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Abstract
Taking an adequate history and competently examining a patient remain essential prerequisites for making a diagnosis. Four 5th year medical students who had completed 18 months of clinical teaching were assessed at the start and end of their ten-week paediatric term and compared with 4 experienced consultants. A videorecording was made of each patient encounter. The students’ history was often incomplete, at times inaccurate and imprecise, despite earlier provision of a framework to obtain the necessary information. The students spent a great proportion of their time examining the child, yet their findings were questionable particularly if the child was uncooperative. The second recording made at the end of the student's paediatric term revealed a general improvement in their confidence and knowledge, though similar deficiencies were observed. The consultants, as expected, did better. They also showed a greater awareness of understanding the child within the context of his family. They spent more time interviewing the parent and child, offered a fuller explanation of the diagnosis and carefully reviewed the management. These findings further emphasize the need to improve and assess the clinical performance of students.
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Wijayarathne P, Thuraisingam A, Menahem S, Grigg L, Skillington P. Medtronic Freestyle Versus Pulmonary Allograft Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Variants. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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3
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Sehgal A, Allison BJ, Gwini SM, Menahem S, Miller SL, Polglase GR. Vascular aging and cardiac maladaptation in growth-restricted preterm infants. J Perinatol 2018; 38:92-97. [PMID: 29120452 DOI: 10.1038/jp.2017.135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess arterial morphology and mechanics in preterm infants with fetal growth restriction (FGR) compared with those appropriate for gestational age (AGA) in the early neonatal period. STUDY DESIGN This observational study involved 20 preterm FGR infants (28 to 32 weeks) of gestational age (GA) and birth weight (BW) <10th centile and 20 preterm AGA infants. Vascular ultrasound was performed to measure aortic properties. RESULTS GA and BW of FGR and AGA infants were 29.8±1.3 vs 30±0.9 weeks (P=0.78) and 923.4±168 vs 1403±237 g (P<0.001), respectively. At 10.5±1.3 (s.d.) days after birth, blood pressure (systolic 51±3 vs 46±4 mm Hg, P<0.001) and maximum aorta intima-media thickness (621±76 vs 479±54 μm; P<0.001) were significantly higher in FGR infants. Arterial wall stiffness and peripheral resistance were also increased in the FGR infants (2.36±0.24 vs 2.14±0.24, P=0.008 and 22.2±5 vs 13.7±2.3 mm Hg min ml-1, P<0.001), respectively. Significant correlations between vascular mechanics and cardiac function were observed (resistance vs E/E', r=0.7 and Tei index, r=0.79). CONCLUSION Maladaptive arterial-ventricular coupling was noted. Early detection may aid in early therapeutic strategies such as afterload reduction.
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Affiliation(s)
- A Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Pediatrics, Monash University, Melbourne, VIC, Australia
| | - B J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - S M Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - S Menahem
- Paediatric and Fetal Cardiac Units, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - S L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - G R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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Snell GI, Davis AK, Menahem S, Kotecha S, Whitford HM, Levvey BJ, Paraskeva M, Webb A, Westall GW, Walker RG. ABO incompatible renal transplantation following lung transplantation. Transpl Immunol 2016; 39:30-33. [PMID: 27663090 DOI: 10.1016/j.trim.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/10/2016] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
We present management strategies utilised for the first case of an urgent live-donor ABO incompatible B blood group renal transplant, in a patient with a prior A blood group lung transplant for cystic fibrosis. Three years on, renal function is excellent and stable, whilst lung function has improved.
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Affiliation(s)
- G I Snell
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia.
| | - A K Davis
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - S Menahem
- Department of Renal Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - S Kotecha
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - H M Whitford
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - B J Levvey
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - M Paraskeva
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - A Webb
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - G W Westall
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - R G Walker
- Department of Renal Medicine, Alfred Hospital and Monash University, Melbourne, Australia
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Sehgal A, Malikiwi A, Paul E, Tan K, Menahem S. Systemic arterial stiffness in infants with bronchopulmonary dysplasia: potential cause of systemic hypertension. J Perinatol 2016; 36:564-9. [PMID: 26914016 DOI: 10.1038/jp.2016.10] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic hypertension is common among preterm infants with severe bronchopulmonary dysplasia (BPD); the exact cause is unknown. The objective of this preliminary hypothesis generating study was to examine systemic arterial structure and vasomotor function in a cohort of preterm infants with severe BPD, using a cohort of preterm infants without BPD and a cohort of term infants for comparison. STUDY DESIGN After obtaining informed consent, we measured aortic wall thickness and vasomotor function by ultrasonography in 20 infants with severe BPD, 7 infants with no BPD, and compared them with 20 healthy term infants. RESULTS Maximum aortic thickness was significantly higher in infants with BPD (827±163 μm) compared to those with no BPD (674±22 μm) and term infants (657±67 μm) (unadjusted P<0.0001). The input impedance was similarly elevated in the infants with BPD (574±127 dynes s( )cm(-5)) compared to those with no BPD (325±24 dynes s cm(-)(5)) or term infants (328±113 dynes s cm(-)(5)) (unadjusted P<0.0001). Stiffness index was significantly higher in the infants with BPD (3.4±0.6) compared to those with no BPD (2.6±0.3) or term infants (2.3±0.4) (unadjusted P<0.0001). Systemic vascular resistance was also significantly elevated in the infants with BPD. The results remained significant even after adjusting for gestational age and birth weight. Measures of vasomotor function significantly correlated with blood pressure. CONCLUSION The aortic wall thickness and vasomotor function are significantly altered in preterm infants with severe BPD. These findings may explain the higher incidence of systemic hypertension in this population.
