Acute scrotal swelling: a sign of neonatal adrenal haemorrhage

Two neonates presented with acute scrotal swelling suggestive of testicular torsion. Surgical exploration in one patient revealed an infected haematoma. Subsequent investigations including ultrasonography and urinary catecholamine determination disclosed adrenal haemorrhage as the cause of the scrotal haematoma. A second patient in whom a purplish discolouration of the right hemiscrotum was noted was also investigated with ultrasonography, which revealed a normal right testis and a right adrenal haematoma. Both cases of adrenal haemorrhage resolved spontaneously on conservative treatment. Adrenal haemorrhage should be considered as a possible cause of acute scrotal swelling in neonates. Ultrasonography assessment should be performed in such cases to examine the intra-abdominal organs especially the adrenal glands.

Congenital listeriosis: case reports and review of literature

Four babies with congenital listeriosis were diagnosed in the Prince of Wales Hospital in Hong Kong in 1990-1991. Two died in the early neonatal period. The remaining 2 survived and recovered with no sequelae. The clinical and pathological features of these babies, together with those reported in the recent literature are highlighted so as to raise a high index of suspicion toward this disease and hopefully prompt treatment can be offered.

Interaction of hereditary spherocytosis and alpha thalassaemia: a family study

We report here a family of patients with coexistent hereditary spherocytosis and alpha-thalassaemia. The different clinical presentations of the family members were affected by the severity of the alpha-thalassaemia. The haemolytic effect of hereditary spherocytosis was modulated by the increased osmotic resistance of thalassaemia in the patients with both disorders. Coexistence of haemoglobin H disease and hereditary spherocytosis resulted in an asymptomatic state. In contrast, coexistence of alpha-thalassaemia trait and hereditary spherocytosis was still haemolytic. The different shapes of the osmotic curves in the family members correlated with the severity of their symptoms.

Effect of percutaneous balloon mitral valvuloplasty on serum creatinine phosphokinase MB-isoenzyme levels

Twenty-one patients with moderate to severe mitral stenosis were treated with percutaneous balloon mitral valvuloplasty (PBMV) using Inoue mitral double-lumen balloon catheters. Creatinine phosphokinase MB isoenzyme (CPK-MB) levels were measured at baseline, 5 min, 6 h, and 18 h post dilatation. Haemodynamic indexes, 12-lead ECGs, and 2-dimensional echocardiograms were performed to evaluate systolic function postprocedure. CPK-MB levels were modestly increased at 5 min and at 6 h postprocedure compared with the baseline level (p < 0.001) but were still within the normal reference range, except for one patient who had a level at 5 min minimally above the upper limit of normal. CPK-MB levels were not significantly increased at 18 h after the procedure. No significant changes in ejection fractions, 12-lead ECGs, and regional wall motion occurred in any of the patients studied. In conclusion, PBMV causes modest early elevation of CPK-MB. This elevation is not associated with changes in LV systolic function and does not interfere with the diagnosis of acute myocardial infarction using the enzyme elevation criteria.

Percutaneous mitral balloon valvotomy in a patient with coexistent mitral stenosis and hypertrophic cardiomyopathy

A patient with coexistent mitral stenosis and hypertrophic cardiomyopathy is described, in whom symptoms related to impaired left ventricular diastolic filling improved after successful percutaneous mitral balloon valvotomy.

Percutaneous balloon mitral valvotomy in pregnancy using the Inoue balloon catheter

Percutaneous balloon mitral valvotomy (PBMV) using the Inoue balloon catheter was performed successfully in 2 patients with severe mitral stenosis refractory to medical treatment during pregnancy. Because of its unique design and ease of manipulation, we recommend the Inoue balloon catheter for performing PBMV in selected patients with mitral stenosis during pregnancy, as procedure and fluoroscopy times can be significantly shortened.

Venous thrombosis after long-term transvenous pacing in the Chinese

To determine the incidence of venous thrombosis after long-term transvenous pacing in the Chinese, venograms were performed in 50 consecutive Chinese patients seen at the pacemaker clinic. There were 25 women and 25 men. The mean age was sixty-six years (range thirty-two to eighty-one). The indications for pacing were complete heart block in 16 patients and sick sinus syndrome in the remainder. All pacemakers were of the single-chamber ventricular pacing type and had been implanted for a mean period of four years (range two to seven). In 27 patients the route of entry for the pacing electrode was through the cephalic vein and in the other 23 patients the subclavian veins were used. Of the 50 venograms, 1 showed partial and 1 showed total obstruction at the subclavian vein. Both patients (4%) were asymptomatic. All others (96%) were normal. The incidence of venous thrombosis was not related to the routes of entry of the pacing electrodes. All patients tolerated the procedure well and had no complications. It is concluded that the incidence of venous thrombosis after long-term transvenous pacing is extremely low in the Chinese (4%), and venograms are both safe and useful for identifying venous thrombosis related to transvenous pacing.

Echocardiographic diagnosis of an aortic root abscess after Mycobacterium fortuitum prosthetic valve endocarditis

A patient with an aortic root abscess complicating Mycobacterium fortuitum prosthetic endocarditis is described. The correct diagnosis had been made preoperatively by echocardiography and was confirmed subsequently at surgery.

