Shoulder pain after caesarean section: comparison between general and spinal anaesthesia.

This study investigated shoulder pain as a maternal complication after caesarean section (CS), evaluation of its prevalence and comparison between spinal anaesthesia (SA) and general anaesthesia (GA) groups. A total of 200 women as CS candidates were allocated into two equal groups; SA and GA. The total prevalence of shoulder pain was 39.45%. The two groups were matched according to demographic data. However, the incidence of shoulder pain in the GA group was more than that in the SA group (p =0.004). Shoulder pain in the right shoulder in the GA group was more prevalent than the left shoulder (p <0.001). Moderate severity of shoulder pain was significantly more in the GA group (p =0.000), while in the SA group, the mild severity was significant (p <0.001). Our study revealed that the incidence of shoulder pain after CS is significant. Moreover, shoulder pain was significantly more common in the GA group than the SA group.

Effect of aminoguanidine in sperm DNA fragmentation in varicocelized rats: role of nitric oxide.

BACKGROUND AND PURPOSE: The sperm of infertile men with varicocele exhibit markedly high DNA damage that appears to be related to high oxidative stress (OS). Aminoguanidine (AG) is a specific inhibitor of the nitric oxide synthase (NOS) isoforms iNOS and an antioxidant, the effects of which decrease NO and peroxynitrite production. The aim of this study was to determine the effects of AG on sperm chromatin in varicocelized rats. METHODS: Thirty male Wistar rats were divided into 5 groups: control, sham, varicocele, and AG and placebo-treated groups. At 10 weeks after varicocele induction, sperm chromatin was evaluated in all groups, except in the treated groups. The treated groups received intraperitoneal injections of 50 mg/kg AG or placebo daily for 10 weeks and then were killed for chromatin assessment. Sperm chromatin was evaluated by aniline blue, acridine orange, toluidine blue, and chromomycin A(3) staining. RESULTS: The results of the 4 above tests were significantly increased between varicocele and control (and sham) groups (P < .05). CONCLUSION: The findings of this study suggest that AG improves sperm DNA fragmentation that is associated with infertility in varicocelized rats, and treatment with AG can reduce the damage to sperm DNA.

The effects of swimming exercise and supraphysiological doses of nandrolone decanoate on the testis in adult male rats: a transmission electron microscope study.

Anabolic-androgenic steroids (AAS) are used in high doses by athletes to improve athletic ability, physical appearance, and muscle mass. Unfortunately, the abuse of these agents has significantly increased. It has been established that exercise and high doses of AAS may influence the hypothalamic-pituitary gonadal (H-P-G) axis, which can in turn affect the ultrastructure of the testes. However, the effect of the combination of exercise and high doses of AAS on the ultrastructure of the testes is not known. This study was undertaken in order to examine the combination effects of swimming exercise and supraphysiological doses of nandrolone decanoate on the ultrastructural changes in rat testes. Five groups of male Wistar strain albino rats were treated as follows for 8 weeks: solvent of nandrolone decanoate (peanut oil) as a vehicle (sham); nandrolone decanoate (ND) (10 mg/kg/week) - ND; exercise (1 h/day, 5 days a week) - exercise; ND (10 mg/kg/week) and exercise (1 h/day, 5 days a week) - ND-EX; and sedentary control without any injection or exercise - control. Ultrastructural changes in the rat testes were characterised by transmission electron microscopy. The number and size of Leydig cells were considerably decreased in the interstitial space in the experimental rats. The increased thickness and irregular wavy multilaminar appearance of basement membrane in the treated animals, especially in the ND-EX group, are associated with well developed myoid cells. Cytoplasm vacuolisation, vesicular-like crista of the mitochondria, numerous lipid droplets, and lysosome and phagolysosome in Sertoli cells were significantly observed in the experimental groups. Several apoptotic germ cells were considerably observed in the experimental rats (p ≤ 0.05). Exercise training seems to increase the extent of ultrastructural changes caused by supraphysiological doses of ND in rats, which in turn may affect fertility.

Reptilian echocardiography: insights into ontogeny and phylogeny?

We describe the echocardiographic findings in a large reptile-the carpet python. If ontogeny recapitulates phylogeny, the study of reptilian hearts may provide insights into human cardiac development. In addition, the reptilian heart has unique structural and physiological adaptations that may broaden our perspective on evolutionary cardiac adaptation.

Six-month patient outcomes in a preventive cardiology center.

