Modified Blalock-Taussig shunt using allograft saphenous vein: six years' experience.

BACKGROUND: The occurrence of life-threatening late infectious complications after the use of expanded polytetrafluoroethylene conduits as modified Blalock-Taussig shunts prompted us to apply allograft saphenous veins instead. METHODS: In 23 cyanotic patients (age, 1 week to 18 years) allograft saphenous veins were used for performing Blalock-Taussig shunts from July 1989 onward. Veins stored in Hank's solution were implanted in 8 patients and cryopreserved ones in 15. All patients were followed up regularly up to 15 months. RESULTS: There were two early and two late deaths: none were related to shunt occlusion. Clinical, angiographic, and echocardiographic studies proved that, except for one early occlusion, all shunts were patent and functioning well after an average of 41 months. Donor cells disappeared 1 to 3 days after implantation, and several months after the operation both the wall and the luminal surface of the grafts were repopulated with cells possibly of recipient origin. No difference was found between veins stored in Hank's solution only and cryo-preserved grafts, concerning clinical outcome and histology. CONCLUSIONS: Allograft saphenous veins function well as modified Blalock-Taussig shunts at least up to 6 years. Owing to the good results and lack of complications their clinical use is recommended.

Further evidence for endogenous hypothalamic serotonergic neurons involved in the cimetidine-induced prolactin release in the rat.

The aim of the present work was to further explore the possible relationship between the prolactin-releasing effect of cimetidine and hypothalamic serotonergic neurons controlling pituitary hormone secretion. In a first approach, the prolactin-releasing effect of the drug was determined in adult male rats with total deafferentation of the hypothalamus. Cimetidine injection (60 mg/kg) produced a significant rise in prolactin, but not in luteinizing hormone (LH), both in deafferented rat and in sham-operated controls; by 15 min there was a 5-6 fold increase in prolactin titers. Methysergide, a serotonin receptor blocker, used in a dose (2.5 mg/kg), route (i.p.) and time (50 min earlier) which did not modify the hormone basal level in rats with total deafferentation of the hypothalamus, was able to prevent completely the prolactin release evoked by cimetidine. The same preventive effect on prolactin release was observed with the serotonin receptor blocker ketanserin (5 mg/kg, i.p., 30 min earlier). It is concluded that the prolactin-releasing effect of cimetidine is located at a hypothalamic level related to serotonergic neurons.

Autopsy study of cerebral complications of congenital heart disease and cardiac surgery.

Detailed histological investigation of the brains of 45 neonates, infants and children who had died of various congenital heart defects revealed that the damage to the white matter occurred mostly below 3 months of age, while that to the grey matter occurred above this age. The lesions (glial fatty metamorphosis, telencephalic leucoencephalopathy, focal white matter necrosis, focal nerve cell pyknosis and symmetrical cortical necrosis) were often combined with each other. The necroses were generally not a consequence of microembolization. Various cerebral complications occurred in most of the patients who had undergone cardiac surgery. However, the various cerebral lesions each had several causes and in general the accumulation of predisposing damaging noxae resulted in more serious changes.

Baclofen, a GABA derivative, inhibits stress-induced prolactin release in the rat.

The effect of baclofen, beta-(4-chlorophenyl)GABA, on prolactin secretion was investigated in rats under several experimental conditions. In adult male rats subjected either to immuobilization, ether, swimming or cold stress there was a rapid increase of serum prolactin levels; acute pretreatment with baclofen, 10 mg/kg i.p. inhibited the hormone response to all these stresses. The same blocking effect of the drug was observed in prepubertal male and female rats and in adult gonadectomized animals. In basal conditions, i.e. in undisturbed male rats, baclofen did not change the hormone titers significantly. Taken together our results indicate that baclofen blocks prolactin release when release of the hormone is dynamically stimulated by stress and this effect is relatively independent of the endocrine status of the rat.

[The importance of Doppler echocardiography in the differential diagnosis of causes of neonatal cyanosis]. / Az echo-Doppler-vizsgálat jelentösége az újszülöttkori cyanosisok elkülönítö diagnózisában.

The authors report 329 dopplerechocardiographic examinations performed on 167 term and preterm newborn babies presenting cyanosis. Seventy-six congenital heart defects were detected among their patients, 12 of whom were operated without heart catheterization, according to the ultrasound finding. The diagnosis of ten inoperable heart diseases established without hemodynamic examination was confirmed by autopsy. Cyanosis due to cardiac and pulmonary abnormalities without congenital heart defect was diagnosed in 38 patients. Persistent ductus arteriosus was found in 45 very lowbirth-weight premature babies. Doppler echocardiography proved to be a major advance in the differential diagnosis of newborn cyanosis and in choosing appropriate therapy.

[Experience with percutaneous endoscopic gastrostomy in the nutrition of a patient with 3rd and 4th degree facial burns]. / Percutan endoszkópos gastrostomán át táplált III-IV. fokú arcégett beteg kezelésével nyert tapasztalataink.

Recovery after thermal injury depends in great proportion on nutrition. A major problem is accounted in patients with facial burn, because they can not be nourished per vias naturales. Eliminating disadvantages of parenteral nutrition, but utilizing the advantages of enteral nutrition, we have tried a new method of treatment in a patient whose case is presented. On the second day after injury a percutaneous endoscopic gastrostomy was made. On the 7th day after injury and on the 4th day from the beginning of enteral nutrition complete intake of food and liquid was assured through the percutaneous endoscopic gastrostoma. We had no complication related to the gastrostoma. Nutrition through the percutaneous endoscopic gastrostoma at our patient provided a "natural" route to assure liquid, electrolite and energy balance, prevented atrophy of intestinal mucosa and its metabolic and immunologic complications. With the use of percutaneous endoscopic gastrostoma the possible complications of central line catheter were omitted. Our opinion is that percutaneous endoscopic gastrostomy is a safe and effective method for the clinical nutrition of burned patients.

[Modified Blalock-Taussig shunt using a saphenous vein allograft. Five-year experience]. / Módosított Blalock-Taussig-shuntök allograft vena saphena alkalmazásával. Ot év tapasztalatai.

From July 1989 to June 1994 23 modified Blalock-Taussig shunts were performed using allograft saphenous veins. Veins stored in Hank's solution were implanted in 8, and cryopreserved ones were used in 15 cases. No operative death, bleeding, or infectious complication has occurred. There were 2 early and 2 late deaths, none was related to shunt occlusion. Clinical, angiographic and echocardiographic investigations proved that the rest of the shunts are still patent and functioning well after an average of 30 months follow up. Histological studies showed that donor cells have been replaced after several months with recipient cells both in the wall and at the luminal surface of the grafts. No difference was found between veins stored in Hank's solution and cryopreserved grafts concerning clinical outcome and histology.