BackgroundWe evaluated early and late pulmonary hypertension (PH) in preterm infants and its relation with bronchopulmonary dysplasia (BPD).MethodsSixty-seven preterm infants < 30 weeks' gestation underwent echocardiography within 14 days after birth for early PH and over 28 days after birth for late PH. We measured tricuspid regurgitation (TR) peak velocity, pulse Doppler-derived myocardial performance index (MPI) of right ventricle (RV) (RV MPI), eccentricity index (EI), and tricuspid annular plane systolic excursion (TAPSE).ResultsThe median gestation age of patients was 27 weeks (range, 23โ30 weeks) and median birth weight was 1030 g (range, 450โ1780 g). TR peak velocity was measured only in 19 patients (28.4%). Patients with symptomatic early PH (n = 11) showed a significantly lower systolic EI and a significantly higher incidence of RV MPI > 0.38 and TAPSE < 0.5 cm than patients without PH. The incidence of symptomatic early PH was highest in severe BPD, although this was not statistically significant. Early echocardiographic parameters are not associated with BPD development. Patients with severe BPD showed a significantly higher RV MPI and a significantly higher incidence of RV MPI > 0.38 than patients with mild BPD, and a significantly lower systolic EI and a significantly higher incidence of systolic EI < 0.81 than patients without BPD.ConclusionSystolic EI, RV MPI, and TAPSE were well represented symptomatic early PH, while systolic EI and RV MPI could be useful parameters for identifying late PH in preterm infants with BPD, even if they did not present PH symptoms.
Prolotherapy is a non-surgical injection treatment method that repeatedly injects small amounts of proliferators into damaged ligaments, tendon, joints and surrounding tissues. The most common proliferator is a high concentration of glucose solution. Glucose solutions with a concentration of 10-25% are commonly used. Prolotherapy using glucose solution has few serious adverse events, but common side effects include post injection pain, stiffness, edema, and mild bleeding. There are many cases of complaining of pain caused by injection during or after prolotherapy. Some patients give up treatment if the pain is severe. A 43-year-old male patient visited the hospital with both elbow pain and left wrist pain, and prolotherapy was performed. In order to minimize pain during procedure and post injection pain of the patient, 10% glucose solution with 0.5% lidocaine was injected using a very fine needle of 30 G. The total number of treatments was eight. The patient did not complain of pain caused by needle insertion during procedure and post-injection pain. Chronic pain that lasted for two years after treatment almost disappeared. The patient was very satisfied with this treatment method and result.
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