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PubMedDate not supplied

The effect of lumbar epidural anesthesia on fetal heart rate baseline variability.

Baseline fetal heart rate (FHR) variability has become an important parameter in the diagnosis of fetal distress when electronically monitoring the fetus. Loss of the baseline variability has been noted to be associated with fetal distress, and in association with late deceleration or severe variable deceleration patterns has been shown to be ominous. Baseline FHR variability, however, has been modified not only by fetal distress but also by prematurity and the administration of certain drugs to the mother. Because FHR is often monitored during labor in parturients given lumbar anesthesia, the question of the effect of this procedure on FHR variability arose. Fifteen such patients with no antepartum or intrapartum complications were studied in active labor. All were monitored by electrocardiography on a continuous basis, FHR being studied before and after epidural anesthesia with lidocaine, with and without epinephrine. Of the 15 patients, tracings in 8 (53 percent) revealed a minimal or moderate change in baseline variability within several minutes of drug injection. This change in variability was recorded from 4 to 18 minutes, after which time the pre-epidural FHR variability was reestablished. Although the mechanism for this result was not definitively determined, such variability in FHR does not in itself seem significant of fetal distress but suggests supportive measures for the patient.

Anesthesia, Epidural↗
PubMed2003

The prevalence of preoperative diastolic filling abnormalities in geriatric surgical patients.

UNLABELLED: Preoperative assessment of heart function has typically focused on evaluating left ventricular ejection fraction (LVEF). Recent evidence suggests that diastolic heart failure is common and may cause substantial morbidity and mortality. We designed this study to examine the prevalence and potential clinical correlates of diastolic filling abnormalities as measured by echocardiography in geriatric surgical patients. Patients >=65 yr of age undergoing coronary artery surgery without concomitant valvular surgery or those with one or more risk factors for cardiovascular disease undergoing noncardiac surgery were prospectively studied. Preoperative precordial echocardiography was performed for patients undergoing noncardiac surgery, and intraoperative transesophageal echocardiography was performed for those undergoing cardiac surgery. LVEF and diastolic filling properties including E/A ratio and deceleration time were measured. Overall, 251 patients were enrolled. The mean age was 72 +/- 7 yr. Multiple linear regression analyses showed that patients with a history of myocardial infarction P = 0.021), angina pectoris (beta = -6.09, 95% CI: -9.66, -2.52; P = 0.01), and valvular heart disease (beta = -5.05, 95% CI: -9.56, -0.55; P = 0.028) had lower LVEF than those without such conditions. Of the patients with normal LVEF, 61.5% had diastolic filling abnormalities. Diastolic filling indices including E/A ratio (beta = -1.11, 95% CI -6.02, 3.78; P = 0.65) and deceleration times (beta = -3.42, 95% CI -31.28, 24.45; P = 0.81) contributed no additional predictive value for LVEF. No clinical predictors could be identified to predict diastolic filling abnormalities. For patients undergoing noncardiac surgery, analysis of variance demonstrates that the clinical assessment of LVEF using history and physical examination data was able to grossly discriminate the different levels of LVEF as compared with echocardiography (P = 0.0004). However, under-estimation of LVEF occurred more frequently than over-estimation. Although physicians' clinical assessment of systolic ejection fraction was generally accurate, geriatric patients with normal LVEF often had isolated diastolic filling abnormalities that could not be predicted by clinical factors. These results suggest that evaluation of LV systolic function alone is not discriminatory in comprehensively characterizing LV function in geriatric surgical patients. IMPLICATIONS: Although physicians' clinical assessment of systolic ejection fraction was generally accurate, geriatric patients with normal left ventricular (LV) ejection fraction often had isolated diastolic filling abnormalities that could not be predicted by clinical factors. These results suggest that evaluation of LV systolic function alone is not discriminatory in comprehensively characterizing LV function in geriatric surgical patients.

Aged↗
PubMed2003

Function of pectoral fins in rainbow trout: behavioral repertoire and hydrodynamic forces.