More effective ways to improve lifestyle behaviors need to be developed. Two hundred forty adult patients at a preventive cardiology clinic were randomly assigned to receive either one or five sessions of behavioral instruction to improve cardiovascular risk behaviors. Results for 102 patients from 6-month follow-up data revealed few significant differences between the two groups. However, in the two groups combined, there were significant reductions in total calories, percent of calories from total fat, percent of calories from saturated and monounsaturated fat, and dietary cholesterol. Reductions were also found in systolic blood pressure, triglycerides, body mass index, and weight. In multiple regression analyses, changes in physiologic variables were primarily associated with baseline and demographic characteristics. Changes in total calories, percent of calories from polyunsaturated fat, and walking were predicted by changes in social support or knowledge. Although most patients improved, the intensity of behavior change instruction was not related to the amount of change in cardiovascular risk factors. (c) 2001 by CHF, Inc.

Balloon dilatation of native aortic coarctation in two patients with Turner syndrome.

We report successful balloon dilatation of native coarctation of the aorta in two patients with Turner syndrome, with favorable endovascular remodeling demonstrated by intravascular ultrasound imaging and angiography 1 year after the procedure.

A comparison of fetal echocardiography in university and health maintenance organization settings.

Fetal echocardiographic findings, and decisions to continue or to terminate affected pregnancies, may differ between university (UNIV) and health maintenance organization (HMO) settings. The aim of this study was to review the fetal echocardiographic experience at a combined university/health maintenance organization program over a 4-year period. Imaging and counseling for affected pregnancies were provided by the same, single investigator at both sites. Out of a total of 1382 studies (940 UNIV, 442 HMO), 127 abnormals were identified (94 UNIV, 33 HMO). Among the 127 pregnancies with fetal heart disease, 24 (19%) underwent elective termination, 16% at UNIV and 27% at HMO (p = 0.2). Mean gestational age at the time of diagnosis was 25.2 weeks at UNIV compared with 22.3 weeks at HMO (p = 0.002). At UNIV, only 51% of diagnoses were made before 24 weeks compared with 79% at HMO (p = 0.003). Screening fetal sonograms, performed between 18 and 20 weeks on every pregnancy at HMO but not at UNIV, enabled earlier detection of congenital heart disease (CHD) and allowed more women with severely affected pregnancies the option to terminate. In both settings, indications with the highest yields for CHD included a right-sided stomach, abnormal four-chamber view, sustained bradycardia, abnormal fetal karyotype, fetal omphalocele, and maternal indomethacin. An echogenic reflector was identified in 86 pregnancies (7%) and did not represent a risk factor for CHD. No major differences in CHD were found between UNIV and HMO. In summary, this study found a significantly earlier diagnosis of CHD at HMO than at UNIV. This discrepancy between programs may explain, at least in part, the trend toward a higher frequency of decisions to terminate affected pregnancies at HMO than at UNIV, despite similar fetal findings.

Wire-snare technique with distal flow control for coil occlusion of a modified Blalock-Taussig shunt.

Coil occlusion of Blalock-Taussig shunts has been associated with a high rate of device embolization. We describe a technique consisting of transvenous snaring and exteriorization of a guidewire advanced through a modified left Blalock-Taussig shunt, allowing distal shunt flow control and successful coil occlusion of the shunt. Cathet. Cardiovasc. Intervent. 49:51-54, 2000.

Atrial septostomy as a bridge to lung transplantation in patients with severe pulmonary hypertension.

Long waiting times for lung transplantation have limited the survival of patients with advanced pulmonary hypertension. Atrial septostomy has been used in this group of patients in an attempt to prolong survival. We evaluated the results of atrial septostomy in 12 patients using the static graded balloon dilation technique. Between December 1990 and May 1998, 10 women and 2 men (ages 13 to 56 years, mean 37 years) underwent atrial septostomy. Nine patients had primary and 3 patents had secondary pulmonary hypertension. Five patients deteriorated despite long-term intravenous prostacyclin infusions. The atrial septum was crossed with a Brockenbrough needle, followed by an 0.035-J exchange wire and progressively larger catheter balloons for atrial septal dilation, until systemic oxygen saturation decreased 5% to 10%. An atrial septal defect was successfully created in each patient. The mean right atrial pressure decreased from 23 to 18 mm Hg and the mean systemic oxygen saturation decreased from 93% to 85%. The mean cardiac index increased from 1.7 to 2.1 L/min/m2 and the mean systemic oxygen transport increased from 268 to 317 ml/min/m2. Complications occurred in 3 patients: transient hypotension during transesophageal echocardiography, a femoral pseudoaneurysm, and a femoral arteriovenous fistula. After septostomy, 6 patients had clinical improvement (resolution of ascites, edema, and no further episodes of syncope); 5 of these 6 patients underwent lung transplantation a mean of 6.1 months after septostomy. Six patients did not have clinical improvement after septostomy. Atrial septostomy improves the hemodynamic status and may be useful as a bridge to lung transplantation in selected patients with pulmonary hypertension.

