[Magnetic resonance imaging in the evaluation in utero of Siamese twins]. / Imagerie par résonance magnétique (IRM) dans le bilan in utero des jumeaux siamois.

The authors report a case of twins conjoined at the umbilicus and diagnosed by ultrasound after 19 weeks of amenorrhoea in whom an assessment in utero was carried out using magnetic resonance imaging after the patient had been curarized. A review of the literature on this very difficult problem of conjoined twins has given us the possibility to assess the diagnostic measures as well as the prognosis of this pathology. In particular we point out the results that can be obtained using MRI in utero during the second and third trimesters of the pregnancy.

[Value of amiodarone in the treatment of fetal supraventricular tachycardia. Apropos of a case]. / Intérêt de l'aminodarone dans le traitement des tachycardies supraventriculaires foetales. A propos d'une observation.

Description of a case of supraventricular tachycardia at 33 1/2 weeks of pregnancy following a treatment with salbutamol. After failure of digoxin alone then in association with propranolol, amiodarone allowed control of this tachycardia. A baby was born at 36 weeks, his cardiac and thyrodial assessment were normal. Different problems are discussed: the part of salbutamol on the onset of the tachycardia, the limits of fetal monitoring, the use of echocardiography and the various treatments available.

Concepts and strategies for teaching caring.

Optimal learning of caring occurs when appropriate discussion, analysis, and examples are woven into a structured and guided program of practising the art of caring. Teaching caring includes nurturing the student's perception of the patient's need for caring, the opportunities for caring, and the benefits of caring. It also includes helping the student to acquire effective methods of caring. However, the most important component of teaching caring is helping the student to choose to be caring. The concept of caring as "trying to help love grow" can have a profoundly motivating and integrating effect on the physician's practice of caring. Many of the strategies we use to help love grow in our patients we can also use in a modified form to help medical students at all levels of training. We can also use them to help practising physicians, maintain and expand their capacity to care for and about their patients.

The continuing evolution of family practice services to the elderly in Canada.

The number of elderly individuals in Canada is increasing rapidly and thus producing a major change in the health-care needs faced by the Canadian health-care system. Continued escalation in the cost of institutional care is imposing a severe constraint on that type of medical service. At the same time it is becoming clear that the preservation of the family and continued accommodation within the home are major positive factors in the quality of life of all Canadians, especially elderly Canadians. The present health-care system has three major modes of service: the clinic, the hospital bed, and the nursing home bed. In future there will be development and expansion of home-care/home-support services which are affordable, accessible, adaptable, comprehensive, continuous and well co-ordinated. There will be increased out-patient access to the complex diagnostic and therapeutic tools and services necessarily located at hospitals. This involves changes in the institutional priorities of hospitals, and an increase in the co-ordination of services for non-admitted patients. The family physician has an important role in the planning of medical services in Canada as it adapts to changes in demography, resources and knowledge. The needs of Canadians must continue to be the major determinant of the way the health-care system continues to evolve.

[Steinert disease and pregnancy]. / Maladie de Steinert et grossesse.

Steinert's syndrome and pregnancy with delivery are rarely associated. It is a dominant autosome disease. Certain signs in pregnancy may suggest that the fetus is affected. One case made it possible to demonstrate these facts. Hydramnios with infrequent fetal movements and a slow fetal heart rate may lead to a suspicion of fetal involvement. This is always serious. The presence of the disease in the mother should be sought if it is not already known. If there is already a known family history the patient should see a geneticist so long as early amniocentesis has not yet been performed.