Salmonid fishes (trout, salmon and relatives) have served as a model system for study of the mechanics of aquatic animal locomotion, yet little is known about the function of non-axial propulsors in this major taxonomic group. In this study we examine the behavioral and hydromechanical repertoire of the paired pectoral fins of rainbow trout Oncorhynchus mykiss, performing both steady rectilinear swimming and unsteady maneuvering locomotion. A combination of kinematic analysis and quantitative flow visualization (using digital particle image velocimetry) enables identification of the propulsive roles played by pectoral fin motions. During constant-speed swimming (0.5 and 1.0 body length s(-1)), the pectoral fins remain adducted against the body. These fins are actively recruited, however, for a variety of maneuvering behaviors, including station holding in still water (hovering), low-speed (i.e. non-fast-start) turning, and rapid deceleration of the body during braking. Despite having a shallow pectoral-fin base orientation (the plesiomorphic teleost condition), trout are capable of rotating the fin base over 30 degrees during maneuvering, which affords the fin an impressive degree of kinematic versatility. When hovering, the pectoral fins are depressed beneath the body and twisted along their long axes to allow anteroposterior sculling. During turning and braking, the fins undergo spanwise rotation in the opposite direction and exhibit mediolateral and dorsoventral excursions. Water velocity fields and calculated momentum flows in the wake of the pectoral fins reveal that positive thrust is not generated during maneuvering, except during the retraction half-stroke of hovering. Relatively large laterally directed fluid force (mean 2.7 mN) is developed during turning, whose reaction powers yawing rotation of the body (4-41 degrees s(-1)). During deceleration, the wake-force line of action falls below the center of mass of the body, and this result supports a long-standing mechanical model of braking by fishes with ventrally positioned paired fins. Despite its traditional categorization as a propulsor of limited functional importance, the salmoniform pectoral fin exhibits a diverse locomotor repertoire comparable to that of higher teleostean fishes.

Animals↗
PubMed2005

The start of phonotactic walking in the fly Ormia ochracea: a kinematic study.

Ormia ochracea (Diptera, Tachinidae) are acoustic parasitoids of crickets that have one of the most directionally sensitive auditory systems known. We studied dynamic characteristics of walking phonotaxis in these flies in response to variations in sound source azimuth, and compared phonotaxis of flies in freely walking conditions to tethered flies walking on a treadmill. Motor patterns at the initiation of phonotaxis are not stereotyped even for similar stimulus conditions. Flies respond to directional sound sources by walking in a tight curve that combines rotation and forward translation until they are oriented towards the source direction, then continue on a straight path. Translational velocity accelerates throughout the duration of the stimulus then decelerates following stimulus offset. In contrast, rotational velocity accelerates and then decelerates within the duration of the stimulus such that flies have completed the rotational component of the response and reached their final heading before the end of the stimulus. Rotational velocity is the only response parameter that varies systematically with sound source direction (azimuth). Differences in the amplitude of rotational velocity as a function of source azimuth determine the directional orientation of phonotactic responses. The relationship between rotational velocity and source azimuth is similar to a neural measure of auditory directionality (interaural latency). There were some differences between freely walking and tethered conditions, although both showed qualitatively similar responses. Flies accelerated more slowly and attained lower maximum velocities on the treadmill, consistent with the greater inertia of the treadmill sphere relative to the flies. Also, flies tended to continue walking longer on the treadmill following cessation of the stimulus.

Acoustic Stimulation↗
PubMed2006

Differential leg function in a sprawled-posture quadrupedal trotter.