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Affiliation(s)
- A Sehgal
- Monash Newborn, Monash Children's Hospital, Monash Health, Melbourne, VIC, Australia.,Department of Pediatrics, Monash University, Melbourne, VIC, Australia
| | - A Malikiwi
- Monash Newborn, Monash Children's Hospital, Monash Health, Melbourne, VIC, Australia
| | - E Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - K Tan
- Monash Newborn, Monash Children's Hospital, Monash Health, Melbourne, VIC, Australia.,Department of Pediatrics, Monash University, Melbourne, VIC, Australia
| | - S Menahem
- Department of Pediatrics, Monash University, Melbourne, VIC, Australia.,Paediatric and Fetal Cardiac Units, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
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Ruderman I, Sevastos J, Anthony C, Ruygrok P, Chan W, Javorsky G, Bergin P, Snell G, Menahem S. Outcomes of simultaneous heart-kidney and lung-kidney transplantations: the Australian and New Zealand experience. Intern Med J 2015; 45:1236-41. [DOI: 10.1111/imj.12865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- I. Ruderman
- Department of Renal Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - J. Sevastos
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - C. Anthony
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - P. Ruygrok
- Department of Respiratory Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - W. Chan
- Department of Renal Medicine; St Vincent's Hospital; Sydney New South Wales Australia
| | - G. Javorsky
- Department of Renal Medicine; St Vincent's Hospital; Sydney New South Wales Australia
| | - P. Bergin
- Department of Cardiology; The Prince Charles Hospital; Brisbane Queensland Australia
| | - G. Snell
- Department of Cardiology; Auckland City Hospital; Auckland New Zealand
| | - S. Menahem
- Department of Renal Medicine; Alfred Hospital; Melbourne Victoria Australia
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Kosta L, Harms L, Franich-Ray C, Anderson V, Northam E, Cochrane A, Menahem S, Jordan B. Parental experiences of their infant's hospitalization for cardiac surgery. Child Care Health Dev 2015; 41:1057-65. [PMID: 25652039 DOI: 10.1111/cch.12230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parents are increasingly recognized as important partners in children's health care. Despite their involvement in care, parental experiences of their child's hospitalization have received little research attention. In this study we explored parents' perceptions of what they found difficult, what they would like to be different and what they found to be helpful during their infant's hospitalization and surgery for the treatment of congenital heart disease. METHODS Structured interviews were conducted with 154 parents (91 mothers, 63 fathers) whose infant underwent cardiac surgery (at <3 months of age) 1 month post discharge from hospital. Thematic and frequency analyses were performed. RESULTS Parents reported a range of difficulties from dealing with their baby's unfolding illness, surgery and recovery to the structural and systemic issues associated with the broader context of their experiences. In an effort to be near their baby, parents struggled to obtain the necessities for daily living at the hospital and negotiate transitions between their hospital and home lives throughout the admission. Domains parents identified for change included the availability of facilities and resources and the quantity and quality of information and emotional support. Parents reported relationships with hospital staff as the most common source of support during this challenging time. CONCLUSIONS Opportunities to improve parents' experiences when their infant is in hospital exist at an organizational level as well as at the clinical level. The significance of parents' relationship with hospital staff indicates the potential for each professional to impact on families' experiences on a daily basis. The range of challenges indicates the scope and need for allied health services.
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Affiliation(s)
- L Kosta
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - L Harms
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - C Franich-Ray
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - V Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,School of Behavioural Science, The University of Melbourne, Melbourne, Vic., Australia.,Department of Psychology, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - E Northam
- School of Behavioural Science, The University of Melbourne, Melbourne, Vic., Australia.,Department of Psychology, The Royal Children's Hospital, Melbourne, Vic., Australia.,Cell Biology, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - A Cochrane
- MonashHeart, Monash Medical Centre, Clayton, Vic., Australia
| | - S Menahem
- MonashHeart, Monash Medical Centre, Clayton, Vic., Australia.,School of Psychology and Psychiatry, Monash University, Clayton, Vic., Australia
| | - B Jordan
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia.,Social Work Department, The Royal Children's Hospital, Melbourne, Vic., Australia
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8
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Abstract
Earlier studies, mostly overseas, have explored the reasoning and thought processes underlying women's desires to conceive. A retrospective qualitative study was conducted to explore the motivations and anxieties of an Australian sample of women proceeding to a pregnancy and to explore their decision-making process. Twenty women over 18 years old who had one or more successful pregnancies and were recruited from a tertiary centre and private clinics, completed a questionnaire and a semi-structured interview. Thematic analysis was applied to the data. Multiple factors motivated women to proceed to a pregnancy and including influences arising from society or existing personal relationships, goals and desired experiences for parenthood and innate drives and reproductive related issues. The motivations of an urban Australian sample to proceed to a pregnancy differed little from studies elsewhere. This knowledge may assist in dealing with the concerns that underlie any pregnancy allowing for better obstetric management.
