suMMARY Twenty-four-hour electrocardiograms were recorded in the first 10 days of life on 134 healthy full-term infants with birthweights greater than 2-5 kg. The highest heart rate a minute, measured over nine beats, was 175±19 (SD). The This study shows that normal infants have variations in heart rate and rhythm hitherto considered to be abnormal.The range of heart rate and nature of heart rhythms are poorly documented in normal healthy infants. Twenty-four-hour recordings of the electrocardiogram provide an accurate means of measuring heart rate and rhythm over long periods. The technique does not seriously interfere with normal behaviour and therefore documentation of changes in rhythm and rate is possible during activities such as sleeping, feeding, or crying. This report describes the results of single 24-hour recordings of the electrocardiogram on 134 healthy full-term neonates who weighed over 2-5 kg at birth. Patients and methodsStudies were made between birth and 10 days of age (the normal period of postnatal hospitalisation in this area) on 134 randomly selected infants born in West Dorset between January 1977 and June 1978. They were all healthy and recordings were performed in the maternity ward before discharge home. All infants studied had normal standard 12 lead electrocardiograms with a 10-second rhythm strip. They were studied under standard maternity ward environmental conditions and were fed and handled normally by their mothers during the recording period.Received for publication 5 July 1979 The recordings were made onto a Medilog cassette recorder* and the tapes were analysed for the presence of arrhythmias using a playback system* and arrhythmia detector*, by a trained technician. The Medilog recorder and analyser incorporated a synclock mechanism which, by providing and processing a reference time signal, ensured that possible variations in tape speed did not produce artefactual rhythm or rate disorders. Mothers were encouraged to handle their babies in the normal way while recordings were taken.Heart rates during activity and rest were measured by a histogram module in the analyser*. Histograms of the distribution of different heart rates (as obtained by continuous measurement of all intervals) were made on 79 babies during approximately two hours each of activity and rest.The maximum heart rates, measured by direct electrocardiographic analysis, over nine consecutive beats were recorded. The minimum rates found over three, five, and nine consecutive beats were also measured in this way and the heart rhythm at this time (whether sinus or junctional) was noted.

The objectives of this study are to compare the pathological results from office-based biopsy (OBB) and operative biopsy (ORB) of laryngopharyngeal lesions from 26 patients. Lesion location, specimen concordance, efficacy, cost savings, and patient management are discussed. OBB can provide a sample of laryngopharyngeal tissue that can be used to diagnose lesions in these sites. This study design is retrospective review and involved retrospective analysis and chart review of 26 cases of patients who had an OBB followed by and ORB of the same site; oropharyngeal or laryngopharyngeal lesion. CPT 31576 was to identify patients. Twenty six patients had both OBB and operative biopsy performed of a lesion within the oropharynx and laryngopharynx. All OBB attempts resulted in diagnostic tissue samples. Vocal fold biopsy (69 %) was most common. The most common OBB diagnosis was squamous cell carcinoma or moderate-to-severe dysplasia (54 %). OBB and ORB pathological results were the same in 81 % of patients. Of the benign samples obtained by OBB, 83 % of the ORB were deemed benign. Of the non-benign samples obtained via OBB, 80 % of the ORB were deemed non-benign in the operating room samples. Office-based biopsy is a simple procedure that can be performed in an outpatient setting, avoiding an operating room and the need for general anesthesia. Comparison of results from OBB to ORB together with patient characteristics resulted in very reliable results that can help to guide further patient management.

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SummaryWe have reviewed 21 cases with the clinical diagnosis of Post Traumatic Syringo myelia (P. T.S.). FzJteen of these cases had proven syrinx formation on Contrast Computed Tomography (C.C.T.) and the other 6 had obviously abnormal cords. A much earlier onset of P. T.C.M. was found in complete spinal injuries than in incomplete ones. We have discussed the technique of contrast computed tomography used at this hospital, its value in the diagnosis of this condition and its ability to define actual spinal cord structure. Most cases (91%) benefitted from surgery and several had marked sensory improvement, which previously has been described as unusual. Syringo-cisternal shunting, a new technique for the drainage of cervical and upper thoracic syrinxes is described.A theory is proposed to explain why, in some patients with classical presentations of P. T.S., no syrinx was found on C.C. T., although abnormal cords were found in all cases. It is felt that these abnormal areas of spinal cord are responsible for the presenting symptomatology and may be precursors of syrinxes.

SUMMARY A system for simultaneous 24-hour tape recording of ECG and respiration has been developed and used in the study of 4 groups of newborn infants. In 50 randomly selected, healthy term infants, the mean lowest heart rate (>9 beats' duration; was 88 ± 13. 14 (28%) infants had junctional escape rhythms, 5 had supraventricular, and 2 ventricular premature beats. 34 (68%) subjects had apnoeic episodes >10 seconds' duration; the 95th centile for maximum duration of apnoea was 18 seconds, the longest episode being 28 seconds. Episodes of bradycardia <100/minute were associated with 50 of a total of 288 episodes of apnoea of 10-14 seconds, with all 4 episodes of 15-19 seconds, and with both episodes >20 seconds.In 100 randomly selected, healthy, preterm or low birthweight infants studied within 5 days oftheir discharge from hospital, the mean lowest heart rate was 91 + 18. 18 had junctional, one idioventricular, and 3 both junctional and idioventricular escape rhythms. Two had supraventricular and 6 had ventricular premature beats. 66 subjects had apnoeic episodes >10 seconds' duration; the 95th centile for maximum duration of apnoea was 20 seconds, the longest episode being 52 seconds. Episodes of bradycardia <100/min were associated with 84 of a total of 608 episodes of apnoea 10-14 seconds' duration, with 21 of 37 episodes of 15-19 seconds, and with 15 of 15>20 seconds. One preterm infant with a maximum apnoeic episode of 52 seconds had an associated bradycardia of 27/min.Three of 5 'near-miss' cot death infants and one preterm infant with a family history of cot death studied immediately before discharge showed prolonged apnoea >40 seconds, or extreme bradycardia <50/min, or both.Finally, 11 infants with arrhythmias on a standard ECG were studied. Of these, 6 with premature beats and 3 of 5 with episodes of bradycardia did not exhibit apnoea during arrhythmias. Two of the 5 babies with bradycardia however, demonstrated associated apnoea of 10-14 seconds.There may be a relationship between latent episodes of prolonged apnoea and bradycardia and hypoxaemic brain damage or sudden infant death.

BackgroundMorel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients.Case presentationWe present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting.ConclusionMLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.

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