We examined the ventilatory response to inhaled carbon dioxide with a computerized waveform analyzer in two groups of premature infants. Twenty-seven infants suffered from periventricular-intraventricular hemorrhage (IVH) during the first week of life and comprised the study group (birth weight 1.2 +/- 0.2 kg, gestational age 29 +/- 2 weeks). The control group consisted of 15 infants without IVH (birth weight 1.4 +/- 0.3 kg, gestational age 30 +/- 2 weeks). Study infants were evaluated at a postnatal age of 9 +/- 2 weeks and control infants at 7 +/- 3 weeks. No differences were found in the slope or position of the ventilatory response curve, baseline PACO2, increase in minute ventilation, VT/Ttot, and Ti/Ttot between the two groups. Subgroups with unresolved apnea (10 IVH and eight control infants) demonstrated a rightward shift of the ventilatory response curve compared to those infants without apnea. A previous IVH did not reduce the ventilatory response to CO2 in this group of infants.

Apnea↗

PubMedDate not supplied

Aplastic anemia or aplastic preleukemic syndrome?

The incidence of aplastic anemia appears to be relatively high in some parts of the world, including Pakistan. Since some of the etiological factors are shared by aplastic anemia and the preleukemic syndrome, there is a strong possibility that a proportion of cases of aplastic anemia may in fact be preleukemia. The study of chromosomes offers a relatively easy method of detecting cases of preleukemia, because some chromosomal abnormalities are frequently observed in this condition. Chromosomal studies were carried out in peripheral blood cell cultures of 31 patients with otherwise typical aplastic anemia. Chromosomal abnormalities were detected in 7 (22.5%) cases. The most common chromosomal abnormality detected was trisomy 8, seen in four cases. Other abnormalities detected were 22q-, t(14;22) and t(15;21), in one case each. These abnormalities have been found to be associated with AML, MDS, ALL, and NHL as well. We hypothesize that a proportion of cases of otherwise typical aplastic anemia may in fact be due to a leukemic process in evolution.

Adolescent↗

PubMedDate not supplied

Posterior chamber lens implantation for primary repair of corneal lacerations and traumatic cataracts in children.

Children older than 3 years of age rarely tolerate contact lenses for unilateral surgical aphakia. This problem is even more pronounced following repair of corneal lacerations or perforations that are associated with traumatic cataracts. Even if surgery is successful, such eyes are functionally doomed because of deep anisometropic amblyopia. We evaluated prospectively in 15 children (3 to 8 years) the results of combined operation of corneal repair, aspiration of traumatic cataract, and primary posterior chamber lens implantation. Postoperative occlusion treatment was carefully monitored. Follow up ranged from 6 to 60 months, with an average of 39.2 months. The final best corrected visual acuity at the patient's last visit was 20/40 or better in 11 of 15 children (73.3%). The most frequent complication was a nonfunctional pupil due to traumatic iris damage or posterior synechiae in 13 cases. The most visually significant complication was posterior membrane formation and/or posterior capsule opacification, which required additional surgeries in six children.

Amblyopia↗

PubMedDate not supplied

To reverse or not to reverse: an evaluation of reversal of mivacurium chloride in women undergoing outpatient gynecological procedures.

BACKGROUND: A double-blind, randomized study compared differences between patients administered edrophonium and those administered placebo after mivacurium infusion. Neuromuscular blockade was quantified using the ParaGraph 1800 nerve stimulator-monitor (Vital Signs, Totowa, NJ), which can deliver a train-of-four stimulus to the ulnar nerve and quantify the ratio of the fourth twitch to the first twitch. METHODS: With Investigational Review Board approval and informed consent, 30 healthy outpatient gynecological surgery patients ASA I or II, aged 21 to 37 years, were randomly assigned to treatment or placebo. In a double-blind manner, one group received edrophonium (1 mg/kg) and atropine (0.01 mg/kg) reversal (E/A) and the other group received placebo (P) to recover spontaneously from a mivacurium infusion. Anesthesia was induced and a rapid infusion of mivacurium chloride (0.2 mg/kg) was administered. An infusion of mivacurium chloride was then initiated at a rate of 6-7 microg/kg/min to maintain neuromuscular blockade. Group differences in recovery time (time between administration of the edrophonium or placebo and a 5-second head lift followed by tracheal extubation) were compared, as was time from tracheal extubation to discharge from the postanesthesia care unit (PACU). Nausea and vomiting were documented until the patient was discharged from the hospital; a 24-hour follow-up evaluation was completed by telephone. RESULTS: Each group contained 15 patients, and their demographics were similar. The mean recovery time for E/A was statistically shorter than for P (P, 9.7 +/- 4.8 minutes; E/A, 6.1 +/- 3.9 minutes; p = 0. 017). There were no statistically significant differences found in the incidence of nausea and vomiting (P, 4; E/A, 6) or in time to discharge from the PACU. CONCLUSION: Recovery from a mivacurium chloride infusion is shorter by 3.6 minutes (margin of error +/- 3.3 minutes) when reversal with edrophonium/atropine is used. There is no difference in time to discharge from PACU and no evidence of differences in nausea and vomiting.

Adult↗