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Affiliation(s)
- K Ngu
- a Faculty of Medicine, Department of Dentistry and Health Sciences , University of Melbourne , Melbourne , Australia
| | - M Hay
- b Monash Health , Melbourne, Victoria , Australia
| | - S Menahem
- b Monash Health , Melbourne, Victoria , Australia.,c Department of Obstetrics and Gynaecology , School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, Victoria , Australia
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9
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Ngu K, Hay M, Menahem S. Why babies - What Australian mothers say. J OBSTET GYNAECOL 2015:1-4. [PMID: 26271014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Earlier studies, mostly overseas, have explored the reasoning and thought processes underlying women's desires to conceive. A retrospective qualitative study was conducted to explore the motivations and anxieties of an Australian sample of women proceeding to a pregnancy and to explore their decision-making process. Twenty women over 18 years old who had one or more successful pregnancies and were recruited from a tertiary centre and private clinics, completed a questionnaire and a semi-structured interview. Thematic analysis was applied to the data. Multiple factors motivated women to proceed to a pregnancy and including influences arising from society or existing personal relationships, goals and desired experiences for parenthood and innate drives and reproductive related issues. The motivations of an urban Australian sample to proceed to a pregnancy differed little from studies elsewhere. This knowledge may assist in dealing with the concerns that underlie any pregnancy allowing for better obstetric management.
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Affiliation(s)
- K Ngu
- Faculty of Medicine, Department of Dentistry and Health Sciences, University of Melbourne , Melbourne , Australia
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10
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Eaton S, Wang Q, Menahem S. Quality of life of adults with congenital heart disease, a Melbourne cohort analysis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Sehgal A, Malikiwi A, Tan K, Menahem S. A new look at bronchopulmonary dysplasia: Role of systemic vascular & cardiac function in therapeutic options. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Otani S, Levvey B, Westall G, Paraskeva M, Whitford H, Williams T, Walker R, Menahem S, Snell G. Long-Term Successful Outcomes From Kidney Transplantation Following Lung/Heart-Lung Transplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Yayar O, Buyukbakkal M, Eser B, Yildirim T, Ercan Z, Erdogan B, Kali A, Merhametsiz O, Haspulat A, Akdag I, Ayli MD, Quach T, Tregaskis P, Menahem S, Koukounaras J, Mott N, Walker R, Zeiler M, Santarelli S, Degano G, Monteburini T, Agostinelli RM, Marinelli R, Ceraudo E, Grzelak T, Kramkowska M, Walczak M, Czyzewska K, Guney I, Turkmen K, Yazici R, Arslan S, Altintepe L, Yeksan M, Vaduva C, Popa S, Mota M, Mota E, Wan Md Adnan WAH, Zaharan NL, Moreiras-Plaza M, Blanco-Garcia R, Beato-Coo L, Cossio-Aranibar C, Martin-Baez I, Santos MT, Fonseca I, Santos O, Aguiar P, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Guo Z, Lai X, Theodoridis M, Panagoutsos S, Thodis E, Karanikas M, Mitrakas A, Kriki P, Kantartzi K, Passadakis P, Vargemezis V, Vakilzadeh N, Pruijm M, Burnier M, Halabi G, Azevedo P, Santos O, Carvalho M, Cabrita A, Rodrigues A, Laplante S, Rutherford P, Shutov E, Isachkina A, Gorelova E, Troya MI, Teixido J, Pedreira G, Del Rio M, Romero R, Bonet J, Zhang X, Ma J, Kim Y, Kim JK, Song YR, Kim SG, Kim HJ, Eloot S, Vanholder R, Van Biesen W, Heaf J, Pedersen C, Elgborn A, Arabaci T, Emrem G, Keles M, Kizildag A, Martino F, Amici G, Rodighiero MP, Crepaldi C, Ronco C, Tanaka H, Tsuneyoshi S, Yamasaki K, Daijo Y, Tatsumoto N, Al-Hilali N, Hussain N, Fathy V, Negm H, Alhilali M, Grzegorzewska A, Cieszynski K, Kaczmarek A, Sowinska A, Soleymanian T, Najafi I, Ganji MR, Ahmadi F, Saddadi F, Hakemi M, Amini M, Tong LNMN, Yongcheng HNMN, Qijun WNMN, Shaodong LNMN, Velioglu A, Albaz M, Arikan H, Tuglular S, Ozener C, Bakirdogen S, Eren N, Mehtap O, Bek SG, Cekmen MB, Yilmaz A, Cabana Carcasi MLL, Fernandez Ferreiro A, Fidalgo Diaz M, Becerra Mosquera V, Alonso Valente R, Buttigieg J, Borg Cauchi A, Rogers M, Buhagiar L, Farrugia Agius J, Vella MP, Farrugia E, Han JH, Kim HR, Ko KI, Kim CH, Koo HM, Doh FM, Lee MJ, Oh HJ, Han SH, Yoo TH, Kang SW, Choi KH, Sikorska D, Frankiewicz D, Klysz P, Schwermer K, Hoppe K, Nealis J, Kaczmarek J, Baum E, Wanic-Kossowska M, Pawlaczyk K, Oko A, Hiss M, Gerstein F, Haller H, Gueler F, Fukasawa M, Manabe T, Wan Q, He Y, Zhu D, Li J, Xu H, Yayar O, Eser B, Buyukbakkal M, Ercan Z, Erdogan B, Merhametsiz O, Yildirim T, Kali A, Haspulat A, Oztemel A, Akdag I, Ayli MD, Pilcevic D, Kovacevic Z, Maksic D, Paunic Z, Tadic-Pilcevic J, Mijuskovic M, Petrovic M, Obrencevic K, Rabrenovic V, Ignjatovic L, Terzic B, Jovanovic D, Chang CH, Chang YS, Busuioc M, Guerraoui A, Caillette-Beaudoin A, Bahte SK, Hiss M, Kielstein JT, Polinder-Bos H, Emmelot-Vonk M, Gaillard C. Peritoneal dialysis II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Menahem S, Rotstein A, Meagher S. Rightward convexity of the great vessel arising