Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts

Intrauterine foramen ovale (FO) restriction in association with congenital heart disease (CHD) carries a poor prognosis. However, in the absence of CHD, the clinical importance of restrictive FO in the fetus is not well understood. We evaluated the antenatal prevalence, clinical presentation, diagnostic ultrasound features, and outcome of restrictive FO in fetuses without CHD. We reviewed the echocardiographic and clinical records of 23 fetuses diagnosed with a restrictive FO and structurally normal heart between 2001 and 2012. The atrial septum, dimensions of cardiac structures, left and right cardiac output and Doppler interrogation of cardiac flows were examined. The clinical outcomes of all fetuses with restrictive FO were analysed. Restrictive FO was identified in 23 of 1,682 (1.4%) fetuses with no CHD. Enlarged right heart structures (100%), hypermobile or redundant primum atrial septum (91%), increased right-to-left ventricular cardiac output ratio (91%), and posteriorly angulated ductus arteriosus (68%) were the most common echocardiographic findings associated with this rare phenomenon. Additional noncardiac systemic abnormalities were identified in 13 (56%) babies. Seven (30%) neonates developed persistent pulmonary hypertension, and 7 infants died. Antenatal restrictive FO is an underrecognised entity despite being a common cause of right heart dilatation in the fetus. In the absence of CHD, restrictive FO is well tolerated antenatally, but its frequent association with noncardiac abnormalities and pulmonary hypertension in the neonate are noteworthy.

Total parenteral nutrition via a peripheral vein: A comparison of heparinised and non-heparinised regimens

Administration of total parenteral nutrition solutions via a peripheral vein is an attractive concept. An ideal regimen would meet the requirements of moderately catabolic patients and would contain about 14g of nitrogen and 2200kcals. The feasibility of administering such a regimen was examined in a study at Hammersmith hospital, London. To prolong vein survival and minimise the risk of phlebitis, all patients had a glyceryl trinitrate patch and twice daily hydrocortisone cream applied to the infusion site. Patients were randomised to receive either heparinised or non-heparinised TPN at a concentration of 1 IU/ml. Sixteen patients were recruited to the study of whom nine received heparin in their TPN. The end point was determined as occurring when the cannula was removed electively or accidentally, or when phlebitis around the cannula site necessitated removal. Infusions ending in phlebitis or tissuing were counted as true failures while cannulae electively withdrawn or pulled out were treated as censored data. The median survival time of infusion sites receiving heparinised TPN was 69 hours while the median survival time of sites receiving TPN only was 31 hours. Life table analysis was carried out on the duration of patency of individual cannulation sites. Comparison of the two groups using the logrank test showed a significant difference (p=0.013). Thus, the addition of heparin at 1 IU/ml to TPN infusate produced a marked extension of the survival of the infusion sites. This technique warrants further investigation with other peripheral regimens.

A pilot study using intra-partum ultrasound to aid in the definition of the position of the fetal head before operative delivery

We conducted a pilot study on 60 women in the second stage of labour using trans-abdominal ultrasound to assess fetal position prior to obstetric intervention. Digital examination failed to assess the correct fetal position in 16 (26%) of the cases. Ultrasound helped in determining fetal position in 57 (95%) of the cases. In 40 cases (66%), the obstetrician involved found the use of ultrasound to determine fetal position aided in the management of the second stage. All obstetricians involved in the study rated the ease of use of ultrasound in the second stage highly (>8/10) on a visual analogue scale. We have highlighted the role, ease of use and feasibility of intra-partum ultrasound to determine fetal position in the second stage of labour before an obstetric intervention, by the obstetrician in a District General Hospital setting.

Metastatic unknown primary tumour presenting in pregnancy: a rarity posing an ethical dilemma

This brief report raises the ethical dilemma encountered by an obstetrician involved in the care of a pregnant woman with life-threatening disease. This is a particularly difficult issue if the maternal well-being is in conflict with the survival of the unborn child.