Legs of sprawled-posture, quadrupedal trotting geckos (Hemidactylus garnotii) each functioned differently during constant average-speed locomotion. The center of mass decelerated in the first half of a step and accelerated in the second half, as if geckos were bouncing in fore-aft and side-to-side directions. Forelegs decelerated the center of mass only in the fore-aft direction. Hindlegs provided all the acceleration in the latter half of the step. Lateral ground reaction forces were always directed toward the midline and exceeded the magnitude of fore-aft forces. The differential leg function of sprawled-posture geckos resembled sprawled-posture hexapods more than upright-posture quadrupeds. The pattern of leg ground reaction forces observed may provide passive, dynamic stability while minimizing joint moments, yet allow high maneuverability. Integrating limb dynamics with whole body dynamics is required to resolve the trade-offs, if any, that result from stable sprawled-posture running with differential leg function.

Analysis of Variance↗
PubMed1998

Variation in kinematics and dynamics of the landing flights of pigeons on a novel perch

Pigeons made 10 flights to a novel perch. Kinematic measurements of these flights were obtained from video recordings, and the forces exerted on the perch on each landing were measured. There was wide variation (20-fold range) in the kinetic energy of the pigeons just before landing, arising almost entirely from variation in horizontal velocity. The maximum force exerted on the perch varied in magnitude from approximately twice to eight times the pigeons' body weight, and in direction from 40 to 90 below the horizontal. In landings with high final kinetic energy, the maximum force exerted on the perch was larger and was applied at a shallower angle than in those with low final kinetic energy. Landing flights with high final kinetic energy showed straighter trajectories and a larger peak deceleration during the last 300 ms of approach flight than those with low final kinetic energy, which had downward-curving trajectories and a more prolonged and steady pattern of deceleration. Mean final kinetic energy was lower in the first two landings made on the perch than in subsequent landings, indicating that pigeons are more likely to adopt a slow, downward-curving approach to a novel perch and a fast, straight approach to a familiar one.

Journal Article↗
PubMed2002

Kinematics of diving Atlantic puffins (Fratercula arctica L.): evidence for an active upstroke.

To examine the propulsion mechanism of diving Atlantic puffins (Fratercula arctica), their three-dimensional kinematics was investigated by digital analysis of sequential video images of dorsal and lateral views. During the dives of this wing-propelled bird, the wings are partly folded, with the handwings directed backwards. The wings go through an oscillating motion in which the joint between the radius-ulna and the hand bones leads the motion, with the wing tip following. There is a large rotary motion of the wings during the stroke, with the wings being pronated at the beginning of the downstroke and supinated at the end of the downstroke/beginning of the upstroke. Calculated instantaneous velocities and accelerations of the bodies of the birds show that, during the downstroke, the birds accelerate upwards and forwards. During the upstroke, the birds accelerate downwards and, in some sequences analysed, also forwards, but in most cases the birds decelerate. In all the upstrokes analysed, the forward/backward acceleration shows the same pattern, with a reduced deceleration or even a forward acceleration during 'mid' upstroke indicating the production of a forward force, thrust. Our results show that the Atlantic puffin can use an active upstroke during diving, in contradiction to previous data. Furthermore, we suggest that the partly folded wings of diving puffins might act as efficient aft-swept wingtips, reducing the induced drag and increasing the lift-to-drag ratio. A movie is available on-line.

Animals↗
PubMed2006

Plain computed tomography for assessment of early coronary microcirculatory damage after revascularization therapy in acute myocardial infarction.

BACKGROUND: Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study. METHODS AND RESULTS: Thirteen patients with acute anterior MI underwent successful coronary revascularization within 6 h of symptom onset were enrolled. The coronary flow velocity pattern was measured using a Doppler guidewire and chest CT assessments were performed immediately after coronary revascularization. The ratio of mean CT number of the highest-enhanced myocardial area and the lumen of the left ventricle was defined as a relative CT number. The relative CT number significantly correlated with coronary diastolic deceleration time (r=-0.78, p<0.002) and coronary diastolic deceleration rate (r=0.74, p<0.04). It also correlated with peak myocardial enzyme release in plasma. CONCLUSION: Myocardial contrast enhancement detected using plain CT just after coronary reperfusion therapy implies coronary microcirculatory damage in acute MI. The relative CT number is useful in evaluating the impaired coronary microcirculatory state.

