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Diagnosis of Helicobacter pylori. | In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study of Helicobacter pylori infection in childhood is gaining increasing importance and H. pylori infection is being considered a major issue of public health. H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology for H. pylori without further work-up, and only perform additional investigations when an anti-H. pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvasive tests for Helicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment. | 10771925 | 2,000 | 2000-2004 |
Child and adolescent psychiatry in-patient facility. | The short-term in-patent facility of the Child and Adolescent Psychiatry Unit in the National Institute of Mental Health and Neurosciences, Bangalore is described. Its clientele over one year is reviewed. Totally 152 admissions were made. Hysterical neurosis (30.8%), Psychoses (25.2%), Conduct disorder (10.5%) and Hyperkinetic syndrome (9.8%) were the most common diagnoses observed in this population who needed short-term intervention. Average duration of stay was 4-12 weeks. All children were admitted with a parent. In 95.8% of the cases the treatment expenses were borne partially/fully by the hospital. The policy and functioning of the facility is discussed. | 10771926 | 2,000 | 2000-2004 |
Auditory brainstem responses in high risk and normal newborns. | We studied the auditory brainstem responses of 50 high risk neonates from NICU and compared with those of 25 normal neonates in order to determine the percentage of significant auditory impairment in NICU and correlated it to various risk factors. Infants with the risk factors of low birth weight, hyperbilirubinemia, asphyxia, septicemia and meningitis were included in the study group. All the 150 ears were tested at 4 intensities 30 dB, 46 dB, 60 dB and 75 dB. The study recorded prolongation of latency of wave V and I-V Interwave interval in the study group with a statistically significant difference denoting an impaired condition. Incidence of significant auditory impairment was 18%. On follow up at 6 months incidence of persistent auditory abnormality was 4%. On the basis of this study it is suggested that all high risk neonates should undergo screening for hearing impairment. | 10771920 | 2,000 | 2000-2004 |
Does digoxin still have a role in congestive heart failure? | The role of digoxin in the treatment of congestive heart failure is (CHF) being questioned. Digoxin continues to be the drug of choice for patients with atrial fibrillation in CHF. Large randomised trials have shown that digoxin (in addition to ACE inhibitors and diuretic) is beneficial in CHF due to systolic dysfunction, although it does not reduce mortality. Limited data suggest that digoxin benefit some, but not all patients with CHF due to left to right shunts. Digoxin does not benefit CHF due to diastolic dysfunction and it is not routinely recommended for prematures with patent ductus and CHF. The treatment with digoxin should be individualised. | 10771927 | 2,000 | 2000-2004 |
Immunogenicity and tolerance of H. influenzae type b, tetanus toxoid conjugate vaccine given concurrently or in combination. | The present prospective, open, controlled, randomised comparative trial was undertaken to evaluate the sero response and side effects of PRP-T Conjugate Vaccine (ACT-HIB) in infants and children aged 2 months and 16-24 months. Fifty four babies aged 2 months formed group A, 56 children aged 16-24 months formed group B. Groups A and B were further subdivided into two sub groups each destined to receive either PRP-T vaccine in association with DPT vaccine at different sites (I) or PRP-T and DPT both vaccines at the same site mixed in the same syringe (II). Group A received 3 doses at 2, 3 and 4 months of age and group B received one dose between 16-24 months. The Geometric mean titres of Anti PRP antibodies observed in primary immunisation schedule (A) and single dose vaccination schedule (B) were comparable and significantly higher to prevaccination titres. A serum anti PRP level of > 1.0 mcg/ml after immunisation is believed to correlate with long term protection. Ninety-six percent of infants in Group A and 98% in Group B achieved titres > 1.0 mcg/ml. The side effects were minimal, local and were comparable between the study and control groups, suggesting that PRP-T vaccine is highly immunogenic and well tolerated in Indian infants and children. | 10771928 | 2,000 | 2000-2004 |
Development of secondary sex characteristics in multitransfused thalassemic children. | Secondary sex characteristics were evaluated in thalassemic children (41, boys and 30 girls), who were on regular transfusion therapy and were above 11 years of age. The results of this study indicate that the development of secondary sex characteristics in thalassemic children is markedly delayed as compared to their non-thalassemic siblings and to the expected development criteria. Delay in development of secondary sex characteristics appears to be secondary to chronic hypoxia and iron overload. | 10771930 | 2,000 | 2000-2004 |
In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone. | Ceftriaxone has only recently been introduced in Benghazi and many parts of the word. We determined its in-vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains of H. influenzae, 17 (22.1%) of Str. pneumoniae and 1 (1.3%) of N. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains of H. influenzae. Str. pneumoniae and N. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed for H. influenzae (23% and 11% respectively), and Str. pneumoniae (12% and 0% respectively), in addition, 18% of strains of Str. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing. | 10771929 | 2,000 | 2000-2004 |
Iodine loss from iodised salt on heating. | Iodine deficiency disorders constitute a major public health problem in India. The national IDD control programme (NIDDCP) relies solely on iodine supplementation through fortification of common salt with potassium iodate. However, data regarding iodine loss due to high temperatures of cooking procedure is scarce. Using iodometric titration methods, we calculated iodine content of iodised salt samples subjected to incremental heat up to 350 degree Celsius. The results of the study indicate a gradual but minimal loss of iodine content from the iodised salt samples when subjected to high temperature with a maximum loss noticed being 18.5% at 350 degree Celsius. We conclude that there is minimal loss of iodine from the salt fortified with potassium iodate when subjected to heating (temperature normally attained during cooling process). | 10771934 | 2,000 | 2000-2004 |
Toxoplasmosis in women of child bearing age and infant follow up after in-utero treatment. | A total of 540 women (including 70 pregnant cases) of child bearing age with bad obstetrical history were tested serologically for anti-toxoplasma antibody using microlatex agglutination test. Forty two women including 5 cases of pregnancy were found to be seropositive in a titre of 1:32 or more. Maximum prevalence (10.2%) and highest titer of anti-toxoplasma antibodies were observed in women of 35-42 years age group. The overall prevalence of toxoplasmosis in these women was 7.7%, whereas it was 7.1% in pregnant women. Further studies are needed to estimate the exact rate of prevalence of infection. Of the 70 pregnant women, 5 were seropositive and two of them acquired infection during pregnancy which was detected by IgM immunosorbent assay. Seropositive pregnant women were treated using combined regimen of sulfadiazine and pyrimethamine. Four infected women with pregnancy were followed up and one did not turn up subsequently. There was spontaneous abortion in one case and in 3 other cases full term normal babies were delivered. Incidence of toxoplasmosis in women is low because of infrequent and uncommon practices of ingesting undercooked or uncooked food stuff specially meat by a substantial number of the population surveyed. | 10771933 | 2,000 | 2000-2004 |
Physical growth parameters in thalassemic children. | Various growth parameters of 233 (140 boys, 93 girls) thalassemic children were compared with 74 (45 boys and 29 girls) non-thalassemic siblings, ICMR and NCHS norms. Weight and height were retarded in thalassemic children. The difference between thalassemic and non-thalassemic siblings, was evident from 9+ years in both boys and girls. Growth parameters seemed to be adversely affected with the advancing age. Among head, chest and mid arm circumferences, the mid arm circumference was more affected than head and chest circumferences. Height and weight were more severely retarded in children with hemoglobin levels of less than 8 gm/dl. The findings seemed to suggest that press of retardation was probably secondary to chronic hypoxia and iron overload. | 10771931 | 2,000 | 2000-2004 |
Liver biopsies in patients with lysosomal storage disease: experience with effective sedation. | We prospectively applied a protocol used to sedate children who required a liver biopsy. Sixty liver biopsies were performed on thirty pediatric patients to assess the effects of treatment. Sixteen patients had Type 1 Gaucher's disease of which seven had a platelet count between 50-100,000/mm3. All seven had bleeding time performed and when indicated, intravenous DDAVP (1-deamino-8-D-arginine vasopressin) was used to improve hemostasis. Fourteen patients had Niemann-Pick disease type C of which eight were significantly demented and uncooperative. Before liver biopsy, all patients were sedated with the following regimen: oral chlorpromazine (1 mg/kg) followed one hour later by intravenous meperidine (1 mg/kg) and pentobarbital (maximum dosage 6 mg/kg) administered by slow intravenous injection. Liver biopsies were obtained safely on all patients. Only 1 patient (2%) developed a potentially serious complication: an obstructed airway which was readily corrected by simple repositioning. Transient less serious complications occurred in another 7 patients (12%). There was no long term sequalae of the biopsy procedures. Our study indicates that with appropriate patient selection, this sedation protocol may be useful in pediatric patients requiring a liver biopsy. | 10771935 | 2,000 | 2000-2004 |
Immature gastric teratoma. | Gastric teratoma, a very rare tumor of infancy is essentially benign. Immature (embryonic) elements have been described in only three of the sixty-six cases described previously. This report concerns with one "immature" gastric teratoma seen in infancy. | 10771937 | 2,000 | 2000-2004 |
Tubercular retropharyngeal abscess in early childhood. | We present two cases of Pott's lower cervical spine with retro-pharyngeal abscess presenting at an unusually young age. These children presented with a life threatening respiratory distress; one of them had neurological deficit in the form of paraparesis. External drainage of abscess without anterior cervical fusion was adequate as a surgical measure for their prompt recovery while these cases were on conventional anti-tubercular therapy. | 10771938 | 2,000 | 2000-2004 |
Macrolide antibiotics. | This article is an extensive review of current information available on the macrolide antibiotics. This includes antimicrobial spectrum, pharmacology, complications and side effects, and pediatric use of these drugs. These are important antibiotics, but careful selection of patients must be made and the physician must be alert for evidence of drug-drug interactions, which are not uncommon with several members of this class. | 10771940 | 2,000 | 2000-2004 |
Malignancies in Down syndrome. | Down Syndrome (DS) is associated with an increased incidence of malignancies, especially leukaemias. We came across 8 DS children presenting with malignancies and having trisomy 21 as the sole cytogenetic abnormality. Of these 8 DS cases, 4 presented with acute lymphocytic leukaemia, 2 with acute myeloid leukaemia and one case each with Hodgkin's disease and Wilms' tumour. There are contradictory reports regarding the distribution of myeloid versus lymphoid malignancies in DS children and their response to therapy. The exact mechanism by which patients with DS are predisposed to develop malignancies is unclear. However, presence of the extra chromosome no. 21 is presumed to disrupt the genetic balance which increases generalized susceptibility to genetic and environmental trauma. Furthermore, an increased methotrexate toxicity observed in these patients should also be taken into consideration in designing treatment for DS children with malignancies. | 10771932 | 2,000 | 2000-2004 |
Optimal timing of surgery in common left to right shunts. | Left to right shunts like atrial septal defect, ventricular septal defect and patent ducts arteriosus are commonly encountered congenital malformations of the heart. With advances in diagnostic and therapeutic technology over the last three decades the recognition and management of these lesions has markedly improved. Currently, the surgical procedures are being performed in infants and neonates with the hope that long term results would be better. Children with atrial septal defects are usually asymptomatic or mildly symptomatic and closure of the defect is best performed at 3-4 years of age. Large ventricular septal defects, on the other hand, may produce symptoms like congestive heart failure in early infancy and early closure is recommended for these babies. These defects are also known to close spontaneously and therefore in mildly symptomatic cases without pulmonary arterial hypertension, one may wait for a natural reduction in size. Surgical ligation of a patent ductus arteriosus is a safe and simple procedure and all these cases must undergo closure of the duct. | 10771944 | 2,000 | 2000-2004 |
