Sudden cardiac death caused by native aortic valve thrombosis in an adult patient with a complex congenital cyanotic heart disease.

Cyanotic congenital heart disease is associated with an increased risk of thromboembolism. We describe the case of sudden cardiac death caused by native aortic valve thrombosis in adult cyanotic patient. Such embolic complication was not previously described in cyanotic patient. It is also the first report of sudden cardiac death as an initial presentation of the native aortic valve thrombosis. Cyanotic congenital heart disease (CCHD) is associated with an increased risk of thromboembolism due to different haemathologic abnormalities associated with hypoxemia and secondary polycythemia [H. Kajimoto, M. Nakazawa, K. Murasaki, et al. Increased thrombogenesity in patients with cyanotic congenital heart disease. Circ J Jun 2007;71(6):948-953]. Cerebrovascular events, venous and arterial thrombosis have been described in patients with CCHD [N. Ammash, C.A. Warnes. Cerebrovascular events in adult patients with cyanotic congenital heart disease. J Am Coll Cardiol Sep 1996;28(3):768-772]. We present a case of the native aortic valve thrombosis in an adult patient with a complex cyanotic congenital heart lesion which led to sudden death.

The risk for congenital heart defects in offspring of individuals with congenital heart defects.

BACKGROUND: Congenital heart defects (CHDs) occur in approximately 1% of all live births. Although most CHDs are of unknown etiology, a family history of CHDs is a known risk factor, and offspring of individuals with CHDs are at a higher risk of having CHDs. The aim of this study was to investigate the relative risk for CHDs to offspring of individuals with CHDs. METHODS: The prevalence rates of CHDs in offspring of 203 individuals with CHDs and 282 individuals without CHDs were investigated. The study participants completed a questionnaire that included information on medical and reproductive history, lifestyle indicators, and family history of CHDs and other congenital malformations. The prevalence rates of CHDs in offspring were calculated. RESULTS: The prevalence of CHDs was 3.1% (18/575) in offspring of individuals with CHDs and 1.3% (8/589) in offspring of individuals without CHDs. The adjusted odds ratio for CHDs to offspring of parents with CHDs was 1.73 (95% confidence interval [95% CI] 0.89-2.44, p=0.02). The estimated relative risk for offspring to females with CHD was higher than for males [2.3 (95% CI 1.1-4.7, p=0.03) versus 1.31 (95% CI 0.48-4.30, p=0.66), respectively]. There was no suggestion of association between CHDs and maternal smoking, alcohol consumption, and use of medication during pregnancy. CONCLUSIONS: Offspring of parents with CHDs are at a higher risk for CHDs compared with the general population. Couples where one member is affected with CHD should receive pre-conceptional or pre-natal genetic counseling and should be informed about the magnitude of the potential risk of CHDs to the offspring.

Managing workplace exposure information.

A quality industrial hygiene program must include the collection and management of workplace exposure information. For many industrial hygienists, however, exposure monitoring data are the only exposure information available. Often, there is no attempt to qualitatively estimate and document all known exposures because mechanisms for doing so are not widely available. Industrial hygienists and other occupational health professionals generally lack information that provides sufficient knowledge and understanding about most employee exposures. The subject of this paper is a description of one company's approach to collecting and managing exposure information through a Job Exposure Profile (JEP) system. The JEP system provides a concise and detailed summary of exposure information for defined exposure groups that can be tracked over time. The value of the system lies in its simplicity and versatility, both as a dynamic tool to be incorporated into a comprehensive occupational health program and as a historical document. The system serves as an effective method for identifying and focusing on significant health hazards for each job at a facility from industrial hygiene, medical, epidemiologic, and engineering perspectives.

Continuous rt-PA infusion as a salvage strategy to maintain patency of the infarct artery; safety of high cumulative dose and subsequent emergency coronary artery angioplasty and bypass surgery.

Acute re-occlusion of an infarct artery reperfusion attained by thrombolytic therapy may be treated by emergency coronary angioplasty or bypass surgery. Repeated infusion of a thrombolytic agent is an additional treatment strategy. Three patients with reinfarctions that occurred very early after successful reperfusion were treated with continuous infusion of recombinant tissue-type plasminogen activator (rt-PA). These patients received a rt-PA dose of 300-360 mg while they awaited emergency mechanical revascularization procedures. Two patients had coronary angioplasty immediately after receiving repeated infusions of rt-PA and one underwent coronary bypass surgery while receiving a third rt-PA infusion. There were no bleeding complications in the 2 patients who underwent coronary angioplasty, and no excessive bleeding in the patient who received coronary bypass surgery. Thus, repeated continuous rt-PA infusions can be used to maintain the patency of recurrently occluding infarct arteries until definitive mechanical revascularization can be performed.

