Cranio-facial clefts in pre-hispanic America.

Among the representations of congenital malformations in Moche ceramic art, cranio-facial clefts have been portrayed in pottery found in Moche burials. These pottery vessels were used as domestic items during lifetime and funerary offerings upon death. The aim of this study was to examine archeological evidence for representations of cranio-facial cleft malformations in Moche vessels. Pottery depicting malformations of the midface in Moche collections in Lima-Peru were studied. The malformations portrayed on pottery were analyzed using the Tessier classification. Photographs were authorized by the Larco Museo.Three vessels were observed to have median cranio-facial dysraphia in association with midline cleft of the lower lip with cleft of the mandible. ML001489 portrays a median cranio-facial dysraphia with an orbital cleft and a midline cleft of the lower lip extending to the mandible. ML001514 represents a median facial dysraphia in association with an orbital facial cleft and a vertical orbital dystopia. ML001491 illustrates a median facial cleft with a soft tissue cleft. Three cases of midline, orbital and lateral facial clefts have been portrayed in Moche full-figure portrait vessels. They represent the earliest registries of congenital cranio-facial malformations in ancient Peru.

Intermittent inotropic therapy in an outpatient setting: a cost-effective therapeutic modality in patients with refractory heart failure.

Patients with intractable heart failure (New York Heart Association [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluated on (1) the number of hospital admissions, (2) length of stay, and (3) number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. Thirty-six patients with stable NYHA class III and IV heart failure received milrinone or dobutamine to manage chronic heart failure in an outpatient setting. The cause of heart failure was ischemic heart disease in 12, idiopathic in 11, hypertension in 8, and pulmonary hypertension in 5. Four patients received dobutamine and 32 patients received milrinone. The mean period of observation was 294 days. For the period before entry in the program, patients had 21 emergency room visits, 75 admissions, and 528 days spent in the hospital. After enrollment, patients had 10 emergency room visits, 34 admissions, and 150 days spent in the hospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room visits. Our study supports the concept that the use of intermittent inotropic therapy in the outpatient setting plays an important role in managing this severely ill group of patients.

Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide.

This report describes a 46-year-old white man who suffered an acute myocardial infarction after carbon monoxide exposure. The electrocardiogram and serum enzymes showed myocardial infarction. The coronary angiogram performed one week after admission failed to reveal evidence of coronary obstructive lesions. The case presented is of interest because the clinical presentation suggestive of myocardial infarction was absent, the patient was found unconscious and his medical profile was negative for coronary heart disease risk factors. It is assumed that COHb causes myocardial infarction by severe generalized tissue hypoxia and a direct toxic effect on the myocardial mitochondria. Contributing factors that might also decrease myocardial oxygenation are an inadequate myocardial perfusion and an increased thrombotic tendency.