Effects of trawling on the diets of common demersal fish by-catch of a tropical prawn trawl fishery.

The ecological effect of prawn trawling on the benthos of the Gulf of Carpentaria, northern Australia, was investigated by examining stomach contents of common demersal fishes incidentally caught as by-catch in the fishery. Fishes were collected from high and low fishing intensity sites in three regions based on vessel monitoring system data. The diets of eight species of benthic fish predators were compared between regions and fishing intensities. A regional effect on diet was evident for seven species. Only one generalist species had no significant difference in diet among the three regions. For the comparisons within each region, five predator species had significantly different diet between high and low fishing intensities in at least one region. Across the three regions, high fishing intensity sites had predators that consumed a greater biomass of crustaceans, molluscs and echinoderms. At low fishing intensity sites, predators had diets comprising a greater biomass of cnidarians and teleosts, and a different assemblage of molluscs, crustaceans and fishes. These changes in diet suggest that there may have been a shift in the structure of the benthic community following intensive fishing. Analysis of predator diets is a useful tool to help identify changes in the benthic community composition after exposure to fishing. This study also provided valuable diet information on a range of abundant generalist benthic predators to improve the ecosystem modelling tools needed to support ecosystem-based fisheries management.

Spontaneous complete closure of a congenital coronary artery fistula.

The first documentation is reported of spontaneous closure of a coronary artery to right ventricle fistula that was demonstrated initially in a 14 month old boy. Over a 4 year period after diagnosis, the characteristic continuous murmur gradually disappeared. When the patient was 5 1/2 years of age, selective coronary arteriography showed normal coronary vessels and circulation. Six other cases of coronary fistula observed during the past 10 years are also reviewed. This study supports the rationale for clinical follow-up rather than obligatory surgical intervention in asymptomatic patients with a small shunt who have no evidence of myocardial dysfunction.

Coarctation of the aorta: a study in delayed detection.

The findings and presentations of 65 consecutive patients in whom uncomplicated coarctation of the aorta was diagnosed after 1 year of age were reviewed. Significant delays in diagnosis occurred in the great majority of patients. The median age at diagnosis was 10 years (range 1 to 36 years). Pediatricians made 75% of the referrals. However, the diagnosis of coarctation of the aorta was made before referral in only 14% of these cases. The remaining referrals were made after the incidental notation of hypertension or a heart murmur out of the context of routine medial care (eg, emergency room, school nurses, working paper and insurance physicals, pregnancy, etc). Cardiac murmurs (median age at diagnosis 6 years) and hypertension (median age at diagnosis 18 years) accounted for referrals in whom the condition was not diagnosed. Prompt referral to a cardiologist after the detection of an abnormal finding did not always occur. Additional delays in referral occurred in 29 patients. All of the patients had cardiac murmurs and differential blood pressure between upper and lower extremities. Elevated systolic blood pressure in the upper extremities was found in 89%; femoral pulses were absent in 40%; and pedal pulses were absent in 77%. It is concluded that coarctation of the aorta is a diagnosis that is often overlooked despite specific physical findings. The importance of upper and lower extremity blood pressure determination as part of an initial routine physical examination is emphasized. The impact of delayed diagnosis has yet to be fully defined, but may well be significant in terms of cardiovascular sequelae of prolonged hypertension.

Early diagnosis of coarctation of the aorta in children: a continuing dilemma.

UNLABELLED: Because late repair of coarctation of the aorta (COA) is associated with premature cardiovascular disease in adult life, early detection and treatment is important. OBJECTIVES: To determine the timing of referral to see whether early detection of COA has improved in the past decade, to evaluate the pattern of and reasons for medical center referral, and to assess the clinical signs relating to the diagnosis of COA. METHODS: The records of 50 consecutive patients older than 1 year who had surgical repair of COA from 1980 to 1990 were reviewed. The age of referral, pattern of referral, and presence of standard clinical signs of COA were analyzed, and data were compared with those from the previous decade. RESULTS: The mean and median ages at referral were 8.4 and 5.8 years, respectively. Pediatricians accounted for 64% of the referrals. A specific diagnosis of COA was made in 2 (4%) of 50 patients before referral to a pediatric cardiologist. The most consistent clinical findings were a cardiac murmur and a systolic blood pressure gradient between the arms and legs of greater than 10 mm Hg, which were both present in all patients. Lower-extremity pulses were decreased in 37 (74%) and absent in 9 (18%). Forty-seven children (94%) had upper-extremity hypertension (> 95th percentile for age); 25 (50%) had systolic blood pressure higher than 140 mm Hg. COA would have been missed in 82% of children if absent lower-extremity pulses were required as a diagnostic feature. These findings were similar to those reported by our institution in the previous decade, suggesting that early detection has not improved. CONCLUSIONS: The timing of, reasons for, and sources of referral for COA in this study, compared with data from the previous decade, indicate no improvement in early detection of COA by pediatricians. Screening all children for COA by routinely measuring upper- and lower-extremity blood pressures during at least one physical examination after the newborn period is mandatory.

