Abstract
Pre-eclampsia and long-term maternal health
Williams D.
Obstet Med 2012;5:98-104
Pre-eclampsia is a reversible syndrome of pregnancy, defined by the gestational onset of hypertension and associated endothelial dysfunction variably involving renal, hepatic, haematological and neurological systems. Women who have had pre-eclampsia are more than twice as likely to develop future ischaemic heart disease compared with women who have a normotensive pregnancy. A similar risk exists for future cerebrovascular accident, venous thromboembolism and peripheral vascular disease. These women also have an increased incidence of type-2 diabetes, thyroid disease and cognitive dysfunction.
In this comprehensive review, Williams summarizes current understanding of the magnitude of these risks and the possible pathophysiology underlying these observations.
‘Pre-eclampsia therefore appears to both unmask a latent risk of cardio-reno-vascular disease and to a more limited extent, may itself be responsible for irreparable maternal endothelium dysfunction, especially of the fenestrated capillaries of the renal glomerulus and thyroid gland.’
Reducing ionizing radiation doses during cardiac interventions in pregnant women
Orchard E, Dix S, Wilson N, et al.
Obstet Med 2012;5:108-11
The use of ionizing radiation has traditionally been avoided in pregnant women since it was established in 1956 that its use was associated with an increased rate of childhood malignancy. With advancing maternal age and increasing survival of women with structural heart disease, women are now being referred more frequently for assessment of cardiovascular problems presenting in pregnancy.
Over a five-year period, the authors performed cardiac interventions on 28 patients, 15 pregnant women, nine postpartum women and four women as part of pre-pregnancy assessment. Of the 15 pregnant women, one was in her first trimester, 11 were in their second trimester and three were in their third trimester. The procedures most commonly undertaken were closure of atrial septal defect or patent foramen ovale in 16 women, coronary angiograms in seven, right and left heart catheters in three and two stent placements (1 superior vena cava stent in a patient with transposition of the great arteries and an atrial switch with baffle obstruction and 1 aortic stent in a patient presenting with coarctation during pregnancy).
In this study, Orchard et al. have summarized their techniques to minimize fluoroscopy time and therefore lower ionizing radiation dose to pregnant woman with very low exposure to the fetus. Where there is an appropriate indication, pregnant women can safely undergo cardiac procedures requiring ionizing radiation.
The role of Edward Harrison's (1766-1838) disciples, Thomas Engall, John and George Epps, Charles Hoyland, John Evans Riadore, John Robinson and John Baptiste de Serney in the treatment of spinal deformity in the Victorian medical world
Bovine G, Silver JR, Weiner M-F.
Journal of Medical Biography 2012;20:18-24.
The treatment of spinal deformity is the subject of a collection of papers in the Journal of Medical Biography. Gary Bovine and others write about the role of Edward Harrison's (1766-1838) disciples. Many were those who used methods to try to alleviate the functional effects of spinal deformity and its appearance and among these were Thomas Engall (1808-1887), John (1805-1869) and George (1815-74) Epps, Charles Hoyland (1807-1889), John Evans Riadore (d 1861), John Robinson (1778-1837) and John Baptiste de Serney (1779-1852). The first infirmary for spinal diseases was founded in London in 1837 by the Lancastrian, Harrison, about whom Bovine wrote in the same journal (Journal of Medical Biography 2010;18:124-6). Some houses in Stanhope Street are still in existence where the infirmary stood originally.
Evaluation of clinical threshold policies for cataract surgery among English commissioners
Coronini-Cronberg S, Lee H, Darzi A, Smith P.
Journal of Health Services Research & Policy 2012;17:241 -7
Those responsible for commissioning (purchasing) healthcare in all countries are increasingly using explicit criteria or guidelines to determine which patients should receive treatment. This paper describes a survey of all 151 Primary Care Trusts (PCTs) which have been responsible for commissioning in England over the past decade. It revealed that almost half (71) were restricting access to surgery for cataract. Not only did the threshold vary between commissioners but the authors judged that 92% were using criteria that did not reflect current professional guidance and research evidence. Such differences will inevitably give rise to variations in access depending on the policy of the local commissioner. The 211 Clinical Commissioning Groups that takeover from the PCTs in April 2013 will need to consider whether they are content for such differences to persist or to shift to adopting nationally agreed guidance.