BACKGROUND: Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). METHODS: This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). RESULTS: Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease. CONCLUSION: Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

Aged↗

PubMedDate not supplied

Inferior vena cava stenosis in scimitar syndrome: a case report.

The scimitar syndrome, first described by Chassinat in 1836, consists aessentially of an anomalous pulmonary vein draining whole or part of the right lung into the inferior vena cava. Associated anomalies are frequent, such as hypoplasia of the right lung, dextrocardia, malformations of the right pulmonary artery and bronchial tree, and abnormal arterial supply of the right lung (the so-called sequestration). This article describes a scimitar syndrome associated with stenosis of the inferior vena cava, whose initial diagnosis was made by two-dimensional echocardiographic Doppler color flow mapping. To our knowledge this is the first description of such an unusual association.

Constriction, Pathologic↗

PubMedDate not supplied

Quantification of children's hand and mouthing activities through a videotaping methodology.

A videotaping methodology has been developed for use in quantifying the types and frequencies of children's hand and mouthing activities that could lead to exposure to environmental pollutants via dermal and ingestion pathways. Twenty children in day care, ages 3-6 years and 10 children in residences, ages 2-5 years, were videotaped during their waking hours for 1 day. Parents of each child completed questionnaires for the purpose of evaluating the accuracy of parental reports of hand-to-mouth rates. Videotapes were translated as quantifiable activities by two trained observers whose reporting reliability was checked throughout the investigation. Results determined that reliability of the videotaping method was very good, even over a year post-training. From videotape data, the average hand-to-mouth frequency rate was determined to be 9.5 contacts/h. These values are considerably higher than the current default value of 1.56 contacts/h under consideration by the EPA.

Administration, Cutaneous↗

PubMedDate not supplied

Contribution of children's activities to lead contamination of food.

This study evaluates the relationship of children's hygiene habits and food-handling behaviors on lead levels on hands and handled foods for toddlers living in lead-contaminated homes. Forty-eight inner city toddlers previously identified as having elevated blood lead levels participated in three consecutive days of designated food-handling activities. During the visits, duplicate diets were obtained, the child handled a banana, a hot dog, and had his/her hands wiped with a moist towelette. In addition, wipe samples were collected from the kitchen floor, and food items were deposited on and subsequently collected from the kitchen floor. All samples were analyzed for lead. The child's caregiver completed a questionnaire, which addressed the child's hygiene and eating behaviors. It was demonstrated that children's contact with residential dust containing lead can transfer lead to food. Both lead in the home and on the children's hands contribute to the contamination of food, and hence potential dietary exposure. Mean lead in handled bananas was 26 microg/kg and on hot dogs 65 microg/kg, and mean lead values on cheese and apple slices that had been on the floor were 119 and 215 microg/kg. In addition, the child's hygiene habits as reported by the parent indicate that lack of basic hygiene patterns within a high lead environment can contribute to children's dietary exposure to lead.

Activities of Daily Living↗

PubMedDate not supplied

Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study.

The National Human Exposure Assessment Survey (NHEXAS)/Minnesota Children's Pesticide Exposure Study (MNCPES) was a population-based study designed to characterize children's exposure to residential pesticides and to evaluate the contribution of residential and children's activities to children's exposure. Families of 168 children were surveyed for residential use of pesticides and children's activities. From these homes, families of 102 children between the ages of 3 and 13 years participated in a week-long intensive exposure study. Of the 102 children, 19 children were videotaped for four consecutive hours in their normal daily activities. The survey responses indicated that the youngest children were more likely to exhibit behaviors that would foster exposure to environmental contaminants. Comparison of questionnaire responses indicated that the videotaped subsample was representative of the exposure study population. The microactivities of the videotaped children that might contribute to their exposure via ingestion or dermal routes were quantified. Hand-to-mouth and object-to-mouth activities were observed most frequently among the youngest children. The youngest children were also most likely to be barefoot both indoors and outside. Gender differences were found in mouthing behavior and the proportion of observed time spent outdoors.

Activities of Daily Living↗

PubMedDate not supplied

[Molluscacide activity of piquerol A isolated from Piqueria trinervia (Compositae) on 8 species of pulmonate snails].

In laboratory trials an aqueous solution of Piquerol A from Piqueria trinervia, collected in several regions of Mexico, showed a molluscicide action on the adults of eight different pulmonates snails species: Fossaria (Fossaria) humilis, F. (Bakerilymnaea) sp., Pseudosuccinea columella and Stagnicola attenuata from Mexico; F. (B.) cubensis and Physa cubensis from Cuba; P. columella and Biomphalaria glabrata from Brazil; B. glabrata from Puerto Rico; and S. elodes from U.S.A. The solution was tested at 50, 25 and 5 ppm concentration, for two periods of 6 and 24 hours, at room temperature (20-22 degrees C). A 100% mortality was obtained for all species at 50 ppm concentration after 6 hours of exposure; the same percentage at 25 ppm after 24 hours; and 60 to 100% mortality at 5 ppm concentration during 24 hours of exposure. No recovery was observed among any of the treated snails. Piquerol A is a sesquiterpene with low stability in nature and has previously only been tested as an insecticide and as an inhibitor of metabolism in cell cultures: no field trails have been made on its toxicity to other aquatic fauna as yet, but it is believed Piquerol A could be an excellent molluscicide for use in areas where focal transmission of schistosomiasis and fascioliasis are taking place. This is the first time experiments on molluscicides have been carried out in Mexico.

