bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood pressure and hemodynamic responses to an acute sodium load in humans
Authors: Farquhar William B. , Paul Erin E. , Prettyman Allen V. , Stillabower Michael E.
Published: June 2005

The purpose of this study was to investigate the acute blood pressure (BP) and hemodynamic effects of sodium chloride (3% intravenous solution). Although many studies link a change in dietary sodium to a change in BP, few consider the effects of sodium concentration in the blood on BP. We hypothesized that an intravenous sodium load would increase BP, and we quantified alterations in cardiac output (Q̇c) and peripheral vascular resistance (PVR). Thirteen subjects (age 27 ± 2 yr) underwent a 60-min 3% saline infusion (0.15 ml·kg−1·min−1). BP was assessed on a beat-to-beat basis with a Finometer, Q̇c was assessed via the CO2 rebreathing technique, and PVR was derived. Serum sodium and osmolality increased, and hematocrit declined during the infusion (ANOVA, P < 0.01). Mean arterial pressure (MAP) increased continuously during the infusion from 81.8 ± 3.4 to 91.6 ± 3.6 mmHg (ANOVA, P < 0.01). BP responsiveness to sodium was expressed as the slope of the serum sodium-MAP relationship and averaged 1.75 ± 0.34 mmHg·mmol−1·l−1. BP responsiveness to the volume change was expressed as the slope of the hematocrit-MAP relationship and averaged −2.2 ± 0.35 mmHg/%. The early change in MAP was mediated by an increase in Q̇c and the late change by an increase in PVR ( P < 0.05), corresponding to a 30% increase in plasma norepinephrine. In conclusion, an acute infusion of hypertonic saline was effective in increasing BP, and both sodium and volume appear to be involved in this increase; acute BP responsiveness to serum sodium can be quantified using a MAP-sodium plot.
Endurance exercise training improves endothelium-dependent relaxation in brachial arteries from hypercholesterolemic male pigs
Authors: Woodman Christopher R. , Thompson Mark A. , Turk James R. , Laughlin M. Harold
Published: June 2005

We tested the hypothesis that exercise (Ex) training attenuates hypercholesterolemia-induced impairment of endothelium-dependent relaxation (EDR) in brachial (Br) arteries of adult male pigs by enhancing nitric oxide (NO)-mediated EDR. Adult male pigs were fed a normal-fat (NF) or high-fat/cholesterol (HF) diet for 20 wk. Four weeks after the diet was initiated, pigs were trained or remained sedentary (Sed) for 16 wk, yielding four groups: 1) NF-Sed, 2) NF-Ex, 3) HF-Sed, and 4) HF-Ex. EDR of Br artery rings was assessed in vitro with acetylcholine (ACh) and bradykinin (BK). ACh- and BK-induced relaxation was not impaired by HF; however, relaxation responses were enhanced by Ex in NF and HF arteries. To determine the mechanism(s) by which Ex improved EDR, ACh- and BK-induced relaxation was assessed in the presence of NG-nitro-l-arginine methyl ester (l-NAME; to inhibit NO synthase), indomethacin (Indo; to inhibit cyclooxygenase), or l-NAME + Indo. ACh- and BK-induced relaxation was inhibited by l-NAME, and l-NAME + Indo, in all groups of arteries. Indo did not inhibit ACh-induced relaxation in any group but did inhibit BK-induced relaxation in HF-Ex arteries. In the presence of l-NAME or l-NAME + Indo, ACh- and BK-induced relaxation in HF-Ex arteries remained greater than in HF-Sed arteries. However, in the presence of Indo, ACh-induced relaxation in HF-Ex arteries was no longer greater than in HF-Sed arteries. These results indicate that EDR is not impaired by hypercholesterolemia in Br arteries from adult male pigs; however, Ex improves EDR in HF Br arteries by enhancing production of endothelium-derived hyperpolarizing factor and/or prostacyclin.
Combined pulmonary stenosis and insufficiency preserves myocardial contractility in the developing heart of growing swine at midterm follow-up
Authors: Kuehne Titus , Gleason B. Kelly , Saeed Maythem , Turner Daniel , Weil Jochen , Teitel David F. , Higgins Charles B. , Moore Phillip
Published: June 2005

This study was conducted to determine the effects of chronic combined pulmonary stenosis and pulmonary insufficiency (PSPI) on right (RV) and left ventricular (LV) function in young, growing swine. Six pigs with combined PSPI were studied, and data were compared with previously published data of animals with isolated pulmonary insufficiency and controls. Indexes of systolic function (stroke volume, ejection fraction, and cardiac functional reserve), myocardial contractility (slope of the end-systolic pressure-volume and change in pressure over time-end-diastolic volume relationship), and diastolic compliance were assessed within 2 days of intervention and 3 mo later. Magnetic resonance imaging was used to quantify pulmonary insufficiency and ventricular volumes. The conductance catheter was used to obtain indexes of the cardiac functional reserve, diastolic compliance, and myocardial contractility from pressure-volume relations acquired at rest and under dobutamine infusion. In the PSPI group, the pulmonary regurgitant fraction was 34.3 ± 5.8%, the pressure gradient across the site of pulmonary stenosis was 20.9 ± 20 mmHg, and the average RV peak systolic pressure was 70% systemic at 12 wk follow-up. Biventricular resting cardiac outputs and cardiac functional reserves were significantly limited ( P < 0.05), LV diastolic compliance significantly decreased ( P < 0.05), but RV myocardial contractility significantly enhanced ( P < 0.05) compared with control animals at 3-mo follow-up. In the young, developing heart, chronic combined PSPI impairs biventricular systolic pump function and diastolic compliance but preserves RV myocardial contractility.
Fatigue and recovery of power and isometric torque following isotonic knee extensions
Authors: Cheng Arthur J. , Rice Charles L.
Published: June 2005