Follow-up after negative large loop excision of the transformation zone (LLETZ) of the cervix

We performed a retrospective analysis of 204 patients who underwent large loop excision of the transformation zone (LLETZ) to determine whether women who have a negative LLETZ (no cervical intra-epithelial neoplasia (CIN) present) are at a lower risk of developing further abnormal cytology or CIN than women whose LLETZ is positive (CIN present). Overall 69 of the LLETZ samples were negative (34%) and 135 were positive (66%). The mean duration of negative cytology during follow up was 25.4 months (negative LLETZ) and 21.2 months (positive LLETZ) (P=0.03). In the negative LLETZ group, cytology did not miss any cases of persistent CIN at the 6-month follow-up visit and 39 repeat punch biopsies were all negative. There were 3/69 cases (4.3%) in the negative LLETZ group and 13/135 (9.6%) in the positive LLETZ group of persistent disease (CIN diagnosed at or as a result of the 6-month follow-up). Following a negative 6-month review, one woman developed an abnormal smear in the negative LLETZ group (1/66=1.5%) compared with 10 women (10/122=8.1%) in the positive LLETZ group. Recurrent CIN (CIN subsequently diagnosed following a negative 6-month review) was seen in 0/69 cases (0%) in the negative LLETZ group and 4/135 (3.2%) in the positive LLETZ group. We conclude that women who undergo a negative LLETZ may represent a low-risk group for developing further cytological and histological abnormalities.

Use of a portable bladder scanner to reduce the incidence of bladder catheterisation prior to laparoscopy

The aim of this study was to evaluate the usefulness of estimating bladder volume with a dedicated portable ultrasound device immediately prior to gynaecological laparoscopy. Catheterisation was performed if the estimated volume was greater than 100 ml. Forty consecutive women were studied prospectively. Twenty-six women did not require catheterisation. The procedure was quick and effective in safely reducing the frequency of pre-operative catheterisation.

Environmental factors and health problems among workers of the national project in Toshka

The National Project in Toshka is a recognized agricultural one, as well as a comprehensive developmental project. The present study was carried out to investigate environmental factors and health problems among workers in this National Project. Environmental levels of vibration, noise, heat stress, total suspended particulates and respirable dust were measured in the different activities of the project during May 2000. The health records of Behera Company Incorporation, the project main implementing contractor, in the period 1997-1999 were analyzed. Workers were classified according to the nature of occupational exposure into three groups namely; earth workers, concrete workers, and services and administration workers. Records of occupational accidents of the same group of workers and in the same period were analyzed as well. Results showed that all the measured environmental factors were within the permissible levels of exposure in the different project activities. Workers showed a significant lower rate of total health problems in the last studied year (1999) as compared to the previous two years (1997-1998) (p=0.001). Prevalence rates of musculoskeletal disorders, urinary tract troubles, ear-nose-throat (ENT) problems and chest problems were significantly higher in earth and concrete workers than in services and administration workers (p=0.001, 0.011, 0.036 and 0.044, respectively). Both occupational accident frequency and severity rates were very low in comparison to other major construction projects such as the High Dam. These rates showed decreasing trends throughout the studied years; however, relatively higher rates were observed among earth workers than the other groups. Miscellaneous wounds were the commonest presentation of occupational injuries among the three occupational groups. In conclusion, the current use of modern technology accounted for the low levels of enviro mental exposure factors, as well as the high safety standards. Workers showed a significant degree of acclimatization to work in this region; therefore, inhabitants and workers should be encouraged to engage this new community. The low rates of health problems among workers observed in this study reflected a satisfactory level of medical services. Preplacement and periodic medical examinations of construction workers aught to consider musculoskeletal, urinary tract, ENT and chest conditions among them.

Malignant melanoma metastatic to the ovary: presentation and radiological characteristics

Cutaneous melanomas rarely metastasize to the ovary; however, we have recently encountered three cases which have proved a diagnostic dilemma. All presented with a pelvic mass and a past history of cutaneous melanoma but both ultrasound examination and CT scanning proved inconclusive and neither was able to accurately characterize the lesions. Magnetic resonance imaging (MRI) was able to demonstrate the presence of melanin in one of the ovarian lesions as peripheral high signal change on T1-weighted images. The two lesions without melanin failed to show this feature. MRI may therefore be useful in the diagnosis of ovarian melanoma but only if melanin is present.

An immunoserological study among blood donors of Makkah region, Saudi Arabia

Blood services are inevitable and life-saving. Therefore all measures should be taken to guarantee that the donated blood is pathogen free. The present study intends to throw some light on the prevalence of some infectious and parasitic diseases among blood donors, whether Saudi or expatriates residing in Makkah region (Makkah and Jeddah cities). Results of this work indicate that hepatatis B is one of the most important problems involved in blood services in this region. On the contrary sexually transmitted diseases like syphilis and AIDS do not comprise a real health problem so far. However, periodic check-up and intensive health education are of utmost importance. Hydatidosis does not constitute a real problem as dogs are mostly avoided in this region.

