Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery*

Background: After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery. Methods: The study was performed in a prospective, randomized, and double‐blinded cross‐over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20‐min period of steady state, children received either 2.5 μg·kg^?1·min^?1 dobutamine or 1 μg·kg^?1·min^?1 dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index. Results: No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 ± 0.6 to 4.7 ± 0.8 l·min^?1·m^?2 (P = 0.003) and dobutamine from 4.1 ± 0.7 to 4.8 ± 0.7 l·min^?1·m^?2 (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026). Conclusions: This trial demonstrates that low‐dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.     

Hypothermie bei Traumapatienten

Coincidental hypothermia after trauma can aggravate the severity of injury and it therefore makes sense to monitor the body temperature in the preclinical setting. In a prospective study, incidence and degree of severity of hypothermia were analysed as a function of injury pattern and preclinical care. A main factor of hypothermia was severity of injury measured by the injury severity score (ISS 24.0±15.5 versus 8.3±7.8) and the revised trauma score (RTS 5.6±1.8 versus 7.3±1.1). Of the patients with multiple trauma, 88.2% were hypothermic when administered to hospital, but no reason was found concerning the rescue methods (e.g. rescue time, whole duration, weather). An increase in the rate of hypothermia was seen only after long lasting incarceration. A multivariate data analysis showed, that in addition to ISS and RTS patient age (p=0.014) was primarily responsible for hypothermia after trauma, whereas no dependency was demonstrated for other factors. Thus, parts of this analysis are in contrast with other studies. Overall approximately 50% of trauma patients in the emergency unit suffer from hypothermia, but at this time point changes in physiological control mechanisms are not yet detectable. Nevertheless prevention of hypothermia is very important in the preclinical setting.     

The hospital record of the injured child and the need for external cause-of-injury codes. American Academy of Pediatrics. Committee on Injury and Poison Prevention, 1998-1999

Proper record-keeping of emergency department visits and hospitalizations of injured children is vital for appropriate patient management. Determination and documentation of the circumstances surrounding the injury event are essential. This information not only is the basis for preventive counseling, but also provides clues about how similar injuries in other youth can be avoided. The hospital records have an important secondary purpose; namely, if sufficient information about the cause and mechanism of injury is documented, it can be subsequently coded, electronically compiled, and retrieved later to provide an epidemiologic profile of the injury, the first step in prevention at the population level. To be of greatest use, hospital records should indicate the "who, what, when, where, why, and how" of the injury occurrence and whether protective equipment (eg, a seat belt) was used. The pediatrician has two important roles in this area: to document fully the injury event and to advocate the use of standardized external cause-of-injury codes, which allow such data to be compiled and analyzed.     

Radiological assessment of constipation

A scoring system for faecal loading was constructed by two experienced observers using the abdominal radiographs of 20 children. Four other observers independently graded the radiographs using this system and there was a high degree of agreement between all six observers (p < 0.001), suggesting that radiological assessment of constipation can be standardised.     

Supratentorial ependymoma: CT appearance

The computed tomographic appearances of 22 biopsy-proved supratentorial ependymomas were analyzed. Supratentorial ependymomas were usually intraparenchymal, larger than 4 cm, and cystic. Contrast enhancement was moderate to intense, with homogeneous or ring-enhancement patterns commonly seen. Intratumoral calcification was present in one-third of the cases, while hydrocephalus and peritumoral edema were seen in 50%. Intratumoral hemorrhage was not a characteristic of the lesion. In contrast to cellular ependymomas, malignant ependymomas and ependymoblastomas demonstrate higher attenuation prior to administration of contrast material, more intense enhancement, lower frequency of calcification within the tumor, and less distinct margination.     

Randomized trial of umbilical arterial catheter position: clinical outcome

In order to determine if umbilical arterial Catheter position affects the incidence of necrotizing enterocolitis, clinical outcome was analysed in 308 infants whose umbilical arterial catheter had been randomly allocated to a high ( n =162) or a low ( n =146) position. Necrotizing enterocolitis was classified as suspected or confirmed; all renal, lower limb and local catheter complications were also recorded. High umbilical arterial catheters were in place for longer than low catheters, provided more samples and were removed as an emergency less often. Lower limb blanching and cyanosis were more common with low catheters. Eleven cases of confirmed necrotizing enterocolitis occurred in the "high" group and nine in the "low" group. One case of fatal aortic thrombosis was encountered in the high group. Positioning umbilical arterial catheters in a high position allowed longer functional use and did not increase the incidence of necrotizing cnterocolitis.     

Nordic children with myelomeningocele. Parents' assessments of the handicap and physicians' classifications of the disabilities

The differences between parents' assessments of their child's handicap and professionals' assessment of disabilities were studied in 486 Nordic children with myelomeningocele aged 4–18 years. Although disability and handicap are conceptually different, agreement between the parents' assessments of the handicap and the degree of disability according to Lorber's classification was found in 51% of cases. The parents' assessments showed close agreement with overall disability according to Lagergren's method in 45% of cases. The factors most strongly associated with parental assessment of the handicap were the child's motor disability, intellectual functioning, faecal and urinary incontinence and the parents' inclination to feel inadequate with respect to the child's needs. Data from professional assessment of disabilities alone are of limited value in understanding the impact of disabilities on the daily life of a child.     

Urinary N-acetyl-beta -D-glucosaminidase and its isoenzymes A & B in workers exposed to cadmium at cadmium plating

Objective  

The present study was carried out to determine the effect of cadmium exposure on Urinary N-acetyl-beta -D-glucosaminidase and its isoenzymes A and B in workers exposed at cadmium plating.     

TGF-β2对树突状细胞表型和功能的影响

目的: 研究转化生长因子-β2 (TGF-β2)对树突状细胞(dendritic cells, DC)表型和功能的影响. 方法: 体外培养骨髓来源的DC(BMDC)及TGF-β2诱导的DC(TGFβ2-DC). 采用双色免疫荧光化学染色或流式细胞仪(FCM)分析DC的细胞表型. 分离纯化脾脏来源的同种异体T细胞和CD4+ T细胞. 用BMDC及TGFβ2-DC刺激T细胞增殖,并用混合淋巴细胞反应(MLR)测定其能力. 在CD4+ T细胞与BMDC或TGFβ2-DC共培养5 d后,用FCM检测CD4+ T细胞表型的变化. 结果: BMDC表现为CD11c, CD86, MHC class II+和CD8а-的髓系DC. TGF-β2的诱导抑制了DC表面协同刺激分子、MHC classII的表达(P<0.01),并抑制其刺激同种异体T细胞增殖的能力. 与BMDC诱导的CD4+ T细胞相比,TGFβ2-DC诱导的CD4+ T细胞CD152(细胞毒T淋巴细胞相关分子4, CTLA-4)表达上升(P<0.01). 结论: TGF-β2的诱导促使DC表面协同刺激因子表达下降,T细胞合成CTLA-4增加,T细胞的活化和增殖受到明显抑制.