from the anterior ventricle: a novel fetal marker for transposition of the great arteries. Ultrasound Obstet Gynecol 2013; 41:168-171. [PMID: 22492362 DOI: 10.1002/uog.11171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Traditionally transposition of the great arteries (TGA) is suggested by bifurcation of the great vessel arising from the posterior ventricle and the parallel course of the great vessels as they leave the heart. These findings may be difficult to demonstrate, requiring additional fetal echocardiographic features to indicate TGA. In this study, we investigated a new marker of TGA, namely rightward convexity of the great vessel arising from the anterior ventricle. METHODS We reviewed fetal studies from 2006 to 2010 in which an antenatal diagnosis of TGA was confirmed postnatally. We specifically viewed images obtained by scanning the great vessel arising from the anterior ventricle cranially to the superior mediastinum at the level of the three vessels and trachea view and compared them with similar views in normal hearts. RESULTS In 21 cases of confirmed TGA, the great vessel arising from the anterior ventricle (aorta) coursing cranially demonstrated an abnormal convexity to the right. This was in contrast to convexity to the left or lack of convexity of the great vessel (pulmonary artery) arising from the anterior ventricle in fetuses with a normal heart. In two fetuses rightward vessel convexity from the anterior ventricle was the clue on the initial scan suggesting TGA, which was subsequently confirmed. In addition, only two vessels, the superior vena cava and aorta, were demonstrated in fetuses with TGA, the pulmonary artery and ductus arteriosus lying below (caudal to) the transverse arch. CONCLUSIONS Noting the rightward convexity of the great vessel arising from the anterior ventricle may aid in the prenatal diagnosis of TGA. Furthermore, the relative simplicity of this sign may make it valuable in fetal screening for this cardiac defect.
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Affiliation(s)
- S Menahem
- Fetal Cardiac Unit, Monash Medical Centre, Clayton, Victoria, Australia.
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15
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Gupta A, Cochrane A, Menahem S, Sharma V. Indications for and Outcomes of Cardiac Surgery in Adolescents with Congenital Heart Disease: A Single Centre Review. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Wong F, Menahem S, Veldman A, Schranz D, Edwards A. Cardiac Interventions in the Foetal Lamb Using a Transhepatic Approach. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Re J, Franich-Ray C, Menahem S, Dean S, Paul C, Taffe J, Guedeney A. Infant Withdrawal Following Cardiac Surgery—Treat Mother's Distress. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Ngu K, Hay M, Menahem S. Motivations of Women with Congenital Heart Disease Proceeding to Pregnancy. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE Prenatal ultrasound has led to the early diagnosis of major anomalies. However, the ready availability of this technology has led to increasing challenges for physicians counseling affected parents, which is all the more difficult in a twin pregnancy with only one affected fetus. This paper reviews the medical and ethical considerations in twin pregnancies discordant for a serious cardiac condition. STUDY DESIGN Six recent twin pregnancies discordant for a serious cardiac condition and their outcomes are presented. Options considered in the management of the pregnancy were to continue or terminate the pregnancy, selectively terminate the affected twin or to decide whether to treat the affected twin once delivered. An approach to decision making in such situations has been formulated after critical analysis of the factors involved. RESULTS Four of the six pregnancies were monochorionic twins. Two sets of parents decided to terminate the pregnancy. In the four that continued, two opted for the affected twin to be appropriately managed once delivered. A further two considered selective termination but opted to continue the pregnancy because of the risk of premature labor and/or cerebral hypoxia following such intervention. They sought a commitment, however, that they be given the option whether to treat the affected twin following delivery. Eventually both elected to have their babies treated, one of whom died in the postoperative period. DISCUSSION Medical considerations included the risks of continuation of the pregnancy for the mother and her twins, the safety of termination (total or selective), and the risks to the unaffected fetus. Ethical issues revolved around concepts of autonomy, beneficence and justice from the standpoint of the family and the twins. The gestation and the viability of the twins played an important role in decision making and approaches, taking into account the local legal and other considerations. CONCLUSION Attention is drawn to the complexities of the issues involved in twin pregnancies complicated by a serious cardiac condition in one of the twins. Optimal counseling requires sound clinical knowledge about the medical risks to the mother and her twins, and a clear understanding of the key ethical considerations. Such an approach will assist parents in their very difficult decision making.