The purpose of this study was to assess fatigue and recovery of isotonic power and isometric contractile properties after a series of maximal isotonic contractions. Using a Biodex dynamometer, 13 men [26 yr (SD 3)] performed isotonic [50% of isometric maximal voluntary contraction (MVC) every 1.2 s through 75° range of motion] single-limb knee extensions at the fastest velocity they could achieve until velocity was reduced by 35%. Time to task failure was 38 s, and, compared with baseline, power declined by ∼42% [741.0 (SD 106.0) vs. 426.5 W (SD 60.3) at task failure], and MVC declined by ∼26% [267.3 (SD 42.5) vs. 198.4 N·m (SD 45.7) at task failure]. Power recovered by 5 min, whereas MVC did not recover, and at 10 min was only ∼85% of baseline. Isometric MVC motor unit activation was ∼95% at rest and was unchanged at task failure (∼96%), but a small amount of failure was apparent between 1.5 and 10 min of recovery (∼87 to ∼91%). Half relaxation time measured from a 50-Hz isometric tetanus was significantly prolonged by ∼33% immediately after task failure but recovered by 1.5 min. A decline in the 10- to 50-Hz ratio of the evoked isometric contractions was observed at 5 and 10 min of recovery, which suggests excitation-contraction coupling impairment. Changes in velocity and half relaxation time during the protocol were strongly and negatively correlated ( r = −0.85). Thus mainly peripheral mechanisms were implicated in the substantial depression but relatively fast recovery of isotonic power. Furthermore, isometric muscle contractile properties were related to some, but not all, changes in isotonic function.
Errors of measurement for blood volume parameters: a meta-analysis
Authors: Gore Christopher J. , Hopkins Will G. , Burge Caroline M.
Published: June 2005

The volume of red blood cells (VRBC) is used routinely in the diagnostic workup of polycythemia, in assessing the efficacy of erythropoietin administration, and to study factors affecting oxygen transport. However, errors of various methods of measurement of VRBCand related parameters are not well characterized. We meta-analyzed 346 estimates of error of measurement of VRBCfor techniques based on Evans blue (VRBC,Evans),51chromium-labeled red blood cells (VRBC,51Cr), and carbon monoxide (CO) rebreathing (VRBC,CO), as well as hemoglobin mass with the carbon-monoxide method (MHb,CO), in athletes and active and inactive subjects undergoing various experimental and control treatments lasting minutes to months. Subject characteristics and experimental treatments had little effect on error of measurement, but measures with the smallest error showed some increase in error with increasing time between trials. Adjusted to 1 day between trials and expressed as coefficients of variation, mean errors for MHb,CO(2.2%; 90% confidence interval 1.4–3.5%) and VRBC,51Cr(2.8%; 2.4–3.2%) were much less than those for VRBC,Evans(6.7%; 4.9–9.4%) and VRBC,CO(6.7%; 3.4–14%). Most of the error of VRBC,Evanswas due to error in measurement of volume of plasma via Evans blue dye (6.0%; 4.5–7.8%), which is the basis of VRBC,Evans. Most of the error in VRBC,COwas due to estimates from laboratories with a relatively large error in MHb,CO, the basis of VRBC,CO. VRBC,51Crand MHb,COare the best measures for research on blood-related changes in oxygen transport. With care, VRBC,Evansis suitable for clinical applications of blood-volume measurement.
Effects of induced hyperthyroidism in normal and cardiomyopathic hamsters
Authors: Kuzman James A. , Thomas Tracy A. , Vogelsang Kathryn A. , Said Suleman , Anderson Brent E. , Gerdes A. Martin
Published: June 2005

Thyroid hormones (TH) enhance cardiac function and reverse gene changes typical of pathological hypertrophy. However, reports in humans, but not animals, indicate that excess TH can cause heart failure. Also, the effects of TH on normal and cardiomyopathic hearts are likely to be different. The goal of this study was to characterize the effects of prolonged hyperthyroidism on cardiac function, chamber and cellular remodeling, and protein expression in both normal and cardiomyopathic hearts. Hyperthyroidism was induced in 3-mo-old normal BIO F1B and dilated cardiomyopathic BIO TO2 hamsters. After TH treatment for 10 days and 2 mo, hemodynamics, echos, myocyte length, histology, and protein expression were assessed. After 10 days and 2 mo, there were no differences between TO2-treated (Tx) and TO2-untreated (Untx) hamsters in chamber diameters or left ventricular function. After 2 mo of treatment, however, F1B-Tx showed evidence of dilated heart failure vs. F1B-Untx. Chamber diameters were increased, and ejection fraction and positive and negative changes in pressure over time were reduced. In F1B-Tx and TO2-Tx hamsters, β-myosin isoform expression was reduced, whereas α-myosin increased significantly in F1B-Tx only. In TO2-Tx hamsters, the percent of viable myocardium was increased, and percent fibronecrosis was reduced vs. TO2-Untx. Myocyte length increased with TH treatment in both hamster strains. We conclude that 1) excess TH can induce heart failure in normal animals as observed in humans, 2) reversal of myosin heavy chain expression does not necessarily improve heart function, and 3) excess TH altered cellular remodeling but did not adversely affect chamber function or dimensions in TO2 hamsters.
Attenuation of skeletal muscle atrophy via protease inhibition
Authors: Morris Carl A. , Morris Linda D. , Kennedy Ann R. , Sweeney H. Lee
Published: June 2005

