Mammographic axillary node calcification caused by metastatic breast carcinoma.
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Journal Article↗
Biomedical subjects
A M Groves
Publications and source records attributed to A M Groves.
Superficial collateral veins on abdominal CT: findings in cirrhosis and systemic venous obstruction.
Inspection of the superficial veins of the abdominal wall has long been a routine part of the physical examination. To date, radiologists have given such veins rather scant attention, even though they are elegantly demonstrated by CT. We have performed a study of 21 patients with cirrhosis, 7 patients with caval obstruction and 28 normal control counterparts in order to determine whether superficial veins were more numerous in these two clinical conditions. The 7 patients with caval obstruction included 4 with superior and 3 with inferior vena cava obstructions. Electronic data from the CT examinations of these 28 cases and 28 controls were analysed on a viewing console. Superficial veins were significantly more numerous in patients with cirrhosis (mean maximum=5, p<0.01) and caval obstruction (mean maximum=9.1, p<0.01) than in the normal controls (mean maximum=2.1). The combination of too many superficial veins and a large superior mesenteric vein is a pointer towards cirrhosis. The presence of excessive superficial veins is yet another clue to the presence of underlying disease when analysing abdominal CT.
Abdominal Muscles↗
Rheumatic fever and rheumatic heart disease: an overview.
Rheumatic fever and rheumatic heart disease are still major causes of disease in the developing world today. Diagnosis and prevention, particularly secondary prophylaxis, will become even more important as increased urbanization, with greater population pressure and economic problems, increase the prevalence. The number of children and young adults in their most crucial years of life who would avoid chronic disease and death would more than repay the investment of time and resources.
Adult↗
Outcome of isolated congenital complete heart block diagnosed in utero.
OBJECTIVE: To establish identifiable prenatal factors in fetal heart block which might predict death in utero, the need for intervention, or the probability of pacemaker requirement. SETTING: Tertiary referral unit for fetal echocardiography. SUBJECTS: 36 fetuses with congenital complete heart block and structurally normal hearts identified between 1980 and 1993. METHODS: Maternal anti-Ro antibody status was documented. Prenatal variables examined included absolute heart (ventricular) rate, change in rate, and development of hydrops fetalis. Postnatally, heart rate, need for pacing, and the indications for pacing were detailed. RESULTS: Of the total of 36 patients, there are 24 survivors; 11 are paced. Of those fetuses which died, two were electively aborted for severe hydrops, seven died in utero, two were immediate postnatal deaths, and one was an unrelated infant death. The trend was for the heart rate to decrease during fetal life and postnatally. Fetuses with deteriorating cardiac function did not always show the lowest heart rates. Bradycardia of less than 55 beats/min in early pregnancy or rapid decrease in heart rate prenatally were poor prognostic signs. Hydrops was also associated with bad outcome, 10 out of the 12 hydropic fetuses dying (83%). Of 10 fetuses presenting with a heart rate above 60/min, nine survived of whom three required pacing. Of seven presenting with heart rates of 50/min or less, only three survived and two of these required pacing. Of the two fetuses with negative maternal anti-Ro antibody status one died in utero and one required heart transplantation after pacemaker insertion. CONCLUSIONS: Isolated complete heart block identified in fetal life does not always have a good prognosis. An individual heart rate does not accurately predict the outcome in utero or the need for postnatal pacing. Regular, careful monitoring during pregnancy is required in order to optimise care and timing of any interventions.
Cardiac Pacing, Artificial↗
Therapeutic trial of sympathomimetics in three cases of complete heart block in the fetus.
BACKGROUND: A total of 36 fetuses with isolated congenital complete heart block and structurally normal hearts have been seen in the department of fetal echocardiography since 1980. Although the prognosis is good in the majority of cases, those who develop intrauterine cardiac failure have a high mortality. The aim of this study was to investigate the contribution to management of sympathomimetic therapy by comparing two possible agents administered to the mothers. METHODS AND RESULTS: The effect of two sympathomimetic agents, isoprenaline and salbutamol, was compared in three patients with isolated complete heart block. Fetal heart rate and indexes of cardiac function were monitored during therapy. Maternal cardiovascular status was also regularly assessed. Dosage of isoprenaline increased from 1 to 12 micrograms/min, and salbutamol increased from 4 to 64 micrograms/min during the trial. No significant change was detected with isoprenaline therapy, but all fetuses showed an increase in heart rate and improvement in ventricular function with salbutamol. Salbutamol was maintained until delivery in one case with evidence of cardiac failure, with resolution of fetal hydrops. All three delivered in good condition close to term. Two of three required pacing in the neonatal period. CONCLUSIONS: We conclude that salbutamol can be effective in the treatment of fetal complete heart block and should be considered in patients with this condition where there is evidence of deteriorating cardiac function.
Albuterol↗
Echocardiographic-anatomical correlations in aorto-left ventricular tunnel.
OBJECTIVE: To investigate the echocardiographic, morphological, and histological appearances of aorto-left ventricular tunnel observed in four fetal hearts and compare the findings with those reported in older patients with the malformation. BACKGROUND: Previous studies have concentrated on clinical features of the malformation from birth to adult life and have speculated on either its embryological formation or its acquisition during late intrauterine life. The presentation of a large series of cases in fetal life is a unique opportunity to study the malformation at an early stage in its natural course. METHODS: A retrospective study was performed of four cases of aorto-left ventricular tunnel discovered among 872 cases of congenital abnormalities diagnosed at a tertiary centre for fetal echocardiography. Detailed echocardiographic and anatomical observations were made of the malformation as identified during fetal life. The precise anatomical arrangement was determined and compared with previous descriptions found in journals published in English. RESULTS: In fetal life, as after birth, the malformation is characterised by enlargement and hypertrophy of the left ventricle, enlargement of the aortic root, and free regurgitation at the level of the aortic valve. Anatomical abnormalities are found at the aortic ventriculoarterial and sinutubular junctions as well as in the intervening aortic wall. These are unrelated to necrosis, ischaemia, or the presence of mucopolysaccharides. CONCLUSIONS: The lesion is a developmental abnormality that should be reliably diagnosed by fetal echocardiography combined with colour flow Doppler echocardiography during the mid-trimester. The exact anatomical relations clarified by this study are pertinent to diagnosis and subsequent surgical correction.
