[Pediatric chronic pain : interprofessional and integrative care].

Pediatric chronic pain is an increasingly recognized condition in children and adolescents. Current treatment is based on the bio-psycho-social model of chronic pain: an interprofessional and integrative team will help the young patient and his environment, in order to find a balance between physical, psychological and social impacts. This article focuses on different treatment approaches for pediatric chronic pain in the outpatient and inpatient setting.

Steroids that induce lung maturation acutely affect higher cortical function: a fetal magnetoencephalography study.

Objective: To investigate whether steroids that induce lung maturation have acute effects on higher cortical function in the human fetus.

Methods: Cortical auditory-evoked responses (CAERs) were recorded from 10 singleton fetuses between 29 and 34 gestational weeks by fetal magnetoencephalography (fMEG) using transabdominal auditory stimulation prior to and within 3 hours after administering 2 × 12 mg of betamethasone, at an interval of 18 and 24 hours.

Results: The components of the CAER complex were categorized according to their latency: P2pm (186 + 20 ms, 90%), N2pm (260 + 34 ms, 50%), P3pm (474 + 36, 50%).

Lessons from reproductive immunology for other fields of immunology and clinical approaches.

Reproduction is indispensable to evolution and, thus, life. Nonetheless, it overcomes common rules known to established life. Immunology of reproduction, and especially the tolerance of two genetically distinct organisms and their fruitful symbiosis, is one of the most imposing paradox of life.

Nitric oxide donors: effects on fetoplacental blood flow.

Objective: To investigate fetal and uteroplacental blood flow after transdermal administration of glyceroltrinitrate (GTN) in pregnancies at risk for preterm delivery.

Study Design: Twenty-five pregnant women who received GTN patches (Nitroderm TTS 10) with a dosage of 0.8 mg/h, because of risk for preterm delivery, were included in the prospective study.

Prenatal evidence of left-right asymmetries in auditory evoked responses using fetal magnetoencephalography.

Auditory evoked responses between right- and left-hemispheric derivations were investigated in 53 recordings from fetuses in the third trimester using fetal magnetoencephalography (fMEG). The side-different latency development of the component P2pm suggests an earlier maturation of certain right than homologous left hemispheric brain areas during fetal brain development.

Doppler measurements in fetoplacental vessels after maternal betamethasone administration.

Objective: To observe the influence of maternal betamethasone administration for fetal lung maturation on the arterial, venous and intracardiac blood flow of the fetus and the uterine arteries.

Methods: Twenty-seven women with singleton pregnancies were examined before the first, and 30 min and 8, 24, 48 and 72 h after the second of two single doses of 8 mg of betamethasone. We recorded blood flow velocity waveforms of the umbilical artery (UA), the middle cerebral artery, the uterine arteries, the ductus venosus, the inferior vena cava and the right hepatic vein, the pulmonary trunk, the ductus arteriosus and the right and left intraventricular inflow of the heart.

[Diagnosis of a Twin-Reversed-Arterial-Perfusion-Syndrome (TRAP) in the First Trimester of Pregnancy - Report on Two Cases].

The Twin-Reversed-Arterial-Perfusion-Syndrome (TRAP) is a rare complication of monocygotic multiple pregnancies. It is associated with a high perinatal mortality. One twin (recipient or acardius) is perfused by the other (donour) on the basis of vascular anastomoses.

Influence of intrauterine growth restriction on cardiac time intervals evaluated by fetal magnetocardiography.

Objective: Differences in the cardiac excitation cycle between normotrophic and intrauterine growth-restricted fetuses were to be investigated by fetal magnetocardiography (fMCG).

Study Design: In this study, the time intervals of the fMCG signal in dependence on gestational age were compared between a group of 30 growth-restricted fetuses and 60 normotrophic fetuses by using Spearman's correlation coefficient and two-way analyses of variance.

Results: A significantly increasing duration of the P wave and the QRS complex could be observed with advancing gestational age in the normotrophic collective.

A case report of body stalk anomaly complicating a twin pregnancy.

The body stalk anomaly is described as a maldevelopment during embryonic folding in the third week after conception, resulting in a severe defect of the fetal abdominal wall. The extra-embryonic coelom fails to obliterate and parts of the fetal body remain in an exo-coelomic situation. Reports on its occurrence in multiple pregnancies have in the past focused on concordance between monozygotic twins.

[Fetal hyperechogenic and cystic pulmonary masses: sonographic findings, antenatal management and outcome of 12 cases].

Objective: Presentation of prenatal findings and postnatal outcome of cases with echogenic or cystic lesions of the lungs. Discussion of the prenatal diagnostic and clinical management.

Patients And Methods: Retrospective analysis of the antenatal sonographic findings, the management and outcome of 12 cases of fetal chest masses.

Maternal and fetal side effects of tocolysis using transdermal nitroglycerin or intravenous fenoterol combined with magnesium sulfate.

Objective: To compare the maternal and fetal side effects of transdermal nitroglycerin and intravenous fenoterol combined with magnesium sulfate in a prospective randomised study.

Study Design: Fifty pregnant women between 27 and 35 weeks of gestation with preterm labour were treated with either nitroglycerin (0.4-0.

Fetal magnetocardiography in the investigation of congenital heart defects.

Objectives: To investigate the changes of the fetal magnetocardiography (FMCG), a new noninvasive diagnostic tool in the analysis of electrophysiologic changes of the heart, in cases of congenital heart defect (CHD).