An environmental and medical study of byssinosis and other respiratory conditions in the cotton textile industry in Egypt

This study was conducted in a typical Egyptian textile plant located in Alexandria. Male workers from all operations (N = 506) were examined and their dust exposures were assessed. Results showed that airborne dust concentrations were very high and that the plant fraction is mostly concentrated in respirable dust. Byssinosis prevailed in 21% of workers in opening and cleaning sections and in 13% in carding and combing rooms, but was found in none of the workers in drawing, twisting, and spinning operations, in only 1.1% in weaving, and in 3.1% of workers in other "auxiliary" occupations. The rare prevalence of byssinosis among the latter workers' groups was attributed to the workers' continuous exposure without fixed weekend interruption, the personal and family history of exposure to cotton, the low proportion of plant materials in dust evolved in related operations, the fine quality of Egyptian cotton, and/or the population characteristics of Egyptian workers. Reduction in FEV 1.0 at the end of the first work shift after absence from work occured more often than byssinosis, which indicates the importance of this test for the early detection of effects of cotton dust exposure. It is suggested that a nationwide study in the cotton textile industry is indicated.

Role of family susceptibility, occupational and family histories and individuals' blood groups in the development of silicosis

A previous investigation has shown that family susceptibility and occupational and family histories have a decisive role in the development of byssinosis among workers exposed to flax dust. Results of investigation of silicosis in 814 male workers exposed to silica-bearing dust showed that family susceptibility has an important role in the development of silicosis among examined workers, and workers whose fathers had an occupational history of exposure to silica-bearing dust were more resistant to the development of the disease than those with non-exposed fathers. The degree of consanguinity of parents and individuals' blood groups, also, have a role. Workers with cousin parents were relatively highly susceptible to the development of silicosis as well as workers with blood groups "O" or "AB". It has been concluded that the investigated factors might have a role in the development of other occupational diseases and further investigations are indicated.

Pulmonary function in men with intermittent long-term exposure to hyperbaric oxygen

The effect of intermittent exposure to hyperbaric oxygen over a long period of time was evaluated in 65 subjects. Pulmonary ventilation and diffusion capacities were measured in 65 divers as well as in 67 control subjects. No significant difference was found (P < 0.05) in any of the measured respiratory parameters between the divers and the controls in spite of the diver's long-term occupational exposure to hyperbaric oxygen.

A six-year follow up study for evaluation of the 85 dBA safe criterion for noise exposure

This study included 114 workers who have been exposed to noise levels of 78 to 91.4 dBA and followed over a six year period. Workers exposed to nose levels up to 85 dBA eight hours daily for six days per week and for twelve years showed a slightly higher (1%) hearing impairment than the corresponding control subjects. Impairment of hearing among workers exposed to higher noise levels was 9.6%.

Seasonal exposure to dust in flax processing in Egypt

Previous evidence suggested that interruption of worker's exposure to flax dust may lead to severe symptoms of byssinosis on their return to work. In the present study, the prevalence and severity of byssinosis was studied in a sample of flax workers (n=577) who had been exposed to dust for six months each year. Byssinosis prevailed in 36.9% of them, and 32.3% of them had their FEV 1.0 sec reduced 10% at the end of the first morning work period (4 to 6 hours) of the week. Both syndromes were higher among seasonal workers than what would be predicted if they were pemanently exposed to flax dust. A hypothesis has been presented to interpret this finding.

Study of lung function changes among different grades of byssinosis

El-Sadik, Y. M., Moselhi, M., El-Hinady, A. R., and Mostafa, M. N. (1972).Brit. J. industr. Med.,29, 184-187. Study of lung function changes among different grades of byssinosis. This study comprised 80 workers of whom 50 are byssinotics, 15 are chronic asthmatic bronchitics, and 15 are free of chest symptoms. A comparison of the changes in forced expiratory volume in one second due to exposure in the first working day in the week among them (80 workers) showed a greater reduction in byssinotics than among the others. Reduced maximum expiratory flow rates were found only in byssinotics. Independent of exposure, only third-grade byssinotic cases (22 out of 50) showed changes in predicted vital capacity, residual volume, total lung capacity, three seconds per cent vital capacity, total vital capacity timed in seconds, and air velocity index. The pattern of changes in these lung functions is mostly obstructive; only two cases showed the pattern of restrictive disease. This study denotes that two types of changes in pulmonary functions occur due to byssinosis. The first type is a temporary change in pulmonary functions which occurs only on exposure to the aetiological factor (cotton or flax dust). This type occurs among all grades of the disease. The nature of this type is obstructive. The second type of change is permanent. This type occurs only among the third grade of the disease and is not dependent on immediate exposure. This type of change is mostly obstructive but may show some restriction.