[Severe aortic stenosis in the elderly and cryptogenic intestinal bleeding (Heyde syndrome): a case report]

The Heyde syndrome describes the association between calcific aortic stenosis and intestinal bleeding. The pathophysiologic link between both entities has remained unclear so far. In several studies the intestinal bleeding has been attributed to angiodysplasia of the gut, with following cessation of the bleeding after replacement of the aortic valve. A case report.

Life supporting first aid (LSFA) teaching to Brazilians by television spots

Accidents in developing countries are frequent and have high mortality and morbidity rates. In Brazil, in 1995-1996, the year of this study, life supporting first aid (LSFA), which includes cardiopulmonary resuscitation (CPR) basic life support (BLS) was not taught in schools. With the population of 165 million, the only way to teach the adult population on a large scale would be by television (TV), that is widely viewed. This study compares two groups of factory employees - 86 controls without TV exposure to LSFA and 116 exposed to brief LSFA skill demonstrations on TV. Their ability to acquire eight LSFA skills was evaluated: external hemorrhage control; immobilization of a suspected forearm fracture; treatment of a skin burn by cold flush; body alignment after a fall; positioning for shock and coma; airway control by backward tilt of the head; and CPR (steps A-B-C). Simulated skill performance on the evaluating nurse or manikin was tested at 1 week, 1 month, and 13 months. In the control group, 1-31% performed individual skills correctly; as compared to 9-96% of the television group (P<0.001). There was excellent retention over 13 months. Over 50% of the television group performed correctly five of the eight skills, including positioning and hemorrhage control. Television viewing increased correct airway control performance from 5 to 25% of trainees, while it remained at 3% in the control group. CPR-ABC performance, however, was very poor in both groups. We conclude that a significant proportion of factory workers can acquire simple LSFA skills through television viewing alone, except for the skill acquisition of CPR steps B (mouth-to-mouth ventilation) and C (external chest compressions) which need coached manikin practice.

[Cardiac tamponade due to a right atrial myxoma]

A 60-year-old male patient was urgently admitted to the hospital with chest pain, anemia and shock. The echocardiographic examination revealed myocardial tamponade and, unexpectedly, a mobile mass in the right atrium, prolapsing in the right ventricle which was indicative of myxoma. The patient underwent pericardiocentesis which showed the presence of blood. Cardiac surgery was then performed to remove the tumor which was found to originate in the right atrial appendage. There were some adhesions between the atrial appendage and the anterior wall of the right ventricle. The tamponade was due to a trauma of some small pericardial arteries in the adhesion area. The presence of tamponade and right atrial myxoma, is the peculiar finding of the reported case.

[Wolff-Parkinson-White, a study on the prevalence of the site of accessory pathways: relations between stability of pre-excitation, symptoms, cardiac arrhythmias and association of mitral valve prolapse with localization of pre-excitation]

The aim of this study was to evaluate the prevalence of the anatomic site of accessory pathways using surface electrocardiogram in patients affected by Wolff-Parkinson-White (WPW), and compare it to the stability of preexcitation, symptoms, incidence of arrhythmias, and the possible association of mitral valve prolapse with the localization of preexcitation. From March 1992 to August 1993 at the Cardiology Service of the Civil Hospital "Augusto Murri" in Fermo, USL 21 of the Marche Region, a total of 40 subjects suffering from WPW syndrome were examined prospectively (28 males and 12 females aged between 13 and 75 years). Using surface ECG to evaluate the axis of the delta wave in 12 standard derivations, the authors identified the anatomic site of the accessory pathways. Preexcitation stability was analysed for each patient together with the reported symptoms and the various forms of arrhythmia using dynamic ECG and effort ECG performed using a cycloergometer. Wherever possible an echocardiogram was performed to identify the possible presence of mitral valve prolapse. Out of a total of 40 patients the authors identified 3 cases with an accessory right antero-septal pathway, 13 with an anomalous postero-septal fasciculus, 11 with a right lateral and 13 with a left lateral anomaly. The statistical analysis of data revealed the stability of pre-excitation in 52.5% of cases 55% of patients were found to have a positive record with regard to past symptoms, and supraventricular or ventricular cardiac arrhythmia were diagnosed in 52.5% of the patients examined.(ABSTRACT TRUNCATED AT 250 WORDS)