Methods: The FMCG was analysed and compared to the postnatal ECG in eight cases of CHD: atrial septal defect ASDII (three cases), a combination of atrioventricular-septal-defect (AVSD) and Tetralogy of Fallot (TOF) (one case ), complete transposition of great arteries (d-TGA) (two cases), coarctation of aorta (COA) (one case), stenosis of the pulmonary artery (PS) and right ventricular hypoplasia (one case).

Results: (1) The following FMCG changes were observed: a split R-wave (AVSD/TOF, ASDII), prolongation of QRS complex (COA, PS).

Fetal magnetocardiography: development of the fetal cardiac time intervals.

Objectives: To analyse the physiologic development of fetal cardiac time intervals throughout gestation using fetal magnetocardiography (FMCG).

Methods: FMCG data of 163 uncomplicated pregnancies (19th and 42nd gestational week) were analysed. Mean value, standard deviation, minimum and maximum of the duration of the P-wave, the QRS-complex, the PR and the QT-interval were plotted against gestational age.

MRI of the pelvic ring joints postpartum: normal and pathological findings.

Purpose: To assess the joints of the pelvic ring postpartum and to discern normal postpartum findings and pathologic lesions using MRI.

Materials And Methods: MR images were obtained in six women with severe pelvic ring pain after delivery, in 13 women after uncomplicated vaginal delivery, and in 11 healthy, nulliparous non-pregnant volunteers. Distances of the pubic gap, signal intensities of the pubic cartilage, and signal changes of the pelvic ring bones were determined and evaluated.

Fetal magnetoencephalography: a non-invasive method for the assessment of fetal neuronal maturation.

Objective: To assess the maturation of auditory evoked cortical responses in the human fetus using fetal magnetoencephalography.

Design: Prospective case series over a three-year period.

Setting: Antenatal clinics, university hospital.

[The extralobar sequestration of the fetal lung].

The extralobar sequestration is a rare pulmonary malformation. An accurate antenatal evaluation is required for a timely therapy and subsequently a good outcome. Here an unusual case of extralobar pulmonary sequestration in a male human fetus is reported.

[Nitroglycerin patch for tocolysis--a prospective randomized comparison with fenoterol by infusion].

Objective: To evaluate tocolytic efficacy of transdermal glyceryl trinitrate (GTN) in comparison to fenoterol per infusionem in a prospective randomized multicenter study.

Patients And Methods: 50 pregnant women between 27 and 35 weeks of gestation with preterm labour were treated with either GTN patches (0.4-0.

Signal analysis of auditory evoked cortical fields in fetal magnetoencephalography.

Magnetoencephalography (MEG) using auditory evoked cortical fields (AEF) is an absolutely non-invasive method of passive measurement which utilizes magnetic fields caused by specific cortical activity. By applying the exceptionally sensitive SQUID technology to record these fields of dipolar configuration produced by the fetal brain, MEG as an investigational tool could provide new insights into the development of the human brain in utero. The major constraint to this application is a very low signal-to-noise ratio (SNR) that has to be attributed to a variety of factors including the magnetic signals generated by the fetal and maternal hearts which inevitably obscure a straightforward signal analysis.

The application of fetal magnetocardiography (FMCG) to investigate fetal arrhythmias and congenital heart defects (CHD).

Objectives: Fetal magnetocardiography (FMCG), a new non-invasive diagnostic tool in the analysis of the electrophysiological changes of the heart, was selectively applied in cases of fetal arrhythmias and congenital heart defect (CHD) to demonstrate its value for diagnosis and prenatal management.

Methods: The FMCG was analysed and compared to the postnatal ECG in four cases of fetal arrhythmia [supraventricular tachycardia (two cases), complex tachy-/bradycardia (one case), ventricular extrasystoles (one case)] and a case of right heart hypoplasia diagnosed by established methods prior to investigation.

Results: A Wolf-Parkinson-White (WPW) syndrome was diagnosed by its characteristic features and the appropriate transplacental therapy chosen.

[Concentration of heavy metals (Pb, Cd, Hg) in maternal blood].

Background: It was the aim of these investigations to find out, whether or not pregnancy risks result from the heavy metal concentrations of the mother's blood (Pb, Cd, Hg).

Materials And Methods: The control group is composed of 125 women in child bed. Women with hypertonia during the pregnancy (n = 11), women after premature delivery (n = 25) and after a miscarriage (n = 21) are the risk collective.

[Acoustically evoked brain magnetic activity in normal and growth retarded fetuses during the third trimester of pregnancy].

The fetal magnetoencephalogram with a 31 chanal biomagnetometer made by Philips was measured in a fetal 1F-phase in 20 normotroph unimpaired and in 14 growth retarded fetuses with a birth weight < 5 percentile after completed 36th gestational week. Trough defined acoustic stimulations, which were applied over the maternal abdominal wall, it was possible to measure acoustic evoked cerebromagnetic field changes using a special computer programs. The registrated evoked cerebromagnetic field changes had a latence time of 112.

[Not Available].

OBJECTIVE: We examined the placental transfer of the calcium antagonists Flunarizine and Verapamil and their effects on the placental metabolism using the dual in vitro perfusion of the human placental lobulus. MATERIAL AND METHODS: Eight placental lobuli were perfused with either 10 micrograms/ml Flunarizine or Verapamil over 6 hours. Two perfusions without any substrate were used as control.

[Levels of antioxidants after cesarean section and administration of Multibionta N, Inzolen and selenase].

Patients And Method: In 29 women with the necessity to terminate pregnancy via Cesarean section, lipid peroxidation and antioxidative state were investigated before and 24 hours after the surgical intervention as well as after substitution of antioxidants and trace elements.

Results: The results indicate that administration of antioxidants protects at least partially from consequences of surgically induced oxidative burden.