Prediction of outcome of preterm infants with severe bronchopulmonary dysplasia

Abstract Forty-four preterm infants of less than 30 weeks gestation and birthweight £ 1250 g, with severe bronchopulmonary dysplasia requiring mechanical ventilation for at least 28 days, were reviewed. Twenty-seven infants (61%) survived; 17 died. There were no significant differences between survivors and non-survivors with respect to birthweight, gestational age, sex, Apgar score at 5 min or pulmonary diagnosis. Non-survivors displayed more severe changes on chest X-ray than the survivors. Peak inspiratory pressure (PIP), ventilator rate (VR), ventilator index and mean airways pressure were significantly higher in the non-surviving infants on days 2, 3, 4, 7, 14, 21 and 28, with non-survivors also having significantly higher alveolar-arterial oxygen gradients and lower arterial-alveolar oxygen ratios than the survivors. Discriminant analysis with cross-validation by pairing PIP and VR on day 28 produced a positive predictive value for non-survival of 88% and a negative predictive value of 89%. This result was better than was obtained for any other pair of ventilator parameter or oxygenation index. Discriminant analysis by combining X-ray appearances with ventilator settings did not improve the prediction. Having established a statistical model based on the PIP and VR of ventilator-dependent preterm infants on day 28, the outcome can be predicted with a high degree of confidence. This has the immediate potential application of indicating to staff in the neonatal unit a realistic approach to take when counselling parents of these infants.     

Priapism induced by intracavernosal vasoactive intestinal polypeptide and phentolamine mesylate

This is a case of priapism (21 h) following an intracavernosal injection of vasoactive intestinal polypeptide (VIP) 25 mcg with phentolamine mesylate (PM) 1 mg responding to venesection and intracavernosal injection of 1 mg metaraminol.     

Electrophysiologic Characteristics and Anatomical Complexities of Accessory Atrioventricular Pathways with Successful Ablation of Anterograde and Retrograde Conduction at Different Sites

RF Ablation of Accessory Pathways. Introduction: Catheter ablation may eliminate anterograde and retrograde accessory pathway conduction at closely adjacent but anatomically discrete sites. However, the mechanisms of this discrepancy, the electrophysiologic and anatomical characteristics, and information about systematic study from a large patient population are not available. The purpose of this study was to investigate the electrophysiologic characteristics and anatomical complexities of the accessory pathway in which anterograde and retrograde conduction was successfully ablated at different sites. Methods and Results: Thirty-eight (10.9%) patients (19 men and 19 women; mean age 37 ± 2.4 years) fulfilling the criteria of having separate ablation sites for anterograde and retrograde conduction were designated as group I, and the other 310 patients (215 men and 95 women; mean age 47 ± 0.6 years) were designated as group II. The patients with right-sided free-wall pathways had the highest incidence (18.6%) of separate ablation sites. The anatomical distance between anterograde and retrograde directions (left anterior oblique view. 13 ± 0.6 vs 8 ± 0.9 mm, P < 0.01; right anterior oblique view, 17 ± 0.6 vs 5 ± 0.7 mm, P < 0.01), and incidence of conduction impairment in one direction after successful ablation of another direction (15% vs 78%, P < 0.05) differed significantly between left and right free-wall pathways. The mean distances obtained from left (7 ±0.4 vs 14 ± 0.4 mm, P < 0.05) and right (7 ± 1.1 vs 15 ± 0.9 mm, P < 0.05) anterior oblique views were shorter in patients who had impairment of conduction properties than those in patients without impaired conduction after successful ablation of one direction. Conclusions: This study showed that anatomical and functional dissociation of the accessory pathway into anterograde and retrograde components was possible. Further study on the relation between electropbysiologic and pathologic characteristics would be helpful to confirm these findings.     

Early family predictors of child and adolescent antisocial behaviour: who are the mothers of delinquents?