Acute Disease↗
PubMed1992

Contributors of characteristic mitral flow velocity pattern in congestive heart failure--from clinical observations back to experimental validations.

Mitral flow velocity pattern in patients with left ventricular (LV) diastolic dysfunction usually includes decreased peak early diastolic filling velocity (E), slowed deceleration of the early diastolic filling wave and increased peak filling velocity at atrial contraction (A). However, the abnormal mitral flow velocity pattern can be normalized in the presence of concomitant congestive heart failure. In such cases E can be equal to or even higher than normal, its deceleration is normal or faster than normal value, and A can be normal or lower than normal value. Clinical observations in patients with severe heart failure showed that the mitral flow velocity pattern changes with vasodilating therapy, reflecting the changes in the left atrial (LA) to LV pressure difference rather than those in the absolute LA pressure or LV pressure alone. This was validated in the canine study in which levels of LV dysfunction were made by the injection of microspheres into the left coronary artery to study the interrelation among the mitral flow velocity pattern and LA and LV pressures. In this experiment, the changes in the mitral flow velocity pattern could not be explained by the changes in LA or LV pressure alone but was better explained by the changes in the LA to LV pressure difference. Not only LA-LV crossover pressure but also LA compliance seem to be important as determinants of LA pressure level in diastole. In addition to LV relaxation rate, incompleteness of relaxation, elastic recoil and LV passive elastic properties, extracardiac constraint is also considered to be an important determinant of the level of the LV diastolic pressure and hence of the mitral flow velocity pattern at least in the presence of congestive heart failure. Thus, mitral flow velocity pattern is determined by the interaction of LA and LV pressures, both of which are affected by chamber properties as well as loading conditions.

Animals↗
PubMed2001

Prediction of wall motion recovery from the left anterior descending coronary artery velocity pattern recorded by transthoracic doppler echocardiography in patients with anterior wall myocardial infarction retrospective and prospective studies.

The diastolic deceleration slope of coronary flow velocity is steeper in patients with substantial 'no reflow' phenomenon than in those without it. This study investigated whether functional outcomes in patients with anterior wall acute myocardial infarction (AMI) can be predicted by analyzing the coronary flow velocity pattern recorded with transthoracic Doppler (TTD) echocardiography. Coronary blood flow velocity in the distal left anterior descending coronary artery was recorded with TTD at day-2 after primary percutaneous transluminal coronary angioplasty/Stent in 51 patients with anterior AMI and the diastolic deceleration half time (DHT, ms) was measured. The wall motion score index (WMSI) was measured at day-1 and -21. In the retrospective study, the DHT was much shorter in those with a poor outcome than in those with good outcome (152 +/- 109 vs 395 +/- 128 ms, p<0.05). Receiver-operating characteristic analysis documented that DHT > or = 300 ms is a suitable cut-off point (sensitivity of 83% and specificity of 93%). In the prospective study (n=30), AWMSI(dl-d21) was significantly higher in those with a DHT > or = 300 ms than those without (0.3 > or = 0.5 vs 1.6 > or = 0.7, p<0.001). DHT correlated significantly with AWMSI(dl-d21) (r=0.76, p<0.001). Patients with a shorter DHT of diastolic coronary flow velocity have a poorer functional outcome among patients with anterior AMI. The TTD-determined DHT is a useful predictor of myocardial viability after an anterior AMI.

Adult↗
PubMed2004

Involvement of TRPM7 in cell growth as a spontaneously activated Ca2+ entry pathway in human retinoblastoma cells.

