We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease.
We present the case of a diabetic gentleman who was admitted to the hospital with an infected right foot. Swabs were positive for Staphylococcus aureus and Pseudomonas aeruginosa. His right big toe was amputated. Postoperatively, the patient experienced recurrent episodes of chest pain. He was therefore transferred to the coronary care unit, where he deteriorated rapidly. The patient was subsequently transferred to intensive care. Transthoracic and transesophageal echocardiograms revealed evidence of aortic dissection, but this finding was not confirmed in a computed tomography scan. The patient subsequently experienced cardiac arrest and died. The postmortem examination revealed no aortic dissection but did show a vegetation on the mitral valve with a fistula that tracked into a ruptured epicardium.
Birthweight is an important determinant of perinatal outcome and future health well into adulthood. Before weighing newborn infants became enshrined in practice, birthweights tended to be based on an educated guess or, as alleged by Roederer in 1753, on hallucination. Two centuries later, they led to a Babylonic confusion between weight and maturity at birth. Even nowadays, hallucinations about birthweight and its effect on infant health have not entirely disappeared. New hallucinations still emerge and remain as difficult to dispel as they once were.
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