[Acute pancreatitis and pregnancy: Cases study and literature review]

OBJECTIVE

To describe issues associated with the diagnosis of acute pregnancy-associated pancreatitis.

MATERIALS AND METHODS

Retrospective study of cases presenting at our establishment from 2002 to 2012. These cases were defined on the basis of the association of abdominal pain, serum lipase levels three times normal values, or signs of pancreatitis on ultrasound scans carried out on women pregnant at the time of diagnosis. A retrospective analysis of the medical files of these patients was carried out, considering epidemiological and etiological criteria, the treatments administered and maternal/fetal fate.

RESULTS

We identified 10 cases during the study period, corresponding to an incidence of 1/1942. In 70% of cases, the patient was in the last three months of pregnancy. The pain was atypical in 70% of cases and ultrasound revealed biliary lithiasis in 30% of cases. None of the women died. In terms of neonatal morbidity, there were five preterm births, including one of an infant that died at the age of seven days. We then carried out a literature review, from which we determined the most appropriate course of action in cases of acute pancreatitis during pregnancy.

CONCLUSION

Pancreatitis should be considered in pregnant women with abdominal pains because this diagnosis is easy to confirm and maternal and fetal outcomes are essentially dependent on the early etiological management of this condition. Preterm birth is the predominant factor for neonatal morbidity.

Social spaces for young children in hospital

BACKGROUND

In the last number of years heightened interest has been attributed to the impact of hospital environments on children's psychosocial well-being. With policy largely built around adult assumptions, knowledge about what constitutes a child-friendly hospital environment from young children's perspectives has been lacking. If hospital environments are to aspire to being child friendly then the views of younger aged children must be taken into account. The current study investigated young children's perspectives of hospital social spaces to inform the design of the built environment of a new children's hospital.

METHODS

An exploratory qualitative participatory design was employed. Data were collected through semi-structured interviews (one-to-one and group workshops) which incorporated art-based activities to actively engage young children. Fifty-five young children aged 5 to 8 years with various acute and chronic illnesses were recruited from inpatient, outpatient and emergency departments of three children's hospitals.

RESULTS

Young children want a diversity of readily available, independently accessible, age, gender and developmentally appropriate leisure and entertainment facilities seamlessly integrated throughout the hospital environment. Such activities were invaluable for creating a positive hospital experience for children by combating boredom, enriching choice and control and reducing a sense of isolation through enhanced socialization. When in hospital, young children want to feel socially connected to the internal hospital community as well as to the outside world. Technology can assist to broaden the spectrum of children's social connectivity when in hospital - to home, school and the wider outside world.

CONCLUSION

While technology offers many opportunities to support children's psychosocial well-being when in confined healthcare spaces, the implementation and operation of such services and systems require much further research in the areas of ethics, facilitation, organizational impact and evaluation.

[Contribution of volume ultrasound in the evaluation and prenatal care of fetal cardiovascular anomalies]

OBJECTIVES

To highlight the value of 3D ultrasound in the prenatal assessment of fetal cardiovascular abnormalities.

PATIENTS AND METHODS

A retrospective offline analysis of volume datasets of fetuses diagnosed with cardiovascular anomalies by 2D ultrasound was performed.

RESULTS

Thirty-four fetuses with 38 cardiac malformations were evaluated. Mean gestational age at diagnosis was 26 weeks. Isolated cardiovascular malformations were detected in 23 fetuses. Extracardiac abnormalities were identified in eight fetuses. Ten terminations of pregnancy were performed.

CONCLUSION

Offline analysis of cardiovascular anomalies conferred significant diagnostic advantages over 2D ultrasound. 3D ultrasound is a valuable tool for the prenatal diagnosis and the management of congenital heart diseases.

An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality

OBJECTIVES

In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections.

METHODS

Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records.

RESULTS

In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively.

CONCLUSION

This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.

Achieving the millennium development goal of reducing maternal mortality in rural Africa: an experience from Burundi

OBJECTIVES

To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality.

METHODS

The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi.

RESULTS

In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100,000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100,000 live births).

CONCLUSION

Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.

[Contribution of 3D-ultrasound in the heterotaxy syndromes: about four cases and review of the literature]

The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.

