[Two-dimensional and Doppler echocardiographic evaluation of intrauterine blood flow dynamics in the fetuses with a ventricular septal defect].

In nine fetuses with ventricular septal defect (VSD), intracardiac blood flow was observed with color Doppler ultrasound. Interventricular shunt velocity, maximum systolic velocity in the ascending aorta and pulmonary artery, trans-atrioventricular blood flow velocity, and the flow pattern in the inferior vena cava were also measured with pulsed Doppler ultrasound. The cardio-thoracic ratio and ejection fraction were measured by B- and M-mood ultrasound. In all four fetuses with isolated VSD a bidirectional shunt was demonstrated. In the three normal developed fetuses time analysis showed a right (RT)-to-left (LT) shunt during systole and a LT-to-RT during diastole with maximum systolic velocities of 61cm/s, 42cm/s and 68cm/s. In the five fetuses with complexed cardiac malformation, two fetuses had a unidirectional shunt and three fetuses had a bidirectional shunt, which was a LT-to-RT during systole and a RT-to-LT during diastole. These studies indicate that although the systolic pressure in the right ventricle is slightly higher than that in the left, the pressure is almost the same in both ventricles. The presence of unidirectional shunting or a different time relationship from that of normal fetuses in bidirectional shunting would necessitate a careful check for other cardiac malformations.

[Evaluation of the renal artery in the fetuses with growth retardation and oligohydramnios by two dimensional Doppler ultrasonography].

Renal blood flow dynamics were studied with color and pulsed Doppler ultrasound in 102 normal fetuses at 20 to 40 weeks of gestation, 11 growth retarded fetuses (group A), 15 fetuses with oligohydramnios (group B) and 10 growth retarded and oligohydramniotic fetuses (group C) at 32-40 weeks of gestation. The maximum systolic velocity (VMAX), early diastolic peak velocity (VEA), end diastolic velocity (VED) and resistance index (RIEA:VMAX-VEA/VMAX and RIED:VMAX-VED/VMAX) were measured in the renal artery. VMAX was also measured in the ascending aorta (AO) and pulmonary artery (PA). In the normal fetuses, blood flow velocity increased with gestational age, but VMAX and VEA remained constant after 28 weeks of gestation. The resistance index decreased with gestational age, but RIEA remained constant after 28 weeks of gestation. RIED in groups A and C increased significantly, and VMAX in groups B and C, and VED in group C decreased significantly compared with normal fetuses. VMAX in AO and PA decreased remarkably in the three abnormal groups. It was concluded that the kidneys were poorly perfused in the growth retarded fetuses with oligohydramnios, which may, in part, depend on the decreased stroke volume.

Prenatal diagnosis of infantile hypophosphatasia.

Prenatal diagnosis was attempted in a pregnant Japanese woman whose son had died of infantile hypophosphatasia, using chorionic villi sampled at 10 weeks of gestation. Southern blot analysis of restriction fragment length polymorphism was used as a guide, with cDNA for the human liver-type alkaline phosphatase as a probe, and BclI as a restriction enzyme. The fetus was found to be a heterozygote; the pregnancy was allowed to continue; and the baby born was phenotypically normal.

[Fetal screening of congenital heart disease].

Echocardiograms of two hundred and ninety normal fetuses at 18-39 weeks of gestation were studied with a real-time linear scanner (3.5 MHz). Aortic valvular diameter, pulmonary valvular diameter, mitral valvular diameter, tricuspid valvular diameter and total cardiac dimension were measured. These parameters increased with fetal growth. The ratios of pulmonary to aortic valvular diameter and of tricuspid to mitral valvular diameter were more than 1, suggesting right ventricular dominance in the fetal hearts. The cardio-thoracic ratio was about 50% in this period. The four-chamber view, left ventricular long-axis view, ventricular short-axis view, short-axis view of the great arteries, the view of the aortic arch and the view of the inferior and superior vena cava were also recorded. These six views could be obtained in 9.8% of all subjects at the same time. Detection rates for these views were the greatest in pregnancy at 22-33 (especially 28-29) weeks of gestation. The ventricular short-axis view and short-axis view of the great arteries were easily detected in the dorsoposterior position, whereas the view of the aortic arch was obtained in the dorsoanterior position. It was concluded that fetal echocardiography needed to be performed at least twice, at 22-23 and 28-29 weeks of gestation, and this would be useful in diagnosing some congenital heart diseases.

Effects of multiple administration of halothane on the mixed function oxidase system in liver microsomes. Difference between guinea pigs and rats.

The effects of multiple administration of halothane on the mixed function oxidase system in liver microsomes were investigated and compared between guinea pigs and rats to clarify the difference in sensitivity to halothane. The mixed function oxidase system, except for NADPH-cytochrome P-450 recductase activity was increased in both animals. The inhibition in guinea pigs may have resulted from the microsomal membrane damage induced by the acceleration of lipid peroxidation.

Training perception of air flow obstruction in asthmatics.

Eighteen asthmatics, aged 7 to 43, rated their breathing on a scale of 0 to 5 (worst to best). They were then informed of their predicted normal peak expiratory flow rate (PEFR) and instructed in proper PEFR measurement. Each subject then estimated and measured PEFR under physician supervision and subsequently rated breathing, estimated and measured PEFR at home twice daily recording the observations. At the initial home observation, the correlation coefficient (r1) between estimated and measured PEFR was .98. After ten observations r1 was greater than or equal to .97 in all 18 subjects (group mean .99). The r1 remained unchanged in those subjects who completed 28 and 42 observations. The r1 was .98 when only the observations where measured PEFR was less than 20% predicted were considered, demonstrating the validity of the relationship during abnormal expiratory flow. Multiple regression analysis showed no significant trend in the difference between estimated and measured PEFR over time after the initial observation. Of 12 subjects, 4 were significant underestimators of PEFR and 3 were overestimators, but the magnitude of either tendency was relatively small. The correlation coefficient (r2) between a subjective verbal breathing score and measured PEFR ranged from -.23 to .92 on an individual basis over the three time periods, with statistically significant group mean values of .37, .39, and .45 at 10, 28, and 42 observations, respectively. The r2 for observations where measured PEFR was abnormal was only .14 and not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonographical assessment of follicular growth in delayed ovulation].

The growth of the follicle was monitored in 61 subjects by ultrasonography and by the serial determinations of serum LH, FSH, estradiol (E2) and progesterone. All the subjects were judged to have normal luteal functions on the basis of their BBT patterns. The subjects were divided into two groups according to the length of their follicular phase: one with a follicular phase of 12--17 days (the control group, 39 cycles) and the other with a follicular phase of 18--26 days (the delayed ovulation group, 22 cycles). Ultrasonographically, the follicle grew slowly during the early follicular phase (slow growing phase), but began to grow more rapidly at 7 or 8 days before ovulation (rapid growing phase). In comparison with the control group, the slow growing phase was significantly prolonged in the delayed ovulation group. But in the length of the rapid growing phases and follicular growth rate, there were no significant differences between the two groups. In the serum levels of E2, LH, FSH and P, there were no significant differences between the two groups.