RESUMEN
BACKGROUND: In preterm labour prenatal transfer of the pregnant woman to perinatal centres or subspecialty hospitals is thought to improve outcome of very low birth weight infants (VLBW). Can preterm labour diagnosed early enough? MATERIAL: Records of the neonatal referral centre at the Ulm University Hospital (1974-2003) and of the regional neonatal working group (1986-2003). RESULTS: The rate of inborn VLBW infants increased from 40 to 95-100%. CONCLUSION: It was possible to diagnose preterm labour early enough for prenatal transfer. DISCUSSION: On the strength of past experience it may be assumed that the obstetrician's or institution's willingness to transfer mothers before delivery was the critical factor of the nearly complete regionalization.
Asunto(s)
Hospitales de Condado/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Programas Médicos Regionales/estadística & datos numéricos , Adolescente , Adulto , Femenino , Alemania/epidemiología , Humanos , Embarazo , Adulto JovenRESUMEN
We describe a woman in whom inhibitors to factor VIII:C developed in her first pregnancy. The neonate had a factor VIII:C level of 1% and an inhibitor titer of 5.2 Bethesda units. After an uneventful vaginal delivery, the boy had an intracranial hemorrhage at 5 days of age. To our knowledge, this is the first report of a bleeding complication in a newborn infant with transplacental transfer of an acquired factor VIII:C inhibitor.
Asunto(s)
Hemorragia Cerebral/fisiopatología , Factor VIII , Hemofilia A/complicaciones , Recién Nacido , Intercambio Materno-Fetal , Lóbulo Occipital/fisiopatología , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/diagnóstico , Femenino , Hemofilia A/diagnóstico , Hemofilia A/tratamiento farmacológico , Humanos , Masculino , Embarazo , Tomografía Computarizada por Rayos XRESUMEN
Neonatal ascites is usually attributed to prenatal infections, lysosomal storage disease and anomalies of the genitourinary tract, gastrointestinal tract or cardiovascular system. We report one case of neonatal ascites associated with infantile sialidosis. Cerebral sonography showed stripe-like intracerebral echogenicities in the region of the basal ganglia. Colour Doppler imaging demonstrated blood flow within the echogenicities confirming the suspected diagnosis of intracranial vasculopathy.
Asunto(s)
Ascitis/diagnóstico por imagen , Enfermedades de los Ganglios Basales/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Neuraminidasa/deficiencia , Ultrasonografía Prenatal , Adulto , Ascitis/etiología , Ascitis/metabolismo , Ecoencefalografía , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
We report on a neonate with complete aortic thrombosis following umbilical artery catheterization. Diagnosis was established by colour coded Doppler sonography which showed absent flow in the region distal to the thrombosis. After thrombolytic therapy with recombinant tissue plasminogen recanalization of the descending aorta could be shown by Colour Doppler imaging (CDI).
Asunto(s)
Enfermedades de la Aorta/diagnóstico por imagen , Ecocardiografía Doppler , Enfermedades del Prematuro/diagnóstico por imagen , Recien Nacido Prematuro , Trombosis/diagnóstico por imagen , Aorta Torácica , Enfermedades de la Aorta/etiología , Cateterismo Periférico/efectos adversos , Femenino , Humanos , Recién Nacido , Enfermedades del Prematuro/etiología , Trombosis/etiología , Arterias UmbilicalesRESUMEN
The doppler-sonographic examination of flow velocities in intracerebral arteries is of central importance in the diagnostic evaluation of potential neurologic complications in intensive care patients. Furthermore pulsed Doppler-sonography can assess the hemodynamic consequences of several congenital heart defects (e.g. the ductus arteriosus Botalli). Characteristics of the normal flow profile in the intracranial arteries are the systolic and diastolic forward flow caused by the "Windkessel" function of the aorta. Well known pathologic flow profiles (systolically and diastolically increased flow velocities, diastolically decreased flow velocities and diastolic retrograde flow) occur in neurologic and cardiovascular diseases. We have investigated three children after cardiac surgery, who showed a presystolic increase in the flow velocities, which is clearly different from the flow profiles mentioned above. In our opinion, this abnormal flow pattern is due to a decreased ventricular output in combination with an elevated central venous pressure in these patients.
