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Prophylactic treatment of very premature infants with human surfactant
INTERNATIONAL ABSTRACTS
Modified Diuresis Renography for Assessment of Equivocal Pelviureteric Junction Obstruction. 887 Long-term Results of Conservative and Surgical M a n a g e m e n t o f B l u n t R e n a l L a c e r a t i o n s ........ 8 8 7 P r e n a t a l D i a g n o s e d O v a r i a n C y s t ........................ 887
Musculoskeletal System Intraoperative Isotopic Localization of Osteoid O s t e o m a ............................................................ 888 Ultrasound Measurement of Femoral Antevers i o n i n C h i l d r e n ................................................. 888
Neoplasms Treatment of Children With Neurogenic Sarc o m a .................................................................. 888 P r i m a r y T u m o r s o f T e s t i s in C h i l d r e n ................. 8 8 8 T e s t i c u l a r T u m o u r M a r k e r s in S p e r m a t i c V e i n B l o o d ................................................................. 888
GENERAL CONSIDERATIONS Congenital Aplasia of the Deep Veins of Lower Extremities in Children..4. Gorenstein. E. Shifrin. R.L. Gordon, et aL Surgery
99:414-420, (April), 1986. From a group of 82 children, aged 2 to 15 years, with congenital acquired diseases of the vascular system, ten patients were found to have deep venous aplasia by ascending functional phlebography. The technique involves cannulation of the posterior tibial vein with injection of I mL/kg of 50% Hypaque without tourniquet. Three x-rays are obtained: (1) while the patient is standing with the leg internally rotated; (2) immediately after injection, 30 to 40 seconds later after active functional stress; and (3) three minutes following stress. The degree of venous insufficiency is determined by the amount and location of the contrast material remaining on the last x-ray. Deep venous aplasia was found in ten of the 82 children, all of whom clinically had KlippeI-Trenaunay syndrome. Seven of the patients were explored and found to have aplasia of the deep venous system. With the exception of removing lymphagiomatous or hemangiomatous tissue, no direct treatment of the aplasia was accomplished. The authors feel that ascending functional selective phlebography is important in assessing the degree of venous insufficiency, although from a review of their data it did not seem to alter therapeutic measures.--Eugene S. Wiener Prophylactic Treatment of Very Premature Infants With Human
Surfactant. T..4. Merritt, M. Hallman. B.T. Bloom, et aL N Engl J Med 315:785-790, (September 25), 1986. Premature newborns 24 to 29 weeks of gestation in whom analysis of amniotic fluid for phospholipids revealed a lecithin/sphingomyelin ratio below 2.0 and absence of phosphatidylglycerol or in whom examinations of amniotic fluid, or where pharyngeal or tracheal aspirates obtained immediately after birth revealed such an immature phospholipid profile, were randomly assigned to a surfactanttreated or placebo-treated group in which all participants were blinded to the two treatments. Thirty-one treated infants (birth weight 938 _+ 286 g) were compared with 29 control infants (birth weight 964 _+ 174 g). The surfactant treated group had significantly
881
fewer deaths than the control group, (16% v 52%, P > .001), fewer cases of bronchopulmonary dysplasia (16% v 31%), and significantly fewer cases of pulmonary interstitial emphysema (1 v 14, P > .001) and pneumothorax (2 v 7, P > .02). Surviving surfactant treated infants required neonatal intensive care for 70.25 +_27 days, whereas control infants required intensive care for 122.5 _+ 33.5 days ( P > .015). Treatment with human surfactant in the preliminary study was felt to offer promise for improving survival of very premature infants with surfactant deficiency and for reducing the sequella of respiratory distress syndrome.--Eugene S. Wiener The Comparison of Myocardial Dysfunction in Three Forms of