Chest pain in children. | Chronic chest pain is a complaint that frequently prompts referral to pediatric cardiology clinics although very few pediatric patients with this symptom will be found to have cardiac disease. This review will discuss the common non-cardiac and cardiac causes of chest pain. Guidelines on the office management of this group of patients will be presented as well as the indications for referring patients for evaluation and treatment by the subspecialist. | 10771943 | 2,000 | 2000-2004 |
Recent advances in the treatment of congestive heart failure. | Treatment of heart failure should include correction of the underlying cause. These causes include large left to right shunts, obstructive lesions, arrhythmias, primary myocardial disease etc. The main pharmacological therapy includes inotropic agents, vasodilators and diuretics. Inotropic agents increase myocardial contractility and include digoxin, intravenous dopamine, dobutamine and isoproterenol. Vasodilators improve cardiac pump performance by decreasing the vascular resistance and/or increasing the venous capacitance. Commonly used vasodilator agents include angiotensin converting enzyme inhibitors (captopril, enalapril etc.), hydralazine, prazosin hydrochloride etc. Diuretics inhibit salt and water reabsorption promoting their excretion. Furosemide, thiazide diuretics, aldactone, are commonly used diuretics. Electrolyte and acid-base imbalance can occur on chronic diuretic therapy. Cardiac transplantation is considered for patients where all medical management has failed. | 10771942 | 2,000 | 2000-2004 |
Obstructive total anomalous pulmonary venous drainage. | Obstructive total anomalous pulmonary venous drainage (TAPVD) has a florid presentation in the neonatal period from the resulting pulmonary edema. A complete anatomical and functional diagnosis is usually possible by transthoracic color Doppler echocardiography, and cardiac catheterization with its attendant risks can usually be avoided in the sick neonate. Currently balloon atrial septostomy has a limited role in palliation of these neonates. Corrective surgery on urgent basis has gratifying results and prevents progression of pulmonary vascular occlusive disease. Pulmonary hypertensive crisis in the early post-operative course needs to be avoided and treated vigorously if it were to develop. Late post-operative course can be complicated by anastomotic obstruction or progressive narrowing of the individual pulmonary veins. Although the former can be dealt successfully by re-operation, surgical treatment of the latter is not satisfactory. Balloon dilatation of the obstructed pulmonary venous pathways, native and post-operative, has been reported with equivocal results. Infant heart-lung transplant is a viable option in patients with diffusely narrow pulmonary veins or complex TAPVDs. | 10771945 | 2,000 | 2000-2004 |
Newer concepts and approaches to neonatal brain asphyxia. | The asphyxial injury to neonate brain seems to be mediated through a cascade of biochemical events during ischaemia--reperfusion which includes excitatory amino acids, free radicals and accelerated programmed cell death (Apoptosis). The diagnosis of asphyxia requires rigorous approach based on background clinical information, certain diagnostic tests and exclusion of alternative diagnosis which may have similar clinical presentation. The treatment currently employed for the management of birth asphyxia controversial and requires critical appraisal. The future strategies for management include a number of approaches based on putative mechanism for asphyxial brain injury but they are still being evaluated as research and should not be used for clinical purposes in human newborns as yet. | 10771947 | 2,000 | 2000-2004 |
Early diagnosis and treatment of neonatal sepsis. | Perinatally acquired bacterial neonatal sepsis is a low incidence, high risk disease with a relatively benign treatment. Accurate diagnosis is difficult because there is no definitive diagnostic test; even blood cultures have an unacceptably low sensitivity. Therefore, the clinician must accept that a number of neonates who do not have the disease will have treatment initiated for sepsis. In order to treat rapidly all infants with sepsis and to minimize therapy for those without infection, historical, clinical, and laboratory data can be used together in a management approach to achieve optimal results. A systemized approach using history, examination, sepsis screen laboratory tests, and cultures is presented to guide clinical management. | 10771948 | 2,000 | 2000-2004 |
Endotracheal aspirate cultures in predicting sepsis in ventilated neonates. | Nosocomial infections are the most common complications encountered in the neonatal intensive care unit (NICU). They are associated with high mortality and prolonged duration of hospitalization in the survivors, contributing to an increased cost of health care. In this article, we review the literature on the value of routine endotracheal aspirate cultures for the prediction of neonatal sepsis and provide guidelines to prevent nosocomial infections. Upon reviewing the literature it appears that the practice of routine cultures of endotracheal aspirate and cultures obtained from multiple body sites is an expensive proposition with low yield. The sensitivity of this test is at best 50% and all studies report a very low positive predictive value. The specificity of this test is 80%, hence its role is mainly limited to identifying infants who are at low risk for sepsis. As we do not have any reliable test for early diagnosis of neonatal sepsis and also to identify infants at high risk for sepsis, our main emphasis should be towards preventing nosocomial infections. Guidelines for reducing nosocomial infections are described. | 10771949 | 2,000 | 2000-2004 |
Pituitary tumours. | This report describes the presentation, pre-operative findings, surgical management and follow-up results of 20 pediatric patients with pituitary adenomas. The most common presenting complaints encountered were, headache and decrease in visual acuity. Among the patients with endocrine problems, majority had frank Cushing's disease (30%). Nine patients (45%) were endocrinally normal. The most common, histological type of pituitary tumour encountered in this series was the Chromophobe adenoma. One patient died following surgery. Radiation therapy was given in all post operative cases. Response to radiation therapy has been satisfactory on follow up. The generally encouraging results we have observed following the multi-disciplinary treatment, confirms the findings reported by other workers. | 10771953 | 2,000 | 2000-2004 |
Study of gene probes in childhood leprosy. | The objective was to detect nucleic acids of M. leprae in skin lesions of leprosy patients and study the effect of treatment on these nucleic acids, using r-RNA gene probes, using a cross sectional study. The study was carried out at Department of Paediatrics, S.N. Medical College, Agra and Department of Microbiology, Central JALMA Institute for leprosy, Agra. The study included 32 cases of leprosy less than 16 years of age, divided into 3 groups viz. without treatment (12 cases), in middle of treatment (11 cases) and at the end of treatment (9 cases). All cases were subjected to a detailed history and thorough clinical examination. All of them had smear examination and lepromin test done and their skin biopsies were subjected to gene detection. Nucleic acids were isolated from skin biopsies of all cases by standard procedure. After dot blotting of these nucleic acids, they were hybridised with radioactive (p32) r-RNA probes. The results were interpreted after getting the X-ray films processed with background signals from controls. Majority of cases were between 13-16 years of age. As age advanced, the disease moved from tuberculoid end of spectrum towards lepromatous end (p < 0.05). Majority of paucibacillary (PB) cases were lepromin positive while majority of multibacillary (MB) cases were lepromin negative (p < 0.05). In specimens of untreated cases, 50% of PB specimens and 87.5% of MB specimens were positive for r-RNA probes. In multibacillary type 100% smear positive specimens and 67% smear negative specimens were positive for r-RNA probes. In patients during the middle of treatment positivity for r-RNA decreased and 20% of PB specimens and 16.6% MB specimens were positive. At the end of treatment (1 year for PB cases and 2 years for MB cases), the results of r-RNA were negative, which indicated that the treatment regimens used in the study were effective. This study supports the usefulness of r-RNA probes as a diagnostic and therapeutic tool in childhood leprosy. | 10771952 | 2,000 | 2000-2004 |
Neonatal Klebsiella pneumonia sepsis and imipenem/cilastatin. | Efficacy and safety of imipenem/cilastatin in neonatal Klebsiella pneumonia sepsis was investigated in 45 infants compared to 39 control infants on conventional antibiotic regimen. Sensitivity to imipenem was 94% followed by cephoxitin (88%), quinolons (80%), and amikacin (52%) according to susceptibility results in the study group. Treatment duration of surviving infants was 16.5 +/- 4.6 and 20.3 +/- 6.4 days in the study and control groups respectively (p < 0.05). Five infants (11%) vs 27 (69%) were unresponsive (septic deaths) to treatment in the study and control groups respectively (p < 0.001). The cure rates were 73% and 28% respectively (p < 0.001). Sequelae free discharge rates were 67% and 23% respectively (p < 0.001). The most frequent adverse effects of imipenem/cilastatin were Candida albicans superinfection (20%); Candida albicans colonisation (10%); impairment of liver and renal functions (19% and 10% respectively); seizures (5%); thrombocytosis (3%); thrombophlebitis (3%); urine discoloration (3%); and Staphylococcus epidermidis colonisation (2%). Imipenem is considered a good alternative for neonatal Klebsiella pneumonia sepsis with these results, however, one must be aware of the increased risk of Candida albicans superinfection. | 10771955 | 2,000 | 2000-2004 |
Knowledge beliefs and practices regarding iodine deficiency disorders among the tribals in Car Nicobar. | It is estimated that 1,570 million people are at risk of iodine deficiency. Because of the wide spectrum of disorders that IDD includes, and lack of any obvious association between iodine deficiency and its health effects, IDD is not perceived as a major public health problem. For any disease to be effectively controlled, awareness at all levels from community to policy makers is necessary. This study was conducted to assess knowledge, beliefs and practices regarding iodine deficiency Disorders in Car Nicobar districts of Andaman and Nicobar Islands. The population is predominantly tribals involved in coconut plantations. All the village heads of the sixteen villages and parents of 10% of the school children examined for goiter were interviewed. Initial focus group discussions were conducted as no prior knowledge about local names for goitre or other related IDD information was available. The interview schedule was designed in English which was then translated into Hindi and Nicobarese and back translated into Hindi and English. A total of 114 persons were interviewed 60 males, 54 females. The local name for goiter was "Rulo" and 44% felt that it only affected females. No one had correct knowledge of the cause of goiter. About half of the respondents believed that these swellings caused problems. Sixty three (55.3%) of respondents believed that there was treatment, of which 33 said there was medical treatment, 18 respondents said traditional treatment by "LAM-EEN" and 12 felt that both therapies are required. Majority (85%) brought salt samples from the Government canteen. They did not now whether this salt was iodised. Salt was not washed before use and storage practice was satisfactory. The awareness about IDD needs reinforcement. At present the community is a passive participant in the I.D.D. Control Programme. | 10771954 | 2,000 | 2000-2004 |
Cefoperazone: an analysis of results in the pediatric population from a post-marketing surveillance study in hospitalized patients. The Cefoperazone Collaborative Post-marketing Surveillance Study Group. | The injectable third-generation cephalosporin, cefoperazone, was introduced in India in early 1994. A post-marketing surveillance study was conducted in 1994-95 to collect local data on efficacy and safety, evaluate the native pattern of bacterial susceptibility, and assess the relationship of in vitro susceptibility tests to clinical efficacy. Hospitalized patients with features suggestive of infections that are approved indications for cefoperazone were eligible for the study. This report presents an analysis of the results among patients in the pediatric age group. The recommended dose range for children was 50-200 mg/kg/day. At analysis, 95 patients aged 6 days to 14 years were evaluable for efficacy. About a third of these (31%) were judged to have hospital acquired infections, and 22 (23%) had failed prophylaxis or previous treatment. A successful clinical outcome was observed in 91% of 75 non-neutropenic patients. Eighteen (95%) of 19 patients with pneumonia and 8 (89%) of 9 patients with pyogenic meningitis responded to cefoperazone. Five of 6 patients with complicated or hospital-acquired upper urinary tract infections, 2 of 3 patients with peritonitis, and all patients with skin or soft tissue infections, intra-abdominal abscess, osteomyelitis, and brain abscess also responded. Four of 5 non-neutropenic patients with septicemia recovered with cefoperazone monotherapy. The response rate was 70% among 20 neutropenic patients, 16 of whom were deemed septicemic. Antibiotic disc susceptibility data among pediatric patients was available for 63 isolates and 13% were reported resistant to cefoperazone. Microbiologic eradication was reported with 94% of initial isolates. Mild to moderate adverse events of study, drug-related or uncertain causation occurred in 4 (3.7%) of patients. | 10771951 | 2,000 | 2000-2004 |