This study tested the utility of 29 maternal and familial characteristics for the purpose of prospectively identifying children who are at high risk for antisocial and delinquent outcomes. The family data were drawn from the archives of the Dunedin Multidisciplinary Health and Development Study. The study's design offers certain methodological advantages: the sample is a representative unselected birth cohort; the family measures were taken very early in childhood; information about the child's antisocial behaviour was collected from many different sources and at many different ages; a comparison group of children with other behaviour disorders was included, and it was possible to examine the influence of possible ‘confounding variables'. Three groups of 11-year-old children (antisocial (n = 50), other disorders (n = 37), and non-disordered (n = 220)) were compared on family variables. Nine family variables differentiated the antisocial children from the nondisordered children, the most important of which were parental disagreement about how to discipline the 5-year-old child, and many changes of the child's primary caretaker during childhood. In addition, among the children who were known to police by age 15, prospective family variables accounted for significant amounts of the variance in number of police contacts and age at first police contact.     

The Development of General Practice in China

The concepts and principles of general practice are consistentwith Chinese cultural values; the leading authorities at theGeneral Practice Training Centre are extremely enthusiasticabout the general practice movement; the Ministry of PublicHealth is totally supportive of the general practice training;the medical/allied health professionals are eager to participatein general practice activities; and general practice certainlyis responsive to public expectations. General practice willbe flourishing and prosperous in China; however, there may betimes when the specialty of general practice in China experiencesgrowing pains with obstacles. The experiences gained from thedevelopment of general practice training programmes in Taiwanand other countries to handle the obstacles are of tremendousvalue to the development of general practice in China. It isexpected that communication and exchange between the generalpractice educators of Taiwan and China will play an importantrole in the further development of general practice in China.     

ISOLATED LIVER PERFUSION: THE CHOICE OF ANAESTHETIC

Perfused livers isolated from rats under halothane anaesthesia produced greater amounts of bile, released smaller amounts of aspartate aminotransferase, and had a much greater ability to maintain a constant concentration of glucose in perfusates than those obtained with ether or pentobarbitone. Little or no effect was shown on the ability of the liver to synthesize urea and to retain potassium within the organ. It appears, therefore, that halothane is the anaesthetic of choice when removing the liver from the laboratory rat.     

The Health of Subjects Living with a Permanent Ileostomy

The alms of the present study were to survey the general stateof health of a group of fleostomists, including social, psychologicaland sexual aspects, and to investigate a range of metabolicfunctions in the same patients. The subjects studied were takenat random from patients who had been treated by proctocolectomyand ileostomy in Oxford. There were 39 subjects whose operationhad been performed for ulcerative colitis and 12 subjects whohad had the operation for Crohn's disease involving the colon.A control group consisting of 39 healthy volunteers, matchedfor age and sex with the 39 patients who had had ulcerativecolitis were also studied. The general health of the ileostomists,as judged by their medical history, the findings on completephysical examination and the results of standard biochemicaland haematological investigations was good or excellent Virtuallyall were pursuing their normal occupations. Most of them enjoyedtheir normal recreations but several had given up swimming.An appreciable number considered that they had received inadequateexplanation and guidance before and after the institution ofthe ileostomy. Psychological abnormalities, as judged by responsesto standard inventories, were minor. There was little evidenceof physical impairment of sexual activity but psychologicalproblems were not unusual . The dietary habits of the ileostomists were essentially normalbut they consumed more fluid and more salt than the controlsubjects. In spite of this, the ileostomists showed evidenceof mild dehydration and aldosteronism. It is recommended thatan Qeostomist should consume 15 ml/Kg body weight of additionalfluid and 100 mg/Kg body weight of additional salt each day.There was a mild degree of iron deficiency which was correctibleby oral supplements. Vitamin B₁₂ absorption was enhanced inthe ileostomists who had had ulcerative colitis. There was noevidence of folate depletion. The ileostomists had increasedretention of calcium. This suggests that they were probablydeficient in calcium at the time of operation and were slowlycorrecting the deficit. Male ileostomists had a high incidenceof urinary stones, possibly related to a low pH and volume ofthe urine and a high level of plasma uric acid. The ileostomistshad a high incidence of gallstones. The gastrointestinal hormoneprofile in the fleostomists showed significant differences fromnormal in the values of motflin, en-teroglucagon and neurotensin.