Skeletal muscle atrophy in response to a number of muscle wasting conditions, including disuse, involves the induction of increased protein breakdown, decreased protein synthesis, and likely a variable component of apoptosis. The increased activation of specific proteases in the atrophy process presents a number of potential therapeutic targets to reduce muscle atrophy via protease inhibition. In this study, mice were provided with food supplemented with the Bowman-Birk inhibitor (BBI), a serine protease inhibitor known to reduce the proteolytic activity of a number of proteases, such as chymotrypsin, trypsin, elastase, cathepsin G, and chymase. Mice fed the BBI diet were suspended for 3–14 days, and the muscle mass and function were then compared with those of the suspended mice on a normal diet. The results indicate that dietary supplementation with BBI significantly attenuates the normal loss of muscle mass and strength following unloading. Furthermore, the data reveal the existence of yet uncharacterized serine proteases that are important contributors to the evolution of disuse atrophy, since BBI inhibited serine protease activity that was elevated following hindlimb unloading and also slowed the loss of muscle fiber size. These results demonstrate that targeted reduction of protein degradation can limit the severity of muscle mass loss following hindlimb unloading. Thus BBI is a candidate therapeutic agent to minimize skeletal muscle atrophy and loss of strength associated with disuse, cachexia, sepsis, weightlessness, or the combination of age and inactivity.
Genetic Disorders of Surfactant Homeostasis
Authors: Whitsett Jeffrey A. , Wert Susan E. , Xu Yan
Published: June 2005

Adaptation to air breathing at birth requires the precise orchestration of cellular processes to initiate fluid clearance, enhance pulmonary blood flow, and to synthesize and secrete pulmonary surfactant needed to reduce surface tension at the air-liquid interface in the alveoli. Genetic programs regulating the synthesis of the surfactant proteins and lipids required for the production and function of pulmonary surfactant are highly conserved across vertebrates, and include proteins that regulate the synthesis and packaging of pulmonary surfactant proteins and lipids. Surfactant proteins B and C (SP-B and -C) are small, uniquely hydrophobic proteins that play important roles in the stability and spreading of surfactant lipids in the alveolus. Deletion or mutations in SP-B and -C cause acute and chronic lung disease in neonates and infants. SP-B and -C are synthesized and packaged with surfactant phospholipids in lamellar bodies. Normal lamellar body formation requires SP-B and a member of the ATP-binding cassette (ABC) family of ATP-dependent membrane-associated transport proteins, ABCA3. Mutations in ABCA3 cause fatal respiratory disease in newborns and severe chronic lung disease in infancy. Expression of SP-B, -C, and ABCA3 are coregulated during late gestation by transcriptional programs influenced by thyroid transcription factor-1 and forkhead box a2, transcription factors that regulate both differentiation of the respiratory epithelium and transcription of genes required for perinatal adaptation to air breathing.
Control of Breathing and Neonatal Apnea
Authors: Martin Richard J. , Abu-Shaweesh Jalal M.
Published: June 2005

Great strides have been made in our understanding of developmental respiratory neurobiology. A clear picture is, therefore, emerging of the physiological mechanisms that underlie apnea of prematurity. The ventral surface of the medulla and adjacent areas play a key integrative function for central CO2 chemosensitivity and modulation of afferent inputs from peripheral chemoreceptors and laryngeal afferents. Maturational change in medullary neurotransmitter function appears to contribute to the physiological events that characterize apnea of prematurity. Despite this greater scientific insight, therapeutic strategies for neonatal apnea have changed little in 30 years. Xanthine therapy and continuous positive airway pressure remain the mainstay of therapy while other therapeutic approaches have been inadequately studied. Our understanding of a possible relationship between the triad of apnea, bradycardia and desaturation, and impaired neurodevelopmental outcome is also limited. These are all issues that need our attention if optimal therapy and outcome are to be provided for preterm infants with immature respiratory control.
Surfactant Metabolism in the Neonate
Authors: Zimmermann L.J.I. , Janssen D.J.M.T. , Tibboel D. , Hamvas A. , Carnielli V.P.
Published: June 2005

With the use of stable isotope-labeled intravenous precursors for surfactant phosphatidylcholine (PC) synthesis, it has been shown that the de novo synthesis rates in preterm infants with respiratory distress syndrome (RDS) are very low as are turnover rates. This is consistent with animal data. Surfactant therapy does not inhibit endogenous surfactant synthesis, and prenatal corticosteroids stimulate it. With the use of stable isotope-labeled PC given endotracheally, surfactant pool size was estimated. It turned out to be low in RDS, as expected. Similar studies were performed in term neonates with severe lung diseases. In general, patients with lung injury show a lower surfactant synthesis. The controversy around surfactant in congenital diaphragmatic hernia (CDH) persists: studies on CDH with and without extracorporeal membrane oxygenation yielded different results. In severe meconium aspiration syndrome surfactant synthesis was found to be decreased but surfactant pool size was maintained. It is possible and safe to study surfactant metabolism in human neonates with the use of stable isotopes. This can help in answering clinical questions and has the potential to bring new in vitro and animal findings about surfactant metabolism to the patient.
History of Surfactant from 1980
Authors: Halliday Henry L.
Published: June 2005