Abnormal migration of ascaris into the middle ear. | Ascaris in the middle ear is very rare with very few cases having been reported. We report here two such cases with different presentations. | 10771958 | 2,000 | 2000-2004 |
Early prediction of neonatal hyperbilirubinemia. | The study aim was to predict, using serum bilirubin level measured 18 to 24 hours (SB, 18-24) after birth, the occurrence of peak serum bilirubin level > 15 mg/dL (hyperbilirubinemia) or the requirement of phototherapy, any time from the second to fifth postnatal day. The study was conducted on a prospective cohort of 274 neonates born in north India. The main outcome measures were (a) hyperbilirubinemia and (b) phototherapy. Serum bilirubin level was estimated at 18-24 hours of age and then daily from second to fifth postnatal day. Exclusion criteria were Rh incompatibility, asphyxia and life threatening congenital malformations; and neonates of women with gestational diabetes or history intake of drugs affecting the fetal liver. Hyperbilirubinemia was found in 12.8%; and 19.3% neonates received phototherapy. Dichotomous SB 18-24, using a cut-off of > 3.99 mg/dL, as the "prediction test" had the following sensitivity and specificity for predicting (a) hyperbilirubinemia: 67% and 67%, respectively, and (b) the treatment with phototherapy: 64% and 68%, respectively. We concluded that by using SB 18-24 as the "prediction test", approximately two-thirds of neonates were test negative and had about one in ten chances of re-admission for treatment of hyperbilirubinemia, if discharged. After further validation, our results will be of benefit to neonates delivered in developing countries. | 10771956 | 2,000 | 2000-2004 |
Incidence of hearing impairment among rural and urban school going children: a survey. | A total of 1,670 school going children in the age range of 12-14 years were screened for hearing loss during a survey conducted by the Department of Otolaryngology of the Postgraduate Institute of Medical Education & Research, Chandigarh. 6.31% of cases in the urban group were found to be having hearing loss as compared to 32.81% of cases in the rural group. Secretory otitis media was found to be the commonest cause of hearing impairment in both the urban and rural group accounting for 5.33% and 33.59% respectively. | 10771957 | 2,000 | 2000-2004 |
Pentalogy of Cantrell. | Omphalocele is often associated with various abnormalities. In two patients admitted with omphalocele, we additionally found defects both in the pars stenalis of diaphragm and in the diaphragmatic surface of the pericardium, sternal defect and tetralogy of Fallot. These entities form the components of a syndrome, named pentalogy of Cantrell. It is extremely in the spectrum of midline closure defects that display wide variations and its incidence is very low. Existing cardiac defect is the most important factor influencing morbidity and mortality. Herein we report two cases of pentalogy of Cantrell with the review of the syndrome in the light of literature. | 10771959 | 2,000 | 2000-2004 |
Cholestatic jaundice due to congenital Toxoplasma gondii infection. | A case of congenital toxoplasmosis manifesting as hepatosplenomegaly and cholestatic jaundice in a 4 month old child is reported. To the best of our knowledge this is the first report of cholestatic jaundice due to congenital toxoplasmosis from India. The child was successfully treated with sulphadiazine and pyremethamine combination. | 10771960 | 2,000 | 2000-2004 |
Cord blood transplant: current and future issues. | Cord blood as the source of hematopoietic stem cells has several advantages over bone marrow cells for transplant purpose. It is readily available, and causes no physical harm or inconveniences to the donor in the processing of harvesting cells. Waiting time between initiating the search and the time to transplant from an unrelated donor is much shorter with cord blood than with unrelated donor bone marrow. The incidence of graft-versus-host diseases is much less. Because of these advantages, cord blood has been increasingly used as the source of stem cells. As of this writing, more than 200 cord blood transplants have been done in patients with hematological malignancies, solid tumors, hematological diseases, immunodeficiency syndromes, and metabolic diseases. One of the limitations inherent in the cord blood is its limited number of hematopoietic stem cells. Thus it has been primarily used for pediatric patients, though more recently, adult patients also have been transplanted with cord blood as people have become more experienced in harvesting cord blood thus yielding a larger number of stem cells in a given specimen. Efforts have been made to amplify stem cells in vitro following harvesting cord blood stem cells, so that adult recipients also would routinely benefit from this resource. Cord blood lymphocytes are functionally "naive", do not generate vigorous mixed lymphocyte culture reactivities. The low incidence of graft-versus-host disease in the recipients of cord blood is due to this particular property. It is highly desirable that the world wide cord blood registry, similar to the international bone marrow registry would be instituted, but there are logistic, ethical and financial problems that need to be resolved. Cord blood is one of the best stem cell sources, and its application is quite wide. | 10771961 | 2,000 | 2000-2004 |
Fragile X syndrome. | Fragile X syndrome is the most common form of inherited mental retardation. It is seen in people of all nationalities and in all areas of the world. Fragile X syndrome can be a devastating condition, as many boys are severely retarded and require multiple services. Treatment involves behaviour management techniques, appropriate school placement, community support for the family, and careful medical follow-up often including psychopharmacology. The genetics of fragile X syndrome is now understood, prenatal testing is available, and the disorder is preventable through appropriate genetic counselling. This review focuses on the neurobiology of fragile X syndrome, its clinical features and treatment. | 10771963 | 2,000 | 2000-2004 |
Cerebral infarction in infants and children: clinical features, CT and EEG findings. | In a retrospective study, medical records of twenty one infants and children who were diagnosed for cerebrovascular disease, were analysed. Patients with history of head injury, brain tumor and intracranial infections were excluded from the study. Age ranged between six weeks and 12 years. Fourteen were boys and 7 girls. Ten patients (47%) had known underlying risk factor. Hemiparesis and seizures were commonest presenting features as well as long term neurological sequelae in survivors. CT scan was abnormal in all patients whereas, EEG was abnormal in 90% with 76% lateralizing effect. | 10771962 | 2,000 | 2000-2004 |
Congenital coronary artery abnormalities. | Congenital coronary artery abnormalities are rare and account for approximately 0.1 to 2% of congenital heart defects. They may pose significant risk of mortality or morbidity to the patient. The pediatrician and the pediatric cardiologist should be aware of their subtle but very serious presentations and diagnostic steps to be undertaken to pinpoint the diagnosis. Prevention of serious complications from these abnormalities can be achieved by making the appropriate diagnosis and performing timely surgical intervention. This review will discuss the most common congenital coronary artery abnormalities and their management. | 10771967 | 2,000 | 2000-2004 |
Kawasaki disease: an update. | Kawasaki disease is the leading cause of acquired heart disease in children in many parts of the world. It is an acute systemic vasculitis of unknown etiology predominantly affecting children under 5 years of age. It is diagnosed clinically by the presence of a constellation of manifestations and exclusion of other diseases with similar findings. Children develop a spectrum of cardiovascular manifestations including coronary artery involvement in 30-35% of untreated cases with myocardial infarction and death in < or = 2% of them. Acute stage treatment is by administration of intravenous immunoglobulin and aspirin. Those with coronary artery involvement need long-term cardiac risk stratification and management because many of them will become the part of a growing pool of adults with ischemic heart disease. | 10771968 | 2,000 | 2000-2004 |
Care mapping: a common sense approach. | Because of trends in the health care environment, hospitals are searching for ways to continuously improve the quality of care and to decrease the costs of care. One approach that is gaining widespread recognition throughout the United States is the use of case management and practice guidelines such as critical paths, CareMaps, and in the neonatal field, NeoMaps. The NeoMap is a clinical tool which delineates practice guidelines for each discipline that provide care to a specific infant population. It reduces variation in clinical process and thereby has been shown to improve the quality of infant care. When practice guidelines are linked to both health and economic outcomes, they have significant impact on health care costs. In this paper, case management and the development of the NeoMap will be described in relation to the Intensive Care Nursery (ICN) at Pennsylvania Hospital. | 10771971 | 2,000 | 2000-2004 |
Prostaglandin E1: first stage palliation in neonates with congenital cardiac defects. | E-type prostaglandins lesions with ductus dependent pulmonary blood flow for example pulmonary atresia with or without ventricular septal defect, critical valvular pulmonic stenosis etc, (b) lesions with ductus dependent systemic blood flow for example critical aortic stenosis, coarctation of aorta, interruption of aortic arch etc, and (c) admixture lesions like transposition of great arteries. The drug is given as a continuous intravenous infusion. The initial dose is 0.05 to 0.4 ug/kg/min, infusion rate must be decreased to 0.01 ug/kg/min as soon as the desired effect is achieved as incidence of side effects is more at higher doses. Serious side effects include apnoea, hypotension, hyperthermia, seizures etc. We have used this drug in 43 infants ranging in age from one to forty five days. Beneficial response was seen in 41 of 43 infants and the major side effect was apnoea (seen in 5 of 32 spontaneously breathing infants). Unfortunately the high cost of the drug prohibits its wide spread and long term use. PGE1 is a life saving drug for infants born with ductus dependent congenital cardiac malformations. It helps in stabilizing these patients prior to further surgical palliation or correction. | 10771966 | 2,000 | 2000-2004 |
Continuous positive airway pressure (CPAP). | Progress in neonatal intensive care is closely linked to improvements in the management of respiratory failure in small infants. This applies to the care of the preterm infants with immature lungs, and also to treatment of the preterm or full term infants with specific diseases that are associated with respiratory failure. Respiratory distress of the newborn continues to account for significant morbidity in the intensive care unit. The spectrum of disease ranges from mild distress to severe respiratory failure requiring varying degrees of support. The current modalities of ventilatory assistance range from the more benign continuous positive airway pressure (CPAP) to conventional mechanical ventilation, and on to high frequency ventilation. It is a reasonable supposition that the type of ventilatory assistance provided to these infants should be graded according to the severity of the disease. However, the principal objective in selecting the mode of respiratory support should be to use a modality which results in minimal volo- or barotrauma to the infant. The following detailed description on CPAP explains its physiological effects, delivery system, indications for use, application, maintenance, and associated complications. The equipment described is simple to use, has a greater cost benefit, and has a more universal application, which is of help to smaller units including those in the developing parts of the world. We have also included our institutional clinical experience of CPAP usage in very low birth weight infants from the periods before and after commercial availability of surfactant in the United States. | 10771972 | 2,000 | 2000-2004 |
Respiratory and systemic effects of inhaled dexamethasone on ventilator dependant preterm infants at risk for bronchopulmonary dysplasia. | Short-term inhaled dexamethasone therapy was evaluated in a double blind placebo controlled trial in 36 ventilator dependent preterm neonates who were at risk for bronchopulmonary dysplasia. Pulmonary and systemic effects were compared at early (day 3), late (7-10 days) and post (14 days after initiation) phases of therapy. Airflow mechanics improved as demonstrated by a net 101% improvement in pulmonary resistance (a decrease from 139 to 101 cm H2O/L/s in the dexamethasone treated infants as compared to an increase from 153 to 267 cmH2O/L/s in the placebo treated infants during the early phase of therapy); this was associated with a 45% increase in inspiratory airflow (1.29 +/- 0.43 to 1.87 +/- 0.978 L/min; p < 0.01), and 37% increase in expiratory airflow. These changes resulted in a significant reduction in the work of breathing such that the mean tidal driving pressure significantly decreased from 13.6 cmH2O to 9.4 cm H2O with inhaled steroid administration. Though the brief duration of therapy did not result in cessation of ventilatory support, the level of support was significantly reduced (decreased values of oxygen supplementation, mean airway pressure and oxygenation index and increased ventilatory efficiency index). The inhaled dexamethasone therapy was also associated with systemic absorption of the drug as evidenced by transient but apparently reversible reduction in serum cortisol levels. No systemic side effects of hypertension, hyperglycemia or nosocomial sepsis were observed. These data demonstrate beneficial effects of short-term inhaled dexamethasone on the resistive airflow properties of preterm infants at risk for BPD and may provide adjunctive means to facilitate weaning in the ventilator dependent neonates. | 10771973 | 2,000 | 2000-2004 |
