ABSTRACT
BACKGROUND: The vein of Galen aneurysm (VGAM) is the most common type of arteriovenous malformation in the neonate. These neonates commonly present with high output cardiac failure that may be associated with pulmonary hypertension. The medical management and stabilization of these neonates can be challenging before staged transarterial embolization of the aneurysm is undertaken. CASE: A 2.34 kilogram neonate, antenatally diagnosed to have VGAM, was born at 36 weeks of gestation for fetal distress. The neonate failed to respond to medical management including inotropes, high frequency mechanical ventilation and inhaled nitric oxide. The patient's high-output heart failure and persistent pulmonary hypertension were stabilized with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) using central cannulation. Further transarterial staged embolization of the VGAM was undertaken on VA-ECMO support. CONCLUSION: There may be a role of VA-ECMO using central cannulation to optimize management of high output cardiac failure and persistent pulmonary hypertension in neonatal VGAM patients who fail medical management to facilitate staged transarterial embolization of the VGAM.
Subject(s)
Cerebral Veins , Embolization, Therapeutic , Extracorporeal Membrane Oxygenation , Heart Failure , Vein of Galen Malformations , Heart Failure/etiology , Heart Failure/therapy , Humans , Infant, Newborn , Vein of Galen Malformations/complications , Vein of Galen Malformations/diagnostic imaging , Vein of Galen Malformations/therapyABSTRACT
Rockmelon (Cucumis melo Linnaeus (Cucurbitales: Cucurbitaceae)) is a novel commercialized fruit in Malaysia and has great potential to become an important horticultural crop for the international market. In this study, we investigated the effects of pollination by the Indo-Malaya stingless bee Heterotrigona itama Smith (Hymenoptera: Apidae) on measures of yield and quality of rockmelon cultivated in the greenhouse, compared with hand cross-pollination and self-pollination. Results showed that rockmelon produced from plants pollinated by stingless bees and hand cross-pollination had higher fruit set, were heavier and larger, and contained higher numbers of seed per fruit compared with those produced by self-pollination. Pollination by stingless bees produced fruit with greater sweetness than either hand cross-pollination or self-pollination. This study demonstrated that stingless bee pollination produced rockmelon fruit of similar quality, but better yields compared to the other pollination treatments. We showed that stingless bees should be considered as an alternative, effective pollinator for the improved production of high quality rockmelon in commercial greenhouse cultivation.