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Affiliation(s)
- A Malhotra
- Department of Neonatalogy, Monash Medical Centre, Melbourne, Australia
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21
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Malhotra A, Pateman A, Chalmers R, Coman D, Menahem S. Prenatal Cardiac Ultrasound Finding in Congenital Disorder of Glycosylation Type 1a. Fetal Diagn Ther 2009; 25:54-7. [DOI: 10.1159/000196816] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 03/17/2008] [Indexed: 11/19/2022]
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22
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Yeu BK, Chalmers R, Shekleton P, Grimwade J, Menahem S. Fetal cardiac diagnosis and its influence on the pregnancy and newborn--a tertiary centre experience. Fetal Diagn Ther 2008; 24:241-5. [PMID: 18765936 DOI: 10.1159/000151669] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/24/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the impact of an abnormal fetal cardiac scan on the management of the pregnancy and the outcome of the newborn. METHODS We reviewed all pregnancies that were referred to the Fetal Cardiac Unit for assessment to determine if the finding of a cardiac abnormality influenced the pregnancy and fetus, timing and mode of delivery, the treatment and outcome of the newborn. Diagnoses were confirmed by echocardiography following the baby's delivery. RESULTS Between January 2005 and July 2006, there were 251 detailed fetal cardiac scans carried out on at risk pregnancies or those with suspected abnormal scans in 127 fetuses. Seven of the 92 mothers with abnormal fetal cardiac scans opted for termination. Two were successfully treated during the pregnancy for hydrops fetalis arising from a tachyarrhythmia. One was induced early because of deterioration of fetal well-being and increasing cardiac size. Twenty-six infants required a prostaglandin infusion prior to surgery. Two required intensive care for associated malformations. There were 24 survivors following complex surgery, and 2 deaths. Two infants with severe tricuspid valve incompetence from a dysplastic valve died, one associated with a septicaemia and the other where surgery was delayed because of prematurity and low birth weight. There was no maternal morbidity or mortality. CONCLUSIONS Early detection of fetal cardiac malformation allows for careful counselling of the parents, ongoing antenatal review with a planned site and timing of delivery, and anticipatory postnatal care for optimum outcomes. The importance of careful screening is emphasized to allow for referral of mothers with potentially abnormal scans to an appropriate tertiary centre for confirmation and management.
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Affiliation(s)
- B K Yeu
- Fetal Cardiac Unit, Monash Medical Centre, Southern Health, Monash University, Melbourne, Vic, Australia
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Jordan B, Franich-Ray C, Farquani AA, Menahem S, Cochrane A, Anderson V, Northam E. Cardiac Surgery—A Major Stress for Infants, Parents and Families. Heart Lung Circ 2007. [DOI: 10.1016/j.hlc.2007.06.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE The main aim of this study was to determine the understanding and perception of parents following the diagnosis of a minor cardiac abnormality, namely a small ventricular septal defect, in the child. Other aims included discovering the reasons behind these perceptions and whether they affected the parents' management of their child and his/her cardiac problem. METHODS Fifty-six infants and children from two tertiary centres and the private practices of the participating cardiologists were enrolled over a 5-month period. Questionnaires were prepared and distributed to all their parents. RESULTS Complete data was obtained from 40 parents. Close to 80% of the parents perceived the small ventricular septal defect as a minor problem and most understood the nature of the defect. However, when asked about precautions for their child, only two-thirds recalled the need for antibiotic prophylaxis. Most parents experienced distress and anxiety when told initially of the diagnosis but none reportedly restricted their child's physical activity. CONCLUSIONS Most parents have a clear understanding and perception of their child's small ventricular septal defect. There is a need for further improvement to facilitate parental understanding, especially with regard to the need for antibiotic prophylaxis.
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Affiliation(s)
- S W Lok
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
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Poon K, Menahem S, Weintraub R, Goh T, Fong L, Edis B, Wilkinson J. Pulmonary regurgitation after percutaneous ballon valvuloplasty in isolated pulmonary valvar stenosis in childhood. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.06188.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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See P, David E, Anderson-Weller K, Fong L, Menahem S. Atrial septostomy in neonates in a general hospital. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.0619x.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Innocent murmurs are common in childhood. They require accurate diagnosis to avoid unnecessary anxiety and/or restrictions. With this in mind, we studied prospectively children diagnosed by a paediatric cardiologist as having innocent murmurs to review the necessity of investigations in excluding organic abnormalities. We included 63 children in the study. The majority had the so-called Still's, or musical/vibratory murmur. None had abnormal investigations, suggesting that such investigations are largely superfluous for the purpose of diagnosis in those patients with innocent murmurs seen by a paediatric cardiologist. They are often done, nonetheless, as part of the assessment and/or expectations of the parent or the referring physician.
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Affiliation(s)
- N Advani
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Abstract
Following Doppler echocardiographic evaluation, a 16 hour-old infant underwent successful surgical repair of common pulmonary vein atresia. Investigations for prolonged postoperative ventilatory assistance, including cardiac catheterization and computerized tomography, led to a clinical diagnosis of associated pulmonary lymphangiectasia. Although this has caused continuing tachypnoea, at 16 months of age, he remains otherwise well but with an uncertain prognosis.
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Affiliation(s)
- C Mas
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Abstract
Use of per-catheter atrial septal defect closure devices is becoming increasingly widespread. We report a case of left atrial thrombus formation on a StarFLEX device raising concerns regarding the general use of these devices and as a means of preventing paracloxical embolism in particular.
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Affiliation(s)
- J C Cooke
- Centre for Heart and Chest Research, Monash Medical Centre, Clayton, Victoria, Australia.
