early and late pregnancy (before and after 34 weeks gestation, respectively). Whole blood was diluted 1:1 with RPMI 1640 medium with/without 1 μg/ml lipopolysaccharide at 37 °C for 24 h under a humidified 5% CO₂ atmosphere. Samples were collected at 0, 2, 6 and 24 h and analysed for interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p70), IL-13, IL-17, granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), interferon (IFN)-γ, monocyte chemotactic protein (MCP-1), macrophage inflammatory protein (MIP)-1β and tumour necrosis factor (TNF)-α by fluid-phase multiplex immunoassay.

Results

This study confirms that pregnancy features an increasing inflammatory response with advancing gestational age, which was seen in both control and PET pregnancies (P < 0.01).

Conclusions

This increase in inflammatory responsiveness with advancing gestation may provide an explanation for the incidence of late onset PET in the absence of placental pathology, as well as serving as a potential physiological priming mechanism geared towards increasing maternal sensitivity to the fetal triggers of labour.