Therapeutic Hypothermia After Cardiac Arrest

Despite the publication of two randomized controlled trials of therapeutic hypothermia after cardiac arrest showing a clear benefit in neurologic outcome and mortality nearly a decade ago, the use of therapeutic hypothermia after successful cardiopulmonary resuscitation remains low. This lag in converting clinical research into practice is likely due in part to a lack of familiarity with a relatively new technology and the need for many providers in the chain of care to understand and feel comfortable with its application, from doctors and nurses in the emergency room, to those in the catheterization laboratory, and ultimately to the staff of the intensive care unit. This review summarizes the physiologic consequences of hypothermia as well as the current literature demonstrating the benefit of hypothermia on select patient populations and the impact of hypothermia on outcome assessment after cardiac arrest.     

Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects

We report Down syndrome (DS)-associated congenital gastrointestinal (GI) defects identified during a 15 year, population-based study of the etiology and phenotypic consequences of trisomy 21. Between 1989 and 2004, six sites collected DNA, clinical and epidemiological information on live-born infants with standard trisomy 21 and their parents. We used chi-squared test and logistic regression to explore relationships between congenital GI defects and infant sex, race, maternal age, origin of the extra chromosome 21, and presence of a congenital heart defect. Congenital GI defects were present in 6.7% of 1892 eligible infants in this large, ethnically diverse, population-based study of DS. Defects included esophageal atresia/tracheoesophageal fistula (0.4%), pyloric stenosis (0.3%), duodenal stenosis/atresia (3.9%), Hirschsprung disease (0.8%), and anal stenosis/atresia (1.0%). We found no statistically significant associations between these defects and the factors examined. Although not significant, esophageal atresia was observed more often in infants of younger mothers and Hispanics, Hirschsprung disease was more frequent in males and in infants of younger mothers and blacks, and anal stenosis/atresia was found more often among females and Asians.