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Rev Neurol. 2000 Oct 1-15;31(7):601-4.
[Advances in neonatal neurology]
[Article in Spanish]
Campistol J.
Servicio de Neurologia, Unitat Integrada Hospital Sant Joan de Deu-Clinic, Universitat de Barcelona, Espana. campistosjdbcn.org
INTRODUCTION: Notable changes have occurred in the field of neonatology in recent years. Logically, neonatal neurology has made a major contribution to this progress. DEVELOPMENT AND CONCLUSIONS: Knowledge in the field of neonatal neurology has multiplied: fetal neurology has developed, fetal and neonatal welfare is better understood, and spectacularly modified by techniques of assisted ventilation. High resolution ultrasonography permits visualization of fetal cerebral anomalies, the treatment of hypoxic encephalopathy is advancing as is non-invasive cerebral hemodynamic monitoring. Neuroimaging techniques let us see not only the structure of the brain but also how it functions, to some extent. New antiepileptic drugs have appeared. Various treatable causes of neonatal convulsions have been identified. Infections and the incidence of hemorrhage in premature babies have fallen at the same time as new metabolic disease of neonatal onset (protein glycosilation, folinic-sensitive convulsions and adenylsuccinate deficiency) have been identified. Ethics committees for consensual decisions in neonatal intensive care units have become established. We emphasize the need for units for the follow-up of newborn babies with a risk of developing neurological complications, with programmes adapted to the needs of each individual centre.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11082865&dopt=Abstract hemorrhage
Am J Obstet Gynecol. 2000 Nov;183(5):1082-7.
Impact of head-to-abdominal circumference asymmetry on outcomes in growth-discordant twins.
Dashe JS, McIntire DD, Santos-Ramos R, Leveno KJ.
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
OBJECTIVE: Our aim was to evaluate head-to-abdominal circumference asymmetry as a marker for adverse outcomes in growth-discordant twins. STUDY DESIGN: We conducted a retrospective cohort study of asymmetric and symmetric twins with > or =25% growth discordance, comparing their outcomes with those in concordant symmetric twins. Growth was termed asymmetric on the basis of a head circumference/abdominal circumference ratio at > or =95th percentile on ultrasonography performed < or =4 weeks before delivery. RESULTS: We evaluated 572 twin pairs. Asymmetric discordant twins were more likely than symmetric concordant twins to be delivered at < or =34 weeks' gestation (57% vs. 27%), to require intubation (36% vs. 7%), to remain in intensive care >1 week (36% vs 3%), and to have an outcome composite that included respiratory morbidity, intraventricular hemorrhage, sepsis, or neonatal death (29% vs 6%), all P<.05. Symmetric discordant and symmetric concordant twins had similar outcomes. CONCLUSIONS: Discordant twins with head-to-abdominal circumference asymmetry have an increased risk of morbidity. Moreover, in the absence of asymmetry, outcomes are comparable among discordant and concordant twins.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11084545&dopt=Abstract hemorrhage
World J Gastroenterol. 2002 Dec;8(6):1063-6.
Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases.
Chen ZY, Qi QH, Dong ZL.
Department of surgery, General Hospital of Tianjin Medical University, China.
AIM: To analyze the causes and management of hemorrhage in spontaneous liver rupture. METHODS: Seventy cases of spontaneous liver rupture were retrospectively analyzed for causes of hemorrhage and therapeutic effects of surgical approaches. RESULTS: It was demonstrated that the causes of spontaneous liver rupture were primary liver cancer in 60 cases (85.7 %), cirrhosis in 3 cases (4.3 %), liver angioma in 2 cases (2.9 %), liver adenoma in 4 cases (5.7 %),and secondary liver cancer in 1 case (1.4 %). Hemostasis was achieved with surgical approaches in 68 cases (97.1 %) and non-surgical approaches in 2 cases (2.9 %). Surgical interventions included suture, ligation of hepatic artery, hepatic artery chemoembolization and partial hepatic resection. CONCLUSION: The results suggest that surgical intervention is still the main therapeutic method and the best procedure that should be selected according to causes of disease and patient's condition and history.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12439926&dopt=Abstract hemorrhage
Trop Gastroenterol. 2000 Jul-Sep;21(3):118-20.