Experimental Septic Shock. K.J. Peevy, T. Reed, S.A. Chartrand, et al. Pediatr Res 20:1240-1242, (December), 1986. A rabbit model of septic shock was used to determine if (I) myocardial dysfunction is a common component of shock due to diverse neonatal pathogens, and (2) prostaglandins modulate septic myocardial dysfunction. The infusion of heat-killed Escherichia coil (group 1), Hemophilus influenza (group I1), or Staphylococcus epidermidis (group III) produced significant decreases in the first 9derivative of left ventricular pressure with respect to time (P < .05). Each organism also produced significant changes in mean arterial pressure, cardiac output, and heart rate, while pulmonary artery pressure was altered in groups I and III. Saline-infused control animals (group IV) exhibited no significant changes in any hemodynamic variable. Blood gas variables were not significantly changed in any group. These cardiovascular changes appeared dependent on arachidonic acid metabolism since indomethacin pretreatment prevented the cardiovascular changes induced by bacterial infusion. These results suggest that septic myocardial dysfunction is a common component of gram-negative and gram-positive septic shock, and that myocardial dysfunction is modulated by prostaglandin products.--Prem Puri Organ Procurement for Children: The Anencephalic Fetus As
Donor. M.R. Harrison. Lancet ii:1383-1386, (December), 1986. A possible source of organs for infants with end-stage organ disease is the anencephalic fetus. With anencephaly, termination is justifiable even in the third trimester, and vital organs other than the brain are usually normal. It is easily detected by screening for raised alpha-fetoprotein levels in maternal serum and amniotie fluid, and can be confirmed by sonography. Anencephaly occurs in 1 in 2,000 of the 3.7 million live births annually in the United States, producing about 2,000 cases a year. Even if only a small proportion proves suitable as a source of donor material, it could go a long way toward satisfying estimated needs. The author reviews the possibilities, advantages, and scientific rationale for use of fetal liver, heart, hematopoietic stem cell, intestine, kidney, and pancreatic islet transplants from anencephalic donors for otherwise hopeless childhood diseases. In addition, the ethical and legal issues of fetal organ donation are reviewed. The author concludes that "If organs from prenatally diagnosed anencephalic fetuses can be obtained with safety for the mother and respect for the fetus, the family should be allowed to salvage from their tragedy the consolation that their loss can provide life to another child."---Scott Adzick
THORAX Rasterstereography in the Measurement and Postoperative Follow-Up of Anterior Chest Wall Deformities. E. Hierholzer and F.
Schier. Z Kinderchir 41:267-271, (October), 1986. Rasterstereography is a contact-free photogrammetric method for the evaluation of body surfaces and is, as such, particularly well
Modified Diuresis Renography for Assessment of Equivocal Pelviureteric Junction Obstruction. 887 Long-term Results of Conservative and Surgical M a n a g e m e n t o f B l u n t R e n a l L a c e r a t i o n s ........ 8 8 7 P r e n a t a l D i a g n o s e d O v a r i a n C y s t ........................ 887
Musculoskeletal System Intraoperative Isotopic Localization of Osteoid O s t e o m a ............................................................ 888 Ultrasound Measurement of Femoral Antevers i o n i n C h i l d r e n ................................................. 888
Neoplasms Treatment of Children With Neurogenic Sarc o m a .................................................................. 888 P r i m a r y T u m o r s o f T e s t i s in C h i l d r e n ................. 8 8 8 T e s t i c u l a r T u m o u r M a r k e r s in S p e r m a t i c V e i n B l o o d ................................................................. 888
GENERAL CONSIDERATIONS Congenital Aplasia of the Deep Veins of Lower Extremities in Children..4. Gorenstein. E. Shifrin. R.L. Gordon, et aL Surgery
99:414-420, (April), 1986. From a group of 82 children, aged 2 to 15 years, with congenital acquired diseases of the vascular system, ten patients were found to have deep venous aplasia by ascending functional phlebography. The technique involves cannulation of the posterior tibial vein with injection of I mL/kg of 50% Hypaque without tourniquet. Three x-rays are obtained: (1) while the patient is standing with the leg internally rotated; (2) immediately after injection, 30 to 40 seconds later after active functional stress; and (3) three minutes following stress. The degree of venous insufficiency is determined by the amount and location of the contrast material remaining on the last x-ray. Deep venous aplasia was found in ten of the 82 children, all of whom clinically had KlippeI-Trenaunay syndrome. Seven of the patients were explored and found to have aplasia of the deep venous system. With the exception of removing lymphagiomatous or hemangiomatous tissue, no direct treatment of the aplasia was accomplished. The authors feel that ascending functional selective phlebography is important in assessing the degree of venous insufficiency, although from a review of their data it did not seem to alter therapeutic measures.--Eugene S. Wiener Prophylactic Treatment of Very Premature Infants With Human
