Serial, detailed assessments of left ventricular output (LVO) in critically ill very low-birth-weight (VLBW) infants of four different gestational ages were performed in the early neonatal period using pulsed Doppler echocardiography. Initially, the LVO values of all groups at 3 hours of age were relatively high. However, LVO dropped transiently at 12 hours and then increased again after 24 hours reaching a steady level of 160-180 ml/kg/min after 48 hours of age. In all four groups, heart rate also decreased significantly at 12 hours of age but did not increase at 24 hours of age. Both the left ventricular stroke volume and the left ventricular ejection fraction in all groups exhibited similar longitudinal changes to those observed for LVO. The LVO values observed in the lower gestational age group were significantly lower than those observed in the upper gestational group before 24 hours of age. Both patent ductus arteriosus and mechanical ventilation did not significantly influence the changes in LVO of VLBW infants at least before 36 hours of age. Our results suggest that in the early neonatal period, there are drastic changes in LVO of VLBW infants that reflect not only changes in heart rate but also changes in myocardial contractility.

Cardiac Output↗

PubMedDate not supplied

Serial pulsed Doppler assessment of pulmonary artery pressure in very low birth-weight infants.

We assessed pulmonary artery pressure (PAP) during the early neonatal period in very low birth-weight (VLBW) infants using serial echocardiographic measurements of the ratio of the pulmonary artery acceleration time to the right ventricular ejection time corrected by heart rate [AT:RVET(c)]. Eighty-four VLBW infants weighing less than 1,500 g were examined using serial color Doppler echocardiography from 3 hours to day 7 after birth. The AT:RVET(c) of infants born after 30 weeks of gestation showed a rapid, significant increase during the early neonatal period, whereas those of the groups born at less than 30 weeks showed no significant increase before day 14. At 24 hours after birth, the AT:RVET(c) values of VLBW infants did not correlate well with either the ratio of the right preejection period to the right ventricular ejection time on M-mode echocardiography or the pressure gradient between the right ventricle and the right atrium, as estimated by tricuspid regurgitation on pulsed Doppler echocardiography. The AT:RVET(c) value for the chronic lung disease (CLD) group did not differ significantly from that for the oxygen-dependent group at any assessment point. During the early neonatal period, the AT:RVET(c) of VLBW infants, as calculated by pulsed Doppler echocardiography, differed with their gestational age and did not appear to correlate well with PAP. Our data also suggest that AT:RVET(c) values may not be a good predictor of the subsequent occurrence of CLD in VLBW infants.

Bronchopulmonary Dysplasia↗

PubMedDate not supplied

Effects of erucic acid therapy on Japanese patients with X-linked adrenoleukodystrophy.

Ten Japanese boys with childhood adrenoleukodystrophy (ALD), one adult patient with adrenomyeloneuropathy (AMN), and two presymptomatic ALD boys were treated with dietary erucic acid (C22:1) for more than 12 months; except in a case of childhood ALD patient who died 7 months after beginning erucic acid therapy. During erucic acid therapy, the serum levels of very long-chain fatty acid (VLCFA) (C24:0/C22:0) decreased within 1-2 months in all patients, and these levels in four of the patients decreased to the normal range. Neurological examination and MRI findings in all 10 of the childhood ALD patients showed progression of the disease while they were receiving the dietary therapy. However, the mean interval between the onset of awkward gait and a vegetative state in diet-treated patients was significantly longer than that in the untreated patients. One AMN patient showed slight improvement of spastic gait and lessened pain in the lower limbs due to spasticity. The two presymptomatic ALD boys remained intact on clinical examination and on MRI findings for 38 and 23 months, respectively, after starting the diet.

Adolescent↗

PubMedDate not supplied

Feasibility study on protracted infusional 5-fluorouracil and consecutive low-dose cisplatin for advanced gastric cancer.

