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Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.

Background and AimsLocal anaesthesia (LA) nerve infusions are increasingly used in our institution for rib fracture analgesia; they provide not only excellent analgesia but reduce morbidity, mortality and improve economic outcomes [1]. Data from a local audit demonstrated 33% of rib fracture LA infusions were prematurely removed due to accidental disconnection. Currently there is no consensus on the optimum method of securing LA catheters in place [2]. Accordingly, we aimed to reduce rates of catheter disconnection through a benchtop experiment to determine the optimal LA catheter fixation method.MethodsWe used a porcine abdominal wall model (figure 1) to determine the force required to displace catheters secured using seven methods (table 1). We used our in-service wingless catheter-through-needle system (Pajunk), except when examining suturing strength, where a Vygon arterial line with suturing wings was used. The force required to displace the catheter by 1cm from the skin was measured. Each method was repeated 5 times. Data was analysed using parametric tests.ResultsCatheters secured using Tegaderm and Dermabond (13.04 N, p=0.0004), Epifix and Dermabond (11.18 N, p=0.007) and Tegaderm and suturing (42.18 N, p=0.001) required significantly more force to displace than those using Tegaderm alone (5.94 N)(figure 2).Abstract EP182 Table 1A table demonstrating different methods used to secure local anaesthetic catheters in situ, using a porcine abdominal wall modelAbstract EP182 Figure 1Photographs depicting local anaesthetic catheter fixation methods, in situ, on a porcine abdominal wall model[Figure omitted. See PDF]Abstract EP182 Figure 2A bar chart illustrating the mean force (newtons) required to displace local anaesthetic catheters secured on a porcine abdominal wall model using different methods of fixation. Error bars represent +/- 1 standard deviation. Statistical significance was analysed with ANOVA and post hoc t-tests (*P<0.01)[Figure omitted. See PDF]ConclusionsTegaderm with suturing was the most effective method of catheter fixation, requiring a force several times that required to displace catheters secured using other means. However, Tegaderm and Dermabond provide effective fixation while also being both more cost-effective and patient/operator friendly. Consequently, we changed our department’s catheter fixation policy to advocate routine use of skin glue.

T. S. Eliot greatly enhanced Dante's profound influence on European literature. The essays in this volume explore Dante's importance through a focus on Eliot. Probing the questions what Eliot made of Dante, and what Dante meant to Eliot, the essays here assess the legacy of modernism by engaging its \"classicist\" roots, covering a wide spectrum of topics stemming from Dante's relevance to the poetry and criticism of Eliot. The essays reflect on Eliot's aesthetic, philosophical, and religious convictions in relation to Dante, his influence upon literary modernism through his embracing and championing of the Florentine, and his desire to promote European unity.The first section of the book deals with aesthetic and philosophical issues related to Eliot's engagement with Dante, beginning with Jewel Spears Brooker's masterful essay on the concepts of immediate experience and primary consciousness in Eliot's work, and moving on to essays considering his idea of a \"unified sensibility,\" as well as Eliot's engagement with Hindu-Buddhist and Christian themes and motifs. The second part of the book focuses on Dante's importance to Eliot's founding work in the modernist movement. In what ways did Dante directly and indirectly influence the exemplary path that Eliot blazed for his contemporaries, especially Ezra Pound? How early did Dante's influence show itself in Eliot's work? Why was he unable to complete the great trilogy he seems to have sought to write, based on Dante's Inferno, Purgatorio, and Paradiso?These questions and their answers lead to the book's final section, which considers Eliot's (and Dante's) role in the formation of a twentieth-century concept of Europe. Incisive essays on Eliot's varied sources of \"tradition\" in his attempt to promote the idea of a European union and his anxiety over the heritage of Romanticism are capped by a magisterial contribution from Dominic Manganiello showing precisely how Eliot's reformulation of the Dantesque \"European Epic\" continues to influence the work of Anglo-European and Commonwealth writers.

