Monitoring systemic venous oxygen saturations in the hypoplastic left heart syndrome.

Although progress has been made in treating hypoplastic left heart syndrome, improvements in perioperative care may further decrease mortality. We present a case in which continuous monitoring of systemic venous oxygen saturation allowed stabilization and successful management of a critically ill infant. Systemic venous oxygen saturation may provide a more accurate representation of a child's clinical status, allowing more rapid intervention and better outcomes.

A reliable method to retrieve accident & emergency data stored on a free-text basis.

Accident & Emergency (A & E) data on asthma-related attendances are useful for studies on the effectiveness of asthma interventions, and to determine the relationship of environmental factors to asthma and asthma epidemics. The final diagnoses made in the A & E departments are not usually coded when entered into hospital databases in the U.K.

Effects of general and alcohol-specific media literacy training on children's decision making about alcohol.

This article examines the immediate and delayed effects of media literacy training on third-grade children's perceptions of alcohol advertising, alcohol norms, expectancies for drinking, and behaviors toward alcohol. A Solomon four-group style experiment (N = 225) with two levels of the treatment factor assessed the effectiveness of in-school media literacy training for alcohol. The experiment compared a treatment that included the viewing of a videotape about television advertising along with the viewing of video clips of alcohol ads and discussion pertaining to alcohol advertising specifically versus one that included the viewing of the same general purpose media literacy videotape along with video clips of non-alcohol advertising and then discussion of advertising in general.

An unusually long ligamentum arteriosum.

During routine laboratory dissections an unusually long ligamentum arteriosum, measuring 40 mm, was observed. Apparently, such a length for an otherwise normal ligamentum has not been reported previously. Forty-three other ligamenta in adults and three in newborn or stillborn infants were also measured having a range of 8 mm to 24 mm (mean 15.

Animal model of the univentricular heart and single ventricular physiology.

The univentricular heart complexes are a fairly common and potentially lethal set of congenital cardiac anomalies. Progress in developing new therapeutics has been hampered by a lack of suitable animal models. The authors developed a stable, closed heart preparation to systematically examine potential interventions.

Effects of oxygen, positive end-expiratory pressure, and carbon dioxide on oxygen delivery in an animal model of the univentricular heart.

Objective: Respiratory manipulations are a mainstay of therapy for infants with a univentricular heart, but until recently little experimental information has been available to guide their use. We used an animal model of a univentricular heart to characterize the physiologic effects of a number of commonly used ventilatory treatments, including altering inspired oxygen tension, adding positive end-expiratory pressure, and adding supplemental carbon dioxide to the ventilator circuit.

Results: Lowering inspired oxygen tension decreased the ratio of pulmonary to systemic flow.

Short gut syndrome: treatment by neovascularization of the small intestine.

Surgical treatment for short bowel syndrome has been directed toward slowing intestinal transit or increasing the absorptive surface area of the bowel. In the present work, we attempted to enhance bowel absorption by increasing vascularity, using the omentum's unique ability to revascularize incorporated tissue. After a 90% resection of small bowel with primary anastomosis in 5 mongrel dogs, an omental flap based on the right gastroepiploic vessels was incorporated into a seromuscular incision on the antimesenteric border of the remnant small bowel.

Cis-elements in the promoter region of the human myeloperoxidase (MPO) gene.

We recently reported the identification and initial characterization of the human myeloperoxidase (MPO) promoter. The minimal or basic MPO promoter lies within the proximal 128 bp of the 5'-flanking region of the MPO gene. Plasmids containing progressively larger segments of the 5'-flanking region show correspondingly greater MPO promoter activity and increased tissue specificity compared with smaller promoter fragments.

Inotropes in the hypoplastic left heart syndrome: effects in an animal model.

