Ca(2+)-inhibitable adenylyl cyclase and pulmonary microvascular permeability.

Intracellular mechanisms responsible for endothelial cell disruption are unknown, although either elevated cytosolic Ca2+ ([Ca2+]i) or decreased adenosine 3',5'-cyclic monophosphate (cAMP) promotes permeability. Recent identification that Ca(2+)-inhibitable adenylyl cyclase establishes an inverse relationship between [Ca2+]i and cAMP in macrovascular endothelial cells provided a possible mechanism of development of permeability. However, these data utilized an in vitro model; lacking was evidence supporting 1) expression of Ca(2+)-inhibitable adenylyl cyclase in pulmonary microvascular endothelium and 2) Ca2+ inhibition of adenylyl cyclase and cAMP content as a paradigm for inflammatory mediator-induced permeability in the intact circulation. We therefore addressed these issues in microvascular endothelial cells derived from rat lung and in an isolated perfused rat lung preparation. Results demonstrate expression of a Ca(2+)-inhibitable adenylyl cyclase in microvascular endothelial cells. Furthermore, data suggest that Ca2+ inhibition of adenylyl cyclase is necessary for development of microvascular permeability in the intact circulation. We conclude Ca2+ inhibition of cAMP represents a critical step in genesis of microvascular permeability in the intact pulmonary circulation.

[Results of prenatal echographic studies in the diagnosis of pediatric surgical abnormalities]. / De resultaten van prenataal echoscopisch onderzoek bij de opsporing van specifieke kinderchirurgische afwijkingen.

In 180 newborns with congenital anatomical anomalies, admitted to the Department of Paediatric Surgery, Sophia Children's Hospital, Rotterdam, we retrospectively determined whether ultrasound studies had been performed during the second and third trimesters of pregnancy. The correlation between prenatal and postnatal diagnoses was investigated as well. Ultrasound study had been performed in 86 if the 180 pregnant mothers (48%). In 41 cases the anomaly of the newborn had not been diagnosed prenatally. In 45 cases anomaly had been diagnosed prenatally. The ultimate diagnosis was the same as the prenatal diagnosis in 35 patients and was different in 10. We conclude that routine prenatal ultrasound study in the second or third trimester of pregnancy, aimed at detecting congenital anatomical anomalies to be treated by the (general) paediatric surgeon, provided little certainty about the health of the baby. Permanent education of obstetricians, and at the slightest doubt referral to one of the University Hospital Centres for specific ultrasound study, are mandatory in order to be able to correctly inform an increasing number of parents about the prospects of their unborn child.

[Parents' reactions to the birth of a child with a congenital anatomical abnormality: an exploratory study]. / De reacties van ouders op de geboorte van een kind met een aangeboren anatomische afwijking: een oriënterend onderzoek.

In an exploratory study of 12 couples the emotional reactions to the birth of a child with extensive anatomical malformation were investigated retrospectively, using semistructured interviews (on average 18 months after the birth). The couples were selected from the group of parents of children admitted between January 1986 and August 1988 to the Paediatric Intensive Care Unit of the Sophia Hospital, Rotterdam. The couples were divided into three groups: those who had had no ultrasonography during the pregnancy (n = 4), those in whom ultrasonography during pregnancy had revealed a foetal abnormality (n = 4) and those in whose children no such diagnoses had been made at ultrasonography during pregnancy (n = 4). After the birth of a child with congenital abnormalities, most parental couples displayed a shock reaction, denial, anger and hurt. In general there was no difference in emotional reaction between the three groups. In all couples the mourning process appeared to have begun only after the birth. Parents of a child with clearly visible abnormalities appeared to have more problems. Two-thirds of the couples had accepted the child's anomaly after some time. Persistent anger, feelings of guilt and anxiety are probably due to uncertainty regarding complications in the child or another pregnancy. Teams treating a child with a congenital anomaly should be aware of the consequences for the parents and should regard support of the parents as an essential part of their task.