Long-term follow-up of two infants with an implanted cardiac pacemaker.

The clinical course of two patients with congenital heart block who had pacemaker implantation at age 7 and 8 months, respectively, is reviewed. One patient at age 10 years has had nine pulse generators inserted; the other has had six implantations, the most recent a lithium iodine pacemaker, during 8 1/2 years of observation. Both patients have shown normal physical development and emotional maturation despite multiple hospitalizations and pacemaker replacements, thus demonstrating that electrical pacing, initiated in infancy, can be maintained through childhood without adverse effects.

Muscular ventricular septal defects repaired with left ventriculotomy.

Between 1974 and 1979 nine patients, aged 10 months to 4 years, underwent left ventriculotomy for closure of single or multiple defects in the muscular ventricular septum. The vertical incision paralleled the anterior descending branch of the left coronary artery near the apex of the left ventricle and ranged from 2.5 to 3.5 cm in length. Four patients also had a right ventriculotomy with closure of a high perimembranous ventricular defect in two. Serial electrocardiograms indicated changes of myocardial ischemia or necrosis. Left bundle branch block did not develop in any patient. Three patients died in the early postoperative period. The six surviving patients are living and well 2 to 7 years later. There is apparent complete closure of the ventricular defects, which was documented by cardiac catheterization in four cases. Two patients had cardiomegaly and left ventricular dysfunction as assessed with echocardiographic and angiographic study, whereas four displayed good cardiac function. In three of the latter patients, cardioplegia or deep hypothermia techniques were utilized intraoperatively. The observations indicate that left ventriculotomy of limited size is an acceptable approach to the difficult problem of repair of muscular ventricular defects but may involve some risk of compromise of the coronary circulation.

Traumatic rupture of extracardiac valved conduit: unusual late complication producing outflow tract obstruction.

A 22-year-old woman died suddenly 15 years after successful repair of truncus arteriosus with a valved Dacron conduit. At autopsy there was complete obstruction of the right ventricular outflow tract by a large organizing thrombus between the outer aspect of the conduit and the adherent pericardial tissue. This rare late complication may have resulted from an unrecognized deceleration injury occurring at the time of a serious automobile accident 5 months before death.

Acute rheumatic fever in New York City (1969 to 1988): a comparative study of two decades.

One hundred fifteen attacks of acute rheumatic fever were observed during the past two decades (1969 to 1988) at the Columbia-Presbyterian Medical Center; 104 were initial attacks and 11 were recurrences. The maximum number of cases (18) occurred during the first year of this period, 1969; thereafter the annual incidence decreased until a resurgence was apparent in 1985 to 1986, with 25 cases. There were no differences in the frequency of major manifestations nor the severity of carditis in the 1970s compared with the 1980s. Polyarthritis alone was present in 51 cases, carditis alone in 31, and combined carditis and polyarthritis in 28; chorea was diagnosed in 5. Congestive heart failure occurred in 17 attacks of carditis, including one death from fulminant disease in 1982. In contrast to recent reports, the majority of the affected population was urban, low income, and from crowded communities: more than half were Hispanic, predominantly from Dominican Republic families. The prevalence of acute rheumatic fever underscores the need for early detection and treatment of streptococcal pharyngitis. The observation that 9.5% of the attacks were recurrent reflects failure to comply with antimicrobial prophylaxis and reaffirms the need for more effective secondary prevention programs.

Acquired coarctation of the aorta.

Coarctation of the aorta is usually caused by a congenital narrowing of the aorta. This report describes two children who developed hypertension secondary to an acquired coarctation of the aorta. In one patient the coarctation was temporally related to umbilical artery catheterization and was associated with thrombosis and aneurysmal dilatation of the aorta. In the second patient, the coarctation occurred after surgical aortotomy during the removal of an intrathoracic neuroblastoma. Patients who have interventional damage to the aorta should be periodically examined for the appearance of a coarctation. Although an acquired coarctation of the aorta is an infrequent complication of invasive or surgical procedures, it should be identified since it represents a remediable cause of hypertension in children.