Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique.

Unlabelled: OBJECT.: As more pediatric neurosurgeons become involved with fetal myelomeningocele closure efforts, examining refined techniques in the overall surgical approach that could maximize beneficial outcomes becomes critical. The authors compared outcomes for patients who had undergone a modified technique with those for patients who had undergone fetal repair as part of the earlier Management of Myelomeningocele Study (MOMS).

Is preterm delivery indicated in fetuses with gastroschisis and antenatally detected bowel dilation?

Introduction: Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes.

Materials And Methods: Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria.

Stomatal uptake of O3 in aspen and aspen-birch forests under free-air CO2 and O3 enrichment.

Rising atmospheric carbon dioxide (CO2) may alleviate the toxicological impacts of concurrently rising tropospheric ozone (O3) during the present century if higher CO2 is accompanied by lower stomatal conductance (gs), as assumed by many models. We investigated how elevated concentrations of CO2 and O3, alone and in combination, affected the accumulated stomatal flux of O3 (AFst) by canopies and sun leaves in closed aspen and aspen-birch forests in the free-air CO2-O3 enrichment experiment near Rhinelander, Wisconsin. Stomatal conductance for O3 was derived from sap flux data and AFst was estimated either neglecting or accounting for the potential influence of non-stomatal leaf surface O3 deposition.

Bone metabolism in pregnant women exposed to single compared with multiple courses of corticosteroids.

Objective: To compare markers of maternal bone metabolism between women who received a single compared with multiple courses of antenatal corticosteroids.

Methods: This is an analysis of serum samples from a previously reported randomized, placebo-controlled, multicenter trial. Women at risk for preterm delivery after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone (active) or placebo.

Utility of Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score in maternal admissions to the intensive care unit.

Objective: A mean Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score of > 50 is associated with increased intensive care unit mortality rate in nonpregnant cardiac and trauma patients. The objective was to determine the usefulness of the APACHE III score in maternal admissions to an intensive care unit in a tertiary care center in an urban multicultural city.

Study Design: This was a retrospective review of all maternal admissions (> 20 weeks of gestation or after delivery) to an intensive care unit between January 2002 and May 2004.

Diabetic ketoacidosis in pregnancy.

Objective: The development of diabetic ketoacidosis in pregnancy is a medical emergency, requiring treatment in an intensive care setting. Both the mother and the fetus are at risk for significant morbidity and mortality. Physiologic changes unique to pregnancy provide a background for the development of diabetic ketoacidosis.

Acute hypertensive emergencies in pregnancy.

Objective: Obstetrical hypertensive emergencies are life-threatening conditions involving significant risk to both the mother and fetus. Aggressive treatment of the maternal hypertensive state requires an initial consideration of the effect of treatment on the fetus, via changes to the uteroplacental circulation with treatment. The challenge then is to correct blood pressure using appropriate, safe pharmacologic agents to prevent catastrophic maternal consequences, while minimizing acute changes to placental perfusion and any corresponding fetal ill effects.

Milk-alkali syndrome in pregnancy.

Background: Severe hypercalcemia, a potentially life-threatening medical emergency, is rare in pregnancy.

Case: We report a 32-year-old woman presenting early in the second trimester with severe hypercalcemia (total calcium 22 mg/dL), alkalosis, and acute renal insufficiency resulting from excessive ingestion of calcium carbonate-containing antacid for gastroesophageal reflux. The patient was treated with aggressive hydration and furosemide, and received 1 dose of intravenous etidronate, leading to short-term symptomatic hypocalcemia.

Missing OH reactivity in a forest: evidence for unknown reactive biogenic VOCs.

Forest emissions of biogenic volatile organic compounds (BVOCs), such as isoprene and other terpenes, play a role in the production of tropospheric ozone and aerosols. In a northern Michigan forest, the direct measurement of total OH reactivity, which is the inverse of the OH lifetime, was significantly greater than expected. The difference between measured and expected OH reactivity, called the missing OH reactivity, increased with temperature, as did emission rates for terpenes and other BVOCs.