Successful intrauterine treatment with radiofrequency ablation in a case of acardiac twin pregnancy complicated with a hydropic pump twin.

Twin reversed arterial perfusion sequence is a serious complication of monochorionic twin pregnancy, as the pump twin that perfuses blood to the acardiac twin may experience heart failure and fetal hydrops resulting in a poor perinatal outcome. A woman with an acardiac twin pregnancy complicated by a hydropic pump twin underwent intrauterine treatment with radiofrequency ablation (RFA) at 27 weeks of gestation. Obliteration of blood flow to the acardiac twin from the pump twin was successful. Fetal hydrops resolved by the time of delivery at 32 weeks of gestation, in spite of transient deterioration, and a good postnatal outcome was achieved for the pump twin. We found that RFA was an effective intrauterine treatment for acardiac twin pregnancy and suggest that it could be introduced in cases complicated by a hydropic pump twin.

Asymmetric arthrogryposis multiplex congenita with focal pachygyria.

A male infant with predominantly right-sided arthrogryposis multiplex congenita is presented. His posture in the lower extremities was asymmetric, and left thoracic scoliosis was present. This patient also manifested focal pachygyria dominantly affecting the contralateral cerebral hemisphere and hypoplasia of the corpus callosum, brainstem, and cerebellar vermis. Generalized tonic seizures began at 2 months of age, and an electroencephalogram revealed epileptic discharge. Biopsy of the right biceps revealed a nonspecific change. A direct causal relationship between neuronal migration disorders and arthrogryposis multiplex congenita has not been established, but considering the abnormal neuronal migration along the entire neural axis in focal pachygyria, the predominantly right-sided arthrogryposis in this patient was speculated to be closely related to the pachygyria of the frontal and temporal lobes dominantly affected in the left cerebral hemisphere.

Techniques available for the management of massive sacrococcygeal teratomas.

An infant born in the 34th week of gestation weighing 5,355 g with a massive sacrococcygeal (SC) tumor was delivered by elective cesarean section. An ultrasonographic examination showed solid and cystic components in the tumor. Resection was successfully undertaken with insertion of a Nélaton catheter into the rectum to avoid unnecessary impairment of the viscera. The tumor weighed 2,380 g, measured 25 x 14 x 11 cm, and was clinicopathologically diagnosed to be a SC teratoma. This experience and other publications show that several considerations including control of hemorrhage and coagulopathies, visceral protection, and avoidance of wound infection are necessary to facilitate the surgical management of massive SC tumors. Several suggestions are made concerning the pre- and intraoperative management of this rare tumor.

A prospective clinical study on inhaled nitric oxide therapy for neonates in Japan.

BACKGROUND: This is the first report about a prospective clinical investigation to study the efficacy and safety of nitric oxide (NO) inhalation in infants with persistent pulmonary hypertension of the newborn (PPHN) in Japan. METHODS: Patients in the present study had to meet the following entry criteria: (i) they had to be younger than 7 days of age; (ii) they had to have evidence of PPHN as defined by echocardiograph; (iii) they had to have severe systemic hypoxemia under mechanical ventilation at 100% oxygen supplementation; and (iv) they had to have a failure to respond to conventional therapies. Patients were excluded from this trial if they had any of the following: hypoplastic lung, structural cardiac lesions or severe multiple anomalies. RESULTS: Nitric oxide inhalation therapy was performed in 68 infants who had severe PPHN at 18 hospitals between May 1995 and May 1997. At birth, 21 of 68 infants (31%) weighed less than 1,500 g and 39 infants weighed more than 2,500 g. The diagnoses associated with PPHN were as follows: 27 infants had meconium aspiration syndrome, 15 infants had dry lung syndrome, nine infants had congenital diaphragmatic hernia, six infants had respiratory distress syndrome, three infants had pneumonia and eight infants had other diagnoses. The mean oxygenation index (OI) before NO inhalation therapy in 68 infants was 43.2; 55 infants (81%) had good responses. CONCLUSIONS: These results may be valuable for further randomized controlled and double-blind trials in Japan to evaluate whether NO inhalation therapy is more effective than conventional therapy in infants with severe PPHN.

