Fetal cardiomyopathy--in utero evaluation and clinical significance

OBJECTIVE: To describe the prenatal diagnosis and outcome of fetal cardiomyopathy (CM). METHODS: The charts, photographs and videotapes of all fetuses with CM, who were assessed during pregnancy at two referral centers, were reviewed. RESULTS: The diagnosis of CM was established in 12 fetuses. All had structurally normal hearts, and all cases were diagnosed after 23 weeks of gestation, following normal early fetal echocardiogram. Three clusters of fetal CM appeared: Familial--two sib fetuses of a mother, who is a second generation of CM. Both had dilated CM and pathological findings were consistent with the diagnosis of endocardial fibroelastosis. Secondary--CM that was induced by another factor. Idiopathic--six cases of CM without an underlying specific etiology. Three women elected to terminate their pregnancy. Among the nine who delivered, four had a favorable outcome with normal cardiac function at the age of 1 month, in which three belonged to the secondary category, and five cases were complicated by fetal/infant death. CONCLUSIONS: CM may develop during fetal life and might be diagnosed by prenatal echocardiography. Normal cardiac findings in a midtrimester fetus do not exclude subsequent development of CM. Detailed prenatal sonographic examination may aid in determining the neonatal outcome.     

Establishing signs for acute and healing phases of distal tibial classic metaphyseal lesions

Pediatric Radiology - Stages of healing for classic metaphyseal lesions (CMLs) are not well established. Follow-up skeletal surveys provide an opportunity to evaluate signs of healing CMLs. To...     

Zur Einwirkung der Kurzwellen auf die Blutgefässe

Zusammenfassung Die vonPflomm beschriebenen spezifischen Einwirkungen der Kurzwellen (KW.) auf die Gefäße des Frosches konnten durch die Nachuntersuchernicht bestätigt werden. Die eigenen Untersuchungen lassen mit Sicherheit die Wärme als ursächlichen Faktor für alle beobachteten Erscheinungen erkennen. Die Versuche wurden im KW.-Feld und in erwärmter Ringerlösung ausgeführt. Die gleichzeitig vorgenommenen Temperaturmessungen lassen eine Zuordnung bestimmter Veränderungen zu bestimmten Temperaturen erkennen, die im KW.-Feld und in erwärmter Ringerlösung von gleicher Größenordnung sind.Herrn Prof. Dr.Alois Strasser, der mehrfach auf die zentrale Stellung unseres Themas in alien therapeutisch wichtigen Fragen hingewiesen hat, sind wir für die Anregung zu dieser Arbeit zu besonderem Dank verpflichtet. Weiters danken wir Herrn Prof. Dr.Gustav Sauser, in dessen Institut die Untersuchungen durchgeführt wurden.     

Impact of high intracranial pressure on neurophysiological recovery and behavior in a chronic porcine model of hypothermic circulatory arrest.

OBJECTIVE: This review was undertaken to determine whether high intracranial pressure (ICP) during reperfusion after hypothermic circulatory arrest (HCA) correlates with evidence of suboptimal cerebral protection in a chronic porcine model. METHODS: In concurrent studies of cerebral protection, 48 control pigs (24-31 kg) underwent 90 min of HCA at 20 degrees C using a strictly standardized protocol. Hemodynamic measurements, ICP and neurophysiological data (EEG, SSEP) were assessed before HCA and until 3 h postoperatively. ICP was measured using a Codman microtip catheter inserted directly into brain parenchyma. Neurological/behavioral evaluation (9=full recovery) was carried out daily through postoperative day (POD) 3. RESULTS: There were no significant hemodynamic or metabolic differences between individual animals. ICP (mmHg) increased significantly for the first 3 h after HCA: from baseline levels of 6.2+/-2.1 to 10+/-2.6 at 1 h, 11+/-3.2 at 2 h and 10+/-3.6 mmHg at 3 h; P<0.001 for the trend. EEG recovery 3 h after HCA was observed in 13 animals (27%), and correlated with lower ICP during reperfusion (P<0.001): with each 1 mmHg increase in ICP at 3 h, the odds of early EEG recovery decreased by a factor of 0.72. Lower ICP during reperfusion was also significantly associated with higher behavioral scores on POD 1 and 2, P<0.001. CONCLUSIONS: A significant rise in ICP may help explain the prolonged obtundation and confusion often seen clinically after HCA. If these small but consistent increases in ICP contribute to rather than reflect ischemic neuronal damage, simple maneuvers to reduce ICP may improve cerebral recovery after HCA.     

