Outcomes among preterm infants with patent ductus arteriosus: Relationship with treatment, gestational age, hemodynamic status and timing of treatment.

BACKGROUND: There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. STUDY DESIGN: This retrospective case-control study including infants < 1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios. RESULTS: The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7-4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0-3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6-6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated. CONCLUSION: Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP.

Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial.

OBJECTIVE: Disagreement exists concerning the appropriate delivery room management of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such neonates, whereas others advocate a selective approach. We performed this investigation: 1) to assess whether intubation and suctioning of apparently vigorous, meconium-stained neonates would reduce the incidence of meconium aspiration syndrome (MAS); and 2) to determine the frequency of complications from delivery room intubation and suctioning of such infants. METHODS: Inclusion criteria included: 1) gestational age >/=37 weeks; 2) birth through meconium-stained amniotic fluid of any consistency; and 3) apparent vigor immediately after birth. Subjects were randomized to be intubated and suctioned (INT) or to expectant management (EXP). Primary outcome measures included: 1) the incidence of respiratory distress, including MAS, and 2) the incidence of complications from intubation. RESULTS: A total of 2094 neonates were enrolled from 12 participating centers (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demonstrated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings attributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the development of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 successfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in nature. CONCLUSIONS: Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived.

[The role of the surgeon in treating multiple organ failure]. / Roliata na khirurga pri tretiraneto na mnogoorgannata nedostatuchnost.

Over the period 1990 through 1995, thirty-five patients with multiorgan insufficiency (MOI) undergo treatment. Abdominal operations are performed in all of them, except for one male patient aged 31 years, dying of bilateral pneumonia and metabolic disorders resulting from duodenal stenosis. Overall mortality rate amounts to 77 per cent (20 cases). Programmed peritoneal lavage (PPL) is done in seventeen patients with lethality 77 per cent (13 cases). In two instances iatrogenic damage to the spleen contribute to fatal septic complications development. All PPL treated patients with fatal outcome have bilateral pneumonia. MOI prevention is still closely linked to prophylaxis against the complications producing it. Programmed peritoneal lavage in immunocompromised and malnourished patients is a risk factor equally serious as the septic noxa being attacked, and what is more it runs the risk of inflicting additional iatrogenic noxae. General endotracheal anesthesia in PPL is likewise a factor demanding further clarification.

Identification of mycobacteria by conventional methods.

The methodology and use of the conventional tests employed in the identification of the currently recognized human mycobacterial pathogens are reviewed. The common disease presentations of each species are briefly noted. Tabular summaries of the phenotypic characteristics of these organisms have also been provided. It should be re-emphasized that the use of conventional methods, unlike the rapid methods now available, is not recommended for the initial identification of the M. tuberculosis complex. We also urge caution in the identification of unfamiliar or atypical isolates. It is to be expected that additional species of human mycobacterial pathogens will be characterized in the future; many of these may be represented by isolates that differ phenotypically little, if at all, from species currently recognized.

Mucormycosis in a patient with sarcoidosis.

Mucormycosis is a rare complication of sarcoidosis. We report only the third instance of mucormycosis occurring in a patient with sarcoidosis. Corticosteroid therapy, even short courses of less than one month duration, appears to be a major risk factor for the development of mucormycosis. Mucormycosis should be suspected upon the development of signs and symptoms of chronic sinusitis, necrotic nasal discharge, proptosis or periorbital edema. Mucormycosis is confirmed on routine hematoxylin and eosin stains by the identification of tissue invasion by the broad, aseptate mucor fungi. Prompt identification of the infection is essential to reduce morbidity and prevent mortality.

[Our experience with the surgical treatment of cholelithiasis]. / Nashiiat opit ot khirurgichnoto lechenie na zhluchnokamennata bolest.

The treatment results in 312 patients with cholelithiasis, covering the period 1989 to 1993, are retrospectively analyzed. Overall postoperative lethality amounts to 4.4 per cent. The obtained results are fully comparable in terms of both missed concrements left behind within the extrahepatic bile ducts, and in terms of postoperative complications, associated with the indications for choledochotomy. This is attributed to the therapeutic approach algorithm adopted with respect to the indications for intraoperative cholangiography and choledochotomy.

Rapid method for presumptive identification of Corynebacterium jeikeium.

Corynebacterium jeikeium causes systemic infections, particularly in immunocompromised hosts. A minitube assay has been developed for the presumptive identification of C. jeikeium. With our rapid sucrose-urea test and conventional biochemical tests, sixty isolates of gram-positive, catalase-positive bacilli were identified in our laboratory. Results indicated that our assay has a sensitivity of 100% and a specificity of 90%.

Intensity of thrombin activity and surgical trauma.

Increased level of in vivo thrombin activity represents the essential mark of prethrombotic state. In order to assess the influence of surgical trauma on the constitution of prethrombotic state immediately after the surgical intervention, dynamic estimations of fibrinopeptide A (FPA) have been done in a group of 18 patients who had undergone abdominal surgery and in the group of 25 patients who underwent the replacement of artificial hip, and who were on preventive treatment with subcutaneous heparin. At the same time the presence of soluble fibrinmonomer complex and, in the group of patients on heparin treatment, the concentration of plasma heparin were examined. The investigations were done before the surgical intervention and on the first, third and seventh postoperative day. Our dynamic study showed the existence of certain relation between the surgical trauma and values of FPA which were the expression of intensity of in vivo thrombin activity. The mean values of FPA increased markedly on the first postoperative day in comparison with the preoperative levels. On the third postoperative day significant reduction of FPA was observed and on the seventh day marked increase was found only in patients who were not on heparin prevention. Although preventive application of subcutaneous heparin did not affect the whole blood coagulability it showed a suppressive impact on the thrombin activity level in examined surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of oxytocin on the blood glucose concentration.

Blood-glucose concentration is tested in male volunteers before and on the 1st, 3rd, 7th, 15th, 20th, 30th and 60th min after intravenous administration of oxytocin in doses of 0.1 IU/kg. In the first minutes after the injection there is a hypoglycaemic tendency in the changes of the blood glucose concentration, maintained in 60 per cent of the cases, while in the remaining subjects slight hyperglycaemia after the 7th min is observed. Simultaneously, hyperemia of the skin, moderate decrease in the diastolic blood pressure and tachycardia are observed. The effect of oxytocin is associated with increased influx of blood in the adipose tissue, where the glucose is metabolized with the involvement of the specific oxytocin receptors. The late hypoglycaemia is associated with oxytocin-inhibited insulin decomposition, the hyperglycaemia--with the domination of the sympathoadrenal activation in some of the subjects examined. A conclusion is reached that the effect of oxytocin on carbohydrate metabolism is physiologically unimportant.