The first successful trial of surfactant treatment for respiratory distress syndrome (RDS) was reported in 1980. Since then there have been numerous randomised trials demonstrating first, the efficacy of surfactant treatment in reducing pulmonary air leaks and increasing survival and second, assessing various other aspects of therapy. These studies show that multiple doses may be needed if surfactant is used to treat established RDS but early or prophylactic treatment is superior for infants with gestational ages less than 30 weeks. Natural surfactants (containing proteins) are more effective than synthetic products (protein free), the latter now being infrequently used. Natural surfactants vary and should not be considered to be equivalent in their effects. A porcine surfactant (poractant alfa) acts more rapidly than a bovine preparation (beractant) in infants with moderate to severe RDS. A meta-analysis of 5 comparative studies suggests that a dose of 200 mg/kg of poractant alfa is associated with lower mortality compared with 100 mg/kg of beractant. Chronic lung disease remains a problem but it is hoped that early treatment with surfactant combined with extubation to continuous positive airway pressure will reduce this complication of prematurity. The newer synthetic surfactants, containing analogues of surfactant protein B or C, have undergone some trials for treatment of RDS but comparative studies which have just been published do not show that they are superior to existing natural surfactants. However, as they are more resistant to inactivation they may have a role in treatment of adult or acute RDS. The last 25 years have seen a large increase in basic science research on surfactants with determination of the structure and function of the four surfactant proteins probably being the most important advances. Future studies will focus on widening the indications for surfactant treatment, developing non-invasive means of administration and assessing the role of the newer synthetic surfactants.
Postnatal Changes in Pulmonary Mechanics and Energetics of Infants with Respiratory Distress Syndrome following Surfactant Treatment
Authors: Bhutani Vinod K. , Bowen Frank W. , Sivieri Emidio M.
Published: June 2005

Background: Postnatal alterations in pulmonary mechanics, energetics and functional residual capacity (FRC) describe the structural maturation of the preterm respiratory system. Objective: To evaluate longitudinal changes in pulmonary function in infants with respiratory distress syndrome (RDS) treated with oxygen, positive pressure ventilation and synthetic surfactant (Exosurf®). Methods: Serial pulmonary function tests were performed in surfactant-treated infants [mean ± SD birth weight (BW) = 1,112 ± 276 g, gestational age (GA) = 29 ± 3 weeks] at postnatal ages: <3 days, 1, 2, 3, 4 and 6–8 weeks until term postmenstrual age (PMA). Tidal volume, pulmonary compliance (CL), pulmonary resistance (RT) and flow-resistive work were analyzed following simultaneous measurements of airflow and transpulmonary pressure signals. Serial FRC measurements were made in a randomly selected group. Results: Prior to 28 weeks’ PMA, CL was unchanged irrespective of GA. At age 1 week the likelihood ratio (LR) for bronchopulmonary dysplasia (BPD) based on CL, RT and GA was predicted to be >90% for those with BW <750 g (LR >100) as compared to <10% probability (LR = 0.3) for infants >1,500 g. Significant linear increase in CL to PMA was evident >28 weeks’ PMA (r = 0.86, p < 0.01) at 0.17 ml/cm H2O/kg/week. By term PMA, mean CL was 2.60 ± 0.07 ml/cm H2O. Improvements in FRC of preterm infants with RDS who recovered occur at a more rapid rate (∼25 ml/kg) compared to those who developed BPD (∼20 ml/kg). Conclusions: Slow but incremental postnatal pulmonary improvement, minimal <28 weeks’ PMA, were comparable for all infants. Along with diminished FRC, these changes reflect persistent deleterious effects of positive pressure ventilation, alveolar hyperoxia and unrecognized pulmonary overdistension.
New Synthetic Surfactants – Basic Science
Authors: Curstedt Tore , Johansson Jan
Published: June 2005

The hydrophobic surfactant proteins, SP-B and SP-C, promote adsorption of surface-active lipids to the air-liquid interface of the alveoli and are essential for alveolar stability and gas exchange. Synthetic surfactant preparations must contain at least one of these hydrophobic proteins, or analogs thereof, to have optimal effects when administered into the airways of patients with lung diseases. However, development of clinically active artificial surfactants has turned out to be more complicated than initially anticipated since the native hydrophobic proteins are structurally complex or unstable in pure form. The proteins have been replaced by different analogs which have the right conformation without forming oligomers. Increased understanding of the surfactant proteins will hopefully lead to development of effective synthetic surfactants which can be produced in large quantities for treatment of a wide range of respiratory disorders. Furthermore, the lipid composition seems to be important, as well as a high lipid concentration in the suspension. For successful treatment of many respiratory diseases, it is also desirable that the synthetic surfactant resists inactivation by plasma components leaking into the alveoli.
New Synthetic Surfactants: The Next Generation?
Authors: Pfister Robert H. , Soll Roger F.
Published: June 2005

