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Although venoarterial extracorporeal membrane oxygenation (ECMO) is an accepted form of cardiopulmonary support for critically ill neonates, carotid artery reconstruction (CAR) after decannulation remains controversial. Long-term follow-up information regarding the natural progression of the anastomosis is unavailable. From January 1990 through December 1990, 13 venoarterial neonatal ECMO survivors had CAR performed and were enrolled into this prospective study based on sonographic follow-up of CAR. A total of 34 carotid artery sonographic studies were performed (13 within 1 week after reconstruction, 8 at 6 to 9 months, and 13 at 4 years of age). A high patency rate during the neonatal period was observed (12 of 13, 92%). Among 12 children with normal neonatal sonographic studies, 5 had completely normal studies during 4 years of follow-up. Narrowing at the anastomotic site (defined as structural narrowing with velocity ratio of peak systolic velocity at the anastomosis to peak systolic velocity proximal to the anastomosis > 1.0 but < or =2.0) by 4 years of age developed in 7 children. Two of these 7 children had hemodynamically significant stenotic anastomosis (defined as structural narrowing with velocity ratio >2.0) by 4 years of age. One neonate had a narrowed anastomosis that resolved completely by the age of 4 years. The incidence of normal studies decreased from 92% to 75% to 46% during the neonatal period, at 6 to 9 months, and at 4 years follow-up, respectively (Chi-square test for trend, P < .01). Long-term follow-up information on the natural progression of carotid reanastomosis is required.

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BACKGROUND: Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectable intracranial lesions. Present nomenclature and classifications of parenchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Regionalized perinatal and neonatal care enables population-based studies of these lesions and subsequent outcomes. METHODS: Two- to 3-year outcomes of neonates weighing 500 through 1249 g born in Alberta to Alberta residents during 1987 through 1990 were reviewed in relation to neonatal cerebral ultrasound lesions. Odds ratios and confidence limits for disability were calculated. RESULTS: Of 960 live births in this weight group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebral palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; and projected dependent disability, 1.4%. Lesions considered to be predictive of disability on ultrasound (excluding germinal layer hemorrhage) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic periventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of multiply disabled children, and all children projected to become dependently disabled had parenchymal lesions with or without IVH. Triple lesions of IVH, cerebral ventriculomegaly, and intraparenchymal periventricular echodensity gave an odds ratio for disability of 50. Transient lesions had significant risk. CONCLUSIONS: This province-based study provides a descriptive scheme of serial neonatal cerebral ultrasound lesions and outcome considered useful for clinicians caring for newborns of lowest gestational ages. The overall incidence of parenchymal lesions was lower than frequently reported. Combinations of lesions were linked to increased incidence, complexity, and severity of childhood disability.

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We report 3 cases of primary transitional cell carcinoma of the bladder presenting during pregnancy. Only 10 such cases have been reported in the literature. Patient age ranged from 23 to 24 years at 15 to 24 weeks of gestation. Only 1 of the 3 patients presented with gross hematuria and this was initially mistaken as vaginal bleeding. Initial diagnosis in all cases was made with sonography. Diagnosis then was easily confirmed by cystoscopy and treatment was uneventful. Transurethral resection did not present a problem. All patients had single papillary superficial tumors (stage Ta, grades 1 and 2). Pregnancy was not affected in any case. Diagnosis and prompt treatment are emphasized.

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We report two patients with synovial sarcoma of the foot. Both presented with a soft-tissue mass that exhibited calcification. Although the radiologic findings are non-specific, the presence of foci of calcification within the soft-tissue mass is suggestive of synovial sarcoma. Computed tomography shows the extent of the mass, soft-tissue calcification and bone destruction thus helping in earlier detection and more accurate staging.

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Diverticulosis of the vermiform appendix is not a common entity. Due to possible complications resulting from this lesion the discovery of an appendiceal diverticulum on barium studies should not be overlooked and may be an indication for appendectomy.

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