Liver transplantation for severe hypoxemia caused by patent ductus venosus

The authors describe the case of a 9-year-old girl who underwent liver transplantation because she suffered from severe hypoxemia caused by patent ductus venosus (PDV). Generally, severe hypoxemia (PaO2 < 50 mm Hg in room air or < 300 mm Hg in pure oxygen) is not an indication for liver transplantation because the hypoxemia may not be improved, and may lead to a fatal outcome. PDV, which is associated with mild liver dysfunction, is not an indication for liver transplantation by itself. But in our patient, most of the mesenteric venous flow directly entered the systemic circulation through the PDV just like the portosystemic shunt, and this caused the pulmonary arteriovenous shunt and hypoxemia. Thus, the authors operated on the patient in an attempt to restore her pulmonary function. Nitric oxide (10 to 20 ppm) was added to the inhaled gas to dilate the functional pulmonary capillaries and to deliver sufficient oxygen after the transplantation. Although the patient suffered various complications after the operation, the final results were excellent.     

ICU深静脉导管留置中常见的护理问题及处理

静脉通道的建立及静脉输液在危重患者的救治中起着重要作用.深静脉置管输液不仅可避免反复穿刺给病人带来的痛苦、保护外周静脉的同时,为抢救病人、强刺激药物给药、肠外营养的及时给予等开放了一条快速、有效的静脉通道.在深静脉导管的应用过程中,导管的护理显得尤为重要,2008年10月1日至2009年10月1日,我科深静脉置管267例,现将使用中出现的护理问题及处理措施报告如下.     

Changes of venous blood flow velocity waveforms in fetuses with supraventricular tachycardia

Studies in the fetal lamb have shown that atrial pacing beyond a rate of 300-320 beats/min may be associated with dramatic changes of venous blood velocity waveforms, an increase of venous pressure by up to 75%, hydrops, polyhydramnios and placental edema. The aim of our study was to determine the 'critical' heart rate frequency in the human fetus. In 11 fetuses (five with and six without hydrops) with supraventricular tachycardia, pulsed wave Doppler analysis of flow velocity waveforms of the inferior vena cava, the ductus venosus and the left hepatic vein were performed before and after drug treatment. In ten cases cardioversion was achieved by in utero antiarrhythmic drug therapy; in one case treated with digoxin and flecainide the supraventricular tachycardia was decreased to 160-190 beats/min with disappearance of hydrops. Before intrauterine treatment of supraventricular tachycardia, pulsatile reversal of blood flow in the inferior vena cava, ductus venosus and left hepatic vein was visible, with monophasic forward flow during systole and reversed flow during diastole in ten of 11 fetuses. One fetus with supraventricular tachycardia of 195 beats/min showed a normal biphasic forward flow pattern. During drug-induced sinus rhythm, a normal biphasic forward venous blood flow pattern was shown in all ten cases. In five cases pulsatile reversal was demonstrated during a drug-induced reduction of the heart rate from 280 to 210 beats/min and a normal biphasic forward flow velocity waveform appeared during supraventricular tachycardia below 210 beats/min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Blood flow through the ductus venosus in human fetus: calculation using Doppler velocimetry and computational findings

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.     

Transient increase in nuchal translucency thickness and reversed end-diastolic ductus venosus flow in a fetus with trisomy 18

In a twin pregnancy discordant for trisomy 18, the affected fetus at 13 weeks' gestation had an increased nuchal translucency thickness and reversed end-diastolic ductus venosus flow. At 20 weeks' gestation there was no nuchal edema and Doppler study of the central venous vessels demonstrated normal waveforms. The findings support the hypothesis that one of the mechanisms in the development of increased nuchal translucency is temporary cardiac strain.     

Measurement of velocity waveforms in the median cerebral artery in cases of ventriculomegaly in mature fetuses

The authors give account of three pregnancies, where fetal ventriculomegaly was diagnosed. Their examinations were aimed to prove connection between the figures of velocity waveforms of cerebral arteries and the prognosis of ventriculomegaly. The study based on the results of the published cephalic neonatal and infant ultrasound examinations which consider the method useful. The authors consider on the basis of their examinations, that the measurement of the velocity of the fetal cerebral arteries is useful and maybe has prognostic values. Considering the low number of examined patients further investigations are necessary to statistically analyse the results.     