We investigated the possible involvement of the melastatin family protein TRPM7 in Ca(2+)-mediated proliferative control of human retinoblastoma (RB) cells. The growth of RB cell was facilitated by elevating the extracellular Ca(2+) concentration with a parallel increase in the magnitude of spontaneous Ca(2+) influx. Under nystatin-perforated voltage-clamp, RB cells exhibited an outward-rectifying, spontaneous cation current (I(spont)) having Ca(2+)/Mg(2+)-inhibited but -permeating properties. Various cation channel blockers inhibiting I(spont) (Gd(3+), La(3+), LOE908, 2-APB) suppressed the spontaneous Ca(2+) influx and decelerated the growth of RB cells with similar efficacies. Excision of the RB cell membrane (inside-out) into MgATP-free solution induced a 70pS single channel activity, which was effectively inhibited by millimolar concentrations of Mg(2+) or MgATP. RT-PCR and immunocytochemical experiments revealed the expression of TRPM7 mRNA and protein in RB cells, and heterologous expression of TRPM7 in HEK293 cells reproduced the key features of I(spont). In contrast, elimination of this protein from RB cells by siRNA silencing markedly reduced I(spont) density and the magnitude of spontaneous Ca(2+) influx, which was paralleled by decreased TRPM7 immunoreactivity, decelerated cell proliferation, and retarded G(1)/S cell cycle progression. These results suggest a significant regulatory role of TRPM7 for RB cell proliferation as a spontaneously activated Ca(2+) influx pathway.

Calcium↗
PubMed2006

Randomised controlled trial of unsolicited occupational therapy in community-dwelling elderly people: the LOTIS trial.

OBJECTIVE: The objective of this trial, the Leiden 85-Plus Occupational Therapy Intervention Study (LOTIS), was to assess whether unsolicited occupational therapy, as compared to no therapy, can decelerate the increase in disability in high-risk elderly people. DESIGN: This was a randomised controlled trial with 2-y follow-up. SETTING: The study took place in the municipality of Leiden in the Netherlands. PARTICIPANTS: The participants were 402 community-dwelling 85-y-old people, with a Mini-Mental State Examination score of >18 points at baseline. INTERVENTIONS: Participants in the intervention group were visited by an occupational therapist who provided training and education about assistive devices that were already present and who gave recommendations and information about procedures, possibilities, and costs of assistive devices and community-based services. Control participants were not visited by an occupational therapist. OUTCOME MEASURES: The primary outcome measure was the score achieved on the Groningen Activity Restriction Scale. Secondary outcome measures included self-evaluations of well-being and feelings of loneliness. RESULTS: THE PARTICIPANTS WERE EVENLY DIVIDED BETWEEN THE TWO GROUPS: 202 participants were allocated to the intervention group and 200 participants to the control group. Of the 202 participants randomised to occupational therapy, 55 participants declined the proposed intervention. An occupational therapist indicated that of the remaining 147 participants, 66 (45%) needed an occupational therapy intervention. A total of 44 new assistive devices and five community-based services were implemented. During follow-up there was a progressive increase in disability in the intervention group (mean annual increase, 2.0 points; SE 0.2; p < 0.001) and control group (mean annual increase, 2.1 points; SE 0.2; p < 0.001). The increase in disability was not significantly different between study groups (0.08 points; 95% CI, -1.1-1.2; p = 0.75). There was also no difference between study groups for any of the secondary outcome measures. CONCLUSION: Unsolicited occupational therapy in high-risk elderly participants does not decelerate the increase in disability over time.

Journal Article↗
PubMedDate not supplied

Tracking health care costs: trends turn downward in 2003.

Health care spending per privately insured person increased 7.4 percent in 2003. While lower than the 2002 increase, it still outpaced growth in the overall economy by a margin that exceeds the historical average. The trend for drug spending decelerated the most. Meanwhile, hospital spending grew 9 percent in 2003-1.8 percentage points less than the 2002 increase. This reflected a sharp deceleration in growth of hospital use, while growth in hospital prices accelerated for the sixth year in a row. The trend for health insurance premiums fell in 2004. Employers raised patient cost sharing for the third year in a row.

Cost Sharing↗
PubMed1994

Influence of positive end-expiratory pressure on right and left ventricular performance assessed by Doppler two-dimensional echocardiography.

