Pharmacologic therapy for fetal arrhythmias

Although great strides have been made in diagnosing fetal cardiac anatomic and functional abnormalities, in utero cardiac therapy is limited to the treatment of significant arrhythmias. The fetal prognosis may change if the dysrhythmia persists or if the condition results in intrauterine heart failure. When either complication is evident, intrauterine drug therapy may be indicated if the fetus is considered too immature for delivery. Information from case reports has shown several drugs to be useful to cardiovert the fetus, with digitalis being the pharmacologic agent used most often. At present, treatment consists mainly of transplacental administration of antiarrhythmic agents with the object of normalizing FHR and rhythm and abolishing, or preventing, fetal cardiac failure. Various agents have been used with variable success. More direct fetal therapy by intramuscular injection or umbilical vein infusion may replace unsuccessful indirect maternal therapy. It is unclear why some fetuses respond (or appear to respond) and others have hydrops and die in the absence of congenital heart disease or documented infection. With proper therapy, many fetuses survive and have a satisfactory prognosis, depending on the form of arrhythmia and the nature of any cardiac structural defects.     

Continuous enteral feedings. An important adjunct to the management of complex congenital heart disease

Eleven infants with complex congenital heart lesions were given continuous enteral infusions after failure to gain weight adequately despite use of hypercaloric formulas and nutritional supplementation. Formulas used before institution of enteral feedings were continued. Dietary and caloric intake and weight measurements were obtained at weekly or monthly intervals. Both mean daily caloric intake and mean daily weight gain were greater after initiation of continuous enteral feedings. Rate of weight gain improved in all 11 children after institution of enteral feedings. Continuous enteral feeding increases weight gain in babies with complex congenital heart disease, allowing earlier and safer surgical intervention.     

Untersuchung zur Kategorisierung des mandibulären Wachstumspotentials von Petrovic,Lavergne und Stutzmann

Zusammenassung In der vorliegenden Studie sollte untersucht werden, ob die vonPetrovic, Lavergne undStutzmann vorgeschlagene Kategorisierung des mandibulären Wachstumspotentials für die Behandlung mit dem Funktionsregler Geltung hat. Dazu wurden die Fernröntgenaufnahmen von 140 Patienten der Angle-Klasse II nach zirka zweijähriger Behandlung mit Funktionsreglern analysiert. Im Vergleich zu 133 unbehandelten Kindern mit Angle-Klasse II trat in fast allen Rotationsgruppen eine signifikant größere Zunahme der Unterkiefergesamtlänge ein. Zwischen der Kategorie 2 mit niedrigem Wachstumpotential und Kategorie 5 mit hohem Wachstumspotential wurden keine signifikant unterschiedlichen Zunahmen der Unterkieferlänge festgestellt.

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Summary The results of the study show whether the classification of mandibular growth potential, as proposed by Petrovic, Lavergne and Stutzmann has any influence on the treatment with a function regulator. X-rays of 140 class II patients were analysed after a treatment time of approximately 2 years. In comparison with 133 class II children without any treatment, a significant increase of the overall mandibular length was observed in almost all children treated. There was no significant difference in the increase of mandibular length between category 2 (low growth potential) and category 5 (high growth potential).

     

Abnormalities on chest radiograph reported in subjects in a cancer screening trial

BACKGROUND: Chest radiographs (CXRs) are commonly performed for diagnostic and other purposes. There is little literature either on the prevalence in the general population of various abnormalities seen on CXRs or on the risks associated with these abnormalities. METHODS: We followed up > 70,000 men and women who were enrolled in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Subjects received four annual posteroanterior CXRs for the early detection of lung cancer. Radiologists noted the presence of non-cancer-related abnormalities as well as nodules/masses that were suspicious for lung cancer. Subjects were followed up for mortality and cancer incidence. RESULTS: Abnormalities that were not suspicious for lung cancer were observed on 35% of examinations, compared to 8% of examinations with findings that were suspicious for cancer. The most commonly reported noncancer abnormalities were granuloma (10.7% of examinations), scarring/pulmonary fibrosis (8.2% of examinations), bone/soft tissue lesions (5.5% of examinations), cardiac abnormalities (4.4% of examinations), pleural fibrosis (3.6% of examinations), and COPD/emphysema (2.5% of examinations). Most noncancer abnormalities were more prevalent in men, older subjects, and smokers. Controlling for age, smoking, and other factors, scarring/pulmonary fibrosis was significantly associated with an increased risk of lung cancer with a hazard ratio (HR) of 2.0, while cardiac abnormalities (HR, 2.1), scarring/pulmonary fibrosis (HR, 1.4), COPD (HR, 1.7), and pleural fluid (HR, 2.3) were significantly associated with increased overall (ie, non-lung cancer) mortality. CONCLUSION: Abnormalities that are not suspicious for lung cancer are common in a population undergoing screening. Some of these abnormalities are associated with an increased risk for lung cancer incidence and/or overall mortality.