Cardiovascular effects of enprofylline and theophylline

The cardiovascular effects of enprofylline (with no adenosine receptor antagonism) and of theophylline (with adenosine receptor antagonism) were compared in six normal subjects in a double-blind trial at steady-state concentrations of theophylline (12.5 +/- 1.6 mg/L) and enprofylline (2.7 +/- 0.3 mg/L). The mean (+/- SD) recumbent heart rate (HR) was higher (P less than 0.04) after enprofylline (70 +/- 14 bpm) than after theophylline (58 +/- 13 bpm) or saline solution (57 +/- 10 bpm). Forearm arterial resistance determined by plethysmography was lowered (P less than 0.01) by theophylline (-37% +/- 14%) and enprofylline (-43% +/- 24%) but not by saline solution (-6% +/- 16%). In the semiupright position, the mean arterial pressure was lower (P less than 0.01) after enprofylline (93 +/- 15 mm Hg) than after theophylline (108 +/- 16 mm Hg). The cardiac index (CI) and left ventricular ejection fraction (LVEF) determined by radionuclide angiocardiography and the left ventricular end-systolic pressure/volume ratio were not different for any regimen. During maximal exercise, HR was higher (P less than 0.01) after both enprofylline (176 bpm) and theophylline (175 bpm) than after saline solution (161 bpm), but the increases in mean arterial pressure (18% to 32%), CI (153% to 167%), and LVEF (34% to 74%) were similar for all three regimens. Both theophylline and enprofylline lowered forearm arterial resistance without an increase in CI, LVEF, or cardiac inotropy, although enprofylline tended to cause a lower blood pressure and higher HR than did theophylline.     

Hepatobiliary anomalies associated with polysplenia syndrome

The report of a 29-year-old woman with polysplenia syndrome, Crohn's disease, and bilateral cataracts is presented. The patient was noted to have a right-sided stomach and small bowel, Crohn's ileitis, and a left-sided colon. Results of roentgenography of the chest and echocardiography were consistent with a diagnosis of hypoplasia of the inferior vena cava with azygos continuation. The patient underwent laparotomy with cholecystectomy, exploration of the common bile duct, and choledochoscopy for cholelithiasis, choledocholithiasis, and chronic cholecystitis. Laparotomy revealed a liver that had two lobes, each with the morphologic appearance of the left lobe. The gallbladder was centrally located. T-tube cholangiography revealed a quadruplication of the intrahepatic biliary ducts. To our knowledge, this patient is the only known adult with this syndrome in whom cholangiography demonstrated isomerism of the biliary tree. A review of the literature on this subject is given with emphasis on biliary anomalies.     

房间隔膨出瘤及合并畸形52例临床报告

目的：探讨房间隔膨出瘤（IASA）合并畸形的诊断特征及治疗适应证。方法：32例IASA合并畸形的住院患者及20例孤立性IASA门诊随诊患者,经心电图（ECG）、胸片、体表超声（TTE）、食道超声（TEE）及心导管检查,选择外科开胸,内科介入及门诊随诊观察的IASA患者。结果：32例IASA合并畸形的住院患者,16例（50%）合并畸形行外科开胸手术治疗,其中7例合并多发性房间隔缺损（ASD）。16例（50%）IASA合并ASD行内科介入治疗,其中6例为多发性ASD。结论：IASA合并畸形最常见的为ASD,而ASD中多发性ASD较为常见,通过TTE及TEE准确诊断,选择内、外治疗适应证。     

Measuring prenatal drug exposure

Prenatal drug exposure is an important pediatric health issue. However, the effects on children are not clear because of limitations in the way drug exposure is typically measured. For example, one cannot say cocaine causes a specific outcome if cocaine exposure is not measured accurately. Before we can determine the developmental outcomes associated with drug exposure, 4 measurement issues must be considered: (1) the amount of exposure varies greatly, such as from 1 to 709 g of crack per month; (2) exposure may vary by trimester; (3) exposure could be to one drug or multiple drugs; and (4) different sources of exposure data can be inconsistent (e.g., toxicology and maternal self-report). We use data from 248 families participating in an ongoing longitudinal study to provide concrete examples of these measurement issues. Both nursing researchers and practitioners must carefully attend to measurement issues when interpreting research on the effects of prenatal drug exposure.     