Angiographic visualization of 'tumour vascularity' in atrial myxoma

Nine patients with atrial myxoma in whom selective coronary arteriography had been performed were studied. The angiographic sign of 'tumour vascularity' was found to be present in three patients with highly vascularized atrial myxoma. The clinical significance of the angiographic sign is unknown although highly vascularized myxomata appear to have a greater propensity to bleeding into the tumour, resulting in an acute worsening of clinical symptoms. The angiographic sign of 'tumour vascularity' is not specific but useful to complement the diagnosis of an atrial myxoma. The indication for selective coronary arteriography in patients with atrial myxoma remains the detection of coronary artery disease, thus concomitant coronary artery bypass surgery could be planned preoperatively.

Adverse effect of topical methylsalicylate ointment on warfarin anticoagulation: an unrecognized potential hazard

The adverse effect of topical methylsalicylate ointment on warfarin anticoagulation is studied in 11 patients. All patients had an abnormally elevated international normalized ratio after significant usage of topical methylsalicylate ointment as obvious from both the clinical history and a positive blood level of salicylate. Out of the 11 patients, 3 had bleeding manifestation; 2 with bruises and 1 with gastrointestinal bleeding. It is concluded that topical methylsalicylate ointment should be prescribed with care to patients on warfarin and excessive usage is to be avoided since potentially dangerous drug interaction could occur.

Late metabolic acidosis and poor weight gain in moderately pre-term babies fed with a casein-predominant formula: a continuing need for caution

When our neonatal unit opened in 1984 our formula feeding policy for moderately preterm babies was for casein-predominant rather than "humanized" whey-predominant milk formulae to be given. However, an early cluster of cases of late persistent metabolic acidosis prompted an investigation into the acid-base status and weight gain in preterm infants. This study of 70 healthy, moderately preterm (32-35 weeks) Chinese babies has convincingly shown that a casein-predominant low protein formula is associated with significant metabolic acidosis, persisting sometimes for as long as 8 weeks, and poor weight gain when compared with infants fed on either a humanized or a special low-birthweight formula. This is an important message for the many neonatal units in developing countries where the cost of humanized formulae might initially seem prohibitive, encouraging instead casein-predominant formulae when breast milk is not available. Any additional expense incurred in using humanized formulae will be compensated for by the shortened time spent in hospital.

False detection of left atrial thrombus by the angiographic sign of "neovascularity"

"Neovascularity" in the region of the left atrial appendage was demonstrated by coronary arteriography preoperatively in five patients with mitral valve disease and was attributed to the presence of thrombus in the left atrium. Subsequently, they underwent surgery, but thorough inspection of the left atrium did not reveal thrombus in any of the five patients. The presence of neovascularity without apparent thrombosis or false detection may be a result of tissue reaction and organization in an effort to resorb the thrombus.

Infected atrial myxoma

A patient is reported in whom a left atrial myxoma was found to be infected with Staphylococcus aureus. The clinical presentation, diagnosis and treatment are described and discussed.

Two-dimensional and pulsed Doppler echocardiographic diagnosis of an acquired aortic right ventricular fistula

A patient with an asymptomatic aortic right ventricular fistula acquired after aortic valve and mitral valve replacement is presented. This was diagnosed by two-dimensional and pulsed Doppler echocardiography, and confirmed at cardiac catheterization.

Biventricular perforation by a temporary pacing electrode: recognition from the lateral chest radiograph

A temporary pacing electrode was inserted in a patient with severe calcific aortic stenosis complicated by complete atrioventricular block. Despite normal pacing and sensing function, a diagnosis of myocardial perforation was made on the basis of a lateral chest radiograph. Neither the surface electrocardiogram nor the frontal chest radiograph suggested evidence of myocardial perforation, and echocardiographic diagnosis was limited by poor echogenicity of the patient. Biventricular perforation with pericardial effusion were documented at operation.

The blood flow velocity waveform in the fetal descending aorta; its relationship to fetal heart rate pattern, eye and body movements in normal pregnancy at 27-28 weeks of gestation

In 13 normal pregnancies at 27-28 weeks of gestation the blood flow velocity waveform at the lower thoracic level of the fetal descending aorta was studied in relation to fetal heart rate pattern (FHRP), fetal eye movements (FEM) and fetal body movements (FBM). State parameter combinations in which high fetal heart rate (FHR) variability was present, were associated with a significant reduction in pulsatility index (PI) as compared with periods in which low FHR variability was present, irrespective of FEM and FBM, indicating a reduced peripheral vascular resistance. At 27-28 weeks of gestation FHR variability and PI might be linked to baroreceptor sensitivity. PI values derived from combinations FHRP-A, FEM(-), FBM(-) and FHRP-B, FEM(+), FBM(+) showed a significant inverse relationship (P less than 0.05) with FHR. FHR and FHR variability should be taken into account when studying flow velocity waveforms in the fetal descending aorta at 27-28 weeks of gestation.