Snapshots Quiz

A 37-year-old, previously healthy, man presented with profuse rectal bleeding necessitating transfusion. Colonoscopy and oesophagogastroduodenoscopy were normal. CT angiography was performed. What is the diagnosis?

Infant growth is associated with parental education but not with parental adiposity - Early Stockholm Obesity Prevention Project

AIM

To explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12 months, adjusting for known early-life risk factors for subsequent childhood obesity.

METHODS

Baseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n = 144/53) and parental education (n = 57/139). Observational data on infant growth between 0 and 12 months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12 months and rapid weight gain 0-6 months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking.

RESULTS

Relative weight at 3, 6 and 12 months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education.

CONCLUSION

Low parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year.

Vocal cord dysfunction after cardiac surgery: an overlooked complication

OBJECTIVE

To evaluate the complication of vocal cord dysfunction following open heart surgery and its short- and long-term effects.

MATERIALS AND METHODS

Five cases (1.9%) of vocal cord dysfunction which were diagnosed among 270 cases of adult open heart surgery performed at this centre between February 1993 and May 1995.

RESULTS

All five patients developed respiratory insufficiency following tracheal extubation. They required reintubation and ventilation. Diagnosis was delayed in three cases because of unawareness of the problem. Tracheostomy was performed in three cases and minitracheostomy in two. In one case, shortness of breath on exertion persisted due to partial laryngeal obstruction from bilateral cord paresis and required arytenoidectomy 11 months postoperatively.

CONCLUSIONS

Vocal cord dysfunction can be an easily overlooked complication after open heart surgery. It can be the cause of respiratory insufficiency following tracheal extubation and may lead to reintubation and reventilation. The cause of the problem cannot always be traced but it may be due to direct trauma of the vocal cords during tracheal intubation, or trauma of the recurrent laryngeal nerve from the cuff of the endotracheal tube. A less likely possibility is that it may result from nerve injury due to central venous cannulation, or from cold. The condition may resolve within months, but, in rare cases, may lead to permanent morbidity.