Our results suggest that regional cerebral blood flow and the presence of apoptotic cells, 3 h after hypoxic-ischemic injury, are correlated.
Aim: To evaluate the effect of cerebral hypoxia‐ischaemia induced by partial occlusion of the umbilical cord on the relationship of the regional cerebral blood flow and the cerebral cell death in near‐term fetal lambs. Methods: Fifteen near‐term lambs were assigned to two hypoxic‐ischaemic groups with or without life support (3 h), and a healthy one. Hypoxia‐ischaemia was induced by partial occlusion of the umbilical cord (60 min). Routine light and electron microscopy, and the TUNEL method for apoptosis were performed. Regional cerebral blood flow was measured by coloured microspheres. Cardiovascular, gas exchange and pH parameters were also evaluated. Results: Both hypoxic‐ischaemic groups produced a transient acidosis and a decrease of base excess in comparison to the healthy group. Cortical and cerebellar zones, where the regional cerebral blood flow values were similar to baseline, showed an increased number of oligodendrocyte‐like apoptotic cells. In contrast, in the inner zones, where regional cerebral blood flow was increased, the number of apoptotic cells did not increase. Necrotic neurons were observed in the basal nuclei, mesencephalon, pons and deep cerebellar nuclei. Conclusion: Our results suggest that regional cerebral blood flow and the presence of apoptotic cells, 3 h after hypoxic‐ischemic injury, are correlated.
Introduction: Fever is the manifestation of the organism's defense reaction against various infectious or non infectious agents. Aim of this study is to present the final diagnosis in neonates admitted in our unit with main symptom during admission the fever. Material and method:We studied retrospectively all neonates admitted during the last 2 years with cause of admission the fever. We referred in certain parameters such as: sex, age, level of fever, some laboratory indices( CRP, white blood count (WBC), urine, blood and cerebrospinal fluid (CSF) cultures), somministration or not of antibiotics and final diagnosis.Results: During the 2 years period there were hospitalized 1018 neonates. 81 neonates, 48 boys and 33 girls had fever as the main admission symptom. Their age in admission was 2-29 days. All neonates were mature. Their temperature in admission was 37,2-39,9°C. Half of the neonates (40/81) had as final diagnosis a systemic infection (24 urine infection, 6 meningitis, 6 sepsis, 4 bronchiolitis) and the other half (41/81) had a viral infection. An abnormal WBC was found in 26/81 neonates (14 with systemic and 12 with viral infection). CRP was positive in 32/81 neonates (10 with systemic and 22 with viral infection). Blood cultures were positive in 16 neonates, urine cultures were positive in 24 neonates and CSF cultures were positive in 4 neonates. All of the 40 neonates with systemic reaction received antibiotic therapy. 25/41 neonates with viral infection did not receive any antibiotic therapy while 16/41 neonates received antibiotics because of the positive markers of infection. In 4 of these neonates the therapy was interrupted on the 3rd day after evaluating the clinical condition and the laboratory results of the neonates.Conclusions: Half of the neonates with fever had a systemic infection and the other half a viral infection. 52/81 (65%) neonates received full antibiotic therapy, 25/81 neonates did not receive any therapy and in 4/81 (5%) neonates therapy was interrupted on the 3rd day. The laboratory tests in admission were indicative neither for viral or microbial infection nor for the use of antibiotics. Every neonate with fever must receive antibiotic therapy until the laboratory tests and the clinical condition are evaluated for continuing or not the therapy. SAO PAULO, (BRAZIL) Background: The increase on multiple births has been associated with a rise of low birth weight rates (LBW) in developed countries. In Brazil, despite the steady increase of LBW rate in some settings, there is no evaluation of the impact of multiple births on LBW rates. IMPACT OF MULTIPLE BIRTHS ON LOW BIRTH WEIGHT RATE IN PORTO ALEGRE, BRAZILObjective: To investigate the influence of multiple births on trends of low birth weight rates in the city of Porto Alegre, one of the most developed areas in the South of the country. Methods: This is a registry-based study of all live births from 1993 to 2002. The data were obtained from the SINASC (live birth information system). The Chi-Square test for trend was calculat...
