An Unusual Angiographic Appearance of Ergot Poisoning

A case of upper limb ischaemia secondary to ergot poisoning is presented. We discuss the pharmacology of ergotism and the radiological appearances of ergot induced arteriospasm in relation to this case.     

Transthoracic and transoesophageal echocardiography in the diagnosis and management of a biatrial myxoma

A 40-year-old female presented with a year's history of atrialfibrillation. Transthoracic echocardiography identified thepresence of a biatrial mass and transoesophageal echocardiographydelineated irs extent. At surgery, a huge myxoma originatingfrom the fossa ovalis and straddling the inter-atrial septumwas removed and the atrial septum repaired. This report highlightsthe role of transthoracic and transoesophageal echocardiographyin the diagnosis and management of this extremely rare cardiacrumour.     

Sampling the omentum in ovarian neoplasia: when one block is enough

Infracolic omentectomy should be performed on all patients as part of the surgical management of suspected ovarian neoplasia to allow accurate pathologic staging. Unlike the primary ovarian lesion, no guidelines exist as to how the pathologist should sample the omentum. We retrospectively examined pathology reports from 692 cases of primary ovarian neoplasia and demonstrated a high positive predictive value for omenta described as macroscopically involved (98.4%). We propose a system of sampling omenta in which block taking is minimized in cases where the ovary appears benign and the omentum normal or where the ovary appears malignant and correspondingly the omentum appears involved. Thorough sampling should be focused on those cases where the ovary appears malignant or borderline and the accompanying omentum normal. This will allow a reduction in departmental workload without a reduction in quality of pathologic staging.     

The severity of pulmonary valve or artery obstruction in children estimated by Doppler ultrasound

Doppler echocardiographic estimation of pressure gradient hasbeen compared to that measured at cardiac catheterisation in37 children, 6 weeks to 15 years of age, with suspected pulmonaryvalve stenosis or a pulmonary artery band. Various parasternaland subcostal positions were explored to obtain the maximumvelocity of blood flow and the valve gradient was calculatedfrom the modified Bernoulli formula. The Doppler study was performedat the time of catheterisation in 19, the maximum velocity beingmeasured during catheter withdrawal in 7, immediately afterwithdrawal in 7, and while simultaneous right ventricular andpulmonary arterial pressures were measured in 5. Five otherpatients were studied within 24 hours of catheterisation andthe other 13 within 6 months. Comparison of Doppler and catheterisationgradients showed a close correlation, this being particularlygood where simultaneous right ventricular and pulmonary arterialpressures were measured. Doppler now provides an accurate non-invasivemeasurement of the severity of pulmonary valve stenosis andthe adequacy of a pulmonary artery band.     

THE EFFECT OF MINOR INCREMENTS IN PLASMA THYROXINE ON HEART RATE AND URINARY SODIUM EXCRETION

We studied day/night (D:N) patterns of urinary sodium excretion and the 24 hour ambulatory electrocardiogram in seven normal subjects before and during the administration of T4. Thyroxine increased thyroid hormone levels within the normal range and inhibited the plasma TSH response to TRH. This was associated with a significant decrease in D:N sodium excretion (P less than 0.01) and D:N urine flow (P less than 0.01), a significant increase in mean nocturnal heart rate (P less than 0.01), and a lesser increment in mean daytime heart rate (P less than 0.05). These responses to small changes in thyroid hormone levels suggest that the anterior pituitary is not alone in recognising minor thyroid hormone excess. The clinical implication is that some patients with a normal T3 and T4 but an impaired TSH response to TRH might benefit from antithyroid treatment.     

Use of laparoscopy in children with impalpable testes

Our experience in Manchester using laparoscopy in children with impalpable testes is detailed. Eighty-seven testes were investigated in 77 patients. Of these, 36% had no testes, although in 28% evidence of a vas was found. In those testes which were found, surgery was performed, either orchidopexy or, if positioned high, microsurgery. Orchidectomy was rarely carried out (5 testes only).