Neonatal mechanical ventilation--experience at a level II care centre. | One hundred and fifty nine neonates were ventilated over a period of one year of whom 74 and PPHN (mean 156 hrs). Commonest complication was Sepsis (26%) followed by Pulmonary hemorrhage, Pneumothorax and IVH. Lower success rates in ventilation is due to the poor survival of babies weighing < 1000 gms and those with a gestation of < 28 wks with nosocomial infections as a major complication of assisted ventilation being an additional factor. | 10771975 | 2,000 | 2000-2004 |
Maternal substance abuse. | The epidemic of substance abuse, which has swept through much of the world, has left behind a trail of devastated lives and families. Alcohol and substance abuse by women during pregnancy has also been reported to be widespread and can affect the unborn fetus with the potential for life-long disabilities. While the magnitude of the perinatal substance abuse has been the focus of much discussion in the West, the problem is greatly underestimated in other parts of the world. In this article, the author has focused on five highly-abused substances and explored the effects of the drugs on the fetus and the newborn. There is a constant need for evaluating the epidemiology and the consequences of perinatal substance abuse so that health programs can target measures to eliminate the preventable morbidity that results from this practice. | 10771974 | 2,000 | 2000-2004 |
The effect of asphyxia on gut blood flow in term neonates. | Transcutaneous Doppler ultrasound measurements were made of the superior mesenteric artery of 25 term infants to correlate the intestinal blood flow with neonatal acid-base status as measured in umbilical artery blood and newborn condition as reflected by Apgar score. Compared with the babies whose umbilical artery pH was higher than 7.20 (peak systolic velocity: 84.1 cn/sn, mean velocity 48.6 cm/sn), the blood flow of superior mesenteric artery was significantly decreased in the newborn babies whose umbilical artery pH was less than 7.20 (peak systolic velocity 48.8 cm/sn, mean velocity = 32.6 cm/sn). Although no such relationship existed between Apgar scores and superior mesenteric artery blood flow indices, a significant linear correlation between superior mesenteric artery blood flow and umbilical artery pH was noted. A reduction of intestinal circulation was observed during umbilical cord blood acidemia and hypoxemia. | 10771976 | 2,000 | 2000-2004 |
Non surgical treatment in congenital heart disease. | Dilation of blood vessels transluminally was demonstrated by Dr Andreas Gruntzig in 1978. In 1982, Kan demonstrated that congenitally stenosed valve can be dilated with the use of cylindrical balloon and opened up new vistas in the non-surgical treatment of congenital heart lesions. Rapid progress has been now made in (1) Understanding of mechanism of success or failure of balloon dilation (2) Development of newer hardwares like low profile balloon, high pressure balloons, extra support wires which have contributed to increase in success rate of the procedures (3) Understanding the unnatural history of various congenital heart lesions from the vast data bank of Registries of balloon dilation. As a consequence balloon dilation has become the first procedure of choice in the treatment of valvar pulmonary stenosis and post surgical recurrent coarctation. Although an essentially palliative procedure for the treatment of valvar aortic stenosis and native coarctation beyond the neonatal period, non-randomised studies have shown results similar to that of surgical correction. Balloon dilation of pulmonary artery, pulmonary vein, venous baffles stenosis have shown poor overall results. Balloon dilation for sub-pulmonary stenosis like tetralogy of Fallot is controversial. The development of stents to keep dilated vessel open has also found a place in treatment of congenital heart lesions. Thus pulmonary artery stenosis, recurrent coarctation in adults, venous baffle obstruction, conduit stenosis which respond poorly to balloon dilation alone have shown promising early and mid term results with stents. The use of stents to keep the ductus open, recurrent coarctation in children, in right ventricular outflow tract obstruction is controversial. Development of devices to achieve closure of cardiac defects is relatively new. Patent arterial duct was the first defect to be closed with the help of devices and has shown good results on long term follow up. Recently stainless steel coils have been used to close dose small ducti (up to 3 mm) with very promising medium term results. Its use has also been extended to larger ducti (up to 7 mm). Devices used for closing atrial septal defects, ventricular septal defects are undergoing rapid development. In atrial septal defects its use is restricted to small defects in the fossa ovalis area and in ventricular defects, to only those which are in the muscular septum. Most of the devices in use today for atrial septal closure are relatively new and await long term results. The results achieved by non surgical treatment for many congenital heart lesions are essentially palliative and may require repeat interventions at some point in the unnatural history which increases the cost of treatment substantially. The reuse of balloons, guide wires in developing countries helps reduce the overall cost of the procedure. | 10771965 | 2,000 | 2000-2004 |
Renal dysplasia: an autopsy study of associated congenital malformations. | A retrospective analysis of infant autopsies in the last 14 years was done with the aim of determining the frequency of associated malformations. Renal dysplasia comprised 36 of 594 autopsies done and was the commonest congenital urologic malformation (6.06% of all infant autopsies). Histologically all cases were characterised by hallmarks of disordered metanephric differentiation and organisation. Extrarenal malformations were seen in all (100%) of the cases of which other urologic anomalies were the commonest (28) followed by those of musculoskeletal (18), gastrointestinal (13), cardiovascular (10) and central nervous system (6). Syndromic association was seen in 5 (14%) cases. There were twenty two percent still births and 47% infants died perinatally. A thorough search for systemic malformations is mandatory in all cases of renal dysplasia as these may influence the survival significantly. Cystic renal dysplasia should be differentiated from other causes of cystic renal diseases. | 10771978 | 2,000 | 2000-2004 |
Cost of neonatal intensive care. | Neonates are among those patients generating the highest hospital costs in recent years. There are no published data on the costs of neonatal intensive care in our country. The aim of our study was to analyse the cost of neonatal intensive care in a tertiary care unit. The average hospital charges per day were higher among non-survivors compared to survivors (Rs. 727). Care of more than 1250 gms infant is cost beneficial in our set up. | 10771970 | 2,000 | 2000-2004 |
Etretinate in the management of harlequin siblings. | Harlequin fetus is the severe form of congenital ichthyosis. There are very few reports of babies with this condition surviving the first few weeks of life. We treated two siblings who lived for 22 months and six weeks respectively. We started treatment with oral etretinate every early in their lives and achieved good improvement in the skin condition of these babies. | 10771980 | 2,000 | 2000-2004 |
Epidemiology of endemic cretinism in Sikkim, India. | A survey was conducted in Sikkim to determine the prevalence of endemic cretinism in the state. A household was the basic sampling unit. Villages were selected randomly in the state and from these households were selected randomly using the electoral lists. All members of the households were studied. Total of 17,837 individuals from 3,197 households from 249 villages were studied. There were 8,953 males and 8,884 females. A total of 617 endemic cretins were identified: 316 males and 301 females. The overall prevalence of endemic cretinism was 3.46%: (males 3.53% and females 3.39%). Endemic cretinism was observed in 194 (77.9%) villages studied. Neurological cretinism was the predominant form (98.7%). Deaf-mutism was the most salient neurological feature seen in 472 (76.5%) subjects. Motor system examination revealed proximal spasticity and brisk reflexes, both more marked in the lower limbs. Recording of daily life activities revealed 14.1% of the cretins to be totally dependent and another 23% to be requiring considerable assistance for their daily routine activities. The overall prevalence of goitre found in this survey was 54%. Urinary iodine concentration was estimated from a representative sample of the population; mean 4 micrograms/dl (SD 2.68). This survey shows the existence of severe iodine deficiency in Sikkim. | 10771977 | 2,000 | 2000-2004 |
Nitric oxide: biological role and clinical uses. | Nitric oxide is a product of the conversion of L-arginine by the enzyme nitric oxide synthase. Nitric oxide is involved in a variety of physiological situations and is produced by many different cell types. It is involved in neurotransmission, maintenance of vascular smooth muscle tone, and cytotoxicity. Nitric oxide has been suggested to play an anti-inflammatory role by inhibiting the expression of the genes for inflammatory cytokines. The pathophysiological role of nitric oxide is also evident in a variety of diseases, including septic shock, asthma, reperfusion injury, etc. Nitric oxide, by stimulating the production of cyclic GMP, relaxes smooth muscles of the cardiovascular, respiratory, gastrointestinal, and genito-urinary systems. Recent studies have provided important information on the use of inhaled nitric oxide for the management of several diseases characterized by the presence of abnormal pulmonary vascular tone, such as persistent pulmonary hypertension of the newborn. This review addresses the biology and clinical uses of inhaled nitric oxide. | 10771982 | 2,000 | 2000-2004 |
Emerging issues in pediatric pulmonology in India. | With the advent of ventilatory care for newborn in India, the practicing pediatrician is likely to see the "intensive care nursery survivors" who are likely to manifest an abnormal pulmonary outcome during infancy. These include: sudden death, bronchopulmonary dysplasia (with chronic lung disease and even core pulmonale), reactive airway disease, an increased propensity for respiratory infections and anatomical complications as subglottic stenosis, tracheobronchomalacia or palatal grooves. These not only have effects on respiratory compromise but also impact on feeding, growth and development. | 10771983 | 2,000 | 2000-2004 |
Upper airway disease. | More than 40% of children admitted to hospitals have respiratory disorders. Acute respiratory emergencies are either upper or lower airway obstructive diseases due to various etiological factors. A comprehensive knowledge and understanding of the anatomical variation of the upper airway in children is essential in the management of the critically ill. | 10771984 | 2,000 | 2000-2004 |
Lower airway disease caused by respiratory syncytial virus. | Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract disease in infants and young children. Most infections due to RSV are mild and do not require hospitalization. RSV causes both upper respiratory tract infections as well as lower respiratory tract infections. Infants with underlying disease states like bronchopulmonary dyslasia, congenital heart disease and prematurity appear more prone to develop severe infection and have a higher incidence of hospitalization. The exact pathogenesis of RSV is not well understood. The mortality associated with primary RSV infection in healthy children is estimated to be between.005% to.02%. In hospitalized children the mortality rate is estimated to be from 1% to 3%. Several treatment modalities in the form of bronchodilators, corticosteroids, ribavirin, intravenous immune gammaglobulin and antibiotics are available. Studies have failed to show the true beneficial effect of any of the above treatment modalities. Supportive care is only needed. The best treatment is the supportive care in the form of oxygen and fluids and close monitoring of the vital signs including oxygen saturation. | 10771985 | 2,000 | 2000-2004 |
Paracetamol poisoning in children. | Paracetamol (acetaminophen) has become an antipyretic drug of choice. Due to its widespread use, toxicity secondary to overdose has increased in recent years. Children are especially vulnerable to accidental exposure due to non availability of child proof containers in India. The main clinical features of acute toxicity include anorexia, vomiting, abdominal pain, jaundice, hematuria and metabolic acidoses. Diagnosis is based on history and laboratory findings of acidosis and abnormal liver function tests. N-acetylcysteine is the specific antidote. This article reviews in detail the toxicokinetics, pathophysiology, clinical features and management of paracetamol poisoning in children. | 10771990 | 2,000 | 2000-2004 |
