Longitudinal Preterm Cerebellar Volume: Perinatal and Neurodevelopmental Outcome Associations.

Impaired cerebellar development is an important determinant of adverse motor and cognitive outcomes in very preterm (VPT) infants. However, longitudinal MRI studies investigating cerebellar maturation from birth through childhood and associated neurodevelopmental outcomes are lacking. We aimed to compare cerebellar volume and growth from term-equivalent age (TEA) to 7 years between VPT (< 30 weeks' gestation or < 1250 g) and full-term children; and to assess the association between these measures, perinatal factors, and 7-year outcomes in VPT children, and whether these relationships varied by sex. In a prospective cohort study of 224 VPT and 46 full-term infants, cerebellar volumes were measured on MRI at TEA and 7 years. Useable data at either time-point were collected for 207 VPT and 43 full-term children. Cerebellar growth from TEA to 7 years was compared between VPT and full-term children. Associations with perinatal factors and 7-year outcomes were investigated in VPT children. VPT children had smaller TEA and 7-year volumes and reduced growth. Perinatal factors were associated with smaller cerebellar volume and growth between TEA and 7 years, namely, postnatal corticosteroids for TEA volume, and female sex, earlier birth gestation, white and deep nuclear gray matter injury for 7-year volume and growth. Smaller TEA and 7-year volumes, and reduced growth were associated with poorer 7-year IQ, language, and motor function, with differential relationships observed for male and female children. Our findings indicate that cerebellar growth from TEA to 7 years is impaired in VPT children and relates to early perinatal factors and 7-year outcomes.

Coronary artery bypass on the beating heart with the Octopus: a North American experience.

BACKGROUND: The practice of minimally invasive coronary artery bypass grafting remains controversial. This study outlines the results of single and multiple vessel bypass performed using the Medtronic Octopus Tissue Stabilization System and beating heart techniques. Results are compared with those of a standard cardiopulmonary bypass group. METHODS: The group included 89 patients having operations performed during a 10-month period with average follow-up of 162.3 days. Complications, length of stay, and functional status were recorded. Postoperative stress testing and angiograms were performed selectively. RESULTS: The average age was 62.3 years and the average ejection fraction was 0.65. Twenty-five percent of the patients underwent operations urgently or emergently, averaging 1.8 grafts/patient. In 83 of 89 patients operations were completed without cardiopulmonary bypass using the Octopus without mortality. Morbidities were statistically similar to a group of 369 cardiopulmonary bypass patients. Postoperative length of stay was shorter in the Octopus group (p = 0.005). CONCLUSIONS: The Octopus provided predictable, reproducible immobilization with short-term results comparable with those obtained with standard cardiopulmonary bypass.

Introducing a music program in the perioperative area.

Music can touch patients deeply and thus transform their anxiety and stress into relaxation and healing. Patients with cancer who undergo surgical procedures are highly stressed. To help alleviate these patients' stress and improve their comfort, perioperative nurses at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, surveyed surgical patients and staff members about introducing a perioperative music program. This article reviews the literature on the use of music in perioperative care settings and describes MSKCC's decision to evaluate and then implement a music program.

The effects of forced sexual intercourse on white female adolescents.

In the 1987 National Survey of Children the question was asked: "Was there ever a time when you were forced to have sex against your will, or were you raped?" Among White females, aged 18-22, those who answered yes (n = 41) and no (n = 400) were compared on a number of social-psychological and sexual variables that might be thought of as outcomes affected by having had coercive sexual experience(s). Those who reported being forced to have sexual intercourse, compared to those who did not, had more permissive attitudes about 16-17-year-olds having intercourse and a younger age of first voluntary sexual intercourse themselves. They also had lower internal locus of control and higher depression scores, and they needed and received more psychological help than those not reporting forced sexual intercourse. Dividing the forced sexual intercourse group (FSI) into those reporting FSI before versus after their first date, and those whose FSI was before versus after age 12, yielded essentially the same findings. Even in the presence of multivariate control variables. FSI experience remained a significant predictor of age at first voluntary sexual intercourse, locus of control, depression, and perceived need for psychological help. These analyses of national survey data support the clinical perspective that forced sexual intercourse causes or exacerbates various sexual and psychological problems.

Improved photorefractive time response using a cylindrical lens.

Experimental observations are reported which demonstrate that the response time for beam fanning, self-pumped phase conjugation, and double phase conjugation can be shortened by more than an order of magnitude without a significant reduction in coupling strength by using a cyclindrical lens to focus incident laser light into a photorefractive crystal. These results are compared with those obtained using a spherical lens where a reduction in the photorefractive response time is accompanied by a corresponding reduction in coupling strength. It is shown that the fidelity of a phase conjugate beam is not degraded when cylindrical optics are used.

