Cardiac myxoma is an intracavitory neoplasm, constituting approximately half of all the primary adult cardiac neoplasms. These are commonly seen in the atria; however, uncommon location and atypical characteristics warrant multimodality imaging with paramount role of cardiac magnetic resonance imaging. We report a case of right ventricular outflow tract myxoma in a 40-year-old male with atypical imaging characteristics.

Early nutritional deprivation in animals leads to a decrease in the number and size of brain cells, deficient dendritic arborisation, and to alterations in the reticular formation. Furthermore, the content of neurohumoral agents-namely, 5-hydroxytryptamine, acetylcholine, and gamma-amino-butyric acid (GABA)-is also greatly altered.15 However, the nutritional demands of the fetus during the early stages of gestation are so small that maternal undernutrition has no limiting effect on the growth and maturation of the central nervous system.6The early maturing reflexes and neuromotor features are therefore less likely to be affected. As the neuromotor behaviour and reflex pattern in the newly born are mainly subcortical in origin, the conventional neuromotor evaluation may not show changes in the various regions of the neocortex.Some investigators have shown that bioelectric brain activity, sleep cycle, and various other electroencephalographic patterns make their appearance and mature at a constant rate in accordance with conceptional age, and are unaffected by low birthweight.7-10 Polygraphic study is therefore a sensitive index for evaluating deficits in maturity and Department of Paediatrics, Banaras Hindu University K N AGARWAL, professor of paediatrics V P BHATIA, senior resident paediatrician G P KATIYAR, reader in paediatrics T K DAS, research fellow in physiology P K DEY, professor of physiology organisation during intrauterine growth. In the present study polygraphic recordings were used to evaluate the pattern of sleep cycle in babies suffering from severe intrauterine nutritional deprivation. Material and methodsSubjects. A sample was taken of 19 newborn babies of severely undernourished mothers, who had haemoglobin levels <8 g/dl and serum albumin levels <25 g/l (mean ± SE; 5 5 ± 0 19 g/dl and 17 2 ± 0-96 g/l respectively), and weights < the 25th centile of that expected for height (40.8 ± 0-89 kg). An equal number of healthy newborn babies were chosen as controls from mothers who had had regular antenatal care, and haemoglobin > 1.1 g/dl (12-6±0i29) and albumin >35 g/l (36-1 ± 0 77). These mothers had weights above 50 0 kg (54 9 ± 1I 35) and heights above 150 0 cm (155.1 ± 0 97). The mothers in both groups had uncomplicated antenatal and obstetrical history, and knew the exact dates of their last menstrual periods.Only term newborn babies with gestations of 280 ± 2 days were studied. These babies did not suffer from any birth injury or anoxia and had remained in hospital for a normal period of time.Methods. The following parameters were recorded simultaneously. These comprised the polygraphic 134 on 27 April 2019 by guest. Protected by copyright.

The neurological maturation in 25 newborn babies born to severely undernourished mothers was studied by evaluating muscle tone and excitability status. These mothers had weight below the 25th percentile expected for height, haemoglobin less than 80.0 g/l and serum albumin less than 25.0 g/l. Twenty-three babies born to healthy mothers were studied as control. The babies of undernourished mothers demonstrated gross intrauterine growth retardation. There occurred parallel reduction in placental weight and its protein content. The neuromotor behaviour of these newborns showed significant alteration in the performance of most reflexes, resembling normal motor behaviour of preterm infants. As many as 72% newborns could be classified as hypotonic and 56% hypoexcitable. However, no newborn demonstrated hypertonia or hyperexcitability. The parameters of neuromotor assessment were found to have no correlation with the birth weight in both undernourished as well as control group. These observations suggest that muscle tone and excitability are better indices of maturation of central nervous system than the birth weight. It seems that the neurological evaluation becomes unreliable in babies who suffer from intrauterine nutritional deprivation.

The activities of rat brain enzymes, i.e. glutamine synthetase, glutamine transferase, glutaminase I, glutaminase II, glutamic acid decarboxylase and transaminases were found to increase with age during the preweanling period. In rats subjected to food deprivations for different periods, the activities of glutaminase I, glutaminase II and glutamic acid decarboxylase, were increased while those of glutamine transferase, glutamic oxaloacetic transaminase and glutamic pyruvic transaminase were significantly reduced. These changes during undernutrition produce increased levels of γ-aminobutyric acid in brain. Whether neurological manifestations in human protein energy malnutrition in form of apathy and mental dullness could be due to these biochemical changes is difficult to assess.