Animals↗

PubMedDate not supplied

[Malnutrition of home-based hospital patients].

OBJECTIVE: We pretend to know the nutritional state in all patients that are being treated in the the Home Care Services Hospital Based (HCSHB) units, be which is their entrance causes and we also pretend to know the prevalence of undernutrition. SECONDARY OBJECTIVE: To know the prevalence of nutritional treatments in the HCSHB units, their relationship with the nutritional state, the pathology and the patient's origin inside the sanitary environment. ENVIRONMENT: A Multicentric study, in which the HCSHB units of three hospitals of the Valencia Community have intervened. PATIENT: 40 patients that remained in that moment entered by different causes in the HCSHB units. VARIABLES: Sex, age. Origin service, pathology, Subjective Global Valuation (SGV), IMC, nutritional support, type of nutritional support, albumin, Cholesterol, lymphocytes. RESULTS: The half age has been of 77,45 years (SD 11 years) with 67,5% of males. The patients, in all the cases, came from hospital Services, being the pathology responsible for the entrance mainly the oncological 32,5%, surgical 7,5%, neurological 7,5% and 52,5% others. According to GSV 52.5% present a good nutritional status, 37.5% had a suspect of under nourishment and 10% had a clear under nourishment. The IBM for the 12.5% of the patients is < or = 20 and the IBM for the 42.5% < or = 22. The 35% were receiving nutritional support, supplements the 78% and oral enteral nutrition the 14% of the patients. We have found a lineal relation between the IBM and the levels of albumin that the patients presented, also with the figures of cholesterol and it has not been found any relationship with the lymphocytes number.

Aged↗

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[Total anomalous infra-cardiac pulmonary venous connection. Value of the color Doppler echocardiography].

A case of total anomalous pulmonary venous connection is described in a newborn. The pulmonary veins join a common trunk entering portal vein below the diaphragm. The pattern of pulmonary venous connections was identified by two-dimensional Doppler color flow-mapping echocardiography. The common pulmonary venous trunk was anastomosed to the left atrium at the age of 3 weeks but the infant died because of pulmonary hypertension and acute renal insufficiency. The Doppler color echocardiography allows a good preoperative evaluation. The spontaneous prognosis being poor, surgical correction is indicated and should be performed early, even for critically ill neonates. Patients who survive to childhood lead active and full lives.

Coronary Vessel Anomalies↗

PubMedDate not supplied

[Pre- and post-operative echocardiographic evaluation of the anomalous origin of the left coronary artery from the pulmonary trunk].

OBJECTIVE: Pre and postoperative Doppler echocardiographic assessment of the anomalous origin of the left coronary artery from the pulmonary trunk (OLCAPT). MATERIAL AND METHODS: We analyzed Doppler echocardiographic diagnostic signs, the potential for recovery of left ventricular (LV) function and mitral regurgitation (MR) in 4 patients with OL-CAPT, treated by direct aortic implantation. The age at surgery ranged from 1 to 10 years and the follow-up from 3 months to 6 years. Doppler echocardiographic diagnostic study was performed at the first examination whereas LV function and MR were studied before (3 to 8 days) and serially after surgery. RESULTS: The OLCAPT was visualized in 3 patients and the retrograde flow from the anomalous left coronary in 1. An important right coronary artery dilation was present in 2 patients, being moderate in a third patient. Before surgery, the LV shortening fraction ranged from 17 to 23% and the ejection fraction from 23 to 36%. The qualitative analysis of segmental LV wall motion showed septal akinesis and hypokinesis of the remaining segments. Nine to 12 months after surgery, global and regional indexes of LV function improved, reaching the normal range except for the interventricular septum. In 2 patients with more than 2 years of follow-up, complete normalization of LV function was obtained, as well as with the electrocardiographic features of an old myocardial infarction in one case and a marked decrease in Q wave depth in the other. A moderate to severe MR was detected in all patients which improved markedly after surgery in 3. In the other case, a mitral replacement was necessary. CONCLUSION: Doppler echocardiography allowed: 1. the anatomic diagnosis in 3 of 4 patients with OLCAPT; 2. to follow global and regional LV function and MR improvement after direct aortic implantation of the anomalous left coronary artery.

Child↗

PubMedDate not supplied

[Hypoplasia of the carotid artery].

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Adolescent↗

PubMedDate not supplied

[Use of kinesitherapy to return patients with respiratory insufficiencies to work].

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Adult↗