Prenatally Diagnosed Isolated Coronary Arterial Fistula Leading to Severe Complications at Birth.

Prenatal diagnosis of a huge coronary artery fistula between the left coronary artery and the right ventricle was made by Doppler echocardiography at 22 weeks of gestation. Progression of the dilated fistula was monitored throughout pregnancy. The size of the fistula increased enormously up to 11 mm. Death occurred at birth. Monitoring of these fetuses is essential as severe complications can occur during pregnancy or at birth.

Influence of gestational diabetes on fetal autonomic nervous system: a study using phase-rectified signal-averaging analysis.

OBJECTIVES: Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA. METHODS: This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria. RESULTS: Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry. CONCLUSIONS: Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Women with congenital heart disease: long-term outcomes after pregnancy.

BACKGROUND: Pregnancy in women with congenital cardiac disease is more frequent due to an increased lifespan and improved health situations. However, the long-term outcomes in these women are not known. METHODS: We analysed 267 consecutive pregnant women with congenital heart defects who were seen at the German Heart Centre Berlin. This retrospective study included analysis of long-term follow-up data after pregnancy and standard maternal cardiac, obstetric and neonatal outcomes. The long-term data (n = 103) were acquired with a self-assessment questionnaire from each patient. The main primary outcomes of the study included functional class, health, work capability and physical activity. RESULTS: The median age of the patients at delivery was 27 years (range 17-43 years). The median follow-up of all patients was 11 years (range 1-49 years). Twenty-four percent exhibited complex cardiac defects. Primary long-term outcomes included good health in 61 % of the patients. Approximately 68 % worked, and 76 % engaged in physical activity. Thirty-three percent of the women who answered the questionnaire demonstrated a decrease in functional class during pregnancy, but more than two-thirds of these patients subsequently improved. Secondary short-term outcomes included a 4 % miscarriage rate and a 4 % induced abortion rate. The maternal cardiac data revealed that 30 % of the patients lost at least one functional class during pregnancy. Onset arrhythmias were observed in 12 % of the patients. The most prevalent neonatal complication was premature birth, which was present in 12 % of the neonates. CONCLUSION: Two-thirds of the patients tolerated pregnancy without cardiovascular complications. Most patients displayed good long-term health, work capability and physical activity outcomes. Further prospective controlled studies are necessary to confirm these results and safely advise pregnant women.

[Neonatal intracerebral bleeding as initial symptom of gliomatosis cerebri WHO III--neurological outcome after partial hemispherectomy]. / Eine neonatale intrazerebrale Blutung als Initialsymptom einer Gliomatosis cerebri WHO III--neurologisches Outcome nach partieller Hemisphärektomie.

INTRODUCTION: Anaplastic astrocytomas presenting as gliomatosis cerebri in neonates are extremely rare. Tumours in newborns are mostly of neuroectodermal origin. CASE REPORT: We report about a female newborn at term [birth weight 3 600 g (P 90), head circumference 35 cm (P 95) APGAR 9/10/10] with an intracerebral partially clotted bleeding in the left parieto-occipital region. The bleeding was expansive leading to axial and lateral cerebral herniation. The intracerebral bleeding in the left occipital region was surgically removed. Macroscopically no solid tumour was seen, but small fragments of an anaplastic astrocytic tumour (WHO grade III) were diagnosed histologically. After surgery, no remaining tumour was visible in the MRI. 6 weeks later, a recurrent tumour (4×4 cm) was found in the area of the initial bleeding. Further treatment was initially refused by the parents. The child was readmitted to our hospital at the age of 11 months in good clinical condition and presented with left-sided hemiparesis, right-sided hemianopsia and intermittent strabismus convergens alternans. Because of the good clinical condition further therapeutic treatment was initiated. Due to the final extension of the tumour into the temporal, parietal and occipital lobes, a gliomatosis cerebri WHO III was diagnosed. An extended partial hemispherectomy was done. After neurosurgery, no further neurological failures occurred. In the follow-up examination, MRI showed no relapse of the tumour. Chemotherapy according to the HIT SKK protocol was initiated. A relapse did not occur over a follow-up of 2 years. CONCLUSION: This is a rare case report of a congenital gliomatosis cerebri WHO grade III, treated with partial hemispherectomy, leading to a good clinical and neurological long-term outcome.