Surfactant preparations have been proven to improve clinical outcome of infants at risk for or having respiratory distress syndrome (RDS). In clinical trials, ani mal-derived surfactant preparations reduce the risk of pneumothorax and mortality when compared to non-protein-containing synthetic surfactant preparations. In part, this is thought to be due to the presence of surfactant proteins in animal-derived surfactant preparations. Four native surfactant proteins have been identified. The hydrophobic surfactant proteins B (SP-B) and C (SP-C) are tightly bound to phospholipids. These proteins have important roles in maintaining the surface tension-lowering properties of pulmonary surfactant. Surfactant protein A (SP-A) and D (SP-D) are extremely hydrophilic and are not retained in the preparation of any commercial animal-derived surfactant products. These proteins are thought to have a role in recycling surfactant and improving host defense. There is concern that animal-derived products may have some batch-to-batch variation regarding the levels of native pulmonary surfactant proteins. In addition, there is concern regarding the hypothetical risk of transmission of viral or unconventional infectious agents from an animal source. New surfactant preparations, composed of synthetic phospholipids and essential hydrophobic surfactant protein analogs, have been developed. These surfactant protein analogs have been produced by peptide synthesis and recombinant technology to provide a new class of synthetic surfactants that may be a suitable alternative to animal-derived surfactants. Preliminary clinical studies have shown that treatment with these novel surfactant preparations can ameliorate RDS and improve clinical outcome. Clinicians will need to further understand any differences in clinical effects between available products.
Ethical Considerations in Neonatal Respiratory Care
Authors: Orzalesi Marcello , Cuttini Marina
Published: June 2005

Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant’s demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units.
Fetal Gallstones
Authors: Munjuluri Nalini , Elgharaby Nader , Acolet Dominique , Kadir Rezan Abdul
Published: June 2005

The significance and natural history of fetal cholelithiasis is not yet well defined. We report two cases of echogenic foci detected prenatally by ultrasound. The gallstones resolved in both cases by 16 weeks following birth. Both infants were treated by ursodeoxycholic acid.
Perinatal Outcomes of Twin Pregnancies Discordant for Major Fetal Anomalies
Authors: Gul Ahmet , Cebeci Altan , Aslan Halil , Polat Ibrahim , Sozen Ilker , Ceylan Yavuz
Published: June 2005

Objective: The aim of this study was to determine perinatal outcomes of twin pregnancies discordant for a major fetal anomaly and to compare with twins without anomaly. Methods: All twin pregnancies admitted or referred to the maternal-fetal unit were prospectively entered into a computer database. Chorionicity, fetal anomaly, mean gestational age at delivery, birth weight and perinatal survival rate were reviewed. Main Outcome Measures: Mean gestational age at delivery, birth weight and perinatal survival rate of twins with and without anomaly. Results: There were 48 cases of monochorionic diamniotic (MCDA), 2 cases of monochorionic monoamniotic (MCMA) and 217 twins with dichorionic (DC) placentation. Out of 267 twin pregnancies, there were 17 (6.3%) twins with fetal anomaly. Twins discordant for a major fetal anomaly were diagnosed in 13 cases (4.8%). We observed 3 cases with MCDA and 10 cases with DC placentation and the incidence of discordance for a major fetal anomaly as 4.6% (10/217) in DC and 6.0% (3/50) in MC twin pregnancies. We identified 8 cases (62%) with craniospinal, 2 (15%) with gastrointestinal, 2 (15%) with urinary system, and 1 case (8%) with both craniospinal and gastrointestinal anomalies. There were significant differences between the normal co-twin of the major anomaly group (n = 13) and twins without anomaly group (n = 235) in mean gestational age at delivery (32 vs. 34 weeks; p = 0.029), mean birth weight (1,640 vs. 2,030 g; p = 0.022) and perinatal survival rate (69.2 vs. 91.1%; p = 0.018), respectively. Conclusion: The presence of a fetus with a major anomaly in a twin gestation increases the risk of preterm delivery, low birth weight and perinatal mortality of the normal co-twin.
Expression of Hepatocyte Growth Factor/Scatter Factor Receptor in IUGR Fetuses’ Placentas: An Immunohistochemical Analysis
Authors: Baykal Cem , Güler Gülnur , Al Atakan , Tulunay Gökhan , Özer Süha , Yencilek Raziye , Bülbül Dilek , Ayhan Ayşe
Published: June 2005

Objective: We aimed to evaluate the expression sta tus of c-met, receptor for the hepatocyte growth factor (HGF), in the placentas of intrauterine growth retardation (IUGR) fetuses. Materials and Methods: Placentas were obtained during delivery from both third trimester normal and IUGR complicated pregnancies. Ultrasonographic estimation of fetal birth weight has been done and placentas of those under the fifth percentile for their gestational ages were enrolled in the study group. Eighteen fetuses with IUGR and 6 uncomplicated pregnancies were subjected to the study. Histological sections from placentas were immunohistochemically evaluated for the expression status of c-met. Results: Seventeen of the eighteen patients (94.4%) in the study group were found to have overexpression of the c-met while this figure was only 16.7% (1/6) in the control group (p < 0.0001). There was a strong statistically significant difference between the two groups regarding degree of c-met expression. Conclusion: Our present findings suggest that c-met is an important cell membrane receptor in human placenta. Deregulation of the interaction between HGF and its receptor c-met during placentation may be the cause responsible for the growth retardation of the fetus due to the impaired placental functions.
Non-Invasive Management of Fetal Goiter during Maternal Treatment of Hyperthyroidism in Grave’s Disease
Authors: Lembet Arda , Eroglu Derya , Kınık Sibel Tulgar , Gürakan Berkan , Kuscu Esra
Published: June 2005

