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J Am Coll Cardiol. 2000 Nov 1;36(5):1684-90.
Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management.
Baker CM, McGowan FX Jr, Keane JF, Lock JE.
Department of Cardiology, The Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
OBJECTIVES: We reviewed the management and outcome of patients experiencing pulmonary artery (PA) trauma during balloon dilation (BD). BACKGROUND: Balloon dilation of the PA is important in the management of peripheral pulmonary stenosis. Successful BD requires a controlled tear of the PA; excessive tearing can produce complications ranging from pseudoaneurysms to rupture and death. The incidence and optimum management for such complications are unreported. METHODS: All records of patients who underwent branch PA dilation between June 1984 and October 1997 were reviewed; those with a significant complication were analyzed. RESULTS: Of 1,286 catheterizations in 782 patients, PA trauma (excluding isolated pulmonary edema and PA aneurysms) was identified in 29 catheterizations in 26 patients. Tears occurred distal to the area of stenosis in most cases (62%). Intensive medical management, with and without catheter directed therapy, was employed. The damaged PA was successfully coil embolized in five patients, four of whom survived; temporary balloon occlusion did not prevent death in two patients. There were six deaths from pulmonary hemorrhage. A case control analysis demonstrated that PA trauma was significantly associated with pulmonary hypertension. CONCLUSIONS: Pulmonary artery trauma associated with BD occurs mostly distal to the site of narrowing, is associated with underlying pulmonary hypertension and is frequently (5/12 or 42%) fatal in those with unconfined tears. Intensive management strategies as well as attention to distal balloon position may reduce incidence and mortality. Coil occlusion of the damaged PA appears to be a valuable strategy to prevent fatal hemorrhage.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11079677&dopt=Abstract hemorrhage
Eur Radiol. 2002 Dec;12(12):2926-32. Epub 2002 May 17.
Postnatal cranial ultrasonographic findings in feto-fetal transfusion syndrome.
Breysem L, Naulaers G, Deprest J, Schoubroeck DV, Daniels H, Lammens M, Smet MH.
Department of Radiology, University Hospitals, Herestraat 49, 3000 Leuven, Belgium. luc.breysez.kuleuven.ac.be
Our objective was a retrospective evaluation of cranial US in survivors of twin pregnancy with feto-fetal transfusion syndrome (FFTS), with knowledge of prenatal treatment and neonatal/postnatal clinical data. In 18 pregnancies with FFTS (January 1996 to May 2000), pregnancy management and outcome, and neonatal clinical/neurological data and follow-up (age of 3-7 months) were documented when available. Postnatal cranial US abnormalities were differentiated in prenatal and peri/postnatal lesions, respectively, in "donor" and "recipient." The statistical analysis used was Mann Whitney U test and Fisher's exact test. Overall pregnancy survival rate was 19 of 36 (53%); mors in utero occurred in five twin members. Gestational age at birth was significantly lower in FFTS after laser coagulation (13 of 18; p<0.05). Initial (<or=4 days of age) postnatal cranial US was abnormal in 13 of 27 cases: antenatal brain lesion in 9 of 13 patients (7 of 13 donors, 2 of 14 recipients); after treatment: antenatal hemorrhage (n=6), hydrocephaly (n=1), subependymal germinolysis (n=1), lenticulostriatal vasculopathy (n=1), evidence for brain atrophy (n=2), cystic periventricular leukomalacia in<3 days (n=1); peri/postnatal brain lesions in 4 of 13 patients (hemorrhage (n=3), and periventricular leukomalacia (n=1). Finally, an abnormal brain US was found in 18 patients. Twin pregnancies complicated with FFTS are high-risk pregnancies with antenatal and postnatal mortality and morbidity. In utero cranial hemorrhage dominated the antenatal brain insults; however, pregnancy survivors remain at risk for severe peripartal and/or postnatal brain insults.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12439572&dopt=Abstract hemorrhage
Am J Physiol Regul Integr Comp Physiol. 2000 Dec;279(6):R2042-7.
Elevation of histidine decarboxylase activity in skeletal muscles and stomach in mice by stress and exercise.
Ayada K, Watanabe M, Endo Y.