[Role of MSCT and MRI in the diagnosis of congenital heart disease]

Initial diagnosis of congenital heart disease traditionally relies upon clinical examination and ultrasound. Development of non-invasive imaging, multislice CT (MSCT) and magnetic resonance imaging (MRI) has changed the way those patients are evaluated for diagnosis or follow-up. Cardiac catheterization is no longer the step two and in many clinical situations, non-invasive imaging is the method of choice, either before or instead of invasive angiography examination. Cross-sectional cardiovascular imaging brings thorough examination of the thorax, heart and great vessels, leading to three-dimensional volumes imaging, allowing diagnosis of the cardiopathy, evaluation of the anatomy and associated abnormalities. For each imaging technique advantages and drawbacks are discussed. X-ray use is the main disadvantage of MSCT, although it is a fast, easy and efficient technique, especially in babies because of its high spatial and temporal resolutions. Beside a precise 3D evaluation of the heart and great vessels, MSCT allows evaluation of small structures, like coronary arteries in routine, including in neonates and infants, at a fast cardiac rhythm, and in a short examination time. The air-filled structures are well-depicted with MSCT, and 3D imaging is helpful in evaluation of tracheal and bronchi compression as compared to MRI. MR imaging brings, aside from the morphologic evaluation, helpful functional information for the left and right ventricles, and evaluation of valvular disease (stenosis and regurgitation). Those are critical data in the follow-up of patients treated for tetralogy of fallot or after atrial switch for transposition of the great vessels. The technique is also very powerful in evaluating aortic disease, e.g. aortic coarctation and restenosis, and Marfan's disease. Disadvantages are mainly the accessibility and the examination time, which in young patients may require sedation or general anaesthesia. Cross-sectional cardiovascular imaging, MSCT and MRI, have considerably changed the diagnosis and follow-up of patients suffering of congenital cardiopathy. The techniques are complementary, and the choice will depend on the age, the clinical condition and the diagnosis of the patient.

ADAMTS-2 functions as anti-angiogenic and anti-tumoral molecule independently of its catalytic activity

ADAMTS-2 is a metalloproteinase that plays a key role in the processing of fibrillar procollagen precursors into mature collagen molecules by excising the amino-propeptide. We demonstrate that recombinant ADAMTS-2 is also able to reduce proliferation of endothelial cells, and to induce their retraction and detachment from the substrate resulting in apoptosis. Dephosphorylation of Erk1/2 and MLC largely precedes the ADAMTS-2 induced morphological alterations. In 3-D culture models, ADAMTS-2 strongly reduced branching of capillary-like structures formed by endothelial cells and their long-term maintenance and inhibited vessels formation in embryoid bodies (EB). Growth and vascularization of tumors formed in nude mice by HEK 293-EBNA cells expressing ADAMTS-2 were drastically reduced. A similar anti-tumoral activity was observed when using cells expressing recombinant deleted forms of ADAMTS-2, including catalytically inactive enzyme. Nucleolin, a nuclear protein also found to be associated with the cell membrane, was identified as a potential receptor mediating the antiangiogenic properties of ADAMTS-2.

Mutation in the melanocortin 1 receptor is associated with amber colour in the Norwegian Forest Cat

Amber (previously called X-Colour) is a yellow recessive coat colour observed in the Norwegian Forest Cat (NFC) population and apparently absent in other cat breeds. Until now, there has never been any scientific evidence of yellow recessive mutation (e) reported in the extension gene in Felidae. We sequenced the complete coding sequence region for the melanocortin 1 receptor in 12 amber, three carriers, two wild-type NFCs, one wild-type European Shorthair and two 'golden' Siberian cats and identified two single nucleotide polymorphisms (SNPs): a non-synonymous (FM180571: c.250G>A) and a synonymous (FM180571: c.840T>C) mutation. The c.250G>A SNP, further genotyped on 56 cats using PCR-RFLP, is associated with amber colour and only present in the amber cat lineages. It replaced an aspartic acid with a neutral polar asparagine in the second transmembrane helix (p.Asp84Asn), a position where e mutations have already been described. Three-dimensional models were built and showed electrostatic potential modification in the mutant receptor. With these results and together with those in the scientific literature, we can conclude that amber colour in NFCs is caused by a single MC1R allele called e, which has never been documented.

Aortic root abscess with coronary artery involvement: diagnostic and surgical management

We describe two cases of infectious endocarditis in infants complicated by aortic root abscess involving the coronary artery treated by the Ross operation. Multislice computed tomography was important in defining the diagnosis and in planning subsequent surgical management.