There is an increased risk of fetal goiter in patients who have a history of Grave’s disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave’s disease. A 32 × 38 × 20 mm fetal goiter was detected, each lobe measured 30 × 18 × 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother’s PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment.
Prenatal Diagnosis of Diastematomyelia in a 15-Week-Old Fetus
Authors: Biri A.A. , Turp A.B. , Kurdoğlu M. , Himmetoğlu Ö. , Tokgöz Ercan N. , Balcı S.
Published: June 2005

Objective: A case of prenatal diagnosis of diastematomyelia is presented. Methods: A case of fetal diastematomyelia, diagnosed by prenatal sonography, demonstrated the typical sonographic features of this condition. In this case it was detected at 15 weeks of gestation, and presented with a midline echogenic focus in the posterior region of the thoracolumbar spine. Results: The pregnancy was terminated by induction of labor. The fetus was female and there was a 1-cm long endurated hyperemic lesion at the back of the fetus. We confirmed the diagnosis of diastematomyelia after termination of pregnancy by plain chest and abdominal X-ray and also MRI scanning. Conclusion: Isolated diastematomyelia is a rare form of spinal dysraphism characterized by a sagittal cleft in the spinal cord, conus medullaris and/or filum terminale with splaying of the posterior vertebral elements. Prenatal diagnosis of this anomaly is possible in the early mid-trimester by sonography, thus allowing for early surgical intervention and a favorable prognosis.
Fetal Extradural Hematoma: Prenatal Diagnosis and Postmortem Examination
Authors: Bonnefoy O. , Maugey-Laulom B. , Diris B. , Dallay D. , Diard F.
Published: June 2005

We report the 1st confirmed case of an extradural hematoma diagnosed in utero by ultrasonography and magnetic resonance imaging at 31 weeks’ gestation. No signs of intracranial hemorrhage were found. During pregnancy, the expecting mother suffered from sustained cough, and a blood sample test revealed acute pertussis. The presence of fetal hydrocephaly, brain parenchymal deviation, and other abnormalities suggested a poor outcome, and based on these findings pregnancy termination was recommended and carried out. Postmortem examination confirmed the diagnosis of an extradural hematoma in the posterior fossa.
Combined Prenatal Ultrasound and Magnetic Resonance Imaging in an Extensive Congenital Fibrosarcoma: A Case Report and Review of the Literature
Authors: Huang Shi-Yin , Wang Chia-Woei , Wang Chao-Jan , Chao Angel , Chao An-Shine
Published: June 2005

Objective: Tumors of congenital origin differ in their symptoms and signs, predominant location and prognosis from those occurred later in childhood. To determine whether the prognosis of congenital (infantile) fibrosarcoma in the retroperitoneum, an extremely rare form of soft tissue malignant tumor, can be assessed prenatally. Methods: We describe a case of this condition diagnosed in utero, including the assessment of the tumor behavior by ultrasound and magnetic resonance imaging. We also review the English language literature in Medline over the past 10 years and describe the management options available in such cases. Results: Our case had precise prenatal findings revealed unfavorable conditions such as bulky tumor mass, spinal metastasis and pulmonary hypoplasia. Conclusion: Fetal imaging studies could accurately identify the invasion of tumor. The outcome is usually poor, especially for those fetuses affected by an axial location of the tumor.
Intrauterine Fetal Resuscitation following Complications of Closed Fetal Surgery
Authors: Brumfield Steven S. , Fausett M. Bardett , Fries Melissa H.
Published: June 2005

Background: With advances in prenatal diagnosis and surgical technique more fetal interventions are being performed. There are limited data about the etiology, incidence, management, or long-term outcomes of complications associated with these procedures. Case: A gravida had a fetus diagnosed with posterior urethral valve syndrome. During placement of a peritoneal-amniotic shunt, profound fetal bradycardia was noted. Using closed fetal surgical techniques successful resuscitation was accomplished. Conclusion: Closed fetal surgical interventions carry the potential for significant complications of varying etiologies. Resuscitation can be accomplished. Preparation for potential complications may improve outcome.
Non-Invasive Fetal RHD Exon 7 and Exon 10 Genotyping Using Real-Time PCR Testing of Fetal DNA in Maternal Plasma
Authors: Hromadnikova Ilona , Vechetova Lenka , Vesela Klara , Benesova Blanka , Doucha Jindrich , Kulovany Eduard , Vlk Radovan
Published: June 2005

Objective: In this prospective study, we assessed the feasibility of foetal RHD genotyping by analysis of DNA extracted from plasma samples of Rhesus (Rh) D-negative pregnant women using real-time PCR and primers and probes targeted toward exon 7 and 10 of RHD gene. Methods: We analysed 24 RhD-negative pregnant woman and 4 patients with weak D phenotypes at a gestational age ranging from 11th to 38th week of gestation and correlated the results with serological analysis of cord blood after the delivery. Results: Non-invasive prenatal foetal RHD exon 7 genotyping analyses of maternal plasma samples was in complete concordance with the serological analysis of cord blood in all 24 RhD-negative pregnant women delivering 12 RhD-positive and 12 RhD-negative newborns. RHD exon-10-specific PCR amplicons were not detected in 2 out of 12 studied plasma samples from women bearing RhD-positive foetus, despite the positive amplification in RHD exon 7 region observed in all cases. In 1 case red cell serology of cord blood revealed that the mother had D–C–E–c+e+ Cw– and the infant D+C–E–c+e+ Cw+ phenotypes. RhD exon 10 real-time PCR analysis of cord blood was also negative. These findings may reflect that DCw– paternally inherited haplotype probably possesses no RHD exon 10. In another case no cord blood sample has been available for additional studies. The specificity of both RHD exon 7 and 10 systems approached 100% since no RhD-positive signals were detected in women currently pregnant with RhD-negative foetus (n = 8). Using real-time PCR and DNA isolated from maternal plasma, we easily differentiated pregnant woman whose RBCs had a weak D phenotype (n = 4) from truly RhD-negative patients since the threshold cycle (CT) for RHD exon 10 or 7 amplicons reached nearly the same value like CT for control β-globin gene amplicons detecting the total DNA present in maternal plasma. However in these cases foetal RhD status cannot be determined.Conclusion:Prediction offoetal RhD status from maternal plasma is highly accurate and enables implementation into clinical routine. We suggest that safe non-invasive prenatal foetal RHD genotyping using maternal plasma should involve the amplification of at least two RHD-specific products.
Mild Cerebral Ventriculomegaly in Fetuses: Characteristics and Outcome
Authors: Goldstein Israel , Copel Joshua A. , Makhoul Imad R.
Published: June 2005