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Menahem S, Shvartzman P. [Telling bad news]. Harefuah 2000; 138:404-6. [PMID: 10883145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
OBJECTIVES We reviewed an institutional experience of isolated cleft mitral valve (ICMV), its clinical features, and management in a pediatric population. BACKGROUND As ICMV is relatively uncommon, earlier reports highlighted its anatomical and echocardiographic features. Few studies have collated their clinical features with their outcome. METHODS All patients with ICMV were retrospectively reviewed. Patients who were considered to have an atrioventricular septal defect or variant were excluded. RESULTS Twenty patients (9 male, 11 female) were diagnosed with ICMV. Seven patients had associated cardiac lesions. The median age of diagnosis was 5.2 years (range 0.4 to 13.6 years). Echocardiography aided by color Doppler demonstrated the ICMV in all patients. However, an incomplete diagnosis was made in 4 of 20 patients before surgery. The severity of the mitral regurgitation (MR) at presentation was mild in 11, moderate in 8, and severe in 1 patient. In the 13 patients without associated cardiac lesions, 5 underwent mitral valve (MV) repair at median age of 5.2 years (range 1.2 to 7.7 years) for moderate to severe MR, 4 being symptomatic. The severity of the MR in seven of the eight unoperated patients has remained unchanged over the follow-up period (median 8.3 years, range 0.7 to 14.4 years). In total, 10 patients underwent MV repair (median 6.4, range 0.4 to 13.8 years). No patient required MV replacement. None of the 10 patients had more than mild MR over the follow-up period (median 0.6, range 0.2 to 11.0 years). CONCLUSIONS Now readily diagnosable by echocardiography, ICMV is a correctable cause of MR with a good outcome. Surgery is indicated in those patients with moderate to severe MR and probably should be done early following diagnosis.
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Affiliation(s)
- M Tamura
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Nugent AW, Menahem S, Goh TH, Butt W. Device closure of an atrial septal defect following successful balloon valvuloplasty in a neonate with critical pulmonary valve stenosis and persistent cyanosis. Pediatr Cardiol 2000; 21:170-1. [PMID: 10754092 DOI: 10.1007/s002469910030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Persistent cyanosis after successful balloon valvuloplasty for neonatal critical pulmonary valve stenosis is often related to poor right ventricular compliance and right-to-left shunting at the atrial level. A successful catheter closure of an atrial septal defect was performed with a dramatic increase in systemic oxygen saturation alleviating the need for a surgical systemic-to-pulmonary artery shunt.
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Affiliation(s)
- A W Nugent
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, 3052, Australia
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Abstract
Rhabdomyomas are not uncommon in infants with tuberous sclerosis. We describe a neonate who presented with hydrops fetalis arising from a tachyarrhythmia during fetal life related to rhabdomyomas. After reversion of the arrhythmia, pre-excitation was noted on an interval electrocardiogram. Following regression of the tumours, the delta wave disappeared with no further arrhythmias noted.
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Affiliation(s)
- C Mas
- Monash University Centre for Heart and Chest Research, Monash Medical Centre, Clayton, Victoria, Australia
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Abstract
Considerable resources have been directed towards the recognition and management of child physical and sexual abuse and/or neglect. However, the issue of parental non-compliance is less well defined and under recognized. While outwardly seeking advice, non-compliant parents, especially if anxious, are unable or unwilling to comply with the recommendations made. Conflicts of interest between the parent(s)' and the health professionals' perceptions regarding the best interest of the child may arise. Parental non-compliance is centred around the parents' perception of the child's current problems and its relationship to past problems. Such non-compliance may reflect ignorance or misunderstanding of the clinical situation. Ignorance may be readily addressed if the parents are receptive and trusting. However, non-compliance more commonly arises from the parents' inability to cope emotionally with the stresses surrounding the recommended treatment. Parents may be vulnerable to psychological reactions which inhibit rational thinking. Parental anxieties are best understood in terms of psychological constructs, including 'defences' such as 'denial' and 'splitting', 'repetition compulsion' and the need to 'work through' psychological barriers so that the child's best interest is served. Parental non-compliance can serve to protect the parents from overwhelming fears and anxieties, which if addressed may transform parental defensiveness to co-operation. Extreme parental non-compliance may represent a special form of child abuse where, due to parental psychopathology, parents are unable to consider the child's best interest. Clinical vignettes arising from a consultant private and hospital ambulatory setting will focus on management strategies for successful outcomes. Recommendations offered on ways to reduce the risk of parental non-compliance include building trust, eliciting the aid of a parental partner, and organizing a second opinion, thereby improving the chances of a successful outcome.
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Affiliation(s)
- S Menahem
- Department of Paediatrics and Psychological Medicine, Monash University, Melbourne, Australia
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Abstract
We reviewed 16 patients with coronary arterial fistulas seen between 1976 and 1997, and aged 2 days to 16 years, with a median age of 3.2 years. Only four patients were symptomatic: two had heart failure, one had exertional dyspnoea, and one infective endocarditis. The fistulas originated from the right coronary artery in seven patients, from the left coronary artery in seven, from both coronary arteries in one patient, while the origin was not clearly defined in the final patient. Associated cardiac anomalies were discovered in six patients, with three of the fistulas being diagnosed at the same presentation. Cross-sectional echocardiography had revealed a dilated coronary artery in 7 out of 11 subjects. The ratio of pulmonary to systemic flows ranged between 0.9 to 3.0, with a median of 1.5. Ten patients were referred for corrective surgery without any mortality. Trans-catheter closure was successfully undertaken in one patient, while spontaneous closure of the fistula was noted in two patients. We conclude that coronary arterial fistulas, although rare and potentially serious, are generally treatable.
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Affiliation(s)
- K T Wong
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Affiliation(s)
- C Mas
- Paediatric Cardiology Unit, Monash Medical Centre, Melbourne, Australia
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Abstract
Closure of atrial septal defects be means of intravenous catheterisation has been undertaken using a variety of devices as an alternative to surgical closure. We describe the first case, to the best of our knowledge, of infective endocarditis complicating a successful transcatheter closure. This highlights the potential risk of this procedure, and emphasises the need for appropriate antibiotic prophylaxis until complete endothelialization of the device has occurred.