Differential effects of fornix and caudate nucleus lesions on two radial maze tasks: evidence for multiple memory systems.

The present experiments were designed to examine the hypothesis that the mammalian brain contains anatomically distinct memory systems. Rats with bilateral lesions of caudate nucleus or fimbria-fornix and a control group were tested postoperatively on 1 of 2 versions of the radial maze task. In a standard win-shift version, each of the 8 arms of the maze was baited once, and the number of errors (revisits) in the first 8 choices of each trial was recorded. Fimbria-fornix rats were impaired in choice accuracy, while caudate animals were unimpaired relative to controls. Different groups of rats with similar lesions were tested on a newly developed win-stay version of the radial maze, in which the location of 4 randomly selected baited arms was signaled by a light at the entrance to each arm, and which required rats to revisit arms in which reinforcement had been previously acquired within a trial. Rats with fimbria-fornix lesions were superior to controls in choice accuracy on the win-stay radial maze task, while caudate animals were impaired relative to controls. The results demonstrate a double dissociation of the mnemonic functions of the hippocampus and caudate nucleus. Some implications of the presence of 2 memory systems in the mammalian brain are discussed.

Lissauer form of paretic neurosyphilis with a cerebral mass lesion.

A 40-year-old male patient with progressive dementia presented adversive seizures, and CT scan showed an enlarging focal mass lesion in the right cerebral hemisphere. Cerebrospinal fluid examination and brain biopsy confirmed the diagnosis of neurosyphilis. After a course of penicillin therapy there was disappearance of the cerebral mass lesion and the CT scan showed focal atrophy in the right cerebral hemisphere. This case suggests that Lissauer form of paretic neurosyphilis may present as a focal mass lesion.

Prediction of the need for postoperative mechanical ventilation in myasthenia gravis.

In order to determine predictors for the postoperative need of mechanical ventilation in patients with myasthenia gravis undergoing thymectomy, the authors retrospectively applied multivariate discriminant analysis to preoperative physical, historical, and laboratory data of 24 myasthenic patients. They identified four risk factors--duration of myasthenia, respiratory disease, pyridostigmine dosage, and vital capacity--that allowed prediction of which patients would need postoperative mechanical ventilation and which could readily have their tracheas extubated. The four factors were weighted according to their respective importance in making this prediction and combined to form a preoperative scoring system. Using the resultant scores for each patient, the authors correctly predicted ventilatory need in 91 per cent of the patients, and only conservative errors (predicting the need for ventilatory support) were made. Traditionally used criteria for evaluating myasthenic patients were poorer predictors than the four factors identified by the authors. The scoring system may be clinically useful in the preoperative evaluation and postoperative care of the patient with myasthenia gravis, for its identifies important variables in the evaluation of the myasthenic patient and serves as an aid to the physician in identifying those able to tolerate early tracheal extubation.

A portable, low cost ventilation system for transportation of patients with severe acute respiratory failure.

As part of the development of a life support stretcher for transportation of critically ill patients, a portable ventilation system was developed. This system was used successfully during transportation of 6 of 11 patients who required ventilatory assistance and who were being considered for extracorporeal membrane oxygenator support. Immediately after transportation, PaCO2 values were significantly lower (p less than 0.05) in patients ventilated with this system, when compared to PaCO2 values of the remaining 5 patients in whom ventilation was assisted with a 2-liter anesthesia bag (PaCO2 = 58.7 +/- 3.6). This system offers significant advantages over other presently manufactured systems, including low cost, portability, and efficiency in terms of oxygen utilization. (Manual ventilation is supplied so that no auxiliary electrical power supply is necessary.) Positive end-expiratory pressure (PEEP) can be varied by 2.5 cm H2O increments using a commercially available, weighted ball valve. In addition, it has been useful for transporting patients with acute respiratory failure within the hospital for therapeutic maneuvers or diagnostic studies.