RESUMO
The neurodevelopmental outcome of hypoplastic left heart syndrome in infants remains unclear. All 11 survivors of staged surgical repair of hypoplastic left heart syndrome received standardized neurodevelopmental assessments at one regional children's hospital. Seven children (64%) had major developmental disabilities. Quality-of-life outcomes must be considered when management options for children with hypoplastic left heart syndrome are evaluated.
Assuntos
Deficiências do Desenvolvimento/etiologia , Síndrome do Coração Esquerdo Hipoplásico/complicações , Deficiência Intelectual/etiologia , Qualidade de Vida , Paralisia Cerebral/complicações , Feminino , Seguimentos , Técnica de Fontan , Humanos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Recém-Nascido , Masculino , Destreza Motora , Resultado do TratamentoRESUMO
We previously showed that fetal lambs whose ductus arteriosus is ligated prenatally will have persistent pulmonary hypertension at birth. We investigated the effect of inhaled nitric oxide on the pulmonary circulation in this animal model. The ductus arteriosus of six fetal lambs was ligated at 126 days of gestation. The lambs were delivered and studied at 136 days of gestation. Mechanical ventilation was maintained at a fraction of inspired oxygen of 0.80. Nitric oxide gas was administered at five different concentrations (6, 12, 25, 50, and 100 ppm) for 5-minute periods separated by 10-minute periods of ventilation without nitric oxide. Inhaled nitric oxide caused dose-dependent decreases in pulmonary arterial pressure and vascular resistance and dose-dependent increases in pulmonary blood flow without affecting systemic arterial pressure. Thus pulmonary arterial pressure decreased from equal to aortic pressure to less than aortic pressure. At the highest dose, mean pulmonary arterial pressure decreased by 27% +/- 2%, pulmonary blood flow increased by 86% +/- 6%, and pulmonary vascular resistance decreased by 59% +/- 4%. Nitric oxide also caused dose-dependent increases in systemic arterial oxygen tension and in the saturation of hemoglobin with oxygen. Partial pressure of arterial oxygen increased from 43 +/- 16 mm Hg at baseline to 185 +/- 72 mm Hg at the highest dose; saturation increased from 74% +/- 8% to 96% +/- 2%. In our model of persistent pulmonary hypertension of the newborn, inhaled nitric oxide selectively dilates the pulmonary circulation, thereby improving systemic arterial oxygenation. Nitric oxide is a promising new treatment of persistent pulmonary hypertension of the newborn.
Assuntos
Óxido Nítrico/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Administração por Inalação , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Hemodinâmica/efeitos dos fármacos , Humanos , Recém-Nascido , Óxido Nítrico/administração & dosagem , Óxido Nítrico/farmacologia , Circulação Pulmonar/efeitos dos fármacos , Mecânica Respiratória/efeitos dos fármacos , OvinosRESUMO
Tissue diagnostic services in U.S. dental schools were surveyed to determine activities during 1990. Results were compared with those of similar surveys conducted in 1953, 1958, 1969, 1975, 1980, and 1985. The information gathered from this survey reveals a progressive growth and development of tissue diagnostic services. This is seen not only in the increased numbers of biopsy accessions, which increased by 37% since the last survey, but is also reflected in the diversity of services now offered by oral pathologists.
Assuntos
Biópsia/estatística & dados numéricos , Serviços de Diagnóstico/estatística & dados numéricos , Patologia Bucal/estatística & dados numéricos , Faculdades de Odontologia/estatística & dados numéricos , Imunofluorescência/estatística & dados numéricos , Humanos , Técnicas Imunoenzimáticas/estatística & dados numéricos , Microscopia Eletrônica/estatística & dados numéricos , Doenças da Boca/terapia , Encaminhamento e Consulta , Estados Unidos/epidemiologiaRESUMO
Exposure to cytomegalovirus (CMV) is common in persons infected with the human immunodeficiency virus. Autopsy studies have documented the presence of CMV in multiple organs, but CMV is seldom indicated as the causative agent in specific diseases. Few reports have described localized CMV infection in the oral cavity. This may be due to the occult histopathologic appearance during oral mucosal CMV infections and to a lack of awareness of CMV infection as a potential etiologic agent in nonspecific oral ulcerations and other oral disease entities. This report describes an intraoral ulceration with documented presence of a localized CMV infection in association with human immunodeficiency virus-associated periodontitis in a patient with acquired immunodeficiency syndrome. A causative relationship between these two entities, however, cannot be established or excluded.