Management of idiopathic thrombocytopenic purpura. | Idiopathic thrombocytopenic purpura is not an uncommon bleeding disorder with a prevalence of 40-80 per million children per year. Over the last six decades, the subject of ITP has attracted the attention of pediatricians and hematologists. It is one of the subjects which has many controversies because of its unpredictable course heralded by remission relapses, and chronicity with mortality in less than 1% of cases. In the present review only the controversies in the management of acute and chronic ITP have been reviewed as it interests most pediatricians. Management of intracranial hemorrhage (ICH), severe gastrointestinal hemorrhage and menorrhagia continues to still remain a challenge in spite of newer therapies. | 10771991 | 2,000 | 2000-2004 |
Poisoning in children: Indian scenario. | The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background. | 10771987 | 2,000 | 2000-2004 |
Indian red scorpion envenoming. | The clinical course and treatment outcome of scorpion envenoming in 293 children was studied in a hospital at Mahad in Raigad district of Maharastra. 111 (38%) children who reported 1-10 hours (mean 3.5 hours) after sting had hypertension, 87 (29.6%) with tachycardia reported within 1-24 hours (mean 6.7 hours) of being envenomed and 72 (24.5%) children developed acute pulmonary edema after 6-24 hours (mean 8 hours) of sting. Six victims were brought dead, while 17 (6%) died later owing to multiorgan failure with loss of consciousness and convulsions (who reported after 24 hours of sting). Early administration of prazosin (125-250 ug orally) improved the clinical symptoms. Morbidity and mortality due to scorpion envenoming depends upon time lapse between sting and administration of post synaptic alpha-1 blocker, prazosin hydrochloride. | 10771989 | 2,000 | 2000-2004 |
Free oxygen radicals--predictors of neonatal outcome following perinatal asphyxia. | The study was undertaken to evaluate the role of free oxygen radicals in asphyxiated neonates. Thirty term neonates appropriate for gestational age and with severe birth asphyxia (Apgar score of 3 or less at 1 minute of life) formed the study subjects. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), creatine phosphokinase (CPK) and lipid peroxidase (LPO) in the CSF of these neonates were estimated between 12 and 48 hrs of life. Enzyme estimation was performed by standard methods and the results were analysed statistically using Multivariate Logistic Regression analysis and non parametric tests namely Kruskal Wallis test and Wilcoxon's rank sum test. Out of the thirty babies, 14 were observed to be neurologically normal, 9 had significant morbidity and 7 died. The SOD levels ranged from 12.4 to 140 units/ml, GPx from 128 to 1933 nmol/min/dl, CPK from 2 to 2098 IU/dl and LPO from 5.4 to 30.8 umol/hr/dl. The SOD and GPx levels had an inverse relationship whereas rise in LPO and CPK levels were directly proportional to the extent of neurological damage and ultimate clinical outcome. CPK levels higher than 140 IU/ml were lethal and associated with 100% mortality whereas all normal neonates had CPK below 37 IU/ml. The levels of antioxidant enzymes can reliably and significantly predict mortality and morbidity whereas level of an enzyme cannot confidently confer normalcy. Hence antioxidant enzyme levels with a cut off value can be a useful marker and serve as a prognostic indicator in times to come. | 10771993 | 2,000 | 2000-2004 |
Evaluation of pulse polio immunisation in Chandigarh, India. | An evaluation survey on pulse polio immunization (PPI) was conducted in Union Territory of Chandigarh with a population of 88,100 children under the age of five years. Information was collected by interviewing the companions of 438 children in 18 polio centres, selected by stratified random sampling. Participation of children in the age-group of 4 and 5 years was found to be low. Awareness regarding various components of pulse polio immunization was found to be good in urban areas whereas it was unsatisfactory in slums. Two-dose-coverage of polio drops in 1996 campaign was recorded to be 81.5%. High risk pockets like slums need more attention for the success of polio eradication. | 10771995 | 2,000 | 2000-2004 |
Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit. | Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients. | 10771992 | 2,000 | 2000-2004 |
Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: year 2000. | Epidemiological studies during 1963-1997 were conducted in 45,725 children exposed to high intake of endemic fluoride in the drinking water since their birth. Children with adequate (dietary calcium > 800 mg/d) and inadequate (dietary calcium < 300 mg/d) calcium nutrition and with comparable intakes of fluoride (mean 9.5 +/- 1.9 mg/d) were compared. The toxic-effects of fluoride were severe and more complex and the incidence of metabolic bone disease (rickets, osteoporosis. PTH bone disease) and bony leg deformities (genu valgum, genu varum, bowing, rotational and wind-swept) was greater (> 90%) in children with calcium deficiency as compared to < 25% in children with adequate calcium who largely had osteosclerotic form of skeletal fluorosis with minimal secondary hyperparathyroidism. The syndrome of skeletal fluorosis and associated metabolic bone disease and deformity is a unique clinical entity classified as a variant of osteosclerotic form of skeletal fluorosis. This syndrome chiefly results from the biological impact of excess fluoride, low calcium, high PTH and 1,25 (OH)2D3 separately and through their interactions on bone structure and metabolism as studied by radiology, bone scanning, bone histomorphometry and relevant metabolic and endocrine laboratory investigations. Metabolically active and vascular bones of children accumulate fluoride at faster and greater rate than adults (at the sites of active growth). In calcium deficient children the toxic effects of fluoride manifest even at marginally high (> 2.5 mg/d) exposures to fluoride. Fluoride toxicity also exaggerates the metabolic effects of calcium deficiency on bone. The findings strongly suggest that children with calcium deficiency rickets reported in the literature should be re-investigated for possible fluoride interactions. Deep bore drinking water supply with fluoride < 0.5 ppm and improvement of calcium nutrition provide 100% protection against the toxic effects of fluoride and are recommended as the cost effective and practical public health measures for the prevention and control of endemic fluorosis. | 10771988 | 2,000 | 2000-2004 |
Neonatal mortality rate: relationship to birth weight and gestational age. | A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors. | 10771994 | 2,000 | 2000-2004 |
Neonatal morbidity and mortality in Nigeria. | A retrospective analysis of neonatal morbidity and mortality was conducted over a ten-year period at a tertiary hospital in Ilesa, Nigeria, to determine the trends in neonatal morbidity and mortality in relation to places of delivery. 7,225 babies were admitted into the neonatal unit during the period wherein 3,232. Major causes of death were low birth weight (42.8%), neonatal jaundice (14.1%), neonatal tetanus (12.8%), infections (12.4%), and birth asphyxia (11.6%). In almost all cases, case fatality rates were higher among the outborns (p < 0.001). Similarly, mortality was higher in outborns than inborns in almost all the weight range. Among the outborns, mortality was highest in babies delivered at home and private hospitals. Improved access to neonatal medical and antenatal care will significantly reduce neonatal morbidity and mortality in Nigeria. | 10771996 | 2,000 | 2000-2004 |
Interleukin-1-beta, tumor necrosis factor-alpha, insulin secretion and oral glucose tolerance in non-diabetic siblings of children with IDDM. | Recent reports suggest that the pancreas participates in tumor necrosis factor alpha (TNF-A) production during stress, and that the islets are predominantly responsible for such synthesis. In vitro TNF-A and interleukin 1-beta (IL-1-beta) inhibit insulin release from islet beta-cells. We measured the circulating levels of IL-1-beta, TNF-A and islet cell antibody (ICA) in 30 children with IDDM (10 of them at their first presentation), 30 of their non-diabetic siblings, and 30 normal age-matched children. In the non-diabetic children we investigated the early phase of insulin release after intravenous bolus of glucose and evaluated tolerance to oral glucose (OGTT). IL-1-beta and TNF-A concentrations were significantly higher in IDDM-siblings (31.8 +/- 7.7 pg/ml and 650 +/- 155 pg/ml respectively) versus normal children (21.2 +/- 6.4 pg/ml and 383 +/- 122 pg/ml respectively). IL-1-beta and TNF-A concentrations did not differ significantly between the diabetic children and healthy age-matched controls. ICA were detected in 60% of the recently diagnosed diabetic children versus 30% of those with longer duration of diabetes (3.1 +/- 1.2 years). Despite the significantly high prevalence of ICA in the recently diagnosed children with IDDM, their IL-1-beta and TNF-A concentrations were lower than those for the normal children. In experimental animals these cytokines can induce round cell infiltration (insulinitis) and inhibit insulin secretion by beta-cell. The presence of significantly higher concentrations of these cytokines in IDDM siblings, with high prevalence of ICA (16%), was associated with normal oral glucose tolerance and normal peak insulin response (60 +/- 10.4 mlU/ml) after i.v. glucose bolus compared to normal children (52.3 +/- 9.5 mlU/ml). However, after 2 years of follow up, one of them developed IDDM and another developed IGT but none of the normal controls developed abnormal glucose tolerance. It appears that the process of autoimmune aggression against beta-cells, and its effect on insulin release and glucose homeostasis, is a slow and chronic process. However, the production of these cytokines and consequently the degree of beta-cell destruction, in a genetically susceptible subject, might be enhanced by several factors including viral infections. In summary, IL-1-beta and TNF-A levels can be used as indicators of continuing autoimmune aggression against beta-cells before the development of extensive beta-cell destruction. | 10771998 | 2,000 | 2000-2004 |
Bone and joint infection in neonates. | A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity. | 10771999 | 2,000 | 2000-2004 |
Iodine deficiency in district Kinnaur, Himachal Pradesh. | The state of Himachal Pradesh is a known iodine deficiency endemic region since the last 40 years. The state government is supplying iodised salt to the district since 1970. No recent survey has been conducted on the prevalence of iodine deficiency from the district Kinnaur which is located at an average altitude of 10,000 feet above sea level. A total of 1094 children in the age group of 6-10 years were included in the study and clinically examined. The total goitre prevalence of 6.1% was found in the subjects studied. Urine samples were collected from 226 children and were analysed using standard laboratory procedures. It was found that the percentage of children with < 2 mcg/dl, 2-4.9 mcg/dl, 5-9.9 mcg/dl and 10 and above mcg/dl of urinary iodine excretion (UIE) level was 1.3, 5.8, 10.6 and 82.3 respectively. A total of 242 salt samples were collected and analysed using the standard iodometric titration method. Results showed that almost 90% of the families were consuming salt with an iodine content of 15 ppm and more which is the stipulated level of iodisation of salt. The findings of the study indicate that iodine nutrition is in the transition phase from iodine deficient to iodine sufficient. Findings revealed a need for further strengthening the monitoring of the quality of salt being distributed in Kinnaur to achieve elimination of iodine deficiency. | 10771997 | 2,000 | 2000-2004 |
Nuclear grooves in intermediate cells in cervical smears. | One thousand cervical smears from women who took part in a hospital-based screening programme for early detection of cervical cancer were studied for the presence of nuclear grooves. Grooved nuclei were frequently detected in intermediate cells in all phases of the menstrual cycle, although their frequency of occurrence was slightly lower in the luteal and premenstrual phases. The mean number of nuclear grooves varied from 3.6 to 4.2 in different phases of the menstrual cycle. The differences, however, were not statistically significant. The presence of nuclear grooves in cervical cells appears to be a nonspecific finding at present. | 10772008 | 2,000 | 2000-2004 |
DNA ploidy and p53 protein expression in superficial transitional cell carcinoma of the bladder. | Superficial transitional cell carcinoma of the bladder. No statistical difference was found in DNA ploidy status and grade of malignancy (P = 0.68). A statistically significant difference was found in p53 protein expression between recurrent and nonrecurrent tumours (P < 0.001). No statistically significant difference was found among tumours of grade I, grade II and grade III (P = 0.42). These results could provide useful information on the potential behaviour of STCCB. | 10772009 | 2,000 | 2000-2004 |
Anaerobic septicaemia by Fusobacterium necrophorum: Lemierre's syndrome. | Lemierre's syndrome is characterized by acute pharyngotonsillitis with secondary thrombophlebitis of the internal jugular vein which is complicated by multiple metastatic foci of infections. This syndrome is caused by Fusobacterium necrophorum in healthy young persons and is extremely rare in occurrence. A pre-school child with Lemierre's syndrome is reported. The diagnostic and therapeutic aspects are emphasized in order to sensitize physicians to this uncommon condition. | 10772002 | 2,000 | 2000-2004 |
Thin layer compared to direct smear in thyroid fine needle aspiration. | The efficacy of preparing thyroid fine needle aspirations, a lower proportion of inadequate specimens (41% vs 50%) and, most importantly, a lower false negative rate (3% vs 9%). In conclusion, the changeover to thin layer did not compromise the interpretation of thyroid FNAs. | 10772010 | 2,000 | 2000-2004 |