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Affiliation(s)
- A M Bullock
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Abstract
OBJECTIVES We aimed to explore patients' attitudes towards family physicians' and nurses' appearance. METHODS One hundred and sixty-eight patients from three teaching Family Medicine clinics in Beer-Sheva, Israel, were interviewed in the clinics regarding the medical staff's dress code. They were also asked to choose one picture for either a male or female physician which, in their opinion, was the most suited for their own family physician, from a selection of pictures of the same male and female doctors dressed in different attires. RESULTS One hundred and twenty-six patients (75%) replied that the attire of the physician had no influence on their decision in choosing their own family doctor. Fifty-two per cent of the patients preferred the doctor in a white coat and 71 % had the same preference for the nurse. Older age was associated with increased preference for a white coat. The dressing items which scored high for male doctor were a name tag, a formal suit or a shirt with a tie and sports shoes. For a female doctor a name tag, short haircut, trousers and sports shoes ranked highly. Long hair, earrings, and sandals scored low for a male physician, while mini-dress, shorts and tight clothes scored low for a female physician. CONCLUSION About half of patients still prefer the doctor to be dressed in a white coat. Patients prefer a more formal dressing for male and female physicians in family medicine clinics. Most of the patients claimed that the attire of the physician had no influence on their choice of family physician.
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Affiliation(s)
- S Menahem
- Department of Family Medicine, Center for Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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40
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Abstract
Congenital heart disease is a significant cause of morbidity and mortality in the newborn. Its diagnosis may lead to a crisis in the affected families; there are the perceived implications of having an abnormality of so vital an organ. To that may be added the assumed guilt or blame, grief and at times anger, frequently experienced by parents of abnormal infants. It often befalls the paediatric cardiologist to initiate counselling while providing the expert information concerning the abnormality and its optimum management. Such counselling differs from that needed for minor lesions as compared for more complex abnormalities where a fatal outcome may ensure. While it is important to provide an accurate diagnosis and management plan to the parents, early detailed information is often confusing and may not be assimilated at a time of great stress. The parents seem more concerned as to whether the infant will survive, what the long term outlook will be, whether he or she will attend school, play, work and so on. With the more severe cardiac abnormalities, especially where there is a family history, one need be aware of the often perceived guilt of the parents. At times, it may be necessary to help the parents retain sufficient 'self-control', delaying the grieving process to enable them to contribute to the decision making. Where the infant has died, a follow-up appointment can facilitate grieving and help deal with unresolved issues. Through skilled counselling, the cardiologist in addition to his/her diagnostic and management skills, may meaningfully influence the ongoing care of the infant. They may help avoid the development of unrealistic fears or an over-optimistic outlook, thereby fostering the normal development of the child.
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Affiliation(s)
- S Menahem
- Paediatric Cardiology Unit, Monash Medical Centre, Clayton, Victoria, Australia
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Abstract
A male infant, aged 2 month, with Kawasaki disease had a myocardial infarction despite intravenous infusions of gamma globulin and aspirin at high dosage. He developed progressively a thin walled, dilated aneurysm of the apex of the left ventricle which became lined with thrombus despite treatment with warfarin. Another boy, aged 6 years, was noted on the 10th day of the evolution of Kawasaki disease to have developed a giant aneurysm of the main stem of the left coronary artery. Despite infusion of gamma globulin, the aneurysm remained unaltered and developed a thrombus. The thrombus resolved following treatment with warfarin, though the giant aneurysm has persisted. These two cases illustrate the serious consequences that can follow Kawasaki disease despite management optimal by current standards.
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Affiliation(s)
- N S Kim
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia
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42
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Affiliation(s)
- S Menahem
- Department of Pediatrics, Monash University, Melbourne, Australia
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43
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Abstract
A family is described where the father has the many skeletal, but none of the cardiac abnormalities associated with the Holt-Oram syndrome. His two daughters have similar skeletal anomalies, but with identical cardiac lesions, as does another patient, raising the possibility of an associated genetic marker.
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Affiliation(s)
- R G Bennhagen
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
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Abstract
OBJECTIVE To review the impact of integrating child psychiatry services into a paediatric department. METHOD Following the arrival of a new head of paediatrics, a mandatory multidisciplinary meeting was set up to review, diagnose and manage selected patients under the care of the paediatricians and/or a child psychiatrist. A prospective audit was undertaken of the patients discussed with a brief review of their outcome. The educational value of the meetings and their overall impact on the department was reviewed. RESULTS Over an 8-month period 30 patients were discussed in some detail with diagnoses ranging from a psychiatric disorder to a chronic organic illness, each subjected to the deliberations of the multidisciplinary team of the attending paediatrician, resident staff, child psychiatrist/psychologists, nurses, social worker, etc. Recommendations included further assessment by the psychiatric team, or management by the paediatricians with or without guidance of the former, involvement of an outside agency, etc. Such interventions generally had positive outcomes: at times dramatic, although early discharge often resulted in limited goals. There was also an overall increased awareness within the department of the psychological needs of the child and family and the importance of serious physical illness; this awareness is essential in the training of paediatricians and psychiatric staff. CONCLUSION Closer integration of the two disciplines led to benefits both to the patients and staff. The initiation of a mandatory multidisciplinary meeting facilitated the process, overseen by a psychologically-minded new head of paediatrics. His departure led to a loss of some goals achieved, raising the question as to how such collaboration may be self-generating and ongoing. In addition, the issue of how to deal with those patients with ongoing difficulties not addressed during their limited inpatient stay was unresolved.
