To study the effect of prostacyclin treatment on pulmonary arterial pressure (PAP), systolic pressure (BP), and systemic oxygenation, eight infants with persistent pulmonary hypertension of the newborn (PPHN) born between 34 and 42 weeks' gestation and having a birth weight of 2540-4130 g were studied using Doppler echocardiography. At a mean age of 19 hours (range 3-32 hours), despite maximal ventilator therapy and an FIO2 of 1.0, the mean PaO2/PAO2 was 0.07 (range 0.04-0.09) and the AaDO2 was 616 mmHg (range 521-654 mmHg). After volume correction and during inotropic medication with dopamine and dobutamine, the mean PAP by echocardiography was 68.6 +/- 6.5 mmHg and the mean BP 59.8 +/- 4.8 mmHg. Prostacyclin infusion was then started at a dose of 20 ng/kg/min and increased stepwise to a mean dose of 60 ng/kg/min (range 30-120 ng/kg/min) over 4-12 hours, at which time PAP decreased to 49.2 +/- 3.5 mmHg (p = 0.0005) and BP to 53.2 +/- 9.1 mmHg (p = 0.17); the PAP thereafter remained below the BP. After 72 hours of prostacyclin infusion, PAP was 49.6 +/- 18 mmHg, BP 66.1 +/- 5.4 mmHg, PaO2/PAO2 0.14 +/- 0.12, and AaDO2 428 +/- 189 mmHg at FIO2 0.65. The median duration of prostacyclin infusion was 3.6 days and of respirator treatment 7.0 days. All patients survived without extracorporeal membrane oxygenation. At 6-12 months, none of the patients had severe central nervous system complications, but two had bronchopulmonary dysplasia. These findings indicate that prostacyclin is able to reverse the right-to-left shunt in PPHN by decreasing PAP, and that systemic hypotension can be prevented with adequate volume correction and inotropic medication.

Apgar Score↗

PubMedDate not supplied

The serum transferrin receptor concentration in seven fetuses with hemolytic disease.

Six pregnant women who received intrauterine transfusions and their seven fetuses were followed during gestation. Hemoglobin concentration, hematocrit value, serum ferritin, and serum transferrin receptor (TfR) concentrations were measured. In the fetal samples, there was a tendency for the TfR concentration to decrease during gestation and after the intrauterine transfusions. Serum TfR values varied between 0.7 and 5.2 mg/L, which is near the postnatal level measured in premature infants. On the contrary, one would have expected to find highly elevated values due to the active fetal erythropoiesis. The fetal regulation of TfR production may differ from that described postnatally.

Adult↗

PubMedDate not supplied

The genetic basis of floral variation in Senecio jacobaea (Asteraceae).

The self-incompatible composite Senecio jacobaea (ragwort) exhibits geographic variation in the frequency of rayed and discoid (rayless) individuals. Hybrid progenies from within- and between-morph crosses were established in a seminatural (garden) environment to determine whether patterns of segregation conform to single-gene predictions (as found in other Senecio species), whether the direction of dominance is conducive to rapid evolutionary change in ray morphology, and whether geographically distant populations of the discoid morph utilize the same or different genes to suppress ray development. Data from segregating F2 and BC families were consistent with a genetic model involving one major locus and an unknown number of modifiers. Analysis of F1 progenies from different intermorph crosses using the same rayed plant as a seed parent revealed a variable and incomplete pattern of dominance, with a trend toward partial dominance in some crosses. Hybridizations between discoid populations produced a few rayed progeny (4%), but there was no tendency for the frequency of rayed progeny to increase with the geographic distance separating the parent populations. Results of this study indicate that major mutations have been important for the evolution of discoid populations of ragwort, that ray-suppressing mutations should be directly available to selection in most populations, and that the suppression of rays is conditioned by the same or similar gene(s) in Atlantic and Baltic populations of the discoid taxon.

Adaptation, Biological↗

PubMedDate not supplied

A retrospective clinical comparison between antifungal treatment with liposomal amphotericin B (AmBisome) and conventional amphotericin B in transplant recipients.