The advent of modern Doppler two-dimensional ultrasound technology has overcome the need of invasive measurements of several important cardiac parameters. It allows estimation of preload, contractility, and afterload. Positive end-expiratory pressure (PEEP) is associated with a reduction in cardiac output. The responsible mechanisms are controversial. To evaluate the cardiovascular responses to PEEP, we employed different Doppler hemodynamic indices for the first time, combined with conventional two-dimensional echocardiography. Twenty-one healthy, young, and unsedated volunteers were admitted to the study. Under spontaneous respiration, PEEP level was increased stepwise (0, 5, 7.5, 10, 12.5 cm H2O). At each PEEP level, the following right and left ventricular parameters were assessed with Doppler two-dimensional echocardiography: two-dimensional variables: end-diastolic volume indices (EDVI), ejection fraction (EF), and left ventricular afterload-LaPlace relation (combined with cuff systolic pressure); Doppler variables: cardiac index (CI) (combined with two-dimensional measure of valve area), maximum velocity (Vmax), time velocity integral (TVI), acceleration time (AT), deceleration time (DT), deceleration rate (DR), ratio of early to atrial peak (E/A), ratio of isovolumic contraction time to ejection time (IVCT/ET), and maximum blood acceleration (dv/dt) in aorta and main pulmonary artery. Increasing PEEP resulted in a proportional decrease in biventricular EDVI. Moreover, PEEP application is also causing a drop of CI, which is determined from a decrease in Vmax and TVI, while EF, IVCT/ET, dv/dt, Doppler trans-atrioventricular parameters, and afterload stay in normal ranges. Employing Doppler hemodynamic indices for the first time in this study setting clearly supports data that the drop in EDVI and CI during PEEP is caused by reduction in ventricular filling due to decreased venous return. Using the Doppler parameters IVCT/ET and dv/dt, changes in myocardial contractility, as well as changes in afterload (LaPlace relation) can be ruled out.

Adult↗
PubMed1999

Short-term treatment with troglitazone decreases bone turnover in patients with type 2 diabetes mellitus.

Poorly controlled type 2 or non-insulin dependent diabetes mellitus (NIDDM) patients exhibit high bone turnover, which decelerate with treatment according to the degree of improvement in glycemic control. In adults, higher bone turnover results in rapid bone loss. Therefore, deceleration of bone turnover is beneficial for bone. Troglitazone (Tro), a new anti-diabetic drug, is a thiazolidinedione (TZD) which promotes adipocyte differentiation by activating peroxisome proliferator activated receptor gamma (PPARgamma). Because, in the bone marrow, adipocytes and osteoblasts originate in common mesenchymal stem cells that are also essential for osteoclastogenesis, TZDs may directly affect bone metabolism. Thus, we examined the effects of Tro on metabolic bone markers in type 2 DM patients. Tro (400 mg/day) was administered to 33 type 2 DM patients for four weeks. The day before and four weeks after starting Tro, serum and urine samples were collected after overnight fasting. Metabolic bone markers and glycemic indices were assessed. As bone resorption markers, urinary free and total deoxypyridinoline as well as urinary collagen type I C-terminal telopeptide were measured; as bone formation markers, serum bone type and total alkaline phosphatase (BALP and ALP) levels along with osteocalcin (OC) were used. No significant changes in fasting plasma glucose or HbA1c levels were observed in our short-term treatment with Tro. All the bone resorption markers, BALP and ALP were significantly decreased. OC was not significantly changed. The discrepant changes of OC from all the other metabolic bone markers suggest limitation of the use of OC as a reliable bone formation marker in diabetics. Our results that Tro decreased metabolic bone markers before significantly improving glucose metabolism suggest that it has direct effects on bone and decreased bone turnover. TZDs may spare bone mass in NIDDM subjects through its dual effects on glucose and bone metabolism.

Aged↗
PubMed1996

The 1-exp function as an alternative model of non-linear saturable kinetics.