[A new method in fetal heart electrophysiology - fetal magnetocardiography]. / Neue Möglichkeiten der fetalen Herzdiagnostik - fetale Magnetkardiografie.

Fetal magnetocardiography (fMCG) is used as a non-invasive method for registering the electrophysiological fetal heart activity. Superconducting quantum interference device-based magnetometers are currently used to make fMCG recordings. In contrast to fetal ECG, this method is independent of signal loss due to isolating factors such as, especially, the vernix caesaroa between the 27th and 34th weeks of gestation. We report about a term newborn with a third degree AV block, examined by this method.

[Chronic wounds--perspective for integrated care]. / Chronische Wunden--Perspektiven der integrierten Versorgung.

In Germany more than 4.5 million people are treated for chronic wounds per year with resulting costs for the public health system up to five billion Euro. Within the next 30 years, the demographic development will result in a doubling of these numbers of patients. On the other hand, the social security systems have decreasing resources and are confronted with rising costs of modern medicine. New legislation was designed to limit costs and to enable new ways of cooperation between hospitals and practioners ("Intergrierte Versorgung" = IV) aside of fixed budgets. According to German legislation, the contract is made between practitioners, hospitals, rehabilitation units and homecare companies on the one hand and public health insurance companies on the other hand. When designing special contracts for IV, the strategic interests and expectations of the partners have to be analysed. In these complex models, financial as well as bureaucratic and others aspects of health care are to be considered including quality assessment. In the case of chronic wounds, specific in- and exclusion criteria, duration of the treatment period and clear end-points (treatment success or failure) have to be defined. Optimizing clinical pathways as well as improved process management should be possible with IV. Low-volume contracts with limited duration and well defined clinical features are probably the best way to establish IV for chronic wounds.

[Heparin-induced thrombocytopenia. Case report]. / Die Heparin-induzierte Thrombozytopenie. Beobachtungen im eigenen Krankengut.

This article deals with the causality between perioperative heparin thrombosis prophylaxis and the appearance of acute vessel occlusion. Already 1948 Fidlar and Jaques described this relationship. Today heparin-induced thrombocytopenia (HIT) is a well known illness, but nevertheless vascular complications occur regularly. By means of three case reports problems in diagnosis and therapy of HIT are discussed. Because of the possibility of serious complications including death of the patient prevention methods and early diagnosis of HIT are recommended.

[Compartment syndrome and Volkmann contracture--can they be prevented in supracondylar humerus fracture?]. / Das Compartmentsyndrom und die Volkmann-Kontraktur--sind sie bei der supracondylären Humerusfraktur vermeidbar?

The arterial blood supply of the arm is unique, as the collateral circulation is especially good. Because of this anatomic perculiarity it is possible to deal with lack of peripheral pulse without critical ischemia occurring in fractures in the elbow region. We present two children with supracondylar fractures of the humerus with damage to the brachial artery and the different management results. It is necessary to carry out the immediate diagnostic and therapeutic procedures in order to prevent late complications. We conclude that Volkmann's ischemic contracture can always be prevented.

[Arterial vascular injuries in hip prosthesis implantation]. / Arterielle Gefässverletzungen bei Hüftprothesenimplantation.

Implantation of total endoprosthesis (TEP) is an established method for the operative therapy of acute and chronic hip dysfunction. Beside septic complications iatrogenic injuries of the vascular system regularly occur. Immediate and adequate therapy is necessary in order to prevent loss of an extremity or even patients death. We present three patients with major vascular injuries during hip joint operations. In two patients was the external iliac artery and in one the femoral common artery injured. The cases were managed with PTFE- or Dacron-interposition. The problem of vascular injuries associated with the implantation of total hip joint endoprosthesis will be discussed and the avoidable of most vascular lesions is underlined.