Effect of renal dysfunction in fulminant hepatic failure.
Jain S, Pendyala P, Varma S, Sharma N, Joshi K, Chawla Y.
Postgraduate Institute of Medical Education and Research, Chandigarh, India. drsjailide.net.in
BACKGROUND: Effect of renal dysfunction in fulminant hepatic failure is not studied extensively. METHODS: Fifty consecutive patients of fulminant hepatic failure were studied prospectively to determine the prevalence of renal failure and its effect on survival. RESULTS: The mean age of these patients was 36 +/- 7.2 years and there were 21 males and 29 females. Twenty two patients (44%) were hepatitis B surface antigen (HBsAg) positive. Renal dysfunction was observed in 19 patients (38%). Acute tubular necrosis was seen in 7 patients (38%) while prerenal azotemia and functional renal failure occurred in six patients each (37%). Renal failure occurred more commonly in patients with jaundice. In these patients it occurred in less than four days and prior to onset of encephalopathy, ascites, and gastrointestinal hemorrhage. Histopathological examination of kidney (done in 8 patients) revealed acute tubular necrosis in 4 patients while patients with functional renal failure and prerenal azotemia had normal histology. A good correlation was observed between biochemical parameters and histology of kidney in all the patients. The survival amongst the patients with FHF was 28% (14 of 50 patients). Poor prognostic indicators were a leukocyte count of more than 16.5 x 10(9)/liter, prothrombin index of less than 34%, a peak serum bilirubin of more than 376 mumol/liter and presence of renal failure. Only 3 of 19 patients with renal failure survived. CONCLUSIONS: Renal dysfunction is a major indicator of poor prognosis in patients with FHF.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11084831&dopt=Abstract hemorrhage
Minerva Med. 2000 May-Jun;91(5-6):99-104.
[Prognosis of stroke patients undergoing intubation and mechanical ventilation]
[Article in Italian]
Magi E, Recine C, Patrussi L, Becattini G, Nannoni S, Gabini R.
Servizio di Anestesia e Rianimazione, Ospedale S. Donato, Arezzo.
BACKGROUND: To determine the outcome of patients with acute stroke requiring intubation and mechanical ventilation. METHODS: Design: review of the medical records of 33 patients with stroke intubated at presentation in hospital and not requiring neurosurgery or angiography. Setting: intensive care unit (ICU) of a non teaching hospital. Interventions: none. Measurements: the mean age (SD) was 73.3 (7.7), min 46 max 87, 18 males and 15 females, mean Glasgow coma scale (GCS) (min-max) was 4.5 (3-8). RESULTS: The hospital mortality of intubated patients was 78.7% (26/33), mortality in the ICU was 69.69% (23/33). In survivors: infarction/hemorrhage (INF/HEM) were 4/3, mean age (SD) 75.2 (5.6), males/females 4/3, mean GCS (min-max) 5.2 (3-7), days in the ICU mean (DS) 18 (20.2). In patients who died: INF/HEM were 10/16, mean age (SD) 72.8 (8.2), males/females 14/12, mean GCS (min-max) 4.3 (3-8), days in the ICU mean (DS) 5.5 (8). The difference between groups was significant (p < 0.05) only for ICU staying. The evolution to brain death was observed in 10 cases (30.3%). CONCLUSIONS: The overall prognosis of patients with acute stroke intubated and ventilated at presentation in hospital for deterioration is severe but the observed survival rate is sufficient to justify this treatment even in cases not requiring other invasive procedures like neurosurgery or angiography. A significant fraction of stroke patients is part of the potential organ donors pull.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11084843&dopt=Abstract hemorrhage
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