Invasive fungal infections are an important cause of morbidity and mortality in immunosuppressed bone marrow and solid organ transplant recipients. Treatment with amphotericin B, the drug of choice for these infections, is however often limited by toxicity. Ten transplant patients receiving a liposomal amphotericin B formulation (AmBisome) were compared to ten retrospective control patients given conventional amphotericin B. Each group included bone marrow (8), kidney (1), and liver transplant (1) recipients. Conventional amphotericin B treatment was instituted due to nine Candida infections, and one Aspergillus fumigatus infection. In the AmBisome group treatment was instituted due to eight Candida infections, one infection caused by Saccharomyces cerevisiae and in one case as prophylactic treatment. In the amphotericin B group, maximal daily doses ranged from 0.1 to 0.65 mg kg-1 and cumulative doses were 21-836 mg kg-1 and were given over 3-32 days. In the AmBisome group, maximal daily doses ranged from 0.9 to 2.3 mg kg-1 and cumulative doses ranged from 225 to 3525 mg kg-1 over 8-28 days. All patients in the amphotericin B group experienced severe toxicity, especially nephrotoxicity which in four cases caused withdrawal of the drug. In contrast, the only adverse reaction in the AmBisome group was cholestasis in one patient. Only three out of ten patients in the amphotericin B group responded to treatment, seven patients died and six patients still had evidence of invasive fungal infection at autopsy. In contrast, eight out of nine patients in the AmBisome group responded to treatment, and the patient that received prophylaxis had a successful course.

Adolescent↗

PubMedDate not supplied

The clinicopathologic significance of laminin-5 gamma2 chain expression in cervical squamous carcinoma and adenocarcinoma.

Carcinoma of the uterine cervix is one of the most prevalent malignancies among women in developing countries and the third most common type worldwide. Squamous cell carcinoma predominates in the cervix uteri, while adenocarcinoma and adenosquamous carcinomas represent about 10-15% of all cervical cancers. Many studies have confirmed that the human papillomavirus (HPV) is the most important etiologic factor in the development of cervical cancer. The aim of our study was to investigate the expression of the laminin-5 gamma2 chain in primary malignancies of the cervix uteri and to focus on the clinicopathologic significance of the expression of the laminin-5 gamma2 chain in cervical squamous carcinoma and adenocarcinoma with respect to age and survival of the patients. The study consisted of a total of 89 cases of invasive cervical cancer (54 squamous carcinomas and 35 adenocarcinomas). The laminin-5 gamma2 chain was found in 80% of all the squamous carcinoma and in 66% of cervical adenocarcinoma. There was no correlation of the high expression of laminin-5 with survival. The univariate analysis in squamous cell carcinoma showed that factors such as the stage of the disease and positive lymph nodes had an impact on the survival of the patients, whereas in the multivariate analysis, only age at diagnosis was an independent prognostic factor. However, in cases with cervical adenocarcinoma, only the stage of the disease was an independent prognostic factor. There was no difference between HPV-positive and HPV-negative tumors concerning the high expression of laminin-5 gamma2 chain. Our results indicate that the majority of the primary cervical tumors, especially squamous cell carcinoma, showed expression of laminin-5 gamma2 chain immunoreactivity. Independent prognostic values for the survival of the patients were age and stage of the disease.

Adenocarcinoma↗

PubMedDate not supplied

pH-dependence of the mechanism in the duodenal bulb inhibiting gastric acid responses to exogenous gastrin.

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Animals↗

PubMedDate not supplied

Acupuncture in the management of tinnitus: a placebo-controlled study.

The present study was performed on 20 patients randomly selected from a large group with noise-induced tinnitus in order to investigate the effect of acupuncture on their tinnitus. The patients were divided into two groups. One group first received classical Chinese needle acupuncture for 5 weeks, and the other was given a placebo procedure; after a 2-week interval, the procedures were reversed. A single-blind cross-over design was used. Acupuncture was given by a Chinese otolaryngologist around the ear as well as at distal points on the extremities. Placebo consisted of mock electrical stimulation via surface electrodes connected to a Chinese electro-acupuncture stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. No significant difference between acupuncture and placebo was found in annoyance, awareness or loudness of the tinnitus. Many patients indicated a preference for acupuncture due to unspecific effects such as improved sleep, decreased muscle tension and improved blood circulation. It is concluded that acupuncture has no specific alleviating effect on noise-induced tinnitus.

Acupuncture Therapy↗