Multiple congenital anomalies associated with infantile achalasia

Achalasia is rare in the pediatric age group, particularly in, the neonate and young infant. The symptoms are often nonspecific and may not even suggest a primary esophageal disorder. This is a report of two cases of achalasia seen in neonates, both of whom had other unusual and exceedingly uncommon congenital abnormalities.Presented at the meeting of the Society for Pediatric Radiology, 1978     

产前超声诊断永存左上腔静脉及其合并畸形的价值

正永存左上腔静脉(persistent left superior vena cava,PLSVC)是最常见的体循环静脉畸形,发生率约为0.3%～0.5%,占所有先天性心脏病的2.8%～4.3%~([1-2]),可以单独存在,也可合并其他心内外畸形。本组回顾性分析86例PLSVC胎儿及其合并畸形的相关资料,总结PLSVC的声像图特征、伴发畸形及围产结局,旨在提高产前超声对该病的认识。     

Cardiovascular toxicity associated with cancer treatment

Cardiotoxicity is a well-described and potentially lethal side effect of certain chemotherapeutic agents. Cardiotoxicity is a broad term used to depict conditions ranging from benign forms of arrhythmias to potentially fatal conditions, such as myocardial ischemia or infarction and heart failure. Anthracyclines (daunorubicin, doxorubicin, and epirubicin), mitomycin, and monoclonal antibodies such as trastuzumab have been associated with cardiotoxicities, but other chemotherapeutic agents, such as fluorouracil, cyclophosphamide, interferons, and interleukin-2 and other targeted agents, also can cause this side effect. Although several theories exist about the process that leads to cardiotoxicity from some chemotherapeutic agents, the exact mechanism of action is unknown. Oncology nurses should know the agents associated with cardiotoxicity, including newer targeted therapy drugs. Knowledge of the potential mechanism of action, as well as the possible reversibility of cardiotoxicity with specific agents, is important.     

Late trimester hydranencephaly associated with maternal exposure to methamphetamine

Abstract

Acquired hydranencephaly diagnosed after a normal ultrasound examination is a rare finding in pregnancy. The etiology includes infections, bleeding diatheses, neoplasms and exposure to vasoconstrictive agents. Fetal hydranencephaly was discovered on a third trimester ultrasound examination after a normal examination a month earlier. The pregnant patient admitted to heavy use of crystal meth during the preceding month. Upon the finding of an acquired hydranencephaly, the clinician should have a high index of suspicion for maternal abuse of vasoconstrictive agents such as methamphetamine or cocaine.     

Impaired insulin secretion after prenatal exposure to the Dutch famine

OBJECTIVE: We previously reported that people prenatally exposed to famine during the Dutch Hunger Winter of 1944-1945 have higher 2-h glucose concentrations after an oral glucose tolerance test in later life. We aimed to determine whether this association is mediated through alterations in insulin secretion, insulin sensitivity, or a combination of both. RESEARCH DESIGN AND METHODS: We performed a 15-sample intravenous glucose tolerance test in a subsample of 94 normoglycemic men and women from the Dutch Famine Birth Cohort. We used the disposition index, derived as the product of insulin sensitivity and the first-phase insulin response to glucose as a measure of the activity of the beta-cells adjusted for insulin resistance. In all analyses, we adjusted for sex and BMI. RESULTS: Glucose tolerance was impaired in people who had been prenatally exposed to famine compared with people unexposed to famine (difference in intravenous glucose tolerance test K(g) value -21% [95% CI -41 to -4]). People exposed to famine during midgestation had a significantly lower disposition index (-53% [-126 to -3]) compared with people unexposed to famine. Prenatal exposure to famine during early gestation was also associated with a lower disposition index, but this difference did not reach statistical significance. CONCLUSIONS: Impaired glucose tolerance after exposure to famine during mid-gestation and early gestation seems to be mediated through an insulin secretion defect.     

Birth outcomes, health problems, and neglect with prenatal exposure to cocaine.

Thirty children exposed prenatally to maternal use of cocaine were compared to 30 nonexposed subjects on maternal variables, birth outcomes, health problems in early childhood, and issues related to child maltreatment. Cocaine-exposed infants were more likely to have mothers who received inadequate prenatal care, have adverse birth outcomes including prematurity and retarded intrauterine growth, and have health problems beyond the newborn period including small stature and hypertonia. More cocaine-exposed children were placed in foster homes due to maternal neglect.