[Value of inpatient care in rheumatoid arthritis-an evidence based report].

Our aim was to analyze the existing body of evidence about inpatient care of patients suffering from rheumatoid arthritis (RA). The report was induced by the executive board of the German Society of Rheumatology which assigned the "Oliver-Sangha committee" to dissect and point out the tasks of inpatient care during the next few years. A systemic search of the literature was performed covering the years 1966 to 2001.

In utero nicotine exposure causes persistent, gender-dependant changes in locomotor activity and sensitivity to nicotine in C57Bl/6 mice.

Maternal cigarette smoking during pregnancy can result in a wide variety of adverse fetal outcomes, ranging from preterm delivery and low birth weight, to sudden infant death syndrome. In addition, in utero tobacco smoke exposure is associated with delayed or impaired neuropsychological development. Although the causative agent in tobacco smoke that leads to these aberrations is not known, some studies have concluded that nicotine may play an important role.

Maternal smoking and partial exchange transfusion for neonatal polycythemia.

The aim of this study was to determine if maternal smoking was associated with an increased need for partial exchange transfusion for symptomatic polycythemia in term neonates. The study population consisted of 8,961 term neonates, of whom 28.7% were categorized as babies born to mothers who smoked.

Decreased incidence of retinopathy of prematurity, 1995-1997.

Purpose: To report a significant decrease in the incidence of retinopathy of prematurity (ROP), both in our neonatal intensive care unit (NICU) and internationally, and review factors in patient care that may be contributory.

Methods: We retrospectively reviewed the records of all neonates weighing less than 1251 g admitted to our NICU from 1995 to 1997 and evaluated the incidence and stage of ROP. These data on 191 neonates were compared with an international NICU database of 9989 similar neonates, which represents all infants who received an ophthalmologic examination in the Vermont-Oxford Network Database (VOND) in 1997, except those from our institute (the University of Kentucky).

A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates: a randomized trial.

Background: Although several trials of early dexamethasone therapy have been completed to determine if such therapy would reduce mortality and chronic lung disease (CLD) in infants with respiratory distress, optimal duration and side effects of such therapy remain unknown.

Purpose: The purpose of this study was: 1) to determine if a 3-day course of early dexamethasone therapy would reduce CLD and increase survival without CLD in neonates who received surfactant therapy for respiratory distress syndrome and 2) to determine adverse effects associated with such therapy.

Design: This was a prospective multicenter randomized trial comparing a 3-day course of dexamethasone therapy beginning at 24 to 48 hours of life to placebo therapy.

House staff supervision, workload, and experience in the neonatal intensive care unit: results of a national survey.

One hundred fifty-nine pediatric chief residents were surveyed regarding characteristics of the neonatal intensive care unit rotation for house staff at their institution. We documented substantial interinstitution variability in house staff NICU rotations in terms of number of rotations, and the workload and supervision of house staff.

Elevated circulating calcitonin gene-related peptide in umbilical cord and infant blood associated with maternal and neonatal sepsis and shock.

The role of the sensory neuropeptide calcitonin gene-related peptide (CGRP) was studied in preterm and term neonates with sepsis and shock. CGRP levels in blood were measured by RIA. The identity of immunoreactive CGRP (irCGRP) in adult and infant human blood was confirmed by reverse phase-HPLC.

Endotracheal tolazoline administration in neonates with persistent pulmonary hypertension.

Objectives: Our purpose was to study the effectiveness of endotracheal tolazoline (ET-Tz) in the treatment of neonatal persistent pulmonary hypertension (PPHN).

Study Design: ET-Tz was administered to 12 neonates with a clinical diagnosis of PPHN. The gestational age ranged from 25 to 42 weeks, and the birth weights from 850 to 3612 gm.

Elevated laminin concentrations in lung secretions of preterm infants supported by mechanical ventilation are correlated with radiographic abnormalities.

Objective: The objective of this study was to test the hypothesis that the presence of laminin in neonatal tracheal aspirates would be indicative of damage to the structural integrity of the basal laminae of the lung caused by barotrauma and hyperoxia. We predicted that disruption of the basal laminae would be a critical determinant of lung injury and fibrotic repair in the preterm infant whose lungs were ventilated with supplemental oxygen.

Study Design: The study group consisted of 23 premature infants in the neonatal intensive care unit whose lungs were ventilated by supplemental oxygen.

