[Resuscitation of neonates in the delivery room. Recommendations by the American Heart Association and American Academy of Pediatrics]. / Ujszülöttek szülöszobai resuscitatiója.

According to the recommendation of the American Heart Association and the American Academy of Pediatrics 43 newborn babies with mean birth weight 3300 g (range 610-5100 g) were resuscitated. One-minute Apgar score was 0:1, 1:22, 2:11, 3:7, 4:2 cases. Mask and bag ventilation were needed in 43, heart compression in 7, tracheal intubation in 2, drugs in 2 cases. Five-minute Apgar values were 8:39, 5:1, 7:1 case. All resuscitations were successful. The resuscitation program is a great advance in the field of neonatology. Nationwide application of it might be helpful to decrease neonatal mortality in Hungary.

[Laparoscopic cholecystectomy. Initial experiences]. / Laparoscopos cholecystectomia. Kezdeti tapasztalatok.

Between February 1991 and July 1991, 74 laparoscopic cholecystectomies were performed. The number of all cholecystectomies during this period was 168. Two surgeons performed the operations. Stone in the common bile duct, old age, acute cholecystitis, severe obesity and heart rhythm disorders were regarded as contraindications. The duration of the operation was 45-210 min. (mean 127 min). The intervention was diverted to open cholecystectomy in 2 instances (2.7%). Early postoperative complications were observed in 2 cases (2.7%): biliary discharge and bleeding. Reoperation was necessary in one patient (1.3%) because of bleeding. There was no operative mortality. The mean duration of hospitalization was 5.6 days, and the mean postoperative period was 2.7 days. It is considered that, laporoscopic cholecystectomy can be carried out only by specialists in both bile surgery and laparoscopic techniques, provided that all the personal and technical conditions necessary for traditional cholecystectomies are at hand. Both medically and economically, the laparoscopic cholecystectomy results attain or even exceed those of the traditional open technique.

[Hypoxic myoglobinemia in severe neonatal disorders of adaptation to extrauterine life]. / Hypoxiás myoglobinaemia vizsgálata az újszülöttek extrauterin élethez való súlyos adaptációs zavaraiban.

In two series of newborns needing intensive care the presence, the degree and the prognostic value of myoglobinaemia was examined. In series I. of hypoxic newborns the myoglobinaemia was present even in infants requiring less than 60% O2 therapy. The serum myoglobin value was significantly higher in cases needing oxygen therapy over 60% oxygen. This was most pronounced in the critically severe and progressive cases. In series II. of 34 consecutive cases of hypoxic newborns exceeding 7 nM/l proved to have a prognostic value indicating critically severe course or fatal outcome of the disease. The myoglobinaemia observed in the present study may explain the effectivity of the peritoneal dialysis therapy introduced previously by us in severe hypoxic newborns. This possibility was supported by further observations on the transperitoneal passage of myoglobin in 4 renal hilus ligated and peritoneally dialyzed newborn piglets. In conclusion, early detection of the elevated myoglobinaemia in severely hypoxic newborns has a definite prognostic value and its degree can be used in the indication of peritoneal dialysis.

Effect of allopurinol treatment in premature infants with idiopathic respiratory distress syndrome.

A randomized prospective study of the effectiveness of allopurinol (Ap), a potent and specific inhibitor of the enzyme xanthine oxidase, was performed in premature infants endangered by hypoxia. The drug was given at a dose of 20 mg/kg/day orally for 3 days. In the Ap-treated group the expected decrease in the serum concentration and urinary excretion of uric acid was accompanied by a decrease in the mortality rate of infants with idiopathic respiratory distress syndrome. In these patients a concomitant improvements in renal function, as indicated by an increased urinary flow rate and creatinine output, was also obvious. It is suggested that the observed beneficial effect is due to the specific inhibition of xanthine oxidase associated with Ap therapy leading to reduced generation of superoxide radicals and decreased urinary loss of purine.

Modulation of the blood-brain barrier permeability in neonatal cytotoxic brain edema: laboratory and morphological findings obtained on newborn piglets with experimental pneumothorax.

Acute, bilateral pneumothorax (PT) was produced in 14 newborn piglets. The clinical status of the operated and 14 control animals was monitored by measuring the arterial blood gases, acid-base balance and mean arterial blood pressure. Different brain regions were processed for electron microscopy and albumin immunohistochemistry; water and electrolyte contents were also determined at the end stage of experimental intervention. Electron microscopy showed more intense pinocytotic activity in the endothelium of brain capillaries from PT animals evaluated by morphometry. Statistically significant (p less than 0.01) differences were found in the distribution of pinocytotic vesicles in different brain areas of PT animals. The blood-brain barrier seemed to be impermeable to albumin in all brain regions both in the controls and in the PT group. Parallel with the changes observed in pinocytosis, the water and sodium contents were also increased in the PT group in the parietal cortex (water content 85.18 +/- SD 0.81% vs. 84.10 +/- SD 0.52%, p less than 0.01; sodium content in wet brain tissue 70.94 +/- SD 8.44 mmol/kg vs. 65.09 +/- SD 4.43 mmol/kg, p less than 0.05, in dry brain tissue 481.70 +/- 75.70 mmol/kg vs. 410.15 +/- SD 35.45 mmol/kg, p less than 0.05) and in the cerebellum (water content 83.95 +/- SD 1.08% vs. 83.02 +/- SD 0.89%, p less than 0.05; sodium content in wet brain tissue 60.67 +/- SD 3.16 mmol/kg vs. 55.90 +/- 6.26 mmol/kg, p less than 0.01). However, in other brain regions--especially in the water-shed area--there was no correlation between the changes of pinocytosis and water-electrolyte contents of the tissues. It is suggested that the type of edema developing in this severe cardiovascular/hypoxic collapse is cytotoxic of origin and this fact should be more seriously taken into account in the treatment of the disease.