Amelioration of Child Depression Through Behavioral Parent Training: A Preliminary Study

Child depression is an impairing condition for which tested treatments have shown relatively modest mean effects. One possible explanation is that the treatments have generally adopted an individual child focus, without addressing the dysfunctional parent–child interactions that often accompany child depression. The present study provides preliminary evidence bearing on this hypothesis, using data from a treatment outcome study in which clinically referred children with a depression diagnosis could receive individual cognitive behavioral therapy (CBT) focusing on the depression or behavioral parent training (BPT) focusing on comorbid conduct problems. Among children in the study who met criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed.) depressive disorders, we identified two groups, matched on gender and age: 15 who received only CBT focused on child depression and 15 who received only BPT focused on child conduct problems. Children were 7 to 13, 20 of whom were male, and race included Caucasian (17), Latino (5), African American (2), and multirace (6). Measures assessed depressive diagnoses and symptoms, as well as parenting stress. Analyses focused on whether BPT alone might lead to reduced depression, and if so how that reduction would compare to the depression reduction achieved through CBT that focused on depression. Both groups showed significant reductions from pre- to post-treatment in depressive diagnoses and depression symptoms, and there were no BPT versus CBT group differences at post-treatment. BPT that focuses on child conduct problems, with no emphasis on depression treatment, may produce significant depression reduction in comorbid children who meet criteria for depressive disorders.     

A pragmatic evaluation of sleep patterns before gynecologic surgery

The aim of this study was to evaluate preoperative sleep patterns in-patients scheduled for elective endoscopic surgery and to compare sleep characteristics before different types of endoscopic procedures. A prospective survey cohort study (Canadian Task Force classification II-2) was designed to evaluate quantitative and qualitative (score 1–7) sleep parameters. Patients completed sleep-monitoring forms on the baseline (6 weeks before surgery), two nights (night-2), and the night before surgery (night-1). Of a total 119 women, 73 (61%) underwent laparoscopies and 46 (39%) hysteroscopies. Forty-seven (40%) operations involved organ removal and 72 (60%) were reconstructive surgery. The mean overall sleep-quality score on night-1 (3.29 ± 0.15) was higher (worse) than on baseline (2.09 ± 0.10, P < 0.0001) and night-2 (2.45 ± 0.11, P < 0.001, respectively). Patients reported more difficulty falling asleep on night-1 (2.53 ± 0.15) than on baseline (1.61 ± 0.09, P < 0.0001) and night-2 (1.84 ± 0.12, P = 0.001, respectively). The mean number of nocturnal awaking events was also highest on night-1 (1.52 ± 0.17) than on baseline (0.69 ± 0.09, P < 0.001) and night-2 (0.87 ± 0.09, P < 0.05 respectively). Using logistic regression, we found that age, stress level, and time before surgery (baseline, night-2, night-1), were significant predictors of poor sleep. The type of planned surgery did not influence the quality of sleep. Falling asleep on night-1 took longer than on baseline and night-2. There was no difference in the sleep quality measures between the baseline and night-2. Poor sleep quality is common mainly in the night before surgery. The nature and extent of planned surgery do not affect sleep quality variables.     

Magnetic resonance imaging diagnosis of a cerebral aneurysm in an infant. Case report and review of the literature

A posterior cerebral artery aneurysm presented as a seizure disorder in a 7-week-old infant. A small hemorrhage in the posterior thalamus was seen on CT scan. However, magnetic resonance imaging (MRI study) demonstrated an aneurysm and appropriate therapy was carried out. The incidence, natural history, etiology, and surgical treatment of these lesions are reviewed, and the usefulness of MRI in their diagnosis is emphasized.