Neurosonographic diagnosis of thalamic/basal ganglia vasculopathy in trisomy 13--an important diagnostic aid.

We performed a retrospective review of all the infants diagnosed with trisomy 13 in our institution from 1982 to 1995 and evaluated the neurosonographic findings along with their clinical information and cytogenetic analysis. Nine babies were admitted with trisomy 13. Sonography of the head was performed on 4 patients, and demonstrated in all of them a linear, branching, echogenic pattern in the thalamus/basal ganglia.

In vitro inactivation of pulmonary surfactant replacement preparations by serum albumin.

Inactivation of the surface activity of pulmonary surfactant by serum proteins is an important part of neonatal respiratory distress syndrome. The ability of serum proteins to diminish the surface activity of surfactant preparations used to treat respiratory distress syndrome has not been fully described. The sensitivity of clinically useful pulmonary replacement preparations beractant (Survanta) and colfosceril palmitate, cetyl alcohol, and tyloxapol (Exosurf) to albumin inactivation was examined in vitro by the Wilhelmy plate technique.

Intrinsic microbicidal activity and pulmonary hypertension in isolated newborn piglet lungs.

The lung appears to be one of the dominant sites of bacterial clearance from the blood of infant piglets. Part of the lung bacterial clearance involves activation of an oxygen radical bactericidal mechanism that may be central to induction of acute pulmonary hypertension. The present study determined whether this bactericidal activity was intrinsic to resident lung cells.

Comparative disposition kinetics of 111In-labeled group B streptococcus and neutrophils during onset of sepsis-induced pulmonary hypertension.

Little is known of the time course by which intravascular group B streptococcus (GBS) distributes into the infant lung, though the prompt onset of pulmonary hypertension in GBS-infected animals suggests that bacteria interact initially with a resident lung cell or that they promote rapid pulmonary influx of circulating effector cells. Using external gamma scintigraphy to monitor the organ-specific disposition kinetics of 111In-oxine-labeled GBS in anesthetized piglets, we found that 80% of the infused bacteria rapidly distributed into the lung and that pulmonary bacterial uptake exhibited a close temporal relationship with the onset of pulmonary hypertension. Companion studies demonstrated that the extent of pulmonary 111In-neutrophil sequestration was unaffected by GBS, although a neutrophil secretagogue, phorbol myristate acetate, caused rapid pulmonary neutrophil uptake.

Impact of prostaglandin and thromboxane synthesis blockade on disposition of group B streptococcus in lung and liver of intact piglet.

Group B streptococci (GBS) localizing in the lungs of infant piglets is killed in part by an oxygen radical-dependent mechanism (Bowdy BD, Marple SL, Pauly TH, Coonrod JD, Gillespie MN: Am Rev Respir Dis 141:648-653, 1990). The source of bactericidal oxygen radicals is unknown, but cyclooxygenation of arachidonic acid, an initial event in prostanoid synthesis, is accompanied by substantial oxygen radical generation. Because blockade of prostaglandin H synthase (cyclooxygenase) with indomethacin prevents GBS-induced pulmonary hypertension, we reasoned that the salutary effect of indomethacin might be associated with a reduction in the efficacy of bactericidal activity directed against GBS.

Purpura fulminans in three cases of early-onset neonatal group B streptococcal meningitis.

The diagnosis of purpura fulminans was associated with three cases of early-onset group B beta-hemolytic streptococcal (GBS) disease. All three infants had confirmed bacterial disease, extensive purpuric lesions involving the extremities, and laboratory evidence of a consumptive coagulopathy. All three children survived but had markedly compromised neurologic outcomes.

Bilirubin as an antioxidant: effect on group B streptococci-induced pulmonary hypertension in infant piglets.

Bilirubin scavenges toxic oxygen radicals in vitro, but it is not known whether this potential salutary effect can be extended to the intact animal. Accordingly, the present experiments tested the hypothesis that bilirubin protects against oxygen radical-dependent pulmonary hypertension and arterial hypoxemia in piglets infected with group B streptococci (GBS). Piglets ranging in age and weight from 7 to 14 days and 1.

Dimethylthiourea reverses sepsis-induced pulmonary hypertension in piglets.

