No abstract

The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.

This report describes a patient whose clinical and radiological features conform to those of ankylosing hyperostosis. Posterior bridging osteophytes were also apparent and these have not been previously described in ankylosing hyperostosis. We have considered alternative explanations for this finding and concluded that they were manifestations of the hyperostotic process. This unusual feature occurring in the presence of a comparatively narrow spinal canal resulted in cord compression and a spastic tetraparesis and we would therefore suggest that ankylosing hyperostosis may sometimes have serious neurological consequences.

Haemodialysis is now practised widely in the management of renal failure in children, 1-3 in spite of the problems of creating vascular access.4 For long term haemodialysis, arteriovenous shunts-for example, Brescia shunts5-and internal fistulae-for example, the use of a saphenous vein loop6-can be created successfully using microvascular techniques.

External (transcutaneous) pacing is a temporary means of pacing a patient's heart during an emergency. Pulses of electrical current are delivered through the patient's chest to stimulate the cardiac muscle to contract. It restores electrical stimulation to the myocardium in an emergency setting and its advantage is that it can be initiated quickly by any healthcare professional who has undertaken the necessary training. This article provides the reader with a greater understanding of external pacing by exploring some of the theoretical and practical issues associated with the procedure.