Delayed post-traumatic tamponade together with rupture of the tricuspid valve in a 15 year old boy.

With the increase in the number of high speed motor vehicle accidents, blunt, non-penetrating trauma to the heart has become an important health problem. An unusual case is reported of a 15 year old boy urgently referred with cardiac tamponade and a new systolic murmur four months after a car accident. The problems of the diagnosis and possible causes of late cardiac tamponade and tricuspid regurgitation following this type of accident are discussed.

Usefulness of low-dose dobutamine stress echocardiography in predicting recovery of poor left ventricular function in atrial fibrillation dilated cardiomyopathy.

Assessment of contractile reserve was performed in 16 patients with dilated cardiomyopathy and chronic atrial fibrillation. In this prospective study, low-dose dobutamine echocardiography could predict recovery of left ventricular dysfunction and could identify tachycardiomyopathy before restoration of sinus rhythm.

Elective Wiktor GX stenting for symptomatic stenosis in old aortocoronary saphenous vein bypass grafts: the Antwerp experience.

PURPOSE: We compared initial outcome, peri-procedural complications and long-term clinical follow-up of elective Wiktor GX stent implantation in severely narrowed vein grafts to a historic register of elective angioplasties in saphenous vein grafts in the same center. METHODS: Eighty-one consecutive patients with angina and a history of coronary artery bypass grafting (CABG), all received elective angioplasty (PTCA) of the diseased graft; we described them as group P. The next 38 consecutive patients were treated with elective angioplasty and Wiktor Stent implantation, followed by one month ticlopidine; they were called group S. CONCLUSION: This retrospective study suggests that elective Wiktor stenting in old saphenous vein graft stenosis, in combination with one month ticlopidine, leads to: 1) a better angiographic result, with reduction of peri-procedural complications; and 2) a lower incidence of recurrent angina, need for invasive or surgical re-intervention, myocardial infarction and death during follow-up.

Abnormal BMIPP uptake in chronically dysfunctional myocardial segments: correlation with contractile response to low-dose dobutamine.

UNLABELLED: Discordance between 123I-15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid (BMIPP) and sestamibi uptake has been described as a good predictor of functional recovery in patients with a recent myocardial infarction. The current investigation aimed at evaluating BMIPP as a viability tracer in patients with chronic ischemic left ventricular dysfunction. METHODS: Thirty-one studies were obtained in 25 patients with severe left ventricular dysfunction postinfarction (median infarction age 3.6 mo; range 2 wk-15 yr). All patients underwent dobutamine stress echocardiography and a resting 99mTc-sestamibi/123I-BMIPP SPECT study in a 3-day interval. The relative uptake of the two tracers was compared to the evolution of wall motion during dobutamine infusion in 8 matched myocardial segments. RESULTS: Among the 130 segments with abnormal wall motion at rest, 70 improved under dobutamine. Using sestamibi, a normal uptake was 88% predictive of a positive response to dobutamine, and a decreased uptake of 63% predicted negative stress echocardiography response. In the segments with abnormal sestamibi uptake, adding BMIPP significantly increased the accuracy of scintigraphy to detect residual viability; 28 of 48 segments (58%) with a mismatched pattern demonstrating residual inotropic reserve under dobutamine infusion versus only 5 of 40 segments (13%) with a matched defect. Global agreement between the two approaches was 77%, and positive and negative predictive values for scintigraphy were 72% and 88%, respectively. CONCLUSION: In patients with chronic ischemic left ventricular dysfunction, the combined assessment of metabolism and perfusion with 123I-BMIPP and 99mTc-sestamibi correlates well with the response of wall motion to dobutamine during stress echocardiography and is more sensitive than sestamibi alone for differentiating viable from scar segments.

Fetal ascites associated with an imperforate hymen: sonographic observation.

We report a case of fetal ascites in which no abnormalities other than an imperforate hymen were noted. The ascites resolved after abdominal tap and incision of the hymen. A possible mechanism for an association between imperforate hymen and fetal ascites is proposed.

A retrospective epidemiological study of bacterial meningitis in an urban area in Belgium.

UNLABELLED: In order to obtain epidemiological data on the incidence of bacterial meningitis (BM) before the systematic introduction of vaccination against Haemophilus influenzae type b, a retrospective study of 124 children with proven BM was performed in an urban area in Belgium. N. meningitidis was the most prevalent cause, followed by H. influenzae and S. pneumoniae. Over a period of 6 years the incidence of BM increased ten fold, mainly due to an increase in N. meningitidis. The median age of the children with BM was 17 months and 35% of those with H. influenzae were younger than 1 year. Significant risk factors for BM as a whole were: age under 1 year, male gender, non-Caucasian descent and winter time. These findings may have implications for future vaccination policy in Belgium. CONCLUSION: Future vaccination schemes in Belgium should take into account than N. meningitis was the prevalent cause of bacterial meningitis and that certain factors increase the risk for developing bacterial meningitis.

Benign ulcer in a hiatus hernia complicated with a pericardial fistula.

Penetration of the pericardium by upper gastrointestinal lesions is uncommon. It usually results from trauma, perforation of foreign objects, perforation from gastric or thoracic neoplasm or spontaneous perforation. Unfrequently it is a complication of a benign peptic ulcer of the esophagus or the stomach. Survival from peptic ulcers penetrating to the heart is very rare. From a review of the English literature only 11 survivors have been described. We report the successful outcome of a 76 year old lady with a benign ulcus in a hiatus hernia perforating into the pericardium. Diagnosis of the fistula was established after methylene blue swallow. Treatment consisted of early pericardiotomy and drainage followed by surgical correction of the ulcer and fundoplication of the hiatus hernia.

Escherichia coli endocarditis of a native mitral valve with paravalvular pseudoaneurysm formation and fatal hemopericardium.

Until recently only few cases have been described of acute infective endocarditis with E. Coli limited to a normal native mitral valve. Furthermore, mechanisms of so called abcess formation and rupture are still uncompletely understood. We report the case of an E. Coli endocarditis developing a rapidly progressive pseudoaneurysm of the mitral annulus. At necropsy diffuse infectious tissue weakening with pseudoaneurysm formation of the mitral ring and dissection into an hemorraghic pericard were seen. The authors further discuss the changing pattern of infectious agents causing acute infective endocarditis of the native mitral valve, transesophageal echocardiographic characteristics of paravalvular cavities and insights in mechanisms of pseudoaneurysm formation and dissection from clinicopathological findings.

Two siblings with midline field defects and Hirschsprung disease: variable expression of Toriello-Carey or new syndrome?

We describe 2 sibs with multiple congenital anomalies. The main manifestations include hypoplasia of the corpus callosum and/or cerebellar hypoplasia, Robin sequence, pharyngeal and laryngeal hypoplasia, abnormal ears, excessive neck skin, cardiac defect, and Hirschsprung disease. The presence in 2 sibs born to healthy, consanguineous parents suggests autosomal recessive inheritance. These anomalies must have arisen during blastogenesis; the syndrome resembles most the condition described in 1988 by Toriello and Carey.