Dermoid (hairy polyp) of the nasopharynx. | Dermoids or hairy polyps, the most primitive forms of teratoma are rare lesions affecting the nasopharynx. They arise during early embryogenesis, being derived from only two germinal layers, ectoderm and mesoderm and are invariably benign. They usually present at or soon after birth with signs of upper aerodigestive tract obstruction. A case of hairy polyp of nasopharynx in a neonate is reported for its rarity. The etiology of teratomas, their classification in head and neck region, clinical features, and management in neonates are discussed. | 10772003 | 2,000 | 2000-2004 |
Pseudohypoparathyroidism-Albright hereditary osteodystrophy. | A 13 year old girl with short stature, and retarded mental growth with coarse facies and deranged thyroid function test was initially suspected as a case of hypothyroidism and was started on thyroxine. Lack of response to treatment and on further investigations it was diagnosed as a case of pseudohypoparathyroidism. High index of suspicion and careful evaluation is important to diagnose such an entity. | 10772004 | 2,000 | 2000-2004 |
Comparison of transformation zone sampling rates--a potentially useful indicator of smear taker performance. | Retrospective analysis of 18555 routinely collected smears from women in the age range 20-50 years reveals that there is a statistically significant relationship between the overall transformation zone sampling rate achieved in general practice and the detection rates for cervical abnormality. Similar analysis comparing unsatisfactory smear rates with rates for the detection of abnormality demonstrates a negative correlation which fails to achieve statistical significance. Comparison of transformation zone sampling rates achieved by smear takers sending samples to the same laboratory is proposed as a potentially useful performance indicator for smear takers. | 10772011 | 2,000 | 2000-2004 |
A morphometric analysis of cytological features of tall cell variant and classical papillary carcinoma of the thyroid. | In order to assess whether morphometric parameters could be of value in distinguishing between tall cell variant and classical pattern of thyroid papillary carcinoma, the fine needle aspiration cytology (FNAC) samples of 14 cases were analysed using Arcimage 5 software on an Acorn computer. Histological examination of the specimens allowe classification of nine of them as classical pattern and the remaining five as tall cell variants. The nuclear diameter (NDD) and standard deviation distribution (NDSDD), th nuclear area (NAD) and standard deviation distribution (NASDD), and the nuclear/cytoplasmic ratio (NCR) were assessed on May-Grunwald-Giemsa stained smears. Statistical analysis was performed by use of one-way analysis of variance (ANOVA) of the two groups as identified by histology. Whilst NDD (P = 0.007), NAD (P = 0.015) and NADSD (P = 0.026) all appeared statistically significant, NDSD (P = 0.06) and NCR (P = 0.71) were not. The cytological diagnosis of papillary carcinoma is established and reproducible, but morphometric data on the thyroid have so far focused on the differential diagnosis between benign and malignant nodules. The choice of simple morphometric parameters appears to be helpful in the preoperative distinction between the classical pattern and tall cell variant of papillary carcinoma. | 10772012 | 2,000 | 2000-2004 |
VIP-Man: an image-based whole-body adult male model constructed from color photographs of the Visible Human Project for multi-particle Monte Carlo calculations. | Human anatomical models have been indispensable to radiation protection dosimetry using Monte Carlo calculations. Existing MIRD-based mathematical models are easy to compute and standardize, but they are simplified and crude compared to human anatomy. This article describes the development of an image-based whole-body model, called VIP-Man, using transversal color photographic images obtained from the National Library of Medicine's Visible Human Project for Monte Carlo organ dose calculations involving photons, electron, neutrons, and protons. As the first of a series of papers on dose calculations based on VIP-Man, this article provides detailed information about how to construct an image-based model, as well as how to adopt it into well-tested Monte Carlo codes, EGS4, MCNP4B, and MCNPX. | 10772019 | 2,000 | 2000-2004 |
Foodstuff survey around a major nuclear facility with test of satellite images application. | A foodstuff survey was performed around the Savannah River Site, Aiken, South Carolina. It included a census of buildings and fields within 5 km of the boundary and determination of the locations and amounts of crops grown within 80 km of the Savannah River Site center. Recent information for this region was collected on the amounts of meat, poultry, milk, and eggs produced, of deer hunted, and of sports fish caught. The locations and areas devoted to growing each crop were determined by the usual process of applying county agricultural statistics reported by state agencies. This process was compared to crop analysis of two LANDSAT Thematic Mapper images. For use with environmental radionuclide transfer and radiation dose calculation codes, locations within 80 km were defined for 64 sections by 16 sectors centered on the Site and by 16-km distance intervals from 16 km to 80 km. The median areas per section devoted to each of four food crops based on county agricultural statistics were about two-thirds of those based on satellite image analysis. Most locally-raised foodstuff was distributed regionally and not retained locally for consumption. | 10772020 | 2,000 | 2000-2004 |
Radiation-epidemiological analysis of incidence of non-cancer diseases among the Chernobyl liquidators. | The work is concerned with assessment of radiation risks for non-cancer disease among the Chernobyl liquidators from 1986 to 1996. As of 1 January 1999, the Russian National Medical and Dosimetric Registry contains medical and dosimetric data for 174,000 liquidators. The cohort of 68,309 liquidators for whom best verified medical data are available is discussed. The dose dependency of incidence of non-cancer diseases was estimated by the cohort method and using the software package Epicure. For some classes of non-cancer diseases among liquidators, statistically significant estimates of radiation risk were derived for the first time. The highest excess relative risk per 1 Gy was found for cerebrovascular diseases; ERR Gy(-1)=1.17 at the 95% confidence interval (0.45; 1.88). | 10772021 | 2,000 | 2000-2004 |
Increased 137Cs metabolism during pregnancy. | A woman temporarily visiting the Brjansk area in southern Russia ingested, without her knowledge, 35.5 kBq of 137Cs in a single mushroom meal. Seven months later the woman became pregnant. Her total body content of 137Cs and 40K was measured regularly in a whole-body counter for three years following this intake. Data were thus available for the whole-body content for the periods before, during, and after pregnancy. Urine samples were collected regularly, and on two occasions breast milk was sampled. The 137Cs concentration in urine and breast milk was analyzed with a gamma-ray spectrometer. The body content of 137Cs decreased with a biological half-time of 107 d before pregnancy, 58 d (95% CI: 53,64) during pregnancy, and 96 d (95% CI: 43,346) after the child was born. The ratio between the concentration of 137Cs in the urine (Bq/L urine) and in the body (Bq/kg body weight) increased during pregnancy from 18 +/- 6% to 35 +/- 6% (+/- 1 SD). The results show that there was a rapid decrease in the biological half-time of 137Cs at the beginning of the pregnancy and an increase after the child was born. The biological half-time during pregnancy was 54% of the half-time before pregnancy, which was reflected in the increased excretion of 137Cs in the urine. The ratio of the 137Cs concentration in breast milk to the whole body was 15% in the first month of breast-feeding. The effective dose, E, to the mother as a result from this intake was estimated to be 0.5 mSv, and the absorbed dose to the fetus was 0.06 mGy. These results are consistent with those reported elsewhere. | 10772022 | 2,000 | 2000-2004 |
Study of stabilizing CaF2:Dy ultraviolet sensitivity by double annealing treatment. | The intrinsic thermoluminescent response to ultraviolet radiation of CaF2:Dy phosphor is enhanced by pre-irradiation high-temperature annealing treatment. The thermoluminescent response is stabilized by adding a medium temperature annealing treatment after the previous annealing. The experimental results show that the annealing treatment of 1 h 850 degrees C high-temperature annealing followed by 1 h 350 degrees C medium-temperature annealing is the optimum treatment to have high thermoluminescent response and good stability. The results also show that (1) the thermoluminescent response to 253.7 nm ultraviolet radiation is increased and stabilized, (2) the thermoluminescent sensitivity and glow curve distribution to 235.7 nm ultraviolet radiation are retained, and (3) the thermoluminescent response to 253.7 nm ultraviolet is linear from 3 to 1 x 10(3) Jm(-2), but there is no linear response with respect to 365 nm ultraviolet. | 10772023 | 2,000 | 2000-2004 |
Chelating agents for uranium(VI): 2. Efficacy and toxicity of tetradentate catecholate and hydroxypyridinonate ligands in mice. | Uranium(VI) (UO2(2+), uranyl) is nephrotoxic. Depending on isotopic composition and dosage, U(VI) is also chemically toxic and carcinogenic in bone. Several ligands containing two, three, or four bidentate catecholate or hydroxypyridinonate metal binding groups, developed for in vivo chelation of other actinides, were found, on evaluation in mice, to be effective for in vivo chelation of U(VI). The most promising ligands contained two bidentate groups per chelator molecule (tetradentate) attached to linear 4- or 5-carbon backbones (4-LI, butylene; 5-LI, pentylene; 5-LIO, diethyl ether). New ligands were then prepared to optimize ligand affinity for U(VI) in vivo and low acute toxicity. Five bidentate binding groups--sulfocatechol [CAM(S)], carboxycatechol [CAM(C)], methylterephthalamide (MeTAM), 1,2-hydroxypyridinone (1,2-HOPO), or 3,2-hydroxypyridinone (Me-3,2-HOPO)--were each attached to two linear backbones (4-LI and 5-LI or 5-LIO). Those ten tetradentate ligands and octadentate 3,4,3-LI(1,2-HOPO), an effective actinide chelator, were evaluated in mice for in vivo chelation of 233U(VI) (injection at 3 min, 1 h, or 24 h or oral administration at 3 min after intravenous injection of 233UO2Cl2) and for acute toxicity (100 micromol kg(-1) injected daily for 10 d). The combined efficacy and toxicity screening identified 5-LIO(Me-3,2-HOPO) and 5-LICAM(S) as the most effective low-toxicity agents. They chelate circulating U(VI) efficiently at ligand:uranium molar ratios > or = 20, remove useful amounts of newly deposited U(VI) from kidney and bone at molar ratios > or = 100, and reduce kidney U(VI) levels significantly when given orally at molar ratios > or = 100. 5-LIO(Me-3,2-HOPO) has greater affinity for kidney U(VI) while 5-LICAM(S) has greater affinity for bone U(VI), and a 1:1 mixture (total molar ratio = 91) reduced kidney and bone U(VI) to 15 and 58% of control, respectively--more than an equimolar amount of either ligand alone. | 10772024 | 2,000 | 2000-2004 |
Testing a BEIR-VI suggestion for explaining the lung cancer versus radon relationship for U.S. counties. | The BEIR-VI Report suggests that the large discrepancy between the observed lung cancer rate versus radon exposure relationship for U.S. counties, and the predictions of linear no-threshold theory, may be explained by a strong negative correlation between smoking intensity and radon exposure. It proposes a model for testing that suggestion. We apply that model to the detailed data for U.S. counties; analysis shows that even a perfect negative correlation explains little more than half of the discrepancy, and the largest not-implausible correlation can explain less than a quarter of the discrepancy. We then extend the BEIR-VI suggestion to include a strong negative correlation between both the prevalence of smoking and the intensity of smoking. The largest not-implausible correlations can explain no more than 30% of the discrepancy. It is concluded that the previous interpretation of these data, that linear no-threshold theory fails this test, is sustained. | 10772025 | 2,000 | 2000-2004 |
An improved model for the reconstruction of past radon exposure. | If the behavior of long-lived radon progeny was well understood, measurements of these could be used in epidemiological studies to estimate past radon exposure. Field measurements were done in a radon-prone area in the Ardennes (Belgium). The surface activity of several glass sheets was measured using detectors that were fixed on indoor glass surfaces. Simultaneously the indoor radon concentration was measured using diffusion chambers. By using Monte Carlo techniques, it could be proven that there is a discrepancy between this data set and the room model calculations, which are normally used to correlate surface activity and past radon exposure. To solve this, a modification of the model is proposed. | 10772026 | 2,000 | 2000-2004 |
