H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging.

Many diagnostic methods have been used to establish the diagnosis for a suspected H-type tracheoesophageal fistula (TEF). In case of a strong assumption of an H-type fistula, besides all standard diagnostic work-up tools a more aggressive combined approach is advisable. However, in a critically ill premature infant, conventional invasive investigations could not be performed as being potentially hazardous and not always easy to achieve. We describe the unique imaging features of an H-type TEF on magnetic resonance imaging (MRI). Our case demonstrates that MR images could be used for diagnosis, and localization of an H-type TEF could be detected safely and accurately in a sick preterm infant.

Protective effects of N-acetylcysteine on peroxidative changes of the fetal rat lungs whose mothers were exposed to cigarette smoke.

BACKGROUND: This experimental study investigated the protective effects of N-acetylcysteine (NAC) on peroxidative changes in fetal lungs in the offspring of rats exposed to cigarette smoke. METHODS: Thirty fetal rats used for analysis, were divided into three groups as follows: control group (n = 10), whose mothers were exposed to fresh air; group I (n =10), whose mothers were exposed to cigarette smoke; and group II (n =10), whose mothers were exposed to cigarette smoke and given 10 mg/kg per day NAC. In groups I and II, smoke exposure was started 4 weeks before the pregnancy, and continued to the 14th day of pregnancy, and in Group II, NAC was administered intraperitoneally for 14 days. The mothers and their fetuses were decapitated on the 14th day of pregnancy. Malondialdehyde (MDA) and glutathione (GSH) levels were determined in the lung tissues of fetuses to determine the oxidant-antioxidant balance. RESULTS: While tissue MDA levels in Group I were found significantly higher than the control group (129.7+/-65.4 versus 63.4 +/-15.4 nmol/100 mg protein, P <0.05), GSH levels were significantly lower (17.1+/-7.3 versus 45.4 + 8.1 nmol/mg protein, P <0.01). Furthermore, in Group II, MDA levels were significantly lower (56.9+/-20.6 versus 129.7+/-65.4 nmol/100 mg protein, P <0.05), and GSH levels were significantly higher (34.57+/-10.7 versus 17.1+/-7.3 nmol/mg protein, P <0.0001) when compared with Group I. No statistically significant difference was found in tissue MDA and GSH levels between Group II and the control group (P >0.05). CONCLUSIONS: These results suggest that smoke exposure during pregnancy causes oxidative damage in fetal lungs. This smoke-induced damage might be prevented by NAC.

Impaired esophageal reactivity in adriamycin-induced rat esophageal atresia: an in vitro study.

PURPOSE: The aim of this study was to investigate the reactivity of lower esophageal smooth muscle in the Adriamycin-induced esophageal atresia (EA) rat model. METHODS: The fetuses were divided into 3 groups. The control group was exposed to saline. The second group comprised fetuses that were exposed to Adriamycin but in whom EA did not develop. The third group comprised of fetuses that were exposed to Adriamycin and EA was observed. The reactivity of distal esophageal strips was studied in organ chambers. RESULTS: The tension was similar in all groups precontracted with carbachol for the study of relaxation to serotonin. Relaxation of lower esophageal strips to serotonin was comparably unaffected in the control and Adriamycin-no EA groups, whereas it was significantly inhibited in the EA group with decreased E(max) and pD(2) values. Contractile responses of esophageal smooth muscle to carbachol or 80 mmol/L KCl and relaxant responses to papaverine were similar in all groups. No change in agonist potency was observed among the groups. CONCLUSIONS: Our study showed impairment of serotonin-receptor-mediated relaxation; but not of cholinoceptor-mediated contraction of the lower esophageal smooth muscle in the EA. Thus, impaired relaxant responses may be, at least in part, a contributing factor in the esophageal dismotility seen in EA.

Sirenomelia with esophageal atresia.

Sirenomelia, is a rare fatal condition characterized by fusion of the lower extremities. It has been suggested that sirenomelia is a severe form of caudal regression syndrome complex for which the pathogenesis is controversial. Our case is a sirenomelia associated with esophageal atresia and tracheoesophageal fistula. In the literature, it has been pointed out that the VATER association may represent a less severe form of sirenomelia but no sirenomelia case associated with esophageal atresia and tracheoesophageal fistula has been found. Finally, we detected a single large artery which diverts the blood of the embryo's caudal part to the placenta with the detailed autopsy especially with focusing on the abdominal vasculature. This vascular steal is thought to be the main pathogenic mechanism of the condition.