Percutaneous coil occlusion of ascending aorta to pulmonary artery shunts.

Two patients with pulmonary atresia and intact ventricular septum each underwent early palliative surgery with a pulmonary valvotomy and an ascending aorta to pulmonary artery shunt. Adequate right ventricular growth and relief of pulmonary stenosis rendered the shunts unnecessary. The shunts were successfully occluded percutaneously with Gianturco coils.

Pulmonary hypertension and trisomy 16.

An infant girl, born small for gestational age, with abnormal single creases on the fifth digits, subsequent severe developmental delay, hypertelorism, bilateral equinovalgus deformities, grade IV genitourinary reflux and mild right hydronephrosis, was found to have an inverted duplication of the short arm of chromosome 16 [46,XX; inv dup (16) (p 13.3-->p 11.2]. The cardiac anomalies included a large perimembranous ventricular septal defect (VSD) and a moderate-sized atrial septal defect (ASD). Cardiac catheterization at 6 months of age revealed systemic level pulmonary artery pressure, bilateral pulmonary venous desaturation, and in room air a pulmonary/systemic blood flow ratio (Qp/Qs) of 0.8:1.0, which did not change significantly with administration of oxygen and nitric oxide. To our knowledge, this is the first description of early nonreactive pulmonary vascular disease in a patient with duplication 16p and a large VSD.

Balloon angioplasty of native aortic coarctation in infants 3 months of age and younger.

The use of balloon dilation to treat native aortic coarctation is controversial, particularly in infants. Between January 1991 and September 1996, 12 patients < or = 3 months of age with native coarctation of the aorta (CoA) underwent balloon angioplasty (BA). All 12 lesions were dilated successfully with a mean reduction in peak systolic gradient from 49.3 +/- 16.5 mm Hg to 6.8 +/- 4.0 mm Hg (p < 0.001) and a mean increase in minimum CoA diameter from 2.4 +/- 0.6 mm to 5.5 +/- 1.3 mm (p < 0.001). Intimal flaps or tears were detected immediately after BA in 4 (33%) of 12 patients by angiography and in 8 (89%) of 9 patients by intravascular ultrasonography. No deaths or major complications related to the BA occurred. One patient had documented asymptomatic femoral artery obstruction, and one patient with hydrops fetalis and congenital pleural effusions died with gram-negative sepsis 1 week after the procedure. Follow-up was available for 10 patients (1 was lost to follow-up) between 2 months and 4.1 years (mean 2.4 +/- 1.3 years) after BA. No patient had an aortic aneurysm. Restenosis occurred in 5 (50%) of 10 patients, requiring reintervention a mean of 2.6 +/- 2.1 months after BA. One patient underwent surgical repair. Repeat BAs were performed in the other four patients; three were successful, and one with partial gradient relief required surgical repair. Five patients have not required reintervention a mean of 2.9 +/- 1.0 years after the initial BA. Among these five patients, follow-up intravascular ultrasound performed in three patients a mean of 2.0 +/- 1.9 years after BA showed favorable endovascular remodeling. There was a tendency for early reintervention in patients < 1 month of age and coexistence of a patent ductus arteriosus at the time of BA. In conclusion, selected infants < or = 3 months of age with discrete native CoA may be treated initially with balloon dilation. Most patients who have restenosis respond successfully to repeat BA.

Familial occurrence of pulmonary atresia with intact ventricular septum.

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare disease, accounting for less than 3% of all congenital heart lesions. The cause of PA/IVS is unknown. We report the occurrence of two first cousins with PA/IVS, suggestive of autosomal dominant inheritance with incomplete penetrance. The study of such families should ultimately lead to the identification of the gene(s) that cause congenital heart disease.

Percutaneous coil occlusion of patent ductus arteriosus.