Background: A fetal ultrasonographic (US) finding of mild ventriculomegaly (MVM) is not uncommon, but its prognostic significance is not clearly defined. Objective: To evaluate the clinical and US characteristics and outcome of fetuses with mild dilatation of the cerebral lateral ventricles. Patients and Methods: We reviewed the medical records of 34 consecutive fetuses with US evidence of MVM (atrial width of the lateral ventricles = 10–15 mm) at 18–35 weeks of gestation. Results: Of the 34 fetuses with MVM, 7 underwent karyotype examination and were normal. In 4 of the 34 fetuses the pregnancy was terminated (at autopsy: 1 was normal, 2 had hydrocephalus and for 1 the parents refused autopsy). Eight fetuses that were delivered had congenital malformations; 3 of them died during the early neonatal period. In 6 of the 8 fetuses with malformations, karyotypes were available and 3 had chromosomal aberrations (trisomy 18, 45XO, and triploidy 69XXX). Spontaneous in utero resolution of the MVM occurred in 10/30 (33.3%) of the cases. Of the 26 infants that remained in follow-up, 16 (61.1%) were normal at 1 month and at 2 years of age. Conclusions: Our data confirm those of previous reports as to the characteristics and outcome of MVM. In the setting of mild fetal ventriculomegaly with a normal karyotype and an absence of malformations, the outcome appears to be favorable.
Management of Delayed-Interval Delivery in Multiple Gestations
Authors: Cristinelli Stéphane , Fresson Jeanne , André Monique , Monnier-Barbarino Patricia
Published: June 2005

Objective: Proving that delayed delivery is possible, debating its modality, suggesting a guideline for its managing. Method: Six cases of delayed delivery were treated at the Maternity Hospital of Nancy, between 1979 and 2001, and the results were compared to a literature review of 148 found thanks to Medline database. Results: Delayed delivery reduces the risk of neonatal mortality and morbidity. The delivery interval is 2–93 (median 7) days in our experience and 2–153 (median 31) days in the literature. After the first expulsion, cerclage was used in 60% of the cases, prophylactic tocolysis and antibiotics in 79% and 71%, respectively. Conclusion: There is no consensus for its management but it must be performed with precise conditions to restrict both maternal and fetal risks. Our study is supporting an interventionist attitude with cerclage, prophylactic tocolysis and antibiotics.
Congenital Cervical Rhabdomyosarcoma Arising in One Fetus of a Twin Pregnancy
Authors: Yoshino Kiyoshi , Takeuchi Makoto , Nakayama Masahiro , Suehara Noriyuki
Published: June 2005

Objective: To describe a huge congenital cervical rhabdomyosarcoma. Methods: We were recently confronted with a case of fetal solid neck mass arising in one fetus of a twin pregnancy. Prenatally, the cervical tumor was consistent with teratoma, but it was diagnosed histologically as a rhabdomyosarcoma. Genetic amniocentesis showed a mosaic pattern consisting of 46,XY/46,XY,t(2;8)(q35;q21.2). Results: EXIT procedure was proposed to the parents but declined. The twin with huge cervical tumor died in utero at 35 weeks’ gestation due to hydrops fetalis. Conclusion: Fetal cervical rhabdomyosarcoma is an extremely rare condition that has not been previously reported, but should be considered in the presentation of fetal solid neck mass.
Prenatal Diagnosis of Cloverleaf Skull: Watch the Hands!
Authors: Gorincour Guillaume , Rypens Françoise , Grignon Andrée , Garel Laurent , Bortoluzzi Patricia , Oligny Luc , Lemyre Emmanuelle , Duperron Louise
Published: June 2005

Pfeiffer syndrome is an extremely rare autosomal-dominant condition whose prenatal diagnosis has only been reported 6 times, mainly on the basis of a fetal cloverleaf skull deformity. Three types have been described, each with a different prognosis. This case report stresses the need to thoroughly analyze the fetus and particularly the fetal hands in case of prenatal observation of a cloverleaf skull. The discovery of characteristic hand abnormalities allowed the early prenatal detection of type 2 Pfeiffer syndrome in our patient.
Maxillo-Nasal Dysplasia (Binder Syndrome): Antenatal Discovery and Implications
Authors: Cuillier F. , Cartault F. , Lemaire P. , Alessandri J.L.
Published: June 2005