Modeled concentrations in rice and ingestion doses from chronic atmospheric releases of tritium. | The expansion of nuclear power programs in Asia has stimulated interest in the improved modeling of concentrations of tritium in rice, a staple crop grown throughout the far east. Normally, the specific activity model is used to calculate concentrations of tritium in the tissue water of edible plants to assess ingestion dose from chronic releases. However, because rice, like other grains, has much lower water content than most crops, the calculation must also account for organically bound tritium. This paper reviews ways to calculate steady-state concentrations of tritium in rice, including the methods of Canadian and United States regulatory models, and the assumptions behind them. Concentrations in rice and resulting ingestion doses are compared for the various methods, and equations for calculating concentrations are recommended. The regulatory models underestimate doses received from ingestion of rice contaminated with tritium since they do not account explicitly for organically bound tritium. The importance of including organically bound tritium is illustrated in a comparison of doses from rice, leafy vegetables and milk for an Asian diet. Dose factors from tritium for these foods are estimated to be 135, 47, and 20 nSv y(-1)/(Bq m(-3)), respectively. Assuming known air concentrations, tritium concentrations in rice, calculated with the recommended equations, are uncertain by less than a factor 2 when tritium concentrations in the rice paddy water are known, and by less than a factor of 2.3 when concentrations in paddy water are unknown. | 10772027 | 2,000 | 2000-2004 |
Dose reconstruction system for the exposed population living along the Techa River. | The Mayak Production Association, which began operation in 1948, was the first facility in the former Soviet Union for the production of plutonium. Significant worker and population exposure occurred as a result of failures in the technological processes in the late 1940's and early 1950's. Members of the public were exposed via discharge of about 1017 Bq of liquid wastes into the Techa River during 1949-1956, an explosion in the radioactive waste-storage facility in 1957, and gaseous aerosol releases within the first decades of the facility's operation. Residents of many villages downstream on the Techa River were exposed via a variety of pathways; the more significant included drinking of water from the river and external gamma exposure due to proximity to sediments and shoreline. The specific aim of this project is to enhance the reconstruction of external and internal radiation doses for individuals in the Extended Techa River Cohort. The purpose of this paper is to present the details of the methods that are being used in this enhanced dose-reconstruction effort and to provide example and representative results of the calculations. The methods of dose assessment currently being developed for the exposed population, which are a significant improvement on past methods, are presented. The new TRDS-2000 doses from the ingestion of radionuclides are substantially higher for the gastrointestinal tract, due to consideration of short-lived radionuclides. The TRDS-2000 doses from external exposure are substantially lower due to improvements in several factors. Assessment of uncertainty and validation of the "new" doses are significant issues currently under investigation. | 10772028 | 2,000 | 2000-2004 |
Population dose due to natural radiation in Hong Kong. | In densely populated cities such as Hong Kong where people live and work in high-rise buildings that are all built with concrete, the indoor gamma dose rate and indoor radon concentration are not wide ranging. Indoor gamma dose rates (including cosmic rays) follow a normal distribution with an arithmetic mean of 0.22 +/- 0.04 microGy h(-1), whereas indoor radon concentrations follow a log-normal distribution with geometric means of 48 +/- 2 Bq m(-3) and 90 +/- 2 Bq m(-3) for the two main categories of buildings: residential and non-residential. Since different occupations result in different occupancy in different categories of buildings, the annual total dose [indoor and outdoor radon effective dose + indoor and outdoor gamma absorbed dose (including cosmic ray)] to the population in Hong Kong was estimated based on the number of people for each occupation; the occupancy of each occupation; indoor radon concentration distribution and indoor gamma dose rate distribution for each category of buildings; outdoor radon concentration and gamma dose rate; and indoor and outdoor cosmic ray dose rates. The result shows that the annual doses for every occupation follow a log-normal distribution. This is expected since the total dose is dominated by radon effective dose, which has a log-normal distribution. The annual dose to the population of Hong Kong is characterized by a log-normal distribution with a geometric mean of 2.4 mSv and a geometric standard deviation of 1.3 mSv. | 10772029 | 2,000 | 2000-2004 |
Systematic indoor radon and gamma-ray measurements in Slovenian schools. | During the winter months of 1992/93 and 1993/94, instantaneous indoor radon concentrations and gamma dose rates were measured in 890 schools in Slovenia attended in total by about 280,000 pupils. Under "closed conditions," the room to be surveyed was closed for more than 12 h prior to sampling, the air was sampled into alpha scintillation cells with a volume of 700 cm3, and alpha activity was measured. An arithmetic mean of 168 Bq m(-3) and a geometric mean of 82 Bq m(-3) were obtained. In 67% of schools, indoor radon concentrations were below 100 Bq m(-3), and in 8.7% (77 schools with about 16,000 pupils) they exceeded 400 Bq m(-3), which is the proposed Slovene action level. In the majority of cases, radon concentrations were high due to the geological characteristics of the ground. Approximately 70% of schools with high radon levels were found in the Karst region. Gamma dose rates were measured using a portable scintillation counter. An arithmetic mean of 102 nGy h(-1) and a geometric mean of 95 nGy h(-1) were obtained. No extraordinarily high values were recorded. | 10772030 | 2,000 | 2000-2004 |
Decorporation: officially a word. | This note is the brief history of a word. Decorporation is a scientific term known to health physicists who have an interest in the removal of internally deposited radionuclides from the body after an accidental or inadvertent intake. Although the word decorporation appears many times in the radiation protection literature, it was only recently accepted by the editors of the Oxford English Dictionary as an entry for their latest edition. | 10772031 | 2,000 | 2000-2004 |
Pulmonary autograft versus aortic homograft for aortic valve replacement: interim results from a prospective randomized trial. | BACKGROUND AND AIM OF THE STUDY: Although pulmonary autografts offer advantages over aortic homografts, they may also carry additional risks. We reviewed the interim results of a prospective randomized trial of autograft versus homograft aortic valve replacement (AVR) to determine if the greater complexity of the autograft insertion is justified, particularly with regard to time-related hemodynamic function. METHODS: A total of 182 patients (82% male, 18% female; mean age 37.2 +/- 14.3 years; range: 2-64 years) with isolated aortic valve disease were randomized to pulmonary autograft (group A, n = 97) or aortic homograft (group H, n = 85); 42% had previous aortic valve surgery and 19% had native or prosthetic valve endocarditis. Follow up included annual outpatient visits and echocardiography. RESULTS: Autograft AVR required longer cross-clamp (41%) and bypass (43%) times, but did not result in significantly more bleeding, longer recovery or more complications. One 30-day death occurred in group A (1%), and three deaths in group H (4%). Median follow up was 33.9 months (range: 1-61 months). There was one late death in each group, three reoperations in group A (all for pulmonary homografts), and three in group H (including two aortic homograft reoperations, both in children). There were no autograft reoperations. There were no other valve-related events. At 48 months, actuarial survival and reoperation-free survival rates were 97.8% and 94.2% in group A, and 95.3% and 87.7% in group H (p = NS). Echocardiography showed near-perfect function in all autografts, but early signs of subclinical dysfunction in many homografts. CONCLUSION: Both autograft and homograft AVR are safe and produce good intermediate-term results. Early homograft degeneration appears to favor autografts in children. The echocardiographic findings may translate into superior long-term autograft durability and hemodynamics. | 10772034 | 2,000 | 2000-2004 |
Does the Ross operation fulfil the objective performance criteria established for new prosthetic heart valves? | BACKGROUND AND AIM OF THE STUDY: Objective Performance Criteria. Linearized rates (number of events per 100 years patient exposure) were calculated to establish the safety and efficacy of this operation (288.7 years cumulative patient-years). RESULTS: Three patients died perioperatively (2.8%); two patients were reoperated due to autograft incompetence (1.8%, both valve repairs). No patient is currently on anticoagulation therapy, and no events of thromboembolism, valve thrombosis or bleeding were observed during follow up. Two patients had homograft endocarditis but were asymptomatic with moderate incompetence at the last follow up examination. There was no significant increase in aortic incompetence (AI) or pulmonary incompetence (PI) between discharge and follow up (AI, 0.4 +/- 0.5 versus 0.6 +/- 0.6; PI, 0.2 +/- 0.4 versus 0.4 +/- 0.6). In comparing the OPC (events per patient-year) for the Ross operation with those for tissue and mechanical valves, the results were: thromboembolism 0% (tissue 2.5%, mechanical 3%), valve thrombosis 0% (0.2% and 0.8%), all bleeding 0% (1.4% and 3.5%), major bleeding 0% (0.9% and 1.5%), all leakage 0.7% (1.2% and 1.2%), major leakage 0.7% (1.2% and 1.2%) and endocarditis 0.7% (1.2% and 1.2%). CONCLUSION: The pulmonary autograft procedure provides optimal hemodynamics and echocardiographic performance, and low valve-related complication rates; thus, the OPC for tissue and mechanical heart valve prostheses can be fulfilled by this technically demanding operation. These results confirm that the autograft is an ideal aortic valve replacement device. | 10772035 | 2,000 | 2000-2004 |
Annuloplasty and aortoplasty as modifications of the Ross procedure for the correction of geometric mismatch. | BACKGROUND AND AIM OF THE STUDY: Pulmonary autograft replacement of the aortic valve revealed 10 patients with trace 1+ and one patient with 2+ aortic insufficiency. Trace 1+ and 2+ aortic stenosis were present in one patient each. None of the patients undergoing commissural plication had significant regurgitation or stenosis. Both patients with stenosis underwent annular fixation. Aortoplasty was associated with 1+ insufficiency in two patients. CONCLUSION: Prevention of geometric mismatch between the autograft and systemic outflow tract at the annulus and sinotubular junction by plication techniques allows better performance of the autograft, and extends the Ross procedure to patients who otherwise may be unable to undergo such surgery. Fixation may provide similar benefit, but appears to be more susceptible to insufficiency and stenosis. | 10772036 | 2,000 | 2000-2004 |
Interstitial ice formation in cryopreserved homografts: a possible cause of tissue deterioration and calcification in vivo. | BACKGROUND AND AIM OF THE STUDY: Cryopreserved valve homografts often fail in infants. Controversies are ongoing concerning the relative contributions of cryopreservation variables, immune responses, cellular viability, and durability of the extracellular matrix to the mode of tissue failure. METHODS: Tissues to be examined for patterns of ice crystal distribution were cryopreserved. Tissue water was substituted with methanol and the tissues cryopreserved conventionally using dimethylsulfoxide, after which they were warmed and processed for light or electron microscopy. Selected specimens were vitrified to prevent ice crystal formation, cryopreserved, and subsequently warmed and processed for light and electron microscopy. RESULTS: Cryosubstitution of conventionally cryopreserved heart valves, while still frozen, demonstrated extensive extracellular ice formation, with smaller crystals in the ventricularis than in either the spongiosa or fibrosa. Extracellular ice formation was prevented by vitrification, a process in which the biological system is stabilized as an amorphous solid in the absence of crystalline ice. CONCLUSION: It is proposed that the extensive ice formation observed in conventionally cryopreserved heart valves may cause extracellular matrix damage that predisposes the valves to calcification. Future studies will assess the above hypothesis by comparison of conventional and ice-free (vitrification) cryopreservation methods in animal models of calcification. | 10772037 | 2,000 | 2000-2004 |
Banking of cryopreserved heart valves in Europe: assessment of a 10-year operation in the European Homograft Bank (EHB). | BACKGROUND AND AIM OF THE STUDY: The preparation, banking and distribution of cryopreserved heart valves has been carried out at the European Homograft Bank, and quality control are according to the standards of the Belgian Ministry of Health. Cryopreserved valves are shipped to the implantation centers in a dry shipper at about -150 degrees C. RESULTS: Between January 30th 1989 and December 31st 1998, 1,817 non-transplantable hearts and 12 excised semilunar valves were obtained. In total, 2,077 valves; 424 during a Ross procedure, and 76 in the left ventricular outflow tract (LVOT). Of the aortic valves, 732 were implanted in the LVOT and 266 in the RVOT. Mitral homografts were used for tricuspid valve replacement in two cases, and in the mitral position in seven. Complications at distribution and thawing included 10 bag ruptures and 16 transversal conduit wall fractures. Of the valves shipped, 317 (13.16%) were not used and were returned safely in the dry shipper. Comparison of distribution rates in the first 5.5 and last 4.5 years of EHB activity shows: (i) a significant increase in pulmonary valve implantations in the RVOT (from 71.95% to 81.95%); and (ii) a marked increase (265%) in pulmonary homograft implantations as part of a Ross operation, and a significant decrease (28%) in aortic homograft implantation in the LVOT. CONCLUSION: While macroscopic lesions of procured aortic valves remain the most frequent and unavoidable cause of homograft rejection during quality control, the high percentage of inadequate surgical heart valve excision should be corrected. The rates of bacterial contamination and positive serology seem acceptable. Storage and shipping of cryopreserved homografts in liquid nitrogen vapor permits them to be spared very efficiently. The increasing use of pulmonary valves for RVOT reconstruction either in congenital heart disease or as part of the Ross procedure compensates for the limited availability of good quality aortic valves. | 10772038 | 2,000 | 2000-2004 |
