2.Malik AO, Spertus JA, Patel MR, et al. Potential association of the ISCHEMIA trial with the appropriate use criteria ratings for percutaneous coronary intervention in stable ischemic heart disease. JAMA Intern Med.
Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores <70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.
Pheochromocytomas represent a rare, but potentially devastating, cause of hypertension among pregnant patients. Inherited predisposition to these tumors requires vigilant screening, especially in women of child-bearing age. We present an illustrative case of a multiple endocrine neoplasia type 2A patient who was successfully surgically treated for a pheochromocytoma during pregnancy. A review of the existing, English-language literature and screening guidelines was undertaken. Pheochromocytomas presenting during pregnancy, can be safely and effectively treated with laparoscopic surgery, allowing the maintenance of a normal pregnancy. Screening of patients with inherited endocrinopathies that predispose to adrenal medullary tumors must be adapted to maximize the opportunity to detect a pheochromocytoma in the pregravid state. More frequent testing and a lower threshold for biochemical or radiologic investigation are suggested for women in their reproductive years.
Mental stress elicits diverse vascular responses in humans. The coronary circulation is responsible for providing the heart with adequate blood supply during stress. Psychological stress has been linked to the development of coronary artery disease. The effect of mental stress on coronary vascular conductance (CVC) was examined in both men (n=9) and women (n=8). Coronary blood flow velocity (Doppler ultrasound), MAP, and HR were monitored continuously before, during, and after 3 min of mental arithmetic. Mean arterial blood pressure (MAP; 85±2 and 84±4 mmHg) and heart rate (HR; 68±4 and 73±5 beats/min) at rest were not significantly different between men and women, respectively. Mental arithmetic increased HR and MAP (Δ17±3 beats/min and Δ17±2 mmHg, respectively) in all subjects. No sex differences in HR and MAP responses to mental arithmetic were observed (P>0.05). When all subjects were analyzed together, coronary blood velocity increased (17.9±1.4 to 22.5±1.5 cm/s; P=0.001) but CVC did not change with mental stress (0.27±0.02 to 0.29±0.02 cm/s/mmHg; P=0.38). However, when analyzed separately, men demonstrated a significant increase in CVC (Δ21±1%; P<0.002) and women elicited no change in CVC (Δ3±1%; P=0.63). These data indicate that women, unlike men, do not augment CVC during mental stress. Therefore, these results suggest that women may be more susceptible to adverse cardiac events during mental stress.
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