Because antenatal diagnosis is possible, we suggest that there should be a high index of suspicion for idiopathic arterial calcification when there is sonographic hyperechogenicity of vessel walls, evidence of polyhydramnios, cardiomyopathy, or a family history of idiopathic arterial calcification.

No abstract

This report describes iatrogenic pneumocephalus in an obstetriair as the advancing needle emerges from the ligamentum flavum. Despite the many advantages of epidural anaesthesia, complications do occur. Hypotension, local anaesthetic toxicity, total spinal anaesthesia, and inadvertent dural puncture are well-known hazards.We wish to report a case of pneumocephalus following attempted identification of the epidural space by the loss of resistance technique, in the absence of overt evidence of dural puncture. Since the first description of epidural anaesthesia by Coming in 1885, t numerous methods for the identification of the epidural space have been proposed. The "loss of resistance" technique (LOR) jointly credited to Forestier and Sicard 2'3 remains popular. Confirmation of entry into the epidural space, as the name implies, occurs upon recognition of the sudden release of resistance, usually of

In a 14-month period, 409 women with singleton gestations referred for perinatal ultrasound consultation underwent evaluation of the fetal cardiac axis. Cardiac and intrathoracic anomalies were confirmed either by neonatal echocardiography or autopsy. Overall, 32 fetuses had an abnormal axis (nine, smaller axis than normal; 23, larger axis than normal). Of the 29 found to have cardiac (n = 24) or intrathoracic (n = 5) anomalies, 23 had an abnormal axis. The median cardiac axis of the normal group (44.0 degrees) was significantly smaller than that of the cardiac/intrathoracic anomaly group(60.0 degrees) (p = 0.002). The cardiac axis was independent of gestational age. The mean interobserver variation was 1.3 +/- 1.8 degrees. The sensitivity of an abnormal axis (< 28 degrees or > 59 degrees) in detecting congenital heart disease or intrathoracic anomalies was 23/29 (79.3%), with specificity of 371/380 (97.5%), positive predictive value of 23/32 (71.9%), and negative predictive value of 371/377 (98.4%). Of those with a cardiac anomaly and an abnormal axis (n = 18), five were felt to have an initial normal four-chamber view. An abnormal fetal cardiac axis, either larger or smaller than normal, is suggestive of a cardiac or intrathoracic anomaly and requires further investigation, such as fetal echocardiography. The cardiac axis should be considered with the four-chamber view in fetal ultrasound evaluation.