[Developmental plasticity of corticospinal projections in the spinal cord gray matter of normal and hemicortectomized rat].

In the previous study we demonstrated in rats that aberrant ipsilateral CST fibers were increased when the cerebral cortex was surgically ablated unilaterally during the neonatal period. Origin of these aberrant fibers was confirmed to involve collateral axons, ramified from their parent axons. In this study, possible plastic change and the critical period for the outgrowth of CST fibers into the spinal cord gray matter in the rat after unilateral (right side) cortical damage at different ages measured in days were examined using anterograde horseradish peroxidase (HRP). HRP was injected into the left sensorimotor cortex in both normal and experimental rats. In the normal control rats, the outgrowth of HRP positive axons into the spinal gray matter was first noticed at 7 day of age in the vicinity of the right dorsal funiculus, and then reached maximal density and extension at 10 and 14 days of age, respectively. From 21 days onwards, the density and extension of HRP positive axons in the gray matter decreased rapidly except in the medial part close to the dorsal funiculus. In rats whose right cerebral cortex were damaged at day 1 of age, the pattern of the outgrowth of HRP positive axons into the right gray matter was much the same as that in age-matched controls. However, significantly different from the control, many HRP positive axons were noted even in the contralateral gray matter. HRP-positive axons in the contralateral left gray matter were also abundant in the rats who sustained cortical damage at 7 and 14 days, but were decreased considerably when the cerebral cortex was damaged at 28 days of age. When damage occurred at 56 days of age, HRP-positive axons did not increase in the left gray matter, indicating that the critical period of axonal plasticity after localized damage was before 4 weeks of age in rats.

Glial responses to hypoxic/ischemic encephalopathy in neonatal rat cerebrum.

This study was undertaken to examine glial responses in the immature rat brain to hypoxic/ischemic injury. The results indicate that developing microglia are the first and principle glial element that responds to hypoxic/ischemic injury during the neonatal period. The astrocyte response occurs later and macrophage infiltration may be delayed or absent.

Cervical cord birth injury and subsequent development of syringomyelia: a case report.

A 2830 g full-term baby, born by breech delivery, exhibited weak crying and sucking and severe hypotonia of the extremities after birth. Magnetic resonance imaging (MRI) showed marked thinning of the cervical cord at the level of C4 and C5. This lesion evolved into focal syringomyelia by the fourth month after birth. In this patient, MRI was useful in detecting the initial spinal cord injury, which appeared as marked thinning, and the subsequent syringomyelia as well. The role of birth trauma in cervical spinal cord injuries is discussed.

[Neural plasticity after neonatal hypoxic and ischemic insult in rats].

Rats with huge porencephaly occupying the left cerebral hemisphere were used for this study. Porencephaly was caused experimentally by the ligation of the left common carotid artery and subsequent hypoxic exposure at the age of 7 days. A large band of horseradish peroxidase (HRP) positive fibers was found crossing at the pyramidal decussation to reach the contra-lateral corticospinal tract and the deeper part of the funiculus, in the cervical cord. However, a small band of HRP positive fibers was noticed to reach the ipsilateral corticospinal tract without crossing at the pyramidal decussation. This result indicates that the developing pyramidal neurons in the right hemisphere carry the plasticity even after suffering from considerable hypoxia.

Clinical and electroencephalographical follow-up study of early myoclonic encephalopathy.

We report a clinico-electroencephalographical follow-up study on a male patient with early myoclonic encephalopathy. Frequent massive and fragmentary myoclonic seizures, and myoclonic-clonic seizures were the initial symptoms at the age of 3 days. EEG revealed a suppression-burst pattern at the onset in which burst phases often coincided with myoclonic seizures. Subsequently, non-epileptic erratic myoclonus, various partial seizures and flexor spasms were observed. The partial seizures ceased at around 4 months of age, while the non-epileptic myoclonus and flexor spasms have persisted beyond the age of 6 months. The EEG pattern evolved into atypical hypsarhythmia at two months of age. No specific biochemical or neuroradiological findings were disclosed. His neuropsychiatric development was arrested from the onset. These observations suggest that early myoclonic encephalopathy is an independent epileptic syndrome and that it might be different from early-infantile epileptic encephalopathy described by Ohtahara.