Dimethylthiourea (DMTU), a putative hydroxyl radical scavenger, attenuates thromboxane generation and pulmonary hypertension in the piglet model of group B streptococcal (GBS) sepsis. This study tested the hypothesis that DMTU reverses ongoing GBS-induced pulmonary hypertension coincident with decreased thromboxane production. Piglets (n = 15) received a 60 min infusion of GBS (10(-8) cfu/kg/min).

Organ-specific disposition of group B streptococci in piglets: evidence for a direct interaction with target cells in the pulmonary circulation.

Despite the serious pulmonary manifestations of early onset group B streptococcal (GBS) sepsis, it is not known whether the organism distributes into lung tissue and whether adverse pulmonary hemodynamic abnormalities relate to an interaction between the organism and target cells in the pulmonary vascular bed. Accordingly, this study evaluated the distribution and fate of GBS in the lung, liver, and spleen of anesthetized infant piglets and in isolated, salt solution-perfused piglet lung preparations. GBS were radiolabeled with 111Indium-oxine and infused at a dose of 10(8) organisms/kg/min for 15 min into anesthetized piglets ranging in age from 5-10 d.

Group B streptococcus promotes oxygen radical-dependent thromboxane accumulation in young piglets.

Both thromboxane A2 and oxygen-derived free radicals appear to play central roles in group B streptococcus (GBS)-induced pulmonary hypertension in piglets. This study tested the hypothesis that GBS promotes oxygen radical-dependent thromboxane accumulation and pulmonary hypertension in infant piglets. Piglets 4-12 d old were anesthetized and prepared for assessment of pulmonary arterial pressure and arterial blood gases.

Oxygen radical-dependent bacterial killing and pulmonary hypertension in piglets infected with group B streptococci.

The mechanism by which bacteria are cleared by the pulmonary circulation and the relation of this process to development of hemodynamic abnormalities are not understood. This study tested the hypotheses that clearance of Group B Streptococcus (GBS) during transit through the pulmonary circulation of infant piglets is related to oxygen radical-dependent bacterial killing and that killing of the organism is linked to development of pulmonary hypertension. GBS were radiolabeled with 111In and infused intravenously for 15 min (10(8) organisms/kg/min) into infant piglets ranging in age from 5 to 14 days.

Epidermal growth factor augments reactivity to angiotensin II in the rat pulmonary circulation.

To determine if epidermal growth factor (EGF), a vascular smooth muscle mitogen exhibiting systemic vasoactivity, causes constriction or dilation of the pulmonary vascular bed, this study evaluated the actions of EGF in isolated, buffer-perfused rat lungs and in isolated rat pulmonary arteries. In perfused rat lungs with baseline vasomotor tone, EGF administered at bolus doses of 10(-9) to 3 x 10(-7) M failed to exert either constrictor or dilator actions or to promote edema formation as evidenced by a constant lung wet-to-dry-weight ratio. Elevation of baseline tone with either prostaglandin (PG)F2 alpha or angiotensin II also failed to unmask an effect of EGF on pulmonary vascular resistance.

Evidence for hydroxyl radical involvement in group B streptococcus-induced pulmonary hypertension and arterial hypoxemia in young piglets.

Early onset neonatal GBS infection is associated with pulmonary hypertension, pulmonary edema, and arterial hypoxemia. Although the mechanisms underlying these cardiopulmonary disturbances are not completely understood, multiple lines of evidence suggest that inflammatory mediators may be involved. This study examined the actions of dimethylthiourea (DMTU), a relatively selective scavenger of hydroxyl radical, on GBS-induced pulmonary hypertension, arterial hypoxemia, and pulmonary edema formation in young piglets.

Fetal tachycardia as an indicator of maternal and neonatal morbidity.

Presented is a prospective, controlled study to determine if intrapartum fetal tachycardia is reliable as an indicator of maternal and fetal infectious morbidity. Thirty neonates with defined intrapartum tachycardia were matched by gestational age and weight with 30 control subjects without defined tachycardia. There was a significant difference in maternal febrile morbidity and a trend toward a difference in maternal infectious morbidity between the two groups.

Complications associated with digoxin therapy in low-birth weight infants.

Eighteen infants, each weighing less than 1,500 gm, were treated with low dose digoxin therapy for patent ductus arteriosus and signs of circulatory congestion. Nine of the 18 developed one or more signs of clinical deterioration felt to be related to digoxin therapy: eight infants experienced frequent episodes of bradycardia, six had cardiac arrhythmias, and six experienced feeding difficulties. All signs disappeared when digoxin therapy was discontinued.