Non-linear saturation kinetics can be described through a potency function, a trigonometric function, a logarithmic function, a hyperbolic function, or an exponential function. Saturable enzyme reaction kinetics can be alternatively formulated as a 1-exp function without the limitations of a steady-state assumption (d[C]/dt = 0, where C is the enzyme-substrate complex). The time-dependent substrate conversion (-d[S]/dt = V(max) [1-exp(-Ka [S])]) depends on the maximum velocity (V(max)), the association constant (Ka) and substrate concentration [S]. In contrast to the classical Michaelis-Menten equation, the 1-exp function has an explicit solution for the substrate concentration [S] in an integrated form. [S] = (1/Ka) ln[1-exp(Ka [S]o)) exp(- Ka V(max) t)] A deceleration term must be introduced to describe enzyme reaction kinetics realistically. The 1-exp function with deceleration term can also be expanded to describe the three inhibition types of enzyme reaction kinetics.

Binding, Competitive↗
PubMed2005

The effect of letrozole on bone age progression, predicted adult height, and adrenal gland function.

A common problem in pediatric endocrinology is limited growth potential resulting from advancing skeletal maturation. We determined the efficacy of letrozole, an aromatase inhibitor, on delaying bone age advancement in adolescent males with limited growth potential. Twenty-four patients met the study inclusion criteria. Six patients treated with androgen were analyzed separately. Low-dose ACTH stimulation tests were performed to ascertain the effect of letrozole on adrenal gland function. In patients not on androgen, bone age progression decelerated from 1.51+/-0.57 (deltabone age/deltachronological age) before treatment to 0.68+/-0.66 on therapy (mean duration 12.4 months; p <0.0005). Predicted adult height standard deviation scores (SDS) increased from -1.41+/-0.54 to -0.64+/-0.65 on treatment (p <0.0005). Similar results were noted in androgen-treated patients. Approximately one-fourth of patients displayed subnormal responsiveness to ACTH. In summary: 1) letrozole decelerates skeletal maturation, resulting in significant increases in predicted adult height, and 2) letrozole causes mild adrenal suppression.

Adolescent↗
PubMed2001

Longitudinal observation of deterioration of Doppler parameters, computerized cardiotocogram and clinical course in a fetus with growth restriction.

We report on a fetus with intrauterine growth restriction detected at 27 weeks' gestation, who was longitudinally followed up until delivery by cesarean section 33 days later (31 + 5 weeks) due to severe decelerations in CTG. Longitudinal Doppler assessment of the umbilical artery (UA), the middle cerebral artery (MCA) and the main branch of the right pulmonary artery (RPA), the ductus venosus (DV) and the left coronary artery was compared to clinical course and computerized CTG. At first presentation (day--33) increased resistance in both the UA and uterine arteries with bilateral notches was found. Absent enddiastolic flow (AED) in the UA was found at day--19 and reverse flow (RED) at day--11. The MCA showed a decreased pulsatility first at day--19 and again at day--11 together with RED in the UA. The RPA initially (day--33) showed increased PI which returned to normal values at day--19 but increased again at day--1, when the DV showed RED and the coronary arteries became visible. The DV was normal until day--11, then its PI began to increase together with occurence of RED in the UA, but reverse flow in the DV occurred only on the eve (day--1) of severe decelerations in CTG. Short-term variability in computerized CTG was stable at 6 to 7 ms, except for an intermediate drop to 4 ms at day--10. Maternal hypertension was found at day--19 and mild preeclampsia developed at day--12. A reduction of fetal movements was noticed at day--5. This report shows that at 29 weeks gestation despite detection of AED resp. RED in the UA a prolongation of pregnancy for 19 resp. 11 days is possible. In addition to abnormal CTG, late signs of fetal deterioration are reverse flow in the DV and visibility of the coronary arteries. The role of increased resistance in the main branches of the pulmonary arteries should be examined in the future.

Adult↗