Double Coronary Artery Fistulae: Clinical and Imaging Concerns, and a Review of the Literature

Coronary artery fistulae (CAF) are a rare entity describing abnormal communication between a coronary artery and cardiac chamber or a large intrathoracic vessel and are seldom described in the literature[1]. These fistulae can be either congenital or acquired. Often incidental in finding, CAFs can have serious clinical sequelae, and should be duly reported and discussed with the cardiac team. More than 50% of patients with CAFs may be asymptomatic; 34% may report chest pain; 13% may have symptoms of heart failure, and a minority of 2% may suffer from endocarditis and arrhythmias[2]. The largest series to our knowledge was reported by the Cleveland Clinic, which found 225 patients with incidental CAF out of 126,595 coronary catheterizations (incidence of 0.18%), performed during a span of 28 years [3]. Multiple CAFs are an even rarer entity and only a handful of cases have been reported in the literature to date. Few cases of double CAFs have been reported that describe two different feeder coronary arteries giving rise to separate drainage sites[3]. In our report, however, we describe a new entity: a single-feeder coronary vessel communicated with two drainage sites. Our case is curiously unique, in which we report a single artery, originating from the right coronary artery (RCA) with double drainage sites – one to the left pulmonary artery and the second to the left bronchial artery

Books

Oral cancer Oral Cancer: Epidemiology, Etiology and Pathology. Ed. by Colin Smith, Jens Pindborg and W. H. Binnie. Pp. ix + 106. Illustrated. R183,30. USA: Hemisphere. 1990.HPV and cervical cancer Human Papillomavirus and Cervical Cancer. Ed. by N. Munoz, F. X. Bosch and O. M. Jensen. Pp. xii + 155. Illustrated. France: International Agency for Research on Cancer. 1989.Child health Child Health in a Multicultural Society. Ed. by John Black. Pp. 75. Illustrated. £7 (including postage). London: BMJ. 1989. (Available also from Libriger Book Distributors).Merck manual of geriatics Merck Manual of Geriatrics. Ed. by William B. Abrams The Andrew J. Fletcher. Pp. xxii + 1267. Illustrated. RI4,50. and I: Merck. 1990. USALiver disease Progress in Liver Diseases. Vol 9. Ed. by Hans Popper and Fenton Schaffner. Pp. xv + 750. Illustrated. RllO. England: Harcourt Brace Jovanovich. 1990.Clinical dietetics and nutrition Clinical Dietetics and Nutrition. 3rd ed. Ed. by F. P. Antia. Pp. xvi +438. Illustrated. Oxford: Oxford University Press. 1989.Atlas of human anatomy Wolf-Heidegger's Atlas of Human Anatomy. Ed. by H. F. Frick, B. Kummer and R. V. Putz. pp. viii + 599. £(j(J. Basel: Karger. 1990.Health system decentralisation Health System Decentralization. Ed. by A. Mills, J. P. Vaughan, D. L. Smith and I. Tabibzadcll. pp. 151. Illustrated. SFr. 26. Geneva: World Health Organisation. 1990.Handbook of occupational medicine Handbook of Occupational Medicine. Ed. by Robert J. McCunney. Pp. xxiii + 510. Illustrated. Boston: Little, Brown. 1988.Leukaemia Leukaemia. 5th ed. Ed. by Edward S. Henderson and T. Andrew Lister. Pp. vii + 821. Illustrated. RHO. Kent: Harcoun Brace Jovanovich. 1990

Regulating the Market in Human Research Participants

Lemmens and Miller critically examine "finder's fees" and other recruitment incentives issued to physicians for successfully referring patients to clinical trial investigators

Blood lead levels in motor mechanics

ArticleThe original publication is available at http://www.samj.org.zaThe whole-blood lead levels of a group of motor mechanics in the Cape Peninsula were determined. Blood was analysed using a graphite furnace atomic absorption spectrometer. The mean whole-blood lead levels of the motor mechanics and of urban controls were 28.4 μg/dl and 9.7 μg/dl respectively, and comparison of these with that of a group from an unpolluted rural area (3.4 μg/dl) revealed highly significant differences.Publisher’s versio

AIDS and dentistry in South Africa.

[No abstract available]Articl

Evidence of undue lead exposure in Cape Town before the advent of leaded petrol

ArticleThe original publication is available at http://www.samj.org.zaLead concentrations were determined in the exhumed teeth of 28 people who lived in the Cape Town area before the combustion of leaded petrol (i.e. before 1922). The lead content of circumpulpal dentine was analysed by graphite-furnace atomic absorption spectrometry The mean lead level in the dentine of primary teeth (N = 6) was 109 μg/g, while that in secondary teeth (N = 22) was 315 μg/g. The current lead levels in circumpulpal dentine of Cape Town residents are reported to be 74 μg/g and 16 μg/g for primary and secondary teeth respectively. It was found that lead pollution of the human body during the period 1812-1922 in the Cape Town area was substantially higher than at present. We conclude that the main reasons for this were the widespread use of lead piping and soldering of water tanks, which resulted in a higher incidence of lead poisoning than that attributable to leaded petrol.Publisher’s versio

Evidence of undue lead exposure in Cape Town before the advent of leaded petrol

No Abstract

The Implications of Social Status on Well-being in Adolescence

Social status is a multi-faceted construct with complex implications for the well-being of youth. Recently, Ferguson and Ryan (2019) reported that lower well-being in early adolescence is associated with both low and high popularity, and low and high liking by peers. The present study aimed to replicate these findings and extend them to preadolescents. Longitudinal analyses were also conducted to test the putative causal relationship between social status and well-being. Participants were 645 students in Grades 4 to 6 (n = 270 boys and 358 girls), and 388 students from Grades 7 to 8 (n = 165 boys and 218 girls) from 8 elementary schools. Peer nominations of liking and popularity were solicited, and participants reported on their loneliness, depression, and self-esteem in the fall and spring of an academic year. Only linear relations between liking, popularity, and well-being emerged for early adolescents, with higher status scores associated with better functioning. However, a significant quadratic relation between popularity and well-being emerged for preadolescents. Notably, the most popular preadolescents reported lower self-esteem and greater depression and loneliness than their moderately popular peers. After controlling for well-being in the fall, popularity and liking were not significant predictors of well-being in the spring for either age group. These findings suggest that the well-being of popular preadolescents are at a higher risk than their moderately popular peers, as they forego important developmental needs; popularity in early adolescence might not be inevitably taxing, but may depend on the stability of their social environments