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly. A normal aortic valve has three cusps, but cases of unicuspid, bicuspid, and quadricuspid aortic valves have been reported. Although QAV usually appears as an isolated congenital anomaly, it may also be associated with other heart conditions. In comparison to the bicuspid aortic valve (BAV) that results in aortic stenosis by the early 50s due to age-related early calcification, this case series suggests that patients with QAV are likely to develop moderate to severe aortic regurgitation in their late 40s or early 50s. Most patients with QAV require tricuspidalization, which is the preferred method for QAV surgical repair, especially in patients with associated aortic regurgitation. The condition was previously diagnosed intraoperatively or postpartum. Today, with imaging modalities like transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases of QAV have been diagnosed in asymptomatic individuals. We present a case series of a previously healthy 49-year-old male and a 47-year-old female who had similar presentations of acute congestive heart failure (CHF). An echocardiogram confirmed that both patients had heart failure with reduced ejection fraction, dilated cardiomyopathy, QAV, and moderate to severe aortic valve regurgitation on echocardiogram. The male patient had an ejection fraction (EF) of 30-35% and a QAV with partial fusion of the leaflets, resulting in a functionally bicuspid aortic valve, while the female patient had an EF of 25-30% with what appears to be a type III QAV according to Nakamura et al. classification. The purpose of this case series is to highlight another potential late complication of congenital QAV.

T. S. Eliot greatly enhanced Dante's profound influence on European literature. The essays in this volume explore Dante's importance through a focus on Eliot. Probing the questions what Eliot made of Dante, and what Dante meant to Eliot, the essays here assess the legacy of modernism by engaging its \"classicist\" roots, covering a wide spectrum of topics stemming from Dante's relevance to the poetry and criticism of Eliot. The essays reflect on Eliot's aesthetic, philosophical, and religious convictions in relation to Dante, his influence upon literary modernism through his embracing and championing of the Florentine, and his desire to promote European unity.The first section of the book deals with aesthetic and philosophical issues related to Eliot's engagement with Dante, beginning with Jewel Spears Brooker's masterful essay on the concepts of immediate experience and primary consciousness in Eliot's work, and moving on to essays considering his idea of a \"unified sensibility,\" as well as Eliot's engagement with Hindu-Buddhist and Christian themes and motifs. The second part of the book focuses on Dante's importance to Eliot's founding work in the modernist movement. In what ways did Dante directly and indirectly influence the exemplary path that Eliot blazed for his contemporaries, especially Ezra Pound? How early did Dante's influence show itself in Eliot's work? Why was he unable to complete the great trilogy he seems to have sought to write, based on Dante's Inferno, Purgatorio, and Paradiso?These questions and their answers lead to the book's final section, which considers Eliot's (and Dante's) role in the formation of a twentieth-century concept of Europe. Incisive essays on Eliot's varied sources of \"tradition\" in his attempt to promote the idea of a European union and his anxiety over the heritage of Romanticism are capped by a magisterial contribution from Dominic Manganiello showing precisely how Eliot's reformulation of the Dantesque \"European Epic\" continues to influence the work of Anglo-European and Commonwealth writers.

Bergsonian aesthetics give art the imperative of constantly reinventing itself and have furnished a useful key to Modernism. Here, they are applied to the continuities and disruptions of the \"postmodern,\" with its hybrid, contradictory, pluralistic claims. Focusing mainly on John Barth and Roland Barthes, this essay argues that, despite the criticism's efforts to finish it off, the \"modern era\" has not ended, and perhaps cannot end until artists cease to believe they live in a constantly modernizing present. Barthes in particular validates Bergson's significance for the artist-theorist, incessantly forging writing anew, trapped by the modern era's demand for ceaseless novelty and experimentation.

[...]the reviewer described its overall effect as \"wearisome. Hoping French forces will come to their aid, the Irishmen have set aside differences between Protestant and Catholic in order to overcome their common enemy, the \"aristocratic tyrants of the land\" as Robert Kee has said (50) , and they are counting on Glenarvon to uphold their cause, as he has frequently promised to do. Lamb and her husband lived at Belline House, half a mile from the main domicile. Since the Bessboroughs had visited their estate only rarely, there was a party atmosphere with a lot of drinking and dancing and a healthy does of friction between the Carrickers, on one had, and the denizens of Piltown Village, who showed as much interest in fighting each other as in drinking and eating. (Works 1: 57-58) Standing on the shoulders of foremothers Mary Wollstonecraft and Germaine de Staël, Lamb demands for women a bigger role in political affairs, literature, and love; and she demands (/women a greater ambition to participate in the world.