Preoperative management of congestive heart failure in neonates: the closed hood.

In this study we report the results of the use of a closed hood with no external administration of CO2 to increase pulmonary vascular resistance by lowering the inspired fraction of oxygen (FiO2) and raising the inspired fraction of carbon dioxide (FiCO2) in patients with congenital heart disease and increased pulmonary blood flow. Between December 1995 and May 1996, 9 neonates (F:5, M:4) were admitted. Each study patient was assigned to clinical classes using a 1 to 4 classification. Ages ranged between 2 and 30 days (mean 18), weight between 2.25 and 3.65 kg (mean 2.89). A plastic hood, closed on the top with a plastic membrane and with the gas entrance open to room air was placed over the head of the patients. Patients increase pCO2 by rebreathing their own expired CO2. After 24 h of the onset of the treatment the media of points of congestive heart failure 1 to 4 classification decrease from a mean of 4 to a mean of 2.28+/-0.44 (p=0.001). A statistically significant improvement in symptoms and lowering of PO2 and pH while raising pCO2 has been demonstrated in this study.

[The index of left and right diastolic ventricular filling with 2D Doppler echocardiography in normal children]. / Indice de llenado diastólico ventricular izquierdo y derecho con ecocardiografía 2-D Doppler en niños normales.

Cross-sectional echocardiographic and Doppler studies were performed to study early and late diastolic inflow velocities transmitral and transtricuspid. The study group consisted of 50 normal subjects. Age varied from 5 hours to 17 years (x: 22 m). The measurements made were E/A ratio, isovolumetric relaxation time of the left ventricle, acceleration and deceleration time. Transmitral E/A ratio is higher than 1 since newborn period, increasing with age (newborn: 1.25 +/- 0.27 over 2 years of age: 1.79 +/- 0.35), and related to increase of "E" wave velocity (newborn: 0.67 +/- 0.09.m/s and over 2 years of age: 0.98 +/- 0.21 m/s). There is also a higher acceleration time (newborn: 50 +/- 10 m/s) and over 6 years of age 130 +/- 30 m/sec; isovolumetric relaxation time of the left ventricle (newborn: 60 +/- 10 msec vs. over 6 years of age: 80 +/- 20 msec). The E/A transtricuspid ratio is lower than 1 in the newborn (0.71 +/- 0.08) and (0.97 +/- 0.32) in infants less than 6 months of age; it is higher than 1 between 6 months and 2 years (1.17 +/- 0.33) and increasing in the group of six years of age and older (1.5 +/- 0.28), due to the higher velocity of "E" (newborn 0.47 +/- 0.07 m/s in relation to 6 years and older group (0.77 +/- 0.08 m/s). There is also an increase of acceleration time with aging (newborn: 50 +/- 10 msec and over six: 70 +/- 10 msec) and deceleration time (newborn: 60 +/- 10 msec and over six: 120 +/- 40 msec). The "A" wave velocities have been similar in the tricuspid and transmitral inflow, with progressive increasing since newborn period up to 2 years of age and decreasing over 6 years of age.

Aneurysmal bone cyst. A clinicopathologic study of 238 cases.

Aneurysmal bone cyst (ABC) is a nonneoplastic expansile bone lesion that mainly affects children and young adults. Primary ABC is relatively rare, with an incidence one half that of giant cell tumor of bone. In 238 patients with ABC studied in the Mayo Clinic files, more than 80% of the lesions were in long bones, flat bones, or the spinal column. Of the lesions initially treated at the Mayo Clinic, 95% were typical ABC; the rest were "solid" variants. Except for the absence of obvious cavernous channels and spaces, there was no significant histologic difference between solid variant and typical ABC. Radiographically, ABC is an eccentric expansile lesion commonly located at the metaphysis of long bones. Computed tomography and magnetic resonance imaging may show multiple internal septations or fluid levels. In the 153 patients treated, 19% had recurrence after curettage (intralesional excision). Recurrence was most common during the first 2 postoperative years.