For infants less than 32 weeks gestation a peak systolic to end diastolic flow velocity ratio>2 within 48 h of birth is associated with a persistent large PDA at 1 month of age.
Alternative therapies for treating heart failure patients are being explored to provide effective options for patients with progressive heart failure. Cardiac assist devices that promote myocardial recovery may be a potential solution. Ventricular assist devices (VAD) have demonstrated long-term efficacy and intraaortic balloon pumps (IABP) have shown short-term successes. In this paper, testing of a hybrid counterpulsation device (CPD) that couples the attributes of device longevity (VAD) with less invasive surgery (IABP) is presented. Hemodynamic and ventricular pressure-volume responses to a 40 ml CPD and 40 ml IABP were evaluated in vitro in an adult mock circulation and in vivo in a large animal heart failure model. The CPD is a flexing diaphragm ventricle with a controlled stroke volume up to 85 cc through a single, valveless cannula. In this study, the CPD was cannulated to the brachiocephalic artery to provide 40 ml of counterpulsation support. The CPD effectively provided diastolic augmentation increasing coronary flow and afterload reduction. These results were comparable to IABP. These preliminary studies suggest that CPD may be an effective therapy for treating patients with early stage heart failure.
1669Before vitamin D was discovered nutritional rickets was treated by exposure to sunlight.:' We report the successful treatment of osteomalacia by ultraviolet light in a patient with malabsorption and draw attention to the value of this long-established, safe, and unduly neglected form of treatment.
Case reportA 42-year-old mentally defective man presented in February 1976 with a one-year history of diarrhoea and loss of weight. He was found to have steatorrhoea and a jejunal biopsy specimen showed partial villous atrophy. Although the steatorrhoea improved on a gluten-free diet (fat excretion falling from 83 mmol/24 h to 27 mmol/24 h; normal < 18 mmol/24 h), complete recovery was never achieved, partly (at least) because of dietary indiscretions. In May 1977 the patient complained of soreness over the ribs and both tibiae for two months. The serum concentration of calcium was 2-08 mmol/1 (8 32 mg/ 100 ml), phosphate 0-67 mmol/l (2-07 mg/100 ml), and alkaline phosphatase 720 IU/l (normal <92 IU/1). A bone biopsy specimen showed wide osteoid seams and a defective calcification front and the plasma 25-OHD concentration was low at 3-9 ng/ml.Whole-body treatment with ultraviolet light was begun in May 1977 using four Westinghouse lamps FS40. The patient was treated three times per week, with increasing exposure times. Within one week of starting treatment (total exposure 20 min) his bone pains had been relieved and after two weeks' treatment (50 min) the plasma 25-OHD concentration had risen to 18 3,/g/l.
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