Binder syndrome (BS) or maxillo-nasal dysplasia is an uncommon developmental anomaly affecting primarily the anterior part of the maxilla and nasal complex. The characteristic findings are a failure of development in the premaxillary area with associated deformities of the nasal skeleton and the overlying soft tissues. Affected individuals typically have an unusually flat, underdeveloped midface (midfacial hypoplasia), with an abnormally short nose and flat nasal bridge, underdeveloped upper jaw, relatively protruding lower jaw and/or a ‘reverse overbite’ (or class III malocclusion). A case of BS was diagnosed at 24 weeks of gestation using two- and three-dimensional ultrasound. The first sign was an isolated flattened fetal nose in the mid-sagittal plane. Further ultrasound imaging showed the absence of the naso-frontal angle, giving impression of flat forehead and small fetal nose. We discuss about this entity.
Success Rate for Culture of Fetal Postmortem Tissue Is Dependent on the Method of Pregnancy Termination
Authors: Winsor Elizabeth J.T. , Windrim Rory , Chitayat David , Ryan Greg , Seaward Gareth , Akoury Hani
Published: June 2005

Objective: To determine the effect of different methods of pregnancy termination on the culture success rate of postmortem fetal tissue. Methods: In a randomized trial, umbilical cord specimens were collected in a standardized manner and culture success rates were compared according to the method of pregnancy termination. Results: There was a significantly higher culture success rate in the vaginal (90.0%) and oral misoprostol (83.0%) groups compared to the intra-amniotic injection of prostaglandin group (52.8%). Conclusion: The results of our study and the very high success rate reported by others from specimens following dilatation and evacuation lead us to suggest that exposure to drugs used to induce abortion may be a more important factor in culture failure than either tissue type or time in transit.
Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis
Authors: Chen Ming , Chen Chih-Ping , Shih Jin-Chung , Chou Hung-Chieh , Yu Chia-Li , Wang Bao-Tyan , Hsieh Chang-Yao
Published: June 2005

Objectives: To present our experience of using OK-432 in treating fetal cystic hygroma and chylothorax complicated with nonimmune hydrops fetalis. Methods: OK-432 (Picibanil®) was injected into the fetal pleural cavity or fetal cystic hygroma. Results:Patient 1: A 23-year-old, gravida 2, para 1, was found to have a recurrent fetal chylothorax at GA 29 weeks. Serial amnioreduction and thoracocentesis was performed at GA 31, 32, 33, and 34 weeks. Intrapleural OK-432 injection was performed twice at GA 33 and 34 weeks. Cyanosis and respiratory distress were noted immediately after birth (GA 34 weeks). The baby expired despite of aggressive neonatal resuscitation. Patient 2: A 26-year-old, gravida 2, para 1, was found to have a cystic hygroma of her fetus at GA 17 weeks. Karyotype of the cystic fluid and the amniocytes were 46, XY. Fetal ascites developed at GA 22 weeks. OK-432 injection into the tumour was performed at GA 23 weeks. Stabilization of the cystic hygroma was noted throughout the pregnancy (about 3.5 cm in diameter). Serial fetal paracentesis and/or amnioreduction were performed. Karyotype of the ascites was again 46, XY. Maternal dietary modification with medium chain triglyceride was also prescribed. Chylothorax developed and the baby was born by cesareans at GA 32 weeks. Resolution of pleural effusion, ascites, and regression of cystic hygroma were noted since the 2nd day after birth. The baby had survived beyond 4 months of age at submission. Conclusion: Combination of antenatal OK-432 injection, maternal dietary modification, serial thoracocentesis plus paracentesis, together with amnioreduction and tocolysis, appeared to contribute to the success of antenatal treatment. Fetal pulmonary expansion may determine the immediate neonatal survival.
Impact of Continuous Intraoperative Monitoring on Outcomes in Open Fetal Surgery
Authors: Keswani Sundeep G. , Crombleholme Timothy M. , Rychik Jack , Tian Zhiyun , MacKenzie Tippi C. , Johnson Mark P. , Wilson R. Douglas , Flake Alan W. , Hedrick Holly L. , Howell Lori J. , Adzick N. Scott
Published: June 2005

Objectives: There are shifts in fetal hemodynamics during open fetal surgery that were not appreciated until the use of intraoperative fetal echocardiography. We have developed an intraoperative monitoring strategy to continuously assess fetal hemodynamics. We hypothesized that this approach would enhance intraoperative management and survival. Methods: Medical records of open fetal surgery patients were reviewed since the implementation of this approach. Intraoperative fetal monitoring was accomplished by continuous echocardiography, pulse oximetry, establishment of intravenous access, and arterial blood gas and hemoglobin measurement. Overall survival was compared to fetal surgeries performed prior implementation of this monitoring strategy. Results: Resections of a congenital cystic adenomatoid malformation or a sacrococcygeal teratoma in nine hydropic fetuses were performed while using this monitoring strategy. Intraoperative echocardiography resulted in a change of management in 7 of 9 fetuses. The main observations on fetal echocardiography resulting in intraoperative intervention were decreased ventricular filling, bradycardia, and decreased ventricular contractility. Therapy included administration of volume expanders and/or inotropic agents. Overall fetal survival was 78% compared to a survival of 42% prior to the implementation of this approach. Conclusion: Continuous intraoperative fetal monitoring provides real time assessment of fetal hemodynamics which results in changes in intraoperative management. The overall outcomes in these critically ill fetuses have been improved.