Case report on the treatment of atrial fibrillation in a pregnant woman of 33 weeks’ gestation

This case report highlights a recent case in the Rotunda Hospital of a patient of 33 weeks’ gestation with fast atrial fibrillation. She had an unusual presentation given that she had no prior cardiac history or obvious aetiology. She underwent successful DC cardioversion and was well on discharge. Follow-up with cardiology has been arranged.

妊娠早期隔膜水囊状淋巴管瘤的发病率、自然病程及儿科结局

Objective: To estimate prevalence, natural history, and outcome of septated cystic hygroma in the first trimester in the general obstetric population, and to differentiate this finding from simple increased nuchal translucency. Methods: Patients at 10.3-13.6 weeks of gestation underwent nuchal translucency sonography as part of a multicenter clinical trial. Septated cystic hygroma cases were offered chorionic villi sampling for karyotype, and targeted fetal anatomical and cardiac evaluations. Survivors were followed up for fetal and long-term pediatric outcome (median 25 months, range 12-50 months). Cases of septated cystic hygroma were also compared with cases of simple increased nuchal translucency. Results: There were 134 cases of cystic hygroma (2 lost to follow-up) among 38,167 screened patients (1 in 285). Chromosomal abnormalities were diagnosed in 67 (51% ), including 25 trisomy-21, 19 Turner syndrome, 13 trisomy-18, and 10 others. Major structural fetal malformations (primarily cardiac and skeletal) were diagnosed in 22 of the remaining 65 cases (34% ). There were 5 cases (8% ) of fetal death and 15 cases of elective pregnancy termination without evidence of abnormality. One of 23 (4% ) normal survivors was diagnosed with cerebral palsy and developmental delay. Overall, survival with normal pediatric outcome was confirmed in 17% of cases (22 of 132). Compared with simple increased nuchal translucency, cystic hygroma has 5-fold, 12-fold, and 6-fold increased risk of aneuploidy, cardiac malformation, and perinatal death, respectively. Conclusion: First-trimester cystic hygroma was a frequent finding in a general obstetric screening program. It has the strongest prenatal association with aneuploidy described to date, with significantly worse outcome compared with simple increased nuchal translucency. Most pregnancies with normal evaluation at the completion of the second trimester resulted in a healthy infant with a normal pediatric outcome.

子宫内膜去除术治疗的近期及远期预后

Objective: To determine the medium-term (1- 3 years) and long-term (3- 5 years) outcome for women who underwent endometrial ablative techniques. To determine the uptake of these operations and the outcome results. Study design: The hospital records of all women who underwent either Uterine Balloon Therapy (UBT) or VESTA (Multiple Electrode Device) since our commencement of use of these procedures in the Rotunda Hospital, Dublin were reviewed. Medium-term assessment was by retrospective analysis of the patient records for the incidence of complications and the necessity of further medical and surgical treatment. Long-term outcome was assessed by completion of a questionnaire by all patients. Demography, complications, patient satisfaction, new symptomatology and the need for further treatment were assessed. Forty-four women who underwent UBT and 40 women who had VESTA ablation formed our study group. Results: Our main outcome measures were assessment of the amenorrhoea rate and patient satisfaction in the long-term. Medium-term follow- up revealed a 90% success rate. Long-term follow- up showed on overall treatment success of 80% and a patient satisfaction rate of 73% . Conclusion: Both UBT and VESTA were associated with high rates of amenorrhoea and patient satisfaction in the long-term.

Overview of clinical forensic services in various countries of the European Union

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings.In the context of a clinical forensic examination,physical findings are recorded and biological trace material is gathered and secured.Ideally,all forensic findings are documented in a detailed report combined with photographic docu-mentation,which employs a forensic scale to depict the size of the injuries.However,the integrity of such forensic findings depends particularly on two factors.First,the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence.Second,the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time.Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union(EU);in some states,they are not available at all.As part of the JUST_(e)U!(Juridical standards for clinical forensic examinations of victims of violence in Europe)pro-ject,the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz,Austria created(in cooperation with its international partner consortium)a questionnaire:the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU.Our paper pro-vides a summary of the responses and an overview of the current situation concerning pro-vided clinical forensic services.