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Affiliation(s)
- S Menahem
- Department of Paediatrics, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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Abstract
OBJECTIVE Isolated congenital complete heart block (CCHB) occurs in 1/20,000 live births. More than 85% of mothers giving birth to affected infants are anti-Ro antibody positive, but only approximately 1% of babies with anti-Ro-positive mothers develop CCHB. We studied 2 sets of monozygotic twins discordant for CCHB. METHODS Monozygosity was determined using placental examination and DNA microsatellite analysis. HLA typing was performed. Autoantibody studies were performed using counterimmunoelectrophoresis, immunoblotting, Ro 52 and Ro 60 enzyme-linked immunosorbent assay (ELISA), and indirect immunofluorescence (IIF) on Ro 60- and Ro 52-transfected HEp-2 cells. RESULTS Both sets of twins were monozygotic. They had similar birth weights. Twin 2 in the second set required a pacemaker at age 2 months. Both mothers were positive for anti-Ro 52 and anti-Ro 60 antibody, and neither had anti-La antibody on immunoblot. One set of twins was studied at birth. Similar titers of anti-Ro 52 and anti-Ro 60 antibody were found by IIF and ELISA. CONCLUSION There are no previous well-documented reports of monozygotic twins discordant for CCHB. These cases demonstrate that there is still discordance in the development of CCHB despite identical genetics and environmental exposure to anti-Ro antibody.
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Affiliation(s)
- H M Cooley
- Royal Melbourne Hospital, Parkville, Victoria, Australia
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Abstract
Infants with anomalous left coronary artery from the pulmonary artery (ALCAPA) may present with heart failure, mitral regurgitation, and dilated cardiomyopathy. Reestablishment of a two coronary artery system markedly improves the morbidity and mortality. However, the mitral regurgitation may continue to deteriorate despite surgical correction of the ALCAPA because of previous ischemic damage to the papillary muscles and chordae. Surgical intervention, including mitral valve replacement, may be required even during infancy. We present two infants with ALCAPA who required early mitral valve replacement for severe mitral regurgitation and have done well subsequently.
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Affiliation(s)
- M C Yam
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia
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Hill DJ, Hudson IL, Sheffield LJ, Shelton MJ, Menahem S, Hosking CS. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol 1995; 96:886-92. [PMID: 8543745 DOI: 10.1016/s0091-6749(95)70224-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of diet change in 38 bottle-fed and 77 breast-fed "colicky" infants, referred from community-based pediatric facilities was studied over a 1-week period in a double-blind (within each feeding mode), randomized, placebo-controlled trial. METHODS Bottle-fed infants were assigned to either casein hydrolysate or cow's milk formula. All mothers of breast-fed infants were started on an artificial color-free, preservative-free, additive-free diet and also randomized to an active low allergen diet (milk-, egg-, wheat-, nut-free) or a control diet. RESULTS The response to diet was assessed on day 1 and day 8 with the use of a previously validated infant distress chart on which parents recorded distress levels. If successful outcome was defined as a reduction in distress of 25% or more, after adjusting for age and feeding mode, infants on active diet had a significantly higher rate of improvement than those on the control diet (odds ratio, 2.32; 95% confidence interval, 1.07-5.0; p = 0.03). Analysis of the day 8 to day 1 distress ratio, again adjusted for age and feeding mode, showed that infants on the active diet had distress reduced by 39% (95% confidence interval, 26-50) compared with 16% (95% confidence interval, 0-30) for those on the control diet (p = 0.012). CONCLUSION The results suggest a period of dietary modification with a low allergen diet and appropriate nutritional support should be considered in healthy infants with colic.
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Affiliation(s)
- D J Hill
- Department of Allergy, Royal Children's Hospital, Parkville, Melbourne, Australia
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Nomura F, Penny DJ, Menahem S, Pawade A, Karl TR. Surgical intervention for infective endocarditis in infancy and childhood. Ann Thorac Surg 1995; 60:90-5. [PMID: 7598627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Infective endocarditis is an uncommon but serious disease in children. Optimal treatment strategy, especially surgical indications, continues to evolve. METHODS Retrospective review of 98 patients treated for infective endocarditis during the past 13 years at the Royal Children's Hospital, including medically and surgically treated patients. RESULTS Thirty of 98 patients had surgical intervention with 6.7% hospital mortality, and 76% survival probability at 45 months. The remaining patients were treated medically, with 10% hospital mortality and 52% 5-year survival probability. The incidence of structural heart disease, congestive heart failure, and spectrum of organisms was similar in the two groups. CONCLUSIONS Despite advances in antibiotic therapy, early surgical intervention is required in a significant subset. Concurrent intracardiac repair may be appropriate.
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Affiliation(s)
- F Nomura
- Victorian Paediatric Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, Australia
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50
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Menahem S, Shvartzman P. Recurrent dermatitis from jellyfish envenomation. Can Fam Physician 1994; 40:2116-8. [PMID: 7888824 PMCID: PMC2380397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Jellyfish envenomation can cause an immediate local skin reaction, which is usually a painful linear vesiculourticarial eruption. Persistent, delayed, or recurrent dermatitis is less common. Because jellyfish sting reactions and their management are unfamiliar to family physicians, we describe a case of recurrent local dermatitis after jellyfish envenomation and suggest appropriate treatment.
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Affiliation(s)
- S Menahem
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev in Beer Sheva, Israel
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