Background: The function of exogenous pulmonary surfactant depends of an adequate stability of its components, a highly complex mixture of lipids (mainly phospholipids) and two hydrophobic polypeptides, SP-B and SP-C. This composition could become instable with long time surfactant storage. The Butantan Institute (Brazil) produced a new porcine pulmonary surfactant preparation composed mainly of 76% of phosphatidylcholine (30 -35% of the phosphatidylcholine is saturated dipalmitoyl phosphatidylcholine), 6 -8% of phosphatidyllethanolamine, 6% of phosphatidylinositolϩphosphatidylserine, and 4 -6% of sphingomyelin, with 5.6% of two hydrophobic polypeptides, SP-B and SP-C. The objective of this study was to evaluate the Butantan exogenous surfactant function one year after its production, using the premature rabbit model.Methods: 16 New Zealand White premature rabbits were delivered by c-section at 27 days gestation and randomized into two study groups according to the type of surfactant treatment: Butantan surfactant (nϭ8, animals treated with Butantan surfactant kept in refrigerator at 4o C for one year), and Curosurf (Farmalab-Chiesi) group (nϭ8; surfactant used 4 months after its production). Animals were ventilated with a preset tidal-volume of 8 ml/kg for 15 minutes, using a ventilator-pletismograph system with the following ventilator settings: respiratory rate (RR), 60 cycles/min; FiO2, 0.21; peak inspiratory pressure (PIP) needed to acquire the target tidal-volume ( 8 ml/kg); PEEP, 0 cmH2O; inspiratory and expiratory time, 0.5 seconds. Ventilatory pressure (VPϭPIP-PEEP), tidal-volume (TV), and dynamic compliance (DCϭTV/VP) were recorded each five minutes until sacrifice. Statistical analysis was performed by t-test. Significance level was set at 0.05.Results: Conclusion:The Butantan surfactant showed to be as effective as a newly synthesized Curosurf to treat respiratory distress syndrome in the premature rabbit model, one year after storage at 4°C in refrigerator. Background:Endogenous nitric oxide (NO) production increases in perinatal asphyxia and inflammatory processes. Histological lesion (necrosis and/or apoptosis) secondary to hypoxic-ischemic (H-I) injury appears in several hours after the insult but biological markers appear earlier. In our previous studies (1,2) we have observed early changes in cerebral blood flow and in O2-uptake. Aim: To study the early changes of serum NO concentration in a model of perinatal asphyxia induced by prolonged umbilical cord clamping in premature lambs. EARLY INCREASE OF NITRIC OXIDE IN A MODEL OF PERINATAL ASPHYXIA IN FETAL LAMBSMethods:10 preterm lambs (80 -90% GE) were randomly assigned to: Control group, after Cesarean section, lambs were managed on conventional mechanical ventilation for 3 hours (nϭ5); Asphyctic group, H-I injury was performed by partial cord clamping during 60 min and later, lambs were managed similar to the control group (nϭ5). NO was measured in serum samples by fluorometric assay at baseline (B), immediately after H-I injury and at the en...
Background: Esophageal atresia (EA) with distal fistula, also called III type, represents the most common form of EA, with a frequency of 1 case in 4000, often associated with other congenital anomalies. VATER syndrome represents a non-random etiologically diverse association of vertebral defects, anal atresia, tracheo-esophageal fistula and radial or renal defects. We describe a novel multiple malformation pattern, characterized by tracheal stenosis, type II laryngeal web, esophageal atresia (EA) with distal fistula, vestibular fistula (VF), atrial septal defect (ASD) and patency of the ductus arteriosus (PDA), never reported in literature Case report: Newborn with normal delivery at the end of pregnancy with polydramnios seen by an ultrasonographic examination, birth weight 2.80 Kg and length 45.6 cm. At birth Apgar score was 7 and 8 at 1' and 5' min, respectively. Insertion of a nasal-gastric probe was immediately tried, with an obstacle to progression. An immediate X-ray thorax-abdomen showed 'a stop of the radiopacal nose-gastric probe at level of D4, with a back-banding, arousing suspection of EA'. Moreover, the presence of air in the digestive tube induced to suppose the presence of a tracheoesophageal fistula. The examination of the perineal region showed an anorectal malformation (VF) with regular canalization and immediate emission of meconio. An ultrasonographic exam of the hearth showed the presence of ASD and PDA. An optic fibers laryngscope, used for repeated episodes of crisis of apnea with cyanosis and bradycardia, showed the presence of an anterior II type laryngeal web. A nuclear magnetic resonance (MRI) pointed out the presence of a tracheal stenosis involving a wide feature of tracheal lume. Cariotype asset was examined without finding any chromosomic alteration.Treatment: On the second day of life, the patient underwent surgery in order to correct the EA through a right posterolateral toracotomy on the fourth intercostal space. An extrapleuric surgical approach was performed and a distal tracheoesophagel fistula was isolated during the surgical exploration. A resection of the laryngeal web was performed by means of laser CO2. Unfortunately, this procedure did not give appreciable improvements of the respiratory dynamics and the patient died in sixtyfourth day of life, during a serious respiratory crisis.Discussion: It could be considered an original syndrome like an expansion of VATER association. In fact, the concomitant presence of tracheal stenosis and EA takes place rarely, and the correlation between these two defects is little studied. If it is taken into account the concomitant presence of a laryngeal web of II type, such an association appears unique. More observations will be necessary, along with in-depth genetic studies, to determine the cause and the genetic transmission of this multiple malformation syndrome.
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