Background: Despite substantial changes in the surgical treatment of children born with the hypoplastic left heart syndrome, overall mortality remains high. Although further improvements in outcomes appear to depend on more effective perioperative care, few experimental data exist to guide appropriate pharmacologic therapy in these infants. Because different inotropic agents may have different effects on the ratio of pulmonary to systemic flow (Qp/Qs), we hypothesize that they may not be equally effective at increasing oxygen delivery.

Haloacetate-induced oxidative damage to DNA in the liver of male B6C3F1 mice.

Brominated and chlorinated haloacetates (HAs) are by-products of drinking water disinfection. Dichloroacetate (DCA) and trichloroacetate (TCA) are hepatocarcinogenic in rodents, but the brominated analogs have received little study. Prior work has indicated that acute doses of the brominated derivatives are more potent inducers of oxidative stress and increase the 8-hydroxydeoxyguanosine (8-OH-dG) content of the nuclear DNA in the liver.

Lipid peroxidation and formation of 8-hydroxydeoxyguanosine from acute doses of halogenated acetic acids.

Chlorinated, brominated, and mixed bromochloro acetates are major by-products of water disinfection by chlorine or ozone. The chlorinated acetates, trichloroacetate (TCA) and dichioroacetate (DCA), are carcinogenic in rodents. Brominated analogs of TCA and DCA have received little study.

Use of a directly conjugated monoclonal anti-D (BRAD-3) for quantification of fetomaternal hemorrhage by flow cytometry.

Background: Determination of the volume of fetal D-positive cells in the circulation of D-negative women after delivery is carried out to determine whether additional prophylactic anti-D should be given to the mother. Although the Kleihauer-Betke test is still widely used to calculate the fetomaternal hemorrhage, increasing use is being made of flow cytometry.

Study Design And Methods: A conjugated monoclonal anti-D was prepared by labeling purified BRAD-3 (IgG3) with fluorescein isothiocyanate (FITC-BRAD-3).

Successful double bypass grafting in a child with coronary artery obstruction due to Kawasaki disease.

We describe the clinical evaluation and surgical treatment of a 7-year-old child who had severe coronary artery obstructions that occurred as a sequela of previously diagnosed Kawasaki disease.

The role of neuromonitoring in cardiovascular surgery.

This review describes the techniques currently used for quantitative neurophysiologic measurement during cardiac surgery and their potential impact on clinical outcome. Electroencephalography (EEG) characterizes cerebrocortical neuronal electrical activity and was part of some of the earliest cardiopulmonary bypass procedures, yet today it is not widespread use. Each of the common misunderstandings regarding a supposed limitation of this technology is explained.

Postbypass effects of delayed rewarming on cerebral blood flow velocities in infants after total circulatory arrest.

Cerebral perfusion is reduced after prolonged periods of total circulatory arrest in infants. Methods of rewarming after arrest may modify the flow pattern of recovery, and a single report has suggested that using cold reperfusion to delay rewarming could mitigate abnormalities in cerebral blood flow. Cerebral perfusion was evaluated by transcranial Doppler sonography in 16 infants who required periods of total circulatory arrest of 35 minutes or more.

Flow cytometry in diagnosis and management of large fetomaternal haemorrhage.

Aims: To evaluate an indirect immunofluorescence flow cytometry technique in a series of patients with large fetomaternal haemorrhage (FMH).

Methods: Patient samples identified by Kleihauer testing in local laboratories as having FMH > 4 ml were sent for flow cytometric analysis. In a proportion of cases the mothers received anti-D immunoglobulin prophylaxis according to the flow cytometer estimate of FMH volume.

Enzyme/prodrug gene therapy: comparison of cytosine deaminase/5-fluorocytosine versus thymidine kinase/ganciclovir enzyme/prodrug systems in a human colorectal carcinoma cell line.

We have been developing an enzyme/prodrug gene therapy approach for the treatment of primary and metastatic tumors in the liver. This system uses the cytosine deaminase/5-fluorocytosine (CD/5-FCyt) enzyme/prodrug combination. Another system that has received considerable attention is the herpes simplex virus thymidine kinase/ganciclovir (HSV-TK/GCV) enzyme/prodrug combination.