Fetal behaviour in normal and compromised fetuses. An overview

Fetal intrauterine behaviour is not a stable situation but a continuous alternation of states characterized by significant changes in fetal motility, heart rate, hemodynamics, metabolism and response to stimulation. Associations between fetal heart rate patterns and movements occur from 26-28 weeks of gestation onwards. As fetuses grow older these variables become gradually more related temporally and clustered in behavioural states similar to those present in newborns. This article describes the technique of recording and analyzing fetal behaviour, its development in normal pregnancy and its influence on different physiological parameters that are assessed in clinical practice. Furthermore the deviations from the norm occurring in compromised fetuses are described.     

Cerebellar growth in normal and growth-restricted fetuses of multiple gestations

OBJECTIVE: Our purpose was to evaluate growth of the cerebellum in growth-restricted fetuses of twin and triplet gestations versus growth in normal in utero sibling(s) and in singleton gestations. STUDY DESIGN: An ultrasonographic study was conducted in a population of pregnant women with twin and triplet gestations. The control group was either the normal in utero sibling(s) when one fetus was growth restricted or normal twin and singleton pregnancies. Standard biometric measurements were obtained on all fetuses throughout pregnancy, including the transverse cerebellar diameter. However, only the last measurement was used for the analysis. Statistical analyses were conducted comparing growth of the transverse cerebellar diameter among the growth-restricted fetuses versus growth in the normal in utero fetal sibling(s) or other normal twin and singleton gestations. RESULTS: Pregnancies were categorized on the basis of the growth status of women with twin and triplet gestations: Group 1 (151) contained women with two fetuses appropriately grown for gestational age; group 2 (52) had one appropriately grown fetus and one with intrauterine growth restriction; group 3 (19) had two fetuses with intrauterine growth restriction. In addition, there were 30 triplet gestations (group 4), five of which had growth-restricted fetuses, and group 5 contained 1405 singleton pregnancies. In all five groups there was a statistically significant relationship between transverse cerebellar diameter and gestational age (p < 0.0001). There was also no significant difference between growth of the transverse cerebellar diameter in the appropriately grown and growth-restricted siblings and among normal singleton and twin pregnancy groups. In most cases of growth-restricted fetuses, except for the transverse cerebellar diameter measurements, all other biometric parameters were < 10th percentile. CONCLUSION: These data confirm the relative preservation of normal cerebellar growth in growth-restricted fetuses and a similar rate of growth in singleton and multifetal gestations. The transverse cerebellar diameter therefore represents an independent biometric parameter that can be used in both singleton and multifetal pregnancies to assess normal and deviant fetal growth.     

Effects of cordocentesis on inferior vena cava velocity waveforms: differences between normally grown and growth-retarded fetuses

PURPOSE: The purpose of this investigation was to evaluate complete denture patients at pretreatment and postinsertion, 6 months and 18 months after denture delivery in order to develop an explanatory model of successful denture therapy to better understand patient acceptance of complete dentures. MATERIALS AND METHODS: Sixty complete-denture patients treated at a dental student clinic were followed through denture therapy and for 18 months thereafter. Subjects were examined and completed pretreatment questionnaires and posttreatment interviews. Three outcome measures of denture success were tested, and factors considered substantive in achieving a successful denture outcome were examined using multivariate analyses. RESULTS: At post-insertion, 76.7% of subjects were satisfied with their dentures, 74.6% said their expectations were met, and 66.7% said they adjusted easily to their new dentures; reports at 6 and 18 months were similarly high. Logistic regression findings suggest that psychological and interpersonal factors are more important determinants of denture satisfaction than anatomic or clinical factors. CONCLUSIONS: Subject characteristics including age, gender, race, income level, education, marital status, and maxillary and mandibular anatomy were not significantly associated with denture success as defined by the three outcome measures used in this study. Although these variables may represent important co-factors in the patient's acceptance of dental services and may affect the way a patient perceives dental care outcomes, statistically significant relationships were not found within our sample. Psychosocial variables, such as pretreatment expectations, satisfaction with the dental care received, and mental health showed a stronger relationship to a successful outcome.     