Self-pumped phase conjugation with nanosecond pulses in strontium barium niobate.

We report the observation of self-pumped phase conjugation by means of internal reflection in a photorefractive medium produced by a series of intense nanosecond pulses. Nanosecond pulses from a YAG laser ranging in intensity from 9 x 10(4) to 9 x 10(5) W/cm(2) were used. The crystal was rhodium-doped strontium barium niobate. The conjugate signal began with the first pulse, and the time to reach 63% of its equilibrium value scaled as I(-2). The equilibrium reflectivity was 29%. A similar cw experiment with the 514-nm line of an argon laser produced a response time that scaled as I(-1.1).

Double phase conjugation in tungsten bronze crystals.

In this paper we report a new method for double phase conjugation particularly suited to the tungsten bronze crystal strontium barium niobate. It has also been observed to produce conjugate waves in BaTiO(3) and BSKNN. This new arrangement is called the bridge conjugator because the two beams enter opposing [100] crystal faces and fan together to form a bridge without reflection off a crystal face. Our measurements indicate that the bridge conjugator is competitive with previously reported double phase conjugate mirrors in reflectivity, response time, ease of alignment, and fidelity.

Enhanced photorefractive beam fanning due to internal and external electric fields.

Significant increases (x10) in both speed and gain of the beam fanning process were obtained via three different methods in SBN and BSKNN. These methods involve the creation of a dc electric field either (1) externally, (2) by the pyroelectric effect, or (3) by thermally cycling the crystal and the presence of laser radiation. The enhanced effects were observed for both ordinary and extraordinary polarized light.

Pulsed and cw photothermal phase shift spectroscopy in a fluid medium: theory.

A theoretical treatment of photothermal phase shift spectroscopy in a fluid medium for the most general conditions is given. The medium is assumed to be flowing. Results for a stationary medium appear as a special case. Both pulsed and cw excitation are considered. For pulsed excitation, the results are valid for excitation pulses of arbitrary length. For the cw case, modulated excitation is explicitly considered, and the results for unmodulated excitation appear as a special case.

Continuous wave photothermal deflection spectroscopy in a flowing medium.

A complete and rigorous theoretical treatment of the continuous wave photothermal deflection spectroscopy in a flowing medium is given. The theoretical results have been verified experimentally.

Results of composite graft replacement for aortic root aneurysms.

From 1972 to 1980, 41 patients (aged 19 to 79) with aortic root problems have been managed surgically with a composite graft. Forty patients (97.5%) are long-term survivors who to date have had no complications related to the aortic root. This series of patients included 10 with acute dissection of the aortic root and ascending aorta. Thirty-one patients undergoing elective operations for aortic root aneurysms included three with chronic ascending aortic dissection with aortic regurgitation, three with previous operations on the aortic root, and six patients who had associated coronary artery bypass or mitral valve replacement. Follow-up to 8 years shows that patients with composite graft replacement have exhibited no early or late complications of this procedure. Two late deaths at 1 1/2 and 5 1/2 years were unrelated to the aortic root procedure. Experience seems to indicate that composite graft management of aortic root aneurysms is a most reliable and durable operation for the majority of patients with this disease.

Cardiac operation and end-stage renal disease.

From 1972-1979, 22 patients with end-stage renal disease underwent 23 cardiac operations involving the pump oxygenator. Fourteen patients had coronary artery bypasss, 2 had aortic valve replacement, 2 had mitral valve replacement (MVR), 2 had MVR with coronary artery bypass, and 2 had ascending aortic root replacement with a composite graft. One patient underwent successful reoperation for a false aneurysm of the left ventricle after MVR. There were 2 postoperative deaths, for a mortality of 9.1%. The patients undergoing coronary artery bypass had an average of 2.7 grafts and an average Functional Class improvement from New York Heart Association Class III or IV to Class I to II. Eighteen patients required preoperative and postoperative dialysis to control blood volume, potassium, and uremia. Four patients had functioning renal transplants, and 4 patients underwent subsequent successful renal transplantation. We conclude that: (1) patients who have transplants and require dialysis can be successfully managed for cardiac operation in spite of their complex associated medical problems; (2) functional and symptomatic improvement simplifies continued management of the patient needing dialysis; and (3) improvement of a cardiac disability can allow favorable renal transplantation in selected patients.