The present study was performed to compare pain‐related oesophageal motility, gastro‐oesophageal reflux and ST‐segment deviations in patients with intermittent chest pain and normal or pathological coronary angiography. Thirty patients (11 males, 19 females; mean age 54.8 years) with normal and 15 patients (12 males, 3 females; mean age 66.7 years) with pathological coronary angiography were investigated by 24‐h oesophageal pressure, pH and ECG recording. Chest pain correlated with motility abnormalities or gastro‐oesophageal reflux occurred in 33% (10/30) of patients with normal coronary arteries and in 26% of patients with pathological coronary angiography. Symptomatic and asymptomatic ST‐segment changes were less frequently observed in patients with normal angiography (4/30) than in patients with pathological coronary angiography (7/14; P = 0.02). Oesophageal dysfunction coincided with ST‐segment deviation in 6.7% (2/30) of patients with normal and 40% (6/15) of patients with pathological coronary angiography (P = 0.02). The conclusions reached were: (1) pain‐correlated abnormal motility or gastro‐oesophageal reflux occurred in patients with normal and pathological coronary angiography at the same frequency; (2) ambulatory motility and pH recording alone does not appear to differentiate between cardiac and non‐cardiac chest pain; (3) simultaneous ECG recording reveals a significant correlation of ST‐segment deviation and gastro‐oesophageal reflux or abnormal motility in patients with coronary artery stenosis.

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A 15-month-old male baby of Chinese ethnicity was brought by his parents to the emergency department of our hospital with lethargy and yellowish discoloration of eyes, noticed for ;24 hours. On examination, the baby was pale and icteric. Blood tests revealed a low hemoglobin of 50 g/L, mild neutrophilia, and normal platelet count. A blood film examination showed normocytic normochromic red cells, hemighosts (blister cells), irregularly contracted cells, and a few bite cells. Indirect bilirubin values were high, and a urine dipstick was positive for hemoglobin. This picture was suggestive of oxidative hemolysis, and the parents stated that the baby was given fava bean soup on the previous day. A glucose 6 phosphate dehydrogenase (G6PD) assay showed a low value (3.2 IU/g Hb; reference range, 8.8-17.6 IU/g Hb), confirming that the baby had hemizygous G6PD deficiency and fava beans had caused hemolytic crisis. There was no family history of favism or neonatal jaundice. The baby received transfusions and the parents were advised about the food and drugs to be avoided. After 8 weeks, his hemoglobin improved to 140 g/L. Since G6PD activity is generally overestimated during hemolytic episodes, a G6PD assay will be repeated subsequently for ascertaining the actual values.These red cell changes during acute hemolytic episodes will be helpful to detect G6PD deficiency.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.

IntroductionAlthough cystic fibrosis (CF) centre care is generally considered ideal, children living in regional Australia receive outreach care supported by the academic CF centres.MethodsThis is a retrospective database review of children with CF treated at the Royal Children's Hospital in Melbourne and its outreach clinics in Albury (Victoria), and Tasmania. The aim was to compare the outcomes of children with CF managed at an academic centre with that of outreach care, using lung function, nutritional status and Pseudomonas aeruginosa colonisation. Three models of care, namely CF centre care, Shared care and predominantly Local care, were compared, based on the level of involvement of CF centre multidisciplinary team. In our analyses, we controlled for potential confounders, such as socio‐economic status and the degree of remoteness, to determine its effect on the outcome measures.ResultsThere was no difference in lung function, i.e. forced expiratory volume in 1 s (FEV 1), the prevalence of Pseudomonas aeruginosa colonisation or nutritional status (body mass index (BMI)) between those receiving CF centre care and various modes of outreach care. Neither socio‐economic status, measured by the Socio‐Economic Index for Area (SEIFA) for disadvantage, nor distance from an urban centre (Australian Standard for Geographical Classification (ASGC)) were associated with lung function and nutritional outcome measures. There was however an association between increased Pseudomonas aeruginosa colonisation and poorer socio‐economic status.ConclusionOutcomes in children with CF in regional and remote areas receiving outreach care supported by an academic CF centre were no different from children receiving CF centre care.