Truncus arteriosus with patent ductus arteriosus and normal aortic arch

In hearts with a common arterial trunk (truncus arteriosus), there is almost always an inverse development of the aortic arch and the ductus arteriosus. Truncus with a normal aortic arch and a patent ductus is a rare echocardiographic and surgical finding. In this report, we describe 2 neonates in whom truncus arteriosus with a normal aortic arch and a medium or large patent ductus was diagnosed by preoperative echocardiography (without catheterization) and confirmed intraoperatively.     

Closure of the ductus venosus in premature infants: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography

OBJECTIVE: Our objective was to use gray-scale, color-flow, and duplex Doppler sonography to study the anatomy, flow pattern, and time of closure of the ductus venosus in healthy premature infants. SUBJECTS AND METHODS: We prospectively examined the ductus venosus in 130 premature infants whom we divided into two groups: Group I comprised 27 neonates of gestational age 28-32 weeks, and group II comprised 103 neonates of gestational age 33-36 weeks. Neonates who had undergone umbilical vessel manipulation were excluded from the study. All examinations included gray-scale, color-flow, and duplex Doppler sonography. Patency, length, color flow, and Doppler characteristics of the ductus venosus were recorded. Neonates were examined 1-2 days after birth, 6-7 days after birth, and subsequently every 3-4 days until ductus closure was observed. The time of closure of the ductus for the two groups was compared using the chi-square test. RESULTS: The ductus venosus was patent during the initial examination in 128 of the 130 neonates. Doppler waveform was venous with little variation in velocity. Ductus length slightly exceeded 1 cm in both groups. We found a statistically significant difference in the percentage of infants having a patent ductus venosus after the initial examination: At 1 week after birth, ductus patency was shown in 85% of the infants in group I and in 56% of the infants in group II; at 2 weeks, the respective percentages were 42% and 14%; and at 3 weeks, 27% and 0%. CONCLUSION: The ductus venosus is patent 1-2 days after birth in virtually all premature infants. From 6 days after birth and onward, a significantly greater percentage of smaller premature infants (i.e., 28-32 weeks' gestational age) have a patent ductus venosus than do larger premature infants (i.e., 33-36 weeks' gestational age).     

Motor responsivity during habituation testing of normal human fetuses

A case of lateral dislocation of the carpal scaphoid associated with a fracture of the triquetral and carpo-metacarpal dislocation of the ring and little finger is described. A thorough search of the literature failed to reveal any previous report of this combination of injuries. The dislocation was reduced by manipulation, but the scapholunate ligament required surgical repair. The results after two year was good.     

A biometric study of the eye, orbit, and face in 205 normal human fetuses

PURPOSE: To develop models for assessing the differential growth of the fetal face along its horizontal and vertical axes, as well as of the orbit and the eye. METHODS: Normal human fetuses (n = 205), whose gestational ages ranged from 15.5 to 41 weeks of amenorrhea, were examined. Orbitofacial parameters were as follows: outer canthal distance, inner canthal distance, palpebral fissure length, and oropalpebral distance. Ocular parameters were corneal diameter and axial length. Correlations were tested among all parameters. Linear and polynomial regression analyses of gestational age and the orbitofacial and ocular parameters were used to develop models of growth. Differential patterns of growth in the face were investigated. RESULTS: The best correlation was found between palpebral fissure length and oropalpebral distance. The increase of each of the parameters studied could be accurately described by a linear model. Sex had no detectable effect on these parameters. Compared with the skull, the face had a more rapid growth along the vertical axis. The palpebral fissure developed more rapidly than the eye. CONCLUSIONS: The parameters that were studied in the fetal face, orbit, and eye follow a roughly linear growth curve.     