Asunto(s)
Velocidad del Flujo Sanguíneo , Arterias Cerebrales/fisiopatología , Cardiopatías Congénitas/fisiopatología , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Arterias Cerebrales/diagnóstico por imagen , Preescolar , Femenino , Defectos del Tabique Interventricular/fisiopatología , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Masculino , Pronóstico , Transposición de los Grandes Vasos/fisiopatología , Transposición de los Grandes Vasos/cirugía , UltrasonografíaRESUMEN
An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).
Asunto(s)
Osteomielitis/complicaciones , Choque Séptico/etiología , Niño , Terapia Combinada , Femenino , Fluidoterapia , Hemofiltración , Humanos , Osteomielitis/microbiología , Síndrome de Dificultad Respiratoria/prevención & control , Choque Séptico/microbiología , Choque Séptico/terapia , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.
Asunto(s)
Dióxido de Carbono/análisis , Cuidados Críticos , Respiración Artificial , Dióxido de Carbono/sangre , Niño , Preescolar , Humanos , Hipercapnia/diagnóstico , Lactante , Monitoreo Fisiológico/métodos , Presión Parcial , Sensibilidad y EspecificidadRESUMEN
Great sacral teratomas are rare congenital tumors. The frequency in liveborns is about 1:40,000. Well known complications of sacral teratomas are malignant degeneration, infection and, in case of intraabdominal expansion, compression of the urogenital tract. We report a case of unusual fulminant perinatal bleeding out of a great sacral teratoma ruptured during birth.
Asunto(s)
Hemorragia/congénito , Sacro/anomalías , Neoplasias de la Columna Vertebral/congénito , Teratoma/congénito , Cesárea , Femenino , Humanos , Recién Nacido , Diagnóstico Prenatal , Reoperación , Rotura Espontánea , Sacro/cirugía , Neoplasias de la Columna Vertebral/cirugía , Teratoma/cirugía , UltrasonografíaRESUMEN
An 11-year experience with 2,029 outpatient arteriograms in a 500-bed community hospital with active vascular and cardiovascular services is reported. During this period 3,864 inpatient arteriograms were also obtained. The major complication rate has been lower for the outpatient procedures than for the inpatient procedures, and no malpractice claims have been made as a result of outpatient arteriography. There were considerable cost savings with the outpatient arteriography. Since conventional arteriography can be done safely and economically on an outpatient basis, and provides images of superior quality, it is considered highly competitive with digital subtraction angiography.
Asunto(s)
Angiografía , Análisis Costo-Beneficio , Pacientes Ambulatorios , Pacientes , Angiografía/normas , HumanosAsunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Hemorragia Cerebral/etiología , Trastornos Cerebrovasculares/etiología , Feocromocitoma/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/metabolismo , Adulto , Femenino , Humanos , Hipertensión/etiología , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/metabolismo , Tomografía Computarizada por Rayos XRESUMEN
In 10 healthy patients, buprenorphine was given as the postoperative analgesic (dosage: peripheral venous injection of 5 microgram/kg BW) after traumatological interventions in the lower extremities, which had been performed under barbiturate-induced halothane anaesthesia. The haemodynamic investigations revealed that buprenorphine has only a minor effect on the high pressure system. In the area of the pulmonary circulation, there was a significant increase in mean pulmonary artery pressure from 15.9 mm Hg to 17.8 mm Hg (+12%), as well as an increase in pulmonary vascular resistance by 16.5%. These changes were most marked 30 to 60 min after the administration of buprenorphine. When 2-3 1 O2/min were administered, none of the patients had PaO2 values of less than 100 mm Hg. 60 min after the injection, the PaCO2 value increased from 33.7 mm Hg to a maximum of 43.9 mm Hg. In 3 patients, PaCO2 increased to more than 45 mm Hg. All patients with greater increases of PaCO2 also evidenced greater increases in the pulmonary vascular resistance. Altogether the haemodynamic changes after buprenorphine administration following halothane anesthesia were not very distinct. In individual cases, however, there were greater increases in PaCO2. The cause of this could involve the additive effects of premedication and anaesthesia medication, and possibly the pain level as well. Both the increase in pulmonary artery pressure and the increase in total pulmonary vascular resistance in these patients were due to hypercapnia (von Euler-Liljestrand mechanism).