In this phase II trial 31 patients with advanced gastric cancer (21 with metastatic cancer and 10 with locally advanced cancer) were treated with a continuous 24-hour infusion of 5-fluorouracil (5-FU) 330 mg/m2/day plus low-dose cisplatin (CDDP) 6 mg/m2/day by bolus infusion on days 1-5. The regimen with a combination of 5-FU and low-dose CDDP (FLDP) was repeated weekly for two to four courses according to response and tolerance. In 24 (77%) of the 31 patients, four courses of this regimen were administered. The overall response rate was in 14/31 (45%) patients with measurable disease, including one complete response and 13 partial responses. An especially high response rate of 60% was seen in 10 patients with liver metastasis. Median survival time was 11 months (range 6-27+) in the 10 cases of locally advanced cancer and 11 months (range 6-24+) in the 21 cases of metastatic cancer. Toxicity was primarily hematologic. Leukopenia and thrombocytopenia of World Health Organization (WHO) grade 3 or 4 occurred in 4/31 (13%) and 4/31 (13%) of patients, respectively. Renal dysfunction, which is a major toxicity associated with CDDP, was not observed without hydration. The patients were able to eat during therapy and preserved a good quality of life. A randomized trial including the FLDP regimen is needed to compare it with other active regimens, particularly the use of high-dose CDDP.

Adult↗

PubMedDate not supplied

Pathogenesis of sports-related spondylolisthesis in adolescents. Radiographic and magnetic resonance imaging study.

We reviewed radiographs and magnetic resonance images of 77 young athletes with spondylolysis and spondylolisthesis (more than 5% vertebral slip) (slip group). The results were compared with similar studies in 88 patients with spondylolysis only (nonslip group). Endplate lesions were found in all patients in the slip group and in 60 (68%) of those in the nonslip group. Slippage between the osseous and cartilaginous endplates was identified in the T1-weighted sagittal magnetic resonance images and categorized according to the type of slippage: total slip of L-5 or S-1, partial slip of L-5 or S-1, or a combination of these (mixed type). In a study of 31 patients whose slippages progressed, no slippage was associated with the early stage of a pars interarticularis defect. Most vertebral slippages developed or progressed in the cartilaginous or apophyseal stage of the lumbar skeletal age. Wedging of the L-5 vertebral body and rounding of the sacrum progressed as the slippage developed; these did not occur in the nonslip group. These results indicate that the advanced stage of a pars interarticularis defect in an immature spine is a risk factor for spondylolisthesis. The deformities of the lumbosacral spine are thought to be the secondary changes caused by vertebral slippage.

Adolescent↗

PubMedDate not supplied

Standardization of parameters in follow-up study after mitral commissurotomy.

Two-hundred and fifty-five patients were followed up to maximum 19 years (1879 patient-years) after mitral commissurotomy by means of either the finger fracture, transventricular dilator or open method. During this period of time, patients were asked to answer a questionnaire and to be examined at 2 to 3 years intervals. Twenty-two late deaths and 17 reoperations were encountered, and significant differences according to operative methods were observed in the survival and reoperation-free curves. Values from CTR, Rv1 + Sv5/Rv5 + Sv1 ratio, LAMP and DDR were standardized, and each standard value showed a tendency of significant improvement followed by gradual deterioration after commissurotomy even in patients with normal social activities. Parameters from patients reoperated on were compared with standard values, and statistically significant differences were noted. It would be concluded that standardization of parameters is of a great importance in follow-up study after mitral commissurotomy especially to establish indications to reoperation most adequately.

Adult↗

PubMedDate not supplied

Intraluminal shunt technique in systemic to pulmonary arterial anastomosis for severely cyanotic patients.

One hundred and seventy two cases of systemic to pulmonary arterial shunt operation have been carried out for congenital cyanotic heart diseases since 1953. Recently shunt operation has been carried out exclusively on patients with complex cardiac malformations and low pulmonary blood flow in the young age group. During the course of shunt operation on such patients the anastomotic site of pulmonary artery is completely excluded. Particularly in severely cyanotic patients, oxygen deficiency develops during anastomosis. We encountered one case who had severe hypotension during anastomosis followed by bradycardia and cardiac arrest. Since this episode in order to avoid the tragedy intraluminal shunt has been used during shunt operation for the five severely cyanotic patients. Intraluminal shunt has few perioperative complications and the technique is easier than that of extracorporeal circulation. Indications and the method of this technique are discussed in this paper.

Child, Preschool↗