Superior mesenteric artery blood flow velocimetry: cross-sectional Doppler sonographic study in normal fetuses

Our objectives were to describe the flow velocity waveform of the fetal superior mesenteric artery and to establish a nomogram for its pulsatility index. In a cross-sectional study using color Doppler ultrasonography, superior mesenteric artery flow velocimetry was investigated prospectively in 96 healthy fetuses of between 14 and 37 weeks of gestation. In normal fetuses the pulsatility index measurements showed a slight but insignificant increase over the course of gestation (r = 0.26; P > 0.5). The lowest mean +/- standard deviation for pulsatility index in the superior mesenteric artery was 1.86 +/- 0.45 (95% confidence interval 1.67-2.06), recorded between 18 and 21 weeks' gestation. Thereafter the pulsatility index increased to 1.94 +/- 6.4 (95% confidence interval 1.74-2.8) at 22 to 25 weeks, and from weeks 26 to 29 it increased to 2.18 +/- 0.52 (95% confidence interval 1.91-2.46). During the third trimester and at term, the mean pulsatility index of 2.23 +/- 0.32 (95% confidence interval 1.43-3.03) did not change significantly with gestational age. In normal fetuses, except for the early stages, a relatively stable vascular resistance of the intestinal circulation was found. The application of this nomogram in clinical practice may facilitate evaluation of intestinal perfusion in compromised fetuses with blood flow centralization.     

Maternal education and risk factors for small-for-gestational-age births

OBJECTIVES: This article examines the association between maternal education, smoking and other risk factors and small-for-gestational-age (SGA) births. DATA SOURCE: The data are from the 1994/95 National Longitudinal Survey of Children and Youth. The analysis was restricted to a subsample of 4,181 children younger than age 2 and was based on information provided by their biological mothers. ANALYTICAL TECHNIQUES: Logistic regression was used to estimate the odds ratios for SGA by maternal education, controlling for maternal smoking during pregnancy, household income, family status, maternal age at birth of child, and use of prenatal care. MAIN RESULTS: Maternal education and smoking during pregnancy appear to have independent effects on SGA, after controlling for other risk factors. The effects of maternal education, smoking and other risk factors are likely underestimated, as the analysis pertains only to children who had survived at the time of the interview.     

Complete hydatidiform mole and coexisting normal fetuses. A report of two cases with contrasting outcomes

BACKGROUND: Multiple pregnancies consisting of a complete hydatidiform mole and coexisting fetuses are relatively rare but may become more common due to the increasing use of ovulation-induction agents. CASES: We report on a twin and a triplet pregnancy, conceived using clomiphene citrate, with contrasting outcomes. The twin pregnancy resulted in a term delivery of a healthy singleton and the triplet pregnancy in a termination at 17 weeks followed by the development of choriocarcinoma. CONCLUSION: The few cases available suggest that a subgroup of complete moles follows a more benign course and can be managed conservatively, allowing the pregnancy to go to term with appropriate follow-up, whereas other cases follow a more aggressive course. Larger case series are needed to develop definitive protocols.     

Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks of gestation

This paper explains the occupational hygiene basis of a new scheme to help small firms control the health risks from supplied chemicals. The scheme groups hazard information and the potential for a material to become airborne into bands and, from this information, predicts the control strategy necessary to ensure that the hazardous substance is used safely. To do this a simple model based upon an empirical approach to risk assessment and risk management has been developed. This work was undertaken in a working group established by the Health and Safety Commission's Advisory Committee on Toxic Substances.     

The differences in growth of cerebellar vermis between appropriate-for-gestational-age and small-for-gestational-age newborns

Positive and negative symptoms are measurable characteristics that may represent core features of schizophrenia and offer a quantitative approach for studying the genetics of schizophrenia and related disorders. The Positive and Negative Syndrome Scale (PANSS) was used to assess 72 members of five families segregating schizophrenia. The study confirmed high internal reliability of PANSS scales in this sample with diverse lifetime diagnoses. Gender but not alcoholism affected scores. Schizophrenia/schizoaffective and schizophrenia spectrum disorder groups had higher mean scores for the positive and negative scales than other lifetime diagnostic groups, consistent with genetic transmission of these symptoms. Positive and negative symptom patterns did not subtype families. The results support the validity of positive and negative symptom measures as independent dimensions in familial schizophrenia.     

The ductus and the coarctation

After Robert E. Gross' historic ligation of a persistent ductus arteriosus in August 1938, it took 6 years before the first coarctation was operated on. Gross initiated experimental procedures directed at repair of coarctation even before the ductal operation had been performed. He had the desire, the drive, and the determination. Why the delay that allowed Clarence Crafoord to perform the first coarctation repair in October 1944?