Percutaneous balloon valvuloplasty for severe mitral stenosis in pregnancy. Four case reports.

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.

Is there any association between dissection after successful percutaneous transluminal coronary angioplasty and late restenosis? An angiographic study.

Restenosis continues to be the most important limitation of percutaneous transluminal coronary angioplasty (PTCA). Many clinical, angiographic, and procedural variables are thought to be related to the development of restenosis. This study was aimed at investigating the effects of no dissection, minor dissections, and major dissections on the long-term outcome of lesions after successful PTCA. The study group comprised 91 patients with 100 lesions who underwent successful PTCA and in whom follow-up coronary angiography was performed at 8.8 +/- 7.2 (two to twenty-three) months after dilation. Dissections were classified according to the National Heart, Lung, and Blood Institute criteria. Restenosis was defined as more than 50% stenosis at follow-up angiography. Restenosis rates were found to be 22% in the no-dissection group (10 restenoses in 46 patients), 27% in the minor dissection group (11 restenoses in 40 patients), and 36% in the major dissection group (5 restenoses in 14 patients). The authors applied corrected Yates Chi-square test and no difference was observed in the restenosis rate between the group without any dissections and that with minor dissections (P > 0.05). However, a statistically significant difference was observed in the restenosis rate between the major dissection group and the other two groups (P < 0.05). The authors conclude that the occurrence of major dissections after successful PTCA may adversely affect the long-term outcome and may increase the restenosis rate.

Quality of life in patients with rate responsive pacemakers: a randomized, cross-over study.

Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 +/- 0.73 min) than in the VVI mode (mean 7.81 +/- 0.62 min) (P less than 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 +/- 16.22 points) compared to the VVI mode (mean 156.27 +/- 21.22 points) (P less than 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).

[Acinetobacter in a metropolitan neonatal unit: clinical and microbiological aspects]. / Acinetobacter en una unidad metropolitana de neonatología: aspectos clínicos y microbiológicos.

Acinetobacter calcoaceticus var. anitratus (ACA) was isolated from two newborn infants and var. Iwoffi of the same species from a third patient within a month in the neonatal unit of a general hospital at Metropolitan Santiago, Chile. The first isolate was obtained from a neonate with infection of the skin surrounding a colostomy operation after surgery for tracheo esophageal fistulae, in march 1989. The second case's skin became colonized after he was admitted for surgical repair of severe gastroesophageal reflux into the same ward room and nursed in proximity to the first case, making necessary the use of antibiotic prophylaxis with sulbactam-ampicillin prior to surgery. The third case, a very immature female baby, was born at the same month; she had early septicaemia due to Acinetobacter calcoaceticus var. Iwoffi sensitive to gentamicin and after appropriate treatment her clinical recovery was uneventful. In the microbiological study of the neonatal unit this last microorganism was isolated from thermometers of the nursery and on the hands of one member of the nursing staff, while ACA had been reported at the preceding month from operating rooms and anesthesia equipment. Intensive surveillance of ward's environment, equipment and personnel, barrier precautions, and improved staff handwashing were then instituted and extension of an outbreak was thus avoided.

[Renal artery thrombosis in newborn infants undergoing umbilical artery catheterization]. / Trombosis de arteria renal en recién nacidos sometidos a cateterización de la arteria umbilical.

A prospective study to detect renal artery thrombosis by radionuclide renal scintigraphy in newborn infants who underwent umbilical arterial catheterization over a one year period was done: 62 babies were catheterized, 92% were preterm and 85% had severe respiratory distress syndrome that required mechanical ventilation, 25/62 (40.3%) survived and in all of them Tc-99m DMSA scans were taken at a median of 5 days after withdrawal of the umbilical artery catheters (range 9 h to 29 days). A baby with renovascular hypertension had a DMSA scan which showed segmental vascular defect in one kidney. Another patient had left iliac artery thrombosis and two others showed evidence of transient vasospasm. Death occurred in 37/62 (59.7%), 92% of whom underwent autopsy studies which showed aortoiliac thrombosis in 8.8%, all of them without clinical symptoms. Other 12 newborn infants who died without previous umbilical artery catheterization had no evidence of thrombosis at autopsy.

[Neonatal bacterial infections: magnitude and clinical aspects]. / Infecciones bacterianas neonatales: magnitud y aspectos clínicos.

A prospective study on major bacterial infections (MBI) has been made over a six-month period in a neonatal unit. Incidence of MBI was 6.8 per 1,000 live births. Rates were significantly higher in low (57/1,000) and very low-birth-weight newborns (200/1,000). Septicemia occurred most frequently with group B hemolyticus streptococcus and staphylococcus aureus as the commonest infecting organisms. In 19/33 haematologic studies abnormal neutrophilic cell counts, thrombocytopenia or both were seen. Case/fatality rate was 50% in this series.

[Neonatal mortality in a Santiago hospital]. / Mortalidad neonatal en un hospital de Santiago.

PIP: This study correlated the neonatal mortality rate with sex, birthweight, age, and cause of death at the San Juan de Dios Hospital from January 1-December 31, 1983. During this period, 7370 babies were born alive and 113 of them died. The neonatal mortality rate was 15.3/1000 livebirths; 14.2 in the early neonatal period and 1.1. in the late neonatal period. 69% of the early neonatal deaths occurred during the 1st 24 hours of life. Birthweight-specific neonatal mortality rates were 646 for those weighing 1500 g or less, 166 for those weighing 2500 g or less, and 4.1 for those more than 2500 g. The neonatal causes of death were: conditions associated with immaturity (43%), perinatal hypoxia and birth trauma (17%), immaturity plus hypoxia (15%), specific conditions (13%), and congenital malformations (12%).^ieng