Surfactant. T..4. Merritt, M. Hallman. B.T. Bloom, et aL N Engl J Med 315:785-790, (September 25), 1986. Premature newborns 24 to 29 weeks of gestation in whom analysis of amniotic fluid for phospholipids revealed a lecithin/sphingomyelin ratio below 2.0 and absence of phosphatidylglycerol or in whom examinations of amniotic fluid, or where pharyngeal or tracheal aspirates obtained immediately after birth revealed such an immature phospholipid profile, were randomly assigned to a surfactanttreated or placebo-treated group in which all participants were blinded to the two treatments. Thirty-one treated infants (birth weight 938 _+ 286 g) were compared with 29 control infants (birth weight 964 _+ 174 g). The surfactant treated group had significantly
881
fewer deaths than the control group, (16% v 52%, P > .001), fewer cases of bronchopulmonary dysplasia (16% v 31%), and significantly fewer cases of pulmonary interstitial emphysema (1 v 14, P > .001) and pneumothorax (2 v 7, P > .02). Surviving surfactant treated infants required neonatal intensive care for 70.25 +_27 days, whereas control infants required intensive care for 122.5 _+ 33.5 days ( P > .015). Treatment with human surfactant in the preliminary study was felt to offer promise for improving survival of very premature infants with surfactant deficiency and for reducing the sequella of respiratory distress syndrome.--Eugene S. Wiener The Comparison of Myocardial Dysfunction in Three Forms of
Experimental Septic Shock. K.J. Peevy, T. Reed, S.A. Chartrand, et al. Pediatr Res 20:1240-1242, (December), 1986. A rabbit model of septic shock was used to determine if (I) myocardial dysfunction is a common component of shock due to diverse neonatal pathogens, and (2) prostaglandins modulate septic myocardial dysfunction. The infusion of heat-killed Escherichia coil (group 1), Hemophilus influenza (group I1), or Staphylococcus epidermidis (group III) produced significant decreases in the first 9derivative of left ventricular pressure with respect to time (P < .05). Each organism also produced significant changes in mean arterial pressure, cardiac output, and heart rate, while pulmonary artery pressure was altered in groups I and III. Saline-infused control animals (group IV) exhibited no significant changes in any hemodynamic variable. Blood gas variables were not significantly changed in any group. These cardiovascular changes appeared dependent on arachidonic acid metabolism since indomethacin pretreatment prevented the cardiovascular changes induced by bacterial infusion. These results suggest that septic myocardial dysfunction is a common component of gram-negative and gram-positive septic shock, and that myocardial dysfunction is modulated by prostaglandin products.--Prem Puri Organ Procurement for Children: The Anencephalic Fetus As
Donor. M.R. Harrison. Lancet ii:1383-1386, (December), 1986. A possible source of organs for infants with end-stage organ disease is the anencephalic fetus. With anencephaly, termination is justifiable even in the third trimester, and vital organs other than the brain are usually normal. It is easily detected by screening for raised alpha-fetoprotein levels in maternal serum and amniotie fluid, and can be confirmed by sonography. Anencephaly occurs in 1 in 2,000 of the 3.7 million live births annually in the United States, producing about 2,000 cases a year. Even if only a small proportion proves suitable as a source of donor material, it could go a long way toward satisfying estimated needs. The author reviews the possibilities, advantages, and scientific rationale for use of fetal liver, heart, hematopoietic stem cell, intestine, kidney, and pancreatic islet transplants from anencephalic donors for otherwise hopeless childhood diseases. In addition, the ethical and legal issues of fetal organ donation are reviewed. The author concludes that "If organs from prenatally diagnosed anencephalic fetuses can be obtained with safety for the mother and respect for the fetus, the family should be allowed to salvage from their tragedy the consolation that their loss can provide life to another child."---Scott Adzick
THORAX Rasterstereography in the Measurement and Postoperative Follow-Up of Anterior Chest Wall Deformities. E. Hierholzer and F.
Schier. Z Kinderchir 41:267-271, (October), 1986. Rasterstereography is a contact-free photogrammetric method for the evaluation of body surfaces and is, as such, particularly well