OBJECTIVE: To determine the success rate and safety of percutaneous patient ductus arteriosus (PDA) coll occlusion. DESIGN: Thirty consecutive pediatric patients with small to moderate-size PDAs (minimum diameter < or = 4 mm) underwent percutaneous coll occlusion. The results were assessed by angiography and echocardiography. The mean age was 5.1 +/- 4.2 years (range, 0.8 to 18.8 years); mean weight was 19.2 +/- 10.3 kg (range, 8.1 to 40.0 kg). The mean minimum diameter of the PDA was 1.8 +/- 0.8 mm (range, 1.0 to 4.0 mm). RESULTS: PDA occlusion was achieved with one coil in 24 patients, 2 coils in 3 patients and 3 coils in 3 patients. The mean coil/PDA diameter ratio was 2.5 +/- 0.5. Immediately after coil occlusion, 29 PDAs had no flow by anglography; one had a small residual shunt. There were no significant complications. In the first 24 hours after coil implantation, echocardiography showed complete occlusion in 28 patients, a small left-to-right shunt in the same patient that had a residual shunt by anglography, and a trace shunt in one additional patient. In the two patients with residual flow by echocardiography, follow-up ultrasonography revealed no residual shunt 1 and 3 months later. At a mean follow-up of 11.8 +/- 9.3 months (range, 0 to 36.0 months), there was no PDA flow by color Doppler echocardiography in any of the 30 patients. CONCLUSION: Coil occlusion is a safe and effective method of percutaneous closure of small to moderate-size PDAs. The largest PDA that can be closed with this technique remains to be determined.

A randomized trial of cardiovascular risk factor reduction: patterns of attrition after randomization and during follow-up.

BACKGROUND: The Preventive Cardiology Center compared two intensities of behavior modification for cardiovascular disease (CVD) risk factors in persons at risk and their families. Characteristics of drop-outs both before and after intervention were compared with subjects who completed the 6-month trial. METHODS: A total of 333 individuals of all ages were enrolled in the study and randomly assigned by family to a single-session ('skills' group-low-intensity) or a five-session ('practice' group-high intensity) intervention. Baseline and follow-up assessments included a personal and family health questionnaire, nutritional intake survey, and clinic visit to obtain blood pressure, lipids, and height and weight data. RESULTS: Two hundred and forty adults over 18 years of age were randomly assigned to one of the two intervention groups. Of these, 68 subjects (28.3%) did not participate in the intervention. Multivariate analysis revealed that these 'early drop-outs' were significantly more likely to be non-white and to have had a lower LDL cholesterol. Of the 172 subjects attending the intervention, 70 (40.7%) did not attend the 6-month follow-up ('late drop-outs'). Multivariate analysis revealed that, compared with follow-up attendees, non-attendees were significantly more likely to be white and to be current smokers. CONCLUSIONS: Both early and late drop-outs in a randomized trial of CVD risk reduction were significantly different than continuing participants in several key factors. These differences suggest the use of caution in both interpreting and making generalizations about behavioral trials of risk factor reduction when attrition is high.

Comparison of results of stent implantation in small (<20 kg) children versus larger children with pulmonary artery stenoses.

We compared the results of stent implantation for pulmonary artery stenoses in patients weighing <20 kg (group 1, 17 patients, 21 stents) versus those weighing > or = 20 kg (group 2, 11 patients, 13 stents). There was no significant difference in the mean percent increase in diameter or mean percent gradient reduction acutely and at short-term follow-up between group 1 and 2 patients.

Successful balloon dilation of an abdominal coarctation of the aorta in patient with presumed Takayasu's aortitis.

An 11-year-old male with a severe abdominal aortic coarctation, presumably secondary to aortitis, underwent successful percutaneous balloon dilation that resulted in near-complete relief of the obstruction. Intravascular ultrasound imaging showed a major endovascular tear immediately following dilation and satisfactorily excluded significant branch (superior mesenteric) artery compromise. Arterial remodeling was demonstrated with persistence of the gradient relief over a 12-month follow-up period.

Accessory hepatic vein to pulmonary venous atrium as a cause of cyanosis after the Fontan operation.

The presence of an accessory hepatic vein to the pulmonary venous atrium should be considered in the setting of progressive cyanosis following the Fontan procedure. An inferior vena caval angiogram with "levo-phase" should demonstrate it. Surgical intervention or transcatheter occlusion should lead to prompt resolution of cyanosis.

Gastrointestinal hemorrhage complicating aspirin therapy in acute Kawasaki disease.

Although gastrointestinal hemorrhage is a well-recognized complication of aspirin therapy, this side effect has not been previously reported in patients with Kawasaki disease (KD). We describe two children with typical KD who had massive gastrointestinal bleeding that required hospitalization and transfusion. Physicians caring for patients with KD should instruct parents on the signs and symptoms of aspirin toxicity. Fortunately, gastrointestinal hemorrhage appears to be a rare complication of salicylate therapy in patients with Kawasaki disease.