Department of Geriatric Dentistry, School of Dentistry, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
The effects of different types of stress (water bathing, cold, restraint, and prolonged walking) on histidine decarboxylase (HDC) activity in masseter, quadriceps femoris, and pectoralis superficial muscles, and in the stomach were examined in mice. All of these stresses elevated gastric HDC activity. Although water bathing, in which muscle activity was slight, was sufficiently stressful to produce gastric hemorrhage and to increase gastric HDC activity, it produced no detectable elevation of HDC activity in any of the muscles examined. The other stresses all elevated HDC activity in all three muscles. We devised two methods of restraint, one accompanied by mastication and the other not. The former elevated HDC activity in the masseter muscle, but the latter did not. These results suggest that 1) HDC activity in the stomach is an index of responses to stress, 2) the elevation of HDC activity in skeletal muscles during stress is induced partly or wholly by muscle activity and/or muscle tension, and 3) stress itself does not always induce an elevation of HDC activity in skeletal muscles.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11080067&dopt=Abstract hemorrhage
J Allergy Clin Immunol. 2000 Nov;106(5):867-73.
Risk of childhood asthma and allergic rhinitis in relation to pregnancy complications.
Nafstad P, Magnus P, Jaakkola JJ.
Section of Epidemiology, Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway.
BACKGROUND: Events occurring during fetal life may affect the development of the immune and respiratory systems and increase the risk of asthma and allergic diseases. OBJECTIVES: We sought to elaborate the relations between the occurrence of pregnancy complications and other pregnancy-related conditions and the risk of bronchial obstruction during the first 2 years of life and the occurrence of asthma and allergic rhinitis by the age of 4 years. Pregnancy complications were considered both as predictors of the health outcomes and as possible effects caused by other prenatal factors. METHODS: A population-based, 4-year, cohort study was carried out involving 2531 children born in Oslo, Norway. We collected information on maternally related (hyperemesis, hypertension, and preeclampsia) and uterus-related complications in pregnancy (antepartum hemorrhage, preterm contractions, insufficient placenta, and restricted growth of the uterus) and the child's health and environmental exposures at birth and at 6, 12, 18, and 24 months and 4 years of age. The outcomes of interest were bronchial obstruction during the first 2 years and asthma and allergic rhinitis at the age of 4 years. RESULTS: In a logistic regression analysis adjusting for potential confounders, uterus-related, but not other pregnancy-related, complications increased the risk of bronchial obstruction (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3-3.4), asthma (OR, 3.0; 95% CI, 1.8-5.4), and allergic rhinitis (OR, 2.9; 95% CI, 1.6-5.2). These relations were similar in children of atopic and nonatopic parents. CONCLUSIONS: Uterus-related complications in pregnancy increase the risk of having asthma and allergic rhinitis in childhood.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11080708&dopt=Abstract hemorrhage
Arq Bras Cardiol. 2000 Nov;75(5):375-9.
Mortality due to cardiovascular disease in women during the reproductive age (15 to 49 years), in the State of Sao Paulo, Brazil, from 1991 to 1995.
Haddad N, Silva MB.
Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil.
OBJECTIVE: To describe mortality due to cardiovascular diseases in women during the reproductive age (15 to 49 years) in the state of Sao Paulo, Brazil, from 1991 to 1995. METHODS: A list of all deaths and their underlying causes, coded according to the International Classification of Diseases, 9th revision, multiple causes of death, and estimates of the female population according to age groups were provided by the SEADE Foundation. Specific coefficients for 100 thousand women for each year as well as the medians of these coefficients related to 5 years, and the percentage of death by subgroups were calculated. RESULTS: Cerebrovascular diseases have the highest coefficients (14.24 for 100 thousand females), followed by ischemic heart disease (7.37), other heart diseases (6.39), hypertensive disease (3.03), chronic rheumatic heart disease (1.58), pulmonary vascular diseases (1.29), and active rheumatic fever (0. 05). Systemic arterial hypertension, as an associated cause, occurred in 55.3% to 57.8% of all the deaths due to intracerebral hemorrhage and in 30.4% to 30.8% due to subarachnoid hemorrhage. CONCLUSION: The significance of cerebrovascular diseases, coronary artery disease, and systemic arterial hypertension as causes of mortality suggests the need to emphasize preventive actions for young women who have the potential to reproduce to avoid possible complications in future pregnancies, and premature mortality.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11080749&dopt=Abstract hemorrhage
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