Anti-D quantification by flow cytometry: an alternative to the AutoAnalyser?

A flow cytometry method for quantifying levels of anti-D is described. The method is based on the indirect antiglobulin test and uses an FITC Fab anti-human IgG reagent for detection of bound anti-D. A standard curve is generated from the fluorescence measured by flow cytometry using the British Standard anti-D preparation 73/515.

Transcriptional regulatory sequences of carcinoembryonic antigen: identification and use with cytosine deaminase for tumor-specific gene therapy.

The 5' sequences from the human carcinoembryonic antigen gene (CEA) were analyzed using luciferase reporter gene assays. This analysis identified important cis-acting sequences needed for selective expression in CEA-positive cells. Over 50 CEA/luciferase reporter clones were constructed and analyzed in two CEA-positive and two CEA-negative cell lines.

Identification and characterization of the human myeloperoxidase promoter.

Myeloperoxidase (MPO) is a microbicidal protein present in the primary granules of myeloid cells. Transcription of the MPO gene is turned on only during the late myeloblast and promyelocyte stages of myeloid maturation. Identification of cis-regulatory elements and transcription factors which regulate the MPO gene should, therefore, shed light on myeloid maturation.

Modification of lipoperoxidative effects of dichloroacetate and trichloroacetate is associated with peroxisome proliferation.

Pretreatment of male B6C3F1 mice with clofibric acid (CFA) or trichloroacetic acid (TCA) in the drinking water results in a marked decrease in the lipoperoxidative response as measured by the production of thiobarbituric acid reactive substances (TBARS) in mouse liver homogenates following acute dosing with TCA or dichloroacetic acid (DCA). Pretreatment with TCA or CFA also increased palmitoyl-CoA oxidase activity, microsomal 12-(omega) hydroxylation of lauric acid and expression of P450 4A isoforms. At the doses utilized, DCA-pretreatment did not increase the level of P450 4A protein, or markers of peroxisome proliferation.

Induction of cellular immune responses by a murine monoclonal anti-idiotypic antibody recognizing the 791Tgp72 antigen expressed on colorectal, gastric and ovarian human tumours.

There is accumulating evidence that cellular rather than antibody responses are more effective for tumour rejection. It is therefore important to screen anti-idiotypic (anti-id) antibodies for their ability to stimulate anti-tumour T-cell responses. The human anti-id monoclonal antibody (MAb) 105AD7 stimulated both delayed-type hypersensitivity (DTH) responses in animals and antigen-specific blastogenesis and IL-2 induction in advanced cancer patients.

Auditory evoked responses in children during hypothermic cardiopulmonary bypass: report of cases.

Variations in core temperature and cerebral blood flow during open heart surgery may affect auditory brainstem responses (ABRs) and middle latency responses (MLRs) in both adults and children. We documented the changes in ABRs of two infants (ages 3 and 11 weeks, respectively) with variations in core temperature during hypothermic cardiopulmonary bypass and total circulatory arrest and compared them with those of a 19-year-old adult. Changes in MLRs that occurred in association with reductions in cerebral blood flow as monitored by transcranial Doppler are also reported in a 6-year-old child.

[Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama].

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling.

Balancing the circulation in hypoplastic left heart syndrome.

A mathematical model based on oxygen flow was developed to study the effects of pulmonary to systemic flow ratios (QP/QS) on systemic oxygen availability. The model suggests that QP/QS = 1 is the safest ratio that would provide the largest safety margin in either low cardiac output or low pulmonary oxygenation conditions. The optimal value of QP/QS that will result in maximum oxygen availability is smaller than unity and depends on several circulatory parameters such as cardiac output, maximal oxygen capacity, level of pulmonary oxygenation, and oxygen consumption.