Results of aortic valve replacement with pulmonary and aortic homografts. | BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement with cryopreserved human pulmonary or aortic valves with non-endocarditic valve lesions. The mean echocardiographic degree of regurgitation for PG was significantly higher than for AG. The peak transvalvular gradient did not differ between groups (PG 12.3 +/- 9 mmHg versus AG 16.7 +/- 10 mmHg, p = NS). In respect of perioperative parameters, patients with PG showed a significantly higher body temperature during the first seven postoperative days (37.3 +/- 0.6 degrees C versus 36.8 +/- 0.3 degrees C, p = 0.003). All three patients with acute graft malfunction in long-term follow up had a perioperative febrile response without overt bacterial infection. CONCLUSION: In contrast to grafts of aortic origin, pulmonary homograft valves should not be used for aortic valve replacement because of their high rate of malfunction, both acutely and chronically. Higher postoperative body temperatures should lead to further investigations of possible enhanced immunoreactions against pulmonary homografts. | 10772039 | 2,000 | 2000-2004 |
Mitral valve surgery utilizing homografts: early results. | BACKGROUND AND AIM OF THE STUDY: Mitral valve repair is superior to prosthetic valve replacement due to preservation of the subvalvular apparatus. We used cryopreserved homografts for mitral valve replacement in selected cases, in whom valve repair would not have been successful. METHODS: Cryopreserved homografts were used in 10 patients (four males, six females; mean age 47 +/- 8 years; range: 27-65 years), for either complete (n = 7) or partial (n = 3) mitral valve replacement. Surgery was indicated due to acute endocarditis (n = 3), stenosis (n = 4) or combined mitral valve disease (n = 3). Transesophageal echocardiography (TEE) was performed to determine correct homograft size; these values were compared with intraoperative measurements of valvular dimensions. The function of the implanted grafts was examined intraoperatively by TEE. Follow up included clinical examination, electrocardiography and echocardiography. RESULTS: All patients survived surgery. Intraoperative TEE revealed mild insufficiency (grade I) in six cases and no insufficiency in four. The papillary muscle-mitral annulus distance was the most reliable preoperative echocardiographic parameter to determine the required homograft. Mean pressure gradients were 3.2 +/- 0.7 mmHg for complete and 2.4 +/- 0.5 mmHg for partial homograft replacement. Sinus rhythm was present in all cases at discharge. Mean follow up was 24 months (range: 6-36 months). At six-month and one-year follow up, the pressure gradients had risen slightly to 3.4 +/- 0.6 mmHg (complete) and 2.8 +/- 0.6 mmHg (partial). To date, four patients had competent grafts, and six presented with an insufficiency (grade I). All patients had normal left ventricular function (EF 65 +/- 6%) at their last follow up; there were no signs of endocarditis during the follow up period. CONCLUSION: Mitral homografts for valve replacement or repair are recommended in selected cases in whom conservative reconstruction techniques are not possible. The avoidance of long-term anticoagulation therapy and preservation of left ventricular geometry are clear advantages to other mitral valve prostheses. | 10772040 | 2,000 | 2000-2004 |
Glutaraldehyde detoxification in addition to enhanced amine cross-linking dramatically reduces bioprosthetic tissue calcification in the rat model. | BACKGROUND AND AIM OF THE STUDY: Enhanced fixation of bioprosthetic tissue by both increased concentrations of glutaraldehyde in pericardium; and 17.5%. Optimal reduction in calcification could be achieved with the combined effect of 3.0% GA fixation, L-lysine enhancement and urazole detoxification. When compared with 0.2% GA-fixed tissue, calcification could be reduced by 99.1% in leaflets, 95.9% in pericardium, and 90.8% in aortic wall tissue. CONCLUSION: Removal of excess GA from fixed bioprosthetic tissue was capable of markedly improving the anti-calcific effect of enhanced GA cross-linking. | 10772041 | 2,000 | 2000-2004 |
Glutaraldehyde-induced cross-links: a study of model compounds and commercial bioprosthetic valves. | BACKGROUND AND AIM OF THE STUDY: The treatment of bioprosthetic tissue routinely involves the use of glutaraldehyde, although the specific chemistry of glutaraldehyde fixation is not fully understood. Descriptions of definitive work on this reaction using model compounds are limited. The aim of the present study was to increase our understanding of the chemistry involved in the treatment of collagen-rich tissue with glutaraldehyde. Initially, 6-aminohexanoic acid (6-AHA) was used to model the lysine/hydroxylysine molecules in collagen before studying the more complex chemistry of the tissue. METHODS: The reaction between 0.6% glutaraldehyde and 6-AHA was studied by positive ion electrospray-mass spectroscopy. Untreated, locally treated and commercially produced explanted and non-implanted tissue were hydrolyzed under various conditions and analyzed both directly and after derivatization with 4-chlorophenylhydrazine, 4-bromophenacyl bromide and dansyl chloride by reverse-phase-high performance liquid chromatography-mass spectrometry. RESULTS: The mass spectral data obtained from the reaction of glutaraldehyde with 6-AHA showed the presence of alpha,beta unsaturated aldehydes and their further condensation products involving Michael reactions of glutaraldehyde, Schiff base cross-links and various cyclization products incorporating pyridinium and dihydropyridine ring structures. The only stable cross-link detected was an 'anabilysine'-like compound. Similar structures were present in the tissue, and anabilysine was identified by tandem mass spectrometry. CONCLUSION: The results from the reaction of glutaraldehyde with 6-AHA agree with those published previously. The only detectable stable cross-link definitively identified in treated bioprosthetic tissue was anabilysine. No long-chain polymers of glutaraldehyde were detected. | 10772042 | 2,000 | 2000-2004 |
Receptor-mediated contraction of aortic valve leaflets. | BACKGROUND AND AIM OF THE STUDY: The mechanisms that regulate the function of the aortic valve are not fully understood. Cusp tissue has been shown to have contractile properties, but little is known as to which receptors mediate these effects. METHODS: We have examined, using isolated organ baths, the response of porcine aortic valve leaflets to a range of vasoactive agents including endothelin-1, noradrenaline, adrenaline, the thromboxane, histamine and angiotensin II. The viability of each individual leaflet was tested by the addition of 90 mM KCl. RESULTS: All agents tested, with the exception of angiotensin II, were capable of inducing concentration-dependent contractions of the valve leaflets. The responses to endothelin-1 and U46619 were significantly greater than those of all the other agents tested. Responses to endothelin-1 could be inhibited by 10 M of the TXA2-receptor antagonist SQ30741. CONCLUSION: These results demonstrate the range of receptor systems that can mediate contraction of aortic valve leaflets. Further studies are required to elucidate the role of these receptors in the physiology and pathophysiology of the aortic valve. | 10772043 | 2,000 | 2000-2004 |
Expression of 5-hydroxytryptamine receptor subtype messenger RNA in interstitial cells from human heart valves. | BACKGROUND AND AIM OF THE STUDY: Severe heart valve disorder has been reported in patients receiving a combination of the anorectic drugs fenfluramine and phentermine. The exact molecular mechanisms involved remain unknown. Fenfluramine alters the serotonin level in the brain, while phentermine interferes with the pulmonary clearance of serotonin; these data suggest that serotonin levels affect regulation of valve function. The aim of the present study was to characterize the serotonin receptor (5-hydroxytryptamine) subtypes expressed in the interstitial cells of human heart valves. METHODS: Interstitial cells were isolated and cultured from the aortic, pulmonary, mitral and tricuspid valves of recipient hearts obtained during transplantation. Total RNA was extracted from cultured cells in order to determine gene expression by reverse transcription-polymerase chain reaction (RT-PCR) using 5-hydroxytryptamine (5-HT) subtype-specific primer pairs. RESULTS: The results show that: (i) 5-HT 1B and 1D receptor subtypes are expressed in all four heart valves. This is significant as the 1B and 1D receptor subfamilies are the target of the anti-migraine drug sumatriptan, and these receptors regulate cardiac function and movement; (ii) 5-HT 1A, 5-HT 1E and 5-HT 1F are not expressed in interstitial cells isolated from the valves. CONCLUSION: We conclude that preliminary evidence exists for the presence of distinct subsets of 5-HT receptors in human heart valves, indicating that interstitial cells of the valves potentially respond to serotonin levels. | 10772044 | 2,000 | 2000-2004 |
Mitral regurgitation following percutaneous transvenous mitral commissurotomy: a single-center experience. | BACKGROUND AND AIM OF THE STUDY: Percutaneous transvenous mitral commissurotomy (PTMC) has revolutionized the treatment of patients with symptomatic mitral stenosis and is now established as the procedure of choice. Despite high technical expertise in PTMC using the Inoue balloon, mitral regurgitation (MR) remains a major procedure-related complication. We retrospectively analyzed our data of PTMC using the Inoue balloon with regard to the incidence of MR, its likely causative mechanism, and follow up of these patients. METHODS: During the past ten years, PTMC was performed in 3,650 patients (median age 26 years; range: 8-76 years), of whom 910 (24.9%) were juveniles. Preprocedure mitral valve area (MVA) was 0.9 +/- 0.4 cm2 (range: 0.3-1.3 cm2); MR was mild in 1,396 cases (38.2%), moderate in 394 (10.8%) and severe in 22 (0.6%). None of the patients was rejected on the basis of echocardiographic score. RESULTS: The procedure was successful in 3,276 (89.8%), with post-procedure MVA of 1.7 +/- 0.6 cm2 (range: 1.4-2.6 cm2), and without development of any major complication. Severe MR was seen in 120 patients (3.3%), of whom 66 (1.8%) required urgent mitral valve replacement (MVR). Echocardiography in these latter patients showed leaflet rupture in 48 (72.7%), chordal rupture in 12 (18.2%) and excessive commissural tear in six (9.1%). Fifty-four patients (1.5%) with severe MR post PTMC were followed with medical treatment; echocardiography in these patients revealed chordal rupture in 40 (74.1%) and excessive commissural tear in 14 (25.9%). Follow up data were available in 49 patients (1.3%); 30 (0.8%) required MVR and 19 (0.5%) were in NYHA class II at a median follow up of 24 months. Moderate MR was seen in 188 cases (5.1%), with predominant causative mechanisms of excessive commissural tear in 120 (63.8%) and chordal rupture in 68 (36.2%). Severity of MR worsened in 30 cases (0.8%), of which 20 (0.6%) required elective MVR on follow up. MR decreased in 58 patients (1.6%), in whom excessive commissural tear was the causative mechanism. CONCLUSION: Significant MR (moderate or severe) after PTMC was seen in 308 patients (8.4%), of whom 116 (3.2%) required MVR urgently or on follow up. All patients with leaflet rupture during PTMC developed severe MR and required urgent MVR. There was a tendency for the severity of MR to decrease with time in cases where excessive commissural tear was the causative mechanism. | 10772045 | 2,000 | 2000-2004 |
Transient mitral regurgitation following vagal stimulation-induced ventricular arrhythmia in rabbits: a color Doppler echocardiographic study. | BACKGROUND AND AIM OF THE STUDY: Cervical vagal stimulation in rabbits frequently causes systolic murmur with bigeminy due to premature ventricular contractions. The bigeminy disappears in a few minutes, but the systolic murmur persists for a few days. Peculiar lesions of the mitral valves, mitral annulus and papillary muscles, and an increase in left atrial weight, frequently develop in a week. In this study, color Doppler echocardiography was used to examine whether the systolic murmur was due to mitral regurgitation. METHODS: Echocardiographic monitoring was carried out in anesthetized rabbits restrained in the supine position. RESULTS: Doppler echocardiography and phonocardiography showed systolic murmur at 6 h, three days, and at one, two, three and four weeks after vagal stimulation. At 6 h after stimulation, phonocardiography showed systolic click and late systolic murmur; Doppler echocardiography showed marked mitral regurgitation. The systolic murmur and mitral regurgitation were attenuated and the papillary muscle was swollen three days after vagal stimulation. Following stimulation, mitral regurgitation disappeared within one week, and papillary muscle swelling improved after three weeks. CONCLUSION: Doppler echocardiography confirmed that systolic murmur caused by vagal stimulation in rabbits was due to mitral regurgitation. | 10772046 | 2,000 | 2000-2004 |
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