Aorta↗
Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus.
OBJECTIVE: This report describes our experience with fetal congenital heart disease since 1980. BACKGROUND: Knowledge and expertise in the diagnosis, management and natural history of fetal congenital heart disease is increasingly demanded by both obstetricians and parents. The analysis of a large series should help the pediatric cardiologist to provide this service. METHODS: The notes of 1,006 patients, where a prospective diagnosis of fetal congenital heart disease was made, were reviewed. The reason for referral, the diagnosis made, the accuracy of diagnosis, the fetal karyotype and the outcome of the pregnancy were noted. The cases were grouped into malformation categories, and the spectrum of disease seen was compared with that found in infants. RESULTS: Most fetal cardiac anomalies are now suspected by the ultrasonographer during obstetric scanning. A different incidence of abnormalities is seen compared with that expected in infants. Chromosomal anomalies were more frequent in the fetus than in live births. The accuracy of diagnosis was good. The survival rate after diagnosis was poor because of frequent parental choice to interrupt pregnancy and the complexity of disease. CONCLUSIONS: A large experience with fetal congenital heart disease allows the spectrum of disease to be described with accuracy and compared with that in infancy. Knowledge of the natural history of heart malformations when they present in the fetus allows accurate counseling to be offered to the parents. If the trend in parental decisions found in this series continues, a smaller number of infants and children with complex cardiac lesions will present in postnatal life.
Female↗
The pediatrician as expert witness. Participation and reaction to this activity.
Little is known about the qualifications and motives of pediatricians who provide expert witness testimony. Pediatricians in Pennsylvania were surveyed anonymously to learn more about this practice. Two hundred fifty-five (49%) of 520 pediatricians responded, and 126 of these physicians had provided expert testimony at some time. Fully affiliated medical school faculty members were more likely to act as expert witnesses than were other pediatricians. Seventy-seven (61%) did so to defend a fellow physician. Only eight (6%) were listed with an organization that provides expert witnesses. Pediatricians were selective about their involvement as expert witnesses, and 96 (76%) had refused to give testimony at some time. Most were paid an hourly rate, which was in keeping with charges for medical consultation or lecturing. More than 80% of respondents were unhappy with the present system of procuring expert witnesses.
Malpractice↗
Cardiac tumours in intrauterine life.
Since 1980, 11 examples of cardiac tumour have been detected in the fetus out of a total of 794 congenital cardiac malformations. Patients were referred because of fetal hydrops in two, a family history of tuberous sclerosis in two, and because of the detection of a tumour mass during a scan at the local hospital in seven. The gestational age range at presentation was from 20-34 weeks. Of eight fetuses where death occurred, the histological type was rhabdomyoma in seven and teratoma in one. In seven cases, the lesion appeared single and in four there were multiple tumours. In two of the cases of rhabdomyoma, other family members had evidence of tuberous sclerosis. Termination of pregnancy took place in four cases; of seven continuing pregnancies, spontaneous intrauterine death occurred in four, and three children are still alive. Two of the three survivors has the clinical picture of tuberous sclerosis. The last case is as yet only 1 month old. In summary, even where the lesion is single, the most likely diagnosis in fetal cardiac tumour is rhabdomyoma, with associated tuberous sclerosis. However, the characteristic features of this latter condition may not become evident until some months after birth.
Echocardiography↗
Predictors of chronic lung disease in the 'CPAP era'.
OBJECTIVE: To assess predictors of chronic lung disease (CLD), in infants requiring nasal continuous positive airway pressure (CPAP) support in the first 4 weeks of life. METHODS: A retrospective case note audit of infants of birthweight 1250 g or less was undertaken. RESULTS: Of 290 infants identified, 50% were initially treated with ventilation, 41% with CPAP, 4% required no support, and 5% had care withdrawn. Of infants initially treated with CPAP, 23% subsequently required ventilation. Overall mortality was 19%, with a further 21% of infants developing CLD. For infants requiring CPAP support, requirement for supplementary oxygen at between 10 and 21 days predicted increased risk of CLD, and receiver operating characteristic curves suggest requirement for supplementary oxygen at 14 days to be the most reliable cut-off (area under curve = 0.72). Positive predictive values for future CLD or death for FiO2 .25, .30 and .40 while on CPAP at 14 days were 0.56, 0.61 and 0.76, respectively. CONCLUSIONS: CLD remains prevalent in very low birthweight infants in the CPAP era. Oxygen requirement at 14 days is the strongest predictor of CLD. Infants requiring 30% oxygen or more while on CPAP at 14 days have a 60% risk of subsequent CLD or death.
Chronic Disease↗
Neonatal alloimmune thrombocytopenia may be less severe in a subsequent pregnancy.
Neonatal alloimmune thrombocytopenia (NAIT) is more common than previously appreciated. Clinical presentation is varied, but it is generally a severe disorder and it is said to be more severe in subsequent pregnancies. The authors present a case of fatal disseminated intravascular coagulation that was diagnosed as NAIT only after presentation of a subsequent surviving sibling with intracranial hemorrhage and thrombocytopenia. Despite the perinatal complications, this second sibling had good neurodevelopmental outcome